It’s almost always the same…time slowing to a crawl, certain sounds growing crystal clear, others fading quietly to the background. A sharp cut or twist attempted in a moment of fatigue. A mistimed step on unforgiving turf. An unfortunate collision of two bodies in accelerated motion. Or even just a simple fall. And then it’s over almost as quickly as it happened.

*****

Having been active in sports and physical activity my whole life, I am no stranger to various aches, pains and injuries.

Through my years playing competitive soccer, I have faced my share of down time from myriad sprains, strains and even broken bones and ruptured muscles. Because of these, I am also no stranger to the world of sports physiotherapy and injury rehabilitation as a patient and a client.

In the years before I would become a physiotherapist myself, after each injury I would make the hour-long trek to my physiotherapist’s clinic on the other side of town; she was the only one I trusted to get me back on the pitch in the shortest period of time, with my body ready to perform as before.

I knew she would help put me back together again.

She would run me through her complete physical assessment, gauging my injuries and devising an appropriate physiotherapy treatment plan, one that was built on the tasks that my body would be required to complete on return to sport. The running. The jumping. The sudden change of directions.

Unfortunately, as was the norm 20 years ago, and still practiced at some clinics today, each of my sessions always included hot/cold packs as well as various electromodalities: therapeutic ultrasound, interferential current, and other electrical stims.

These were used because they were always used: “for swelling, for pain, for speeding up tissue healing”.

These were the unchallenged physiotherapy traditions and at the time, I didn’t know any better.

But in addition to these thermal agents and electrical devices strapped to the various injured body parts, my physiotherapist would give me specific exercises. Empowering exercises.

Movements that started out simple enough: standing on one leg, hopping from side to side, or even just partially squatting down on one leg. With time, these would be progressed to more complex patterns, with greater challenges of speed, balance, control and precision. Eventually, I would be flying through sports specific drills at full tilt, exploding through intense plyometric jumps and pushing through challenging strength exercises.

With her encouragement, this is where I invested my time. These were the activities I took home with me, working on them consistently and diligently between math assignments and science papers.

And every time I returned for a follow-up physiotherapy session after doing my exercise-based homework, I would be stronger, faster, and more powerful.

I would be better. And more confident.

*****

While our knowledge of injury rehabilitation, pain science and motor control has grown by leaps and bounds, there still remains so much to learn and discover, especially when it comes to the nervous system and how the body heals and repairs.

Due to these new challenges, and new opportunities, the physiotherapy profession has also progressed tremendously.

These advances in better understanding the human body have led to novel treatment therapies and techniques and have opened the door for us to challenge and revise old, scientifically unsupported ways of thinking and doing.

Various professional associations, such as the American Physical Therapy Association, have adopted policies and practice guidelines eschewing traditionally used treatment modalities such as heating pads. Our research-focused colleagues have devoted their time and resources at trying to find the most efficient and effective therapies for our clients, the treatments with the lowest risk and highest returns.

This evolution has caused many of us in the physical therapy profession to move away from the traditional passive care approach which primarily used machines and into the realm of active rehabilitation using progressive exercise as the main modality of choice, our gold standard of treatment.

At least that’s where I find myself.

Looking back at what I did as a physiotherapy patient, and what I do now, as a physiotherapist, only one component remains the same…

Using exercise as a way of helping the body heal. Using appropriate movement to create a safe environment for the body to repair and fix itself.

Using graded physical activity to decrease the threat, real or perceived, to an over-excitable nervous system.

Using exercise to help my clients perform.

Using exercise as medicine.