Rehab Science: Common Mistakes, Biggest Surprises, & Recovery Principles With Tom Walters, PT
“The truth is most musculoskeletal conditions can be self-managed with the right information and a graded movement/exercise plan. “
—Tom Walters
Rehab Science is the book I yearned for during my time in OT school. As soon as it landed in my hands, I was flying through the pages, experimenting with the exercises and mobilization techniques it beautifully illustrated I brought it into the clinic, and now my colleagues and I use it as a resource.
Tom Walters, PT is the man behind Rehab Science: How to Overcome Pain and Heal from Injury. I reached out to him to find out more about who he wrote the book for, why we humans are so terrible with adherence, and explore the intensely personal nature of our relationship with pain and how to manage it effectively. Venturing into the realm of evidence-based practice in rehabilitation, rehabilitation protocols, and musculoskeletal rehabilitation, our discussion touches upon common rehab mistakes, his biggest surprises when researching this book, and the best thing that people can do to prevent injury in the first place and recover from it when it happens.
5 Questions With Tom Walters
1. Who is this book written for?
The book was written with two groups in mind. Firstly, it was written for the everyday person who doesn’t have a background in rehabilitation, but would like to have a resource that helps them self-manage common injuries and pain issues. Secondly, the book was meant to serve as a therapeutic exercise resource for movement and medical professionals who work with patients with orthopedic injuries and pain conditions and would like a reference that can help them design exercise programs for their patients/clients.
2. After treating for 14 years I’ve come to realize that pain is ingrained in our evolutionary roots for a reason, yet everyone has a unique and widely varying relationship with it. What are some of the biggest takeaways you’ve come to learn about pain and the best ways to manage it?
In my years of practice, I have come to realize just how individual each person’s pain is and, as you said, that one’s relationship with painful symptoms can also vary considerably. Some people are very matter of fact about their pain and it doesn’t seem to influence their thoughts and emotions too much. On the other hand, we see individuals that are very distressed about their pain and that it has a significant impact on their mental and emotional health.
In terms of how to best manage pain, there are two items that I would say are the most important.
These include educational information that isn’t confusing and is reassuring in terms of letting people know that most musculoskeletal conditions get better with time.
The second element is movement/exercise. Exercise and movement have the best long-term evidence in terms of getting out of pain and rehabilitating injuries and reducing the likelihood that they return.
The great thing about both of these elements is that you can learn and implement them on your own. The truth is most musculoskeletal conditions can be self-managed with the right information and a graded movement/exercise plan.
3. What are some of the most common things that people get wrong when it comes to rehab?
I would say one of the biggest issues is that people jump back into activities that aggravate their issue too early or aren’t willing to temporarily modify lifestyle behaviors in order to let their body heal. While the body is extremely adaptable, rehab takes time (several weeks to months) in order for our tissues to change and become more resilient.
The honest truth is that rehab often requires a fair bit of patience. If you can give your body the necessary time and gradually expose it to increasing levels of stress, it will become more durable and less prone to future injuries.
4. One of my biggest struggles as an occupational therapist is patient adherence. Most of the time I can convince them that the treatment is going to be effective if they participate but the carryover is inconsistent at best. What recommendations do you have?
This is always a challenging area, especially for patients who don’t naturally enjoy exercise. I think the most important strategy here is education focused on the “why” question. If the patient truly understands why the recommended plan is going to help them recover, they are typically more willing to stick with the plan over time. Part of the reason I included ten chapters on pain and injury rehabilitation science in my book was to help answer some of these “why” questions that patients ask.
5. What were some surprising things you found when diving into the research for this book?
I would say the most interesting research was the research I dug up for chapter 14 (complementary and alternative medicine interventions) as this isn’t an area that I typically spend a great deal of time reading. Chapter 14 is organized so that the interventions at the beginning of the chapter have more research support and those toward the end are less supported. In that chapter,
I discuss the value of mental imagery and the cross-transfer effect in rehab and I really enjoyed looking for more studies related to these two concepts. Suffice it to say, visualizing movement when going through the rehab process and training the other side of the body can be very helpful when looking to recover more quickly.
6. What are some of the most common things that people can do as a way to both prevent injury and recover from it?
From the research and what I have seen clinically, I would say the best thing you can do to recover from injury and prevent future occurrences, it to add 2-4 days of resistance training to your program each week. Resistance training directly makes our tissue more durable and resilient and there is a great deal of research showing that this type of exercise is best in terms of reducing the risk of injury.
This doesn’t mean you have to go to a gym and perform a bodybuilding program either (you can do that if that is something you enjoy). The majority of the resistance training benefits can be achieved with bands, dumbbells, and bodyweight exercises that you can perform at home. Phase three in all of the programs in my book includes resistance training exercises. These can obviously be done to help in the rehabilitation process, but they can also be done to keep the body strong and healthy.
Tom also has a great Instagram account with very actionable rehab approaches. Check him out @rehabscience
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