Expanding the 'patient comfort zone', your new clinical best friend.
Words by Craig Hankridge
Have you ever heard one of these quotes before?
‘Life begins at the end of your comfort zone’
‘Outside of your comfort zone is where the magic happens’
‘Get comfortable being uncomfortable’
Odds are, you have heard of at least one. They are all telling us the same thing about what we should do with our lives as a whole.
Push ourselves, find our perceived limits, break through that glass ceilings and then repeat.
Funnily enough, the key principles of life from these wise folks may in fact, be the best clinical approach to take with your patients.
From a logical perspective where do we want our patients to end up? We are aiming for a reduction or removal of pain, an increase in function and the ability for them to undertake activities that are important to them.
Often, we find ourselves in a trade off where an absence of certain movements often reduces symptoms. We get to remove the pain but to do so we also have to remove an activity that is important to that person. Not an ideal outcome.
So lets aim for the opposite.
Let’s expand what we are asking of our patients. Offer the safety but continually push the novel.
Sound confusing? Let’s use a (real life) case study.
43 y.o male, builder by trade but is mostly ‘off the tools’ and managing the company. History of high level snowboarding, consistent gym and football. Significant history of ankle surgery (x3), disc herniation at L5/S1 and associated compensation.
Previous management has consisted of reducing aggravating movements. Hard & rigid orthotics, heavy and ‘supportive’ shoes, light pilates work, no running, no functional movement, no lifting at work.
The wins here? This patient can get through work and normal daily life with minimal if any pain.
The downside? He can’t do the things he actually wants to do (and would put up with a little bit of pain to do so) and his symptoms over the last 3 years of this management has increased year on year.
Currently, his patient comfort zone (PCZ) is a collection of highly regulated patterns of movement that don’t challenge his body. This is good for the short term (comfort) but not great for the long term (de-conditioning). Anything outside of these movements equals fatigue and pain rapidly.
So what did we do? We got him comfortable being UNCOMFORTABLE.
We substituted a rigid orthotic for a more flexible option, we added footwear with cushioning that was light but not trying to limit key movements (like pronation).
We kept the pilates but added in functional personal training to PUSH the structures to work in a COLLABORATIVE way, slowly but surely building up his movement patterns from the ground up.
Put simply, we expanded the number of movements his body could undertake when required and his performance improved markedly.
By EXPANDING his PCZ we make him more resilient. We target symptoms in a prophylactic way.
Safe to say, this approach isn’t a silver bullet or miracle cure. But, it does provide the body with an amount of re-conditioning (that pain often limits), it creates a number of markers and goals to keep the patient on track and finally, it desensitises them to pain. As we know, not all pain equals damage, it is just feedback.
1) Variety - choose your options wisely, but aim for a variety of movements, interventions and modalities. The more the body can handle in treatment and training, the more in can handle in life.
2) Safe zone - those initial interventions reduced symptoms for a reason, so we can keep them there as a back up or as part of a rotation to limit loading when required. However, let’s stop depending on them.
3) Crutches - you wouldn’t recommend your patient use crutches for the rest of their life (in a majority of cases), so why let them depend on a small number of movements in the same way? Push your patient to let go of their perceived boundaries, worst case scenario, they go back to doing what they were doing beforehand. Best case scenario, they end up living ‘where the magic happens’.
Enough talk, start today.
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