• This Is Why

    Aligned At Last

    Finding an anchor in a sea of possibilities.

    Podcast: Listen to 'This Is Why'  

    When I considered entering physical therapy school I was motivated in part by the desire to learn how the body works, so I could prevent future damage to my injury-prone body. A few months into school, after I hurt my back, I knew I had made a good decision.

    My quest for new ways to help others and myself led me to seek out continuing education classes after graduation. Physical therapy seemed filled with endless possibilities that I wanted to explore. The first continuing education class I took after graduating was in 1988 with Shirley Sahrmann, PT, PhD, FAPTA. She explained how musculoskeletal pain and injury can occur over time when we repetitively move or sustain postures while our joints are sub-optimally aligned. Conversely, performance improves and risk of injury decreases when joints are more optimally aligned. She determined that movement can be scientifically evaluated and viewed as another physiological system of the body.

    Although the movement system concept was captivating, I used it only sparingly, as I didn't fully appreciate the significance of maintaining my focus on finding and treating the mechanical cause of pain. I went on to take many valuable continuing education courses that taught me an array of treatment techniques. But I often felt they were presented without the context necessary to help me figure out which patient would benefit most, or least, and why.

    For a while I was adrift in the sea of possibilities that physical therapy offered, without locating the fundamental rationales behind the treatments I was utilizing. Then, "luckily," about 5 years ago I sustained another injury. I developed a painful and stiff shoulder. I went to an orthopedist, had an MRI, did physical therapy, tried a chiropractic soft tissue approach, and had a cortisone injection. Nothing helped. I still couldn't raise my arm or toss a tennis ball without intense pain. Surgery seemed to be the only option remaining.

    As a last resort I decided to see if a movement system evaluation might help. I went to Washington University in St Louis and took a course taught by Dr Sahrmann and her colleagues. One of the physical therapists there analyzed my shoulder and said simply, "You're not moving your scapula well at all. You must start dissociating it from the humerus."

    I began to make specific changes in how I performed everyday activities and practiced a few shoulder exercises, retraining precision of motion more than anything else. Once I realized I could voluntarily alter how I moved—stabilizing a hyper-mobile segment in order to move more easily from a stiffer one—I began to improve, and my pain subsided. Changing a habitual movement pattern definitely was possible! And, from a biomechanical and kinesiological standpoint, normalizing joint mechanics was clearly logical. I came to realize this was the anchor for which I'd been searching.

    My reason for becoming a PT was confirmed—not once, but twice—by Dr Sahrmann, who helped me truly appreciate everything physical therapy is and can be.

    The PTs at Washington University have produced many high-quality, peer-reviewed research studies to prove these theories. I am in the process of videotaping case reports to help validate this system, as well. If more scientists, PTs, and physicians can prove the causal effect of movement patterns on pain and injury, the field of preventive musculoskeletal medicine will flourish. PTs will take their rightful place as the experts in evaluating human movement. This vision is why I am proud to be a member of our profession.


    Howard Nelson, PT, is in private practice in New York City.