The Sint Maartenskliniek (Saint Martin clinic) had a symposium today for physiotherapists regarding the hip. First of all, a befriended sport physician explained the anatomy and diagnostic part of groin and hip problems. Then a orthopedic surgeon talked us through a presentation on a relatively new procedure; arthroscopy of the hip. Then we had a physio explaining to us the rehab treatment he uses. He told us that this wasn’t really evidence based, but then again, the surgeon don’t waste time collecting evidence for their treatments either
Then we had another orthopedic surgeon talking to us about the sport hip.

 
A sport hip can be used by young people if they want to return to their sport in a serious way. Not advisable though, since even these high tech thingies still aren’t able to replace a natural hip.

And sometimes there’s a teacher who really says something you can relate to. Tjeu van den Berk talked to us about the mystery of the brain stem.

I think it’s remarkable that a theologian gets invited by psychosomatic physical therapists to teach them. It’s not so weird if you look at the three considerations he wrote.

1. We human beings have some basic functions (sleep, eat, sex, breath, drink) that do not occur on a conscience level and function on an autonomous manner
2. How is it that when a human being is experiencing stress, the basic functions get disrupted? (breath is erratic, you build up muscle tension, your libido goes down) Wouldn’t it be logical to make sure the body would be able to survive a difficult period instead of making it more difficult?
3. How is it that a lot of major philosophies/world views set these basic functions as essential, whereas western Christianity seems to be a notorious exemption?

I read the book, listened to the man and became richer for it.

With an extremely nice view.

I’m actually very proud to be able to get some work done, come to think about it…

Let’s spread the news about psychosomatic physiotherapy.

I imagine that what statistics is to the mathematician, is what a treasure hunt is to a “normal” person. Proper research reveals exciting stuff you can use to change yourself as a professional. But why does this mean I have to understand things more difficult than 1 + 1? Don’t people know I don’t have knack for numbers?

Anyhow, tomorrow 8.00am statistics exam.

My first exam tomorrow. Don’t know if I know everything I need to know. Exiting and a little bit of STRESS!

I use visualisations to clarify my thoughts. So I’m seeing a pond with water in it. Now work throws in a stone. The stone causes ripples on the surface of the water. Now study adds a stone and relationship does the same. Soon the ripples become waves and the water slushes over the side. The things I’ve done so far to prevent the water from overflowing are lowering the water (social withdrawal; I’m seeing less friends and less acrobatics) and raising the side of the pond (creating a study plan and structuring my work in a better way).
That did not prevent my beloved threesome from throwing rocks into my pond. I reckon time will make the waves become ripples again and a colleague suggested walking. Through walking the though process goes into an automatic, older part of the brain. This part is more adapt in soothing the waves of my hyper reflectiveness into becoming ripples.
Today I walked in “park Brakkenstein” and it’s botanical garden.

Going home after a long day at school. Lars and I had a whole day of lectures, while Inge had some hands-on experience. She’s studying to be a manual therapist.

When you google on psychosomatic physiotherapy/physical therapy you’ll find some stuff on chakra healing, core energy balancing and other pretty alternative therapies. You’ll also find that there are three universities around the world that offer psychosomatic physical therapy as a specialty in their curriculum; Bergen in Norway, Perth in Australia and Utrecht in the Netherlands. If you are so bold as to search for medical evidence it will be hard to find anything under psychosomatic physiotherapy. Most of the evidence is found under the domain of psychology.

My colleagues (when being funny) seem to typify psychosomatic physiotherapy as physiotherapy that revolves around one question: “how do you feel?”. There is truth in this. But psychosomatic physiotherapy goes further than that.
Let’s look at a definition. I could not find one readily available, so I thought one up. Psychosomatic physiotherapy treats physical complaints, but takes into account that psychosocial aspects can hinder or stop recovery. Worst case scenario is even that physical problems occur due to psychological complaints.
Psychosomatic physiotherapists work a lot with unknown and/or unexplained complaints. Now how does this psychosomatic thing work?

When confronted with physical complaints a person will show behavior to improve the situation. You can differentiate between cognitive, behavioral, physical and interpersonal consequences.

Cognitive consequences:

• Extra attention to physical functioning creates heightened awareness to complaints. Whereas distraction takes away this awareness.
• With selective attention a person only experiences something when it fits a certain expectation. For example when you experience a stomach ache you will be alert to anything that happens in your belly. This confirms something is wrong with your stomach.
• Anticipation or self fulfilling prophecy. When someone suffered a heart attach in the past they might think that a pain in the chest is a prelude to another heart attack. This causes anxiety, which in turn can cause pain in the chest. Voila, a vicious circle.

Behavioral consequences:
A person might show either of two behaviors when faced with physical ailments.

• Rest. The thought is that doing too much increases complaints. Doing nothing leads to boredom and despondency. The body weakens even further and a negative vicious cycle occurs.
• Over activity. At the first signs of recuperation a person will become just as active as before the complaints started and therefore causing a relapse. This will create a saw tooth pattern of resting and overloading.

Physical consequences:
A person with complaints will try to avoid certain postures to alleviate pain. Over time these postures can exacerbate instead of alleviate pain.

Interpersonal consequences:
Complaints have influence in the way we interact with our surrounding. We work, have partners, we play and we study. What if this is made impossible due to these complaints? Coping resources in life become less and less. A person becomes agitated. This induces the vicious cycle again.

You might imagine that vicious cycles can also occur when somebody overloads or rests too much due to psychological problems. This can induce physical complaints as mentioned above. In the domain of psychosomatic physiotherapy this has a very high prevalence.

So with all these vicious cycles and psychosocial problems; what do we psychosomatic physiotherapists do? Basically we show people these mechanism and teach them ways of doing things differently. People have to alter their way of living in order to have a sustainable result. You can imagine this to be one of the most complex things to do. The thing to keep yourself interested in the profession.
What are the interventions we use? Relaxation therapy, mindfulness training, biofeedback training, breath exercise therapy, rational emotive behavior therapy and exercise therapy. These therapies are well researched and have a high evidence.

Now luckily I’m studying to be a psychosomatic physical therapist. Part of this study means I have to self reflect together with a group of fellow students and a coach. Coaching people with psychosomatic complaint means you have to know yourself. This means I have plenty of help to get organised.