Let's talk about the elephant in the room, shall we? Healthcare is often focused on treating the symptoms of a condition and not the actual deep-rooted causation of the symptoms.
After treating patients for the past decade, it has become overwhelmingly clear that most of our societies gut issues are rarely treated with physical therapy. In fact, 100% of my patients who I treat for abdominal issues are actually coming in to have a different issue treated altogether, not realizing that their abdomen is also heavily tied into the issue they are seeking help for. An example is low back pain that is also tied into abdominal pain and vice versa.
When examining someone who comes in with Low back pain, I also palpate their abdominal region to assess for tension, and there is a stark difference in the feel of their tissues compared to normal abdominal muscles. When I follow up with a question of, "Do you have any GI problems?" The answer is almost always "yes, I have IBS or constipation." So, our treatment focus will always be to release the abdominal muscles (either through dry needling or myofascial release) and then to retrain appropriate transverse abdominus activation as well as educating the patient in overall postural awareness to avoid patterns that can lead them back into abdominal tension (tight hip flexors, and back extensors and weak abdominals and glutes) also known as "lower cross syndrome." Another region commonly associated with tension in these patients is the cervical region (primarily because of the head forwards nature of their posture). So, I often like to start with a top-down approach when working with patients who have low back pain, because there is often so much more involved (like peeling back the layers of an onion). Also, it's important to realize how the Vagus nerve has numerous functions, including digestion. The Vagus nerve passes through the cervical region and dives into the abdomen and can often times be affected with cervical restrictions. It is a very common pattern I also observe in patients who have this type of posturing and should also be addressed.
This type of care should be fundamental for every patient we see and a first line of defense for IBS and constipation instead of medications. In our current health care system, our focus is primarily on imaging to rule out bigger issues that may very well be present. However, if the image does not show anything, why are we not choosing a more conservative approach other than prescription medications to improve abdominal pain? I hope that by educating people to look at the full picture and not just 1 region of the body, it will change the way we treat in the future. All in all, I believe the healthcare system should work as a team. I do not blame doctors, as this is something they are not taught. In fact, as a physical therapist, it's not something we are taught either. It's something that takes years of practice and pattern awareness to understand. Hopefully, we can all take a step back and begin to understand these patterns to help patients in a more conservative manner.
Amanda Worley PT, DPT, CMTPT
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