Defining Moment Operative Insights A lesson-filled recovery. By Melissa Baudo Marchetti, PT, DPT, SCS, MTC | March 2015 Author and Martina Navratilova at the US Open. Listen to 'Defining Moment' To some people, the prospect of undergoing physical therapy can seem daunting. It requires a commitment to health and wellness, whether one is recovering from an injury or surgery or contending with pesky musculoskeletal aches and pains. Physical therapy can be a lengthy proposition. It may be time-consuming, costly, and at times uncomfortable. But in the hands of a skilled physical therapist (PT), improvements and functional gains result-sometimes immediately. And patients themselves play a vital role in the process. I admire and am inspired by patients who make their health and wellness a priority-arriving at my office invested and engaged in their recovery. During my 12-year career I have worked with recreational, high school, collegiate, and professional athletes, as well as people who aren't actively engaged in sports. I've worked with young adults and senior citizens. For nearly 5 years, I was on a global journey as a full-time sports physiotherapist for the Women's Tennis Association-working with some of the world's elite women athletes, such as Serena and Venus Williams, Maria Sharapova, Martina Navratilova, and Billie Jean King. As a former high school and collegiate athlete, dealing with injury is nothing new to me. I know what pain feels like. I understand its physiology. I'm personally acquainted with the post-injury and postsurgical rehabilitation processes. I've experienced the emotional and mental challenges that arise from physical injury. For many years, I've taught patients my own lessons from the surgical-recovery process-advising them to prepare meals ahead of time, anticipate and deal preemptively with possible pain, take their meds, line up drivers for the first few weeks after surgery, wear a brace for support, and do their exercises. Then, this past summer, I once again was the patient. In July, I underwent an open abdominal surgery. I had anticipated most of the issues about which I educate my patients, and I drew from my past experience. Before the surgery, I coached myself, "You can do this. You are strong. You know what to expect." It was considerably harder, however, than I thought it would be. It was tougher than I remembered. The smallest tasks-sitting up, bathing, walking-were incredibly challenging. The process seemed much more grueling that it had 2 decades earlier. Along my path to recovery, I gained many insights-about myself, my personal strength, the strength we all possess when we're faced with limitations, and the recovery process itself. I found it vastly reassuring to see that the people who really cared about me and my recovery would be there for me every step of the way. I gleaned valuable perspective on our profession. I'd like to share some of it with you. We are experts. Physical therapy is changing in the 21st century. We use our hands to manipulate the neuromusculoskeletal system to evaluate and treat dysfunction. We read diagnostic images, help to reeducate muscles, deactivate painful trigger points, restore original movement patterns, and specialize within our field. More so than ever before, we are the movement experts. It was my good fortune that, among the PTs in our practice are a women's health specialist and an osteopathic spine specialist. They were invaluable to me in treating the dysfunction and limitations that resulted from surgery. I not only wanted PTs to work with me, I found that I needed them to do so. I had pain and stiffness in my lumbar spine and hips, and hypomobility along my incision and within the surrounding soft tissue. I had developed a flexed posture from bracing my abdomen. As a PT, I'm all too aware that without proper treatment, compensation effects and pain can occur elsewhere in the kinetic chain. I didn't want to end up like many of my patients who have chronic pain from old surgeries, or from injuries that had gone untreated or were insufficiently addressed. I am grateful for my profession, as I simply could not have recovered on my own. Teamwork is key. There is true value in building a strong team of experts around you, in addition to your personal support team. My team includes my doctor/surgeon; PT; massage therapist; acupuncturist; instructors in Pilates, Redcord, and yoga; and, of course, my husband, family, and friends. I have weekly private Pilates and Redcord sessions. (Redcord is a suspension exercise system that offloads body weight to help activate weakened or inhibited muscles.) I also attend a weekly yoga class. Each movement therapy offers a particular experience while focusing on movement fundamentals. Now, I know that may sound like a lot of activity, but I have built a schedule that works for me. Some of our patients may not have the discretionary funds to replicate my list, but I encourage them to start with at least 1 adjunct to physical therapy. Few patients are fully aware that these other disciplines can work in concert with physical therapy to help them achieve optimal outcomes. It is up to us to educate them. The recovery process is a team effort, and PTs are leaders within that team. Having my support team there for me was invaluable to getting me physically and mentally prepared for surgery. My team gave me confidence that I not only could recover, but that I could become just as strong, if not stronger, than I'd been before surgery. My team remained my rock throughout the recovery process. The team included some unanticipated members-current and former patients. I was overwhelmed by an outpouring of support. I was showered with emails and text messages of encouragement. People prayed for me. They championed my journey to recovery, while thanking me for having done the same for them. While I'd always known that PTs play an important role in the lives of patients and clients, what I came to realize is that our place in their hearts and lives is even bigger than that. Billie Jean King titled one of her books Pressure is a Privilege. Well, I believe that physical therapy, whatever its pressures might be, is a privilege, as well-for its practitioners. We are privileged that, every day, people invite us into their lives on a deeply personal level, entrusting us to help lead and guide them down what may be a long and difficult road to recovery and restored function. There is a new normal. Patients often ask me, "Can I get back to where I was before?" While some cases are more challenging than others, my answer typically is "Yes." During the rehabilitation process, patients become more self-aware. With our guidance, they learn what they must do to prevent future injury and maintain a healthy lifestyle. Like many of my patients, I was worried that I would not come back from surgery as strong as I had been before. I wondered if my abdominals would work as well. My intense desire to be pain-free motivated me to educate myself and do everything I could to advance my own cause. I read a lot, and listened to the members of my team. I modified my diet, gave up caffeine, began eating organically, and exercised every day. Now, when patients ask me if they can return to their previous level of function, in most cases I honestly can say, from my own experience, "In fact, you can be better than you were before." PTs are integral educators and motivators. Now, fully recovered and back in the clinic, I have renewed and increased gratitude and appreciation for my team and my profession, as well as having a much clearer picture of what my patients go through. I think of that famous line from Chinese philosopher Lao-tzu: "A journey of a thousand miles begins with a single step." My own recovery left me better prepared for my future journeys. I'm eager to help my patients and clients step toward their new-perhaps better-normal. Melissa Baudo Marchetti, PT, DPT, SCS, MTC, is a PT at One on One Physical Therapy in Atlanta.