8 Lessons About Change I Learned from PT

I've had a dull, aching pain in my right knee for probably a decade. I always figured it was due to being overweight (it was), but I assumed that once I lost all that weight it would just go away (it didn't). I decided to see a doctor about it, and he referred me to a physical therapist. A really effective physical therapist.

I've been spending a lot of time recently reflecting on how I've changed so dramatically in the last few years - the actual mechanics of it - and it occurred to me that I could use this little experiment with my knee as a case study of micro-transformation. Within about 3 months of my first PT appointment I had virtually no pain. So how did this happen? This time I was ready. I kept a lot of notes throughout the process, from the end of May until now, and paid close attention to my symptoms and efforts.

Here are some things I learned from PT that I have extrapolated out to be about change in general:

1. Forced action produces results. I signed up for PT for the same reason I did intermittent fasting with my housemate: to force myself to change. I wanted to fix my knee, and I had a feeling that it would involve a lot of frustrating, annoying core and hamstring exercises (spoilers: it did!). I knew I could try to figure it out on my own, but that I probably wouldn't stick with it. I don't like doing things I don't like doing (duh). I needed the accountability of paying someone else to make me do things. I also wanted to save myself time and talk to an expert instead of cobbling together a million YouTube videos and asking the advice of every random friend out there (literally everybody has an opinion about health and exercise). I find that if I spend too much time researching something, I end up paralyzed by too much choice and too much information. Suddenly I have 18 different possible solutions and now have to weed through them all. It's better for me to cut out that middle part. Research just enough to find a possible solution, try it, and then refine according to the results.

2. Our brains get adapted to pain. I was pretty surprised how much our brains are involved in physical pain. I was never an athlete growing up, so I didn't injure myself much. I've never done PT before. So it was news to me to start learning about how our brains sort of get "used to" having pain in a certain area, and how that pain disrupts our neural pathways. Part of the treatment is to get the brain used to the idea that a part of the body is no longer in pain. To stop expecting pain from an area. I definitely felt a connection. The less my knee hurt, the less I noticed it. When I started the treatment, I was used to the pain. It was like an ever-present dull ache. I only really noticed when it was particularly bad, like after a downhill hike.

3. Often the source of the pain isn't the source of the problem. I was surprised by how little of my pain had to do with my knee. The exercises he had me do were all related to core and hamstring strength. The pain would sometimes go away immediately after I did exercises that caused changes in my circulation, like trampoline or acupuncture. There was also sympathetic pain in my lower back, and when I would do exercises that made my back feel better, the pain in my knee would disappear. Spooky. This reminded me a lot of the connection between mental and physical health. For me, 9 times out of 10, I can't get rid of emotional pain with my head. I have to fight it out. I have to go for a hike, or lift heavy weights, or hit something. The emotional pain is just a symptom of needing to burn off those chemicals with my body.

4. Small, consistent actions are more important than big, sweeping changes. This one is tough for me. I want to fix something quickly. I want to figure out the best solution and just make it happen. I don't want slow, gradual change. Nonetheless, it was just doing a bunch of exercises regularly that made it happen. I did my PT exercises about 3x per week at the gym. Small things like dynamic stretches, Bodyblade, foam roller, and massage stick I did almost every day. It wasn't fun. It wasn't exciting. I had no idea if I was making progress. This process confirmed that, in fact, I am a terrible judge of my own progress.

5. Speed is not the goal. Smooth and controlled is. I am tempted to do things quickly just to cross them off a list. With these PT exercises, my doc kept reminding of something: doing controlled movement - slowly and correctly - rewires your brain. One session, he had me wear this crazy laser pointer on my leg and trace a curve while squatting. It was the most tedious and frustrating thing ever, but holy cow did it work. I found myself at the gym unconsciously correcting my squats. I've also experienced this phenomenon of slow, controlled movement in tai chi. Tai chi forms are done slowly, with an emphasis on control and proper alignment. The secret of tai chi is that alignment is actually the key to power. It's not brute force, and it's not sheer speed. It's flow. Speed only matters when the action is performed correctly. Force only matters in the right direction. I can push against a large stone against a wall all day long, or I can roll it down a hill.

6. It's necessary, not just okay, to take breaks. I hate taking breaks. Seriously. My MO is to work 10x harder than most people and then burn out in the process. I found with these exercises that I really couldn't do that, and I learned a valuable lesson about the importance of taking breaks. I observed that even if I took a break sometimes, I was still improving. I'd maybe skip the gym once in three weeks, or I'd only do half a workout or something. In the moment it felt like I was skipping a lot, but journaling helped me keep track and it actually was not that often. Two things about this. First, even with taking breaks, I was doing these exercises way more often (and correctly) than I would have been doing before. So only hitting 70% of my goals, I was still up 70%. Second, more generally, my brain needs that time off. It uses it for problem solving, for rewiring. I experience this all the time with programming. Often when I'm working on a hard problem, I just need to think about something else for a day and let my asynchronous brain handle it for me. I had never really made this connection to the non-programming world until this little experiment with my knee. Sometimes for me taking a break meant going to kung fu instead of doing the PT exercises. This was great because it helped me actually apply what I was working on and reminded me why I was doing it in the first place.

7. Boredom is a sign of progress. I get bored quickly. I've always been that way. Once I feel like I understand the basics of a problem, I need to move on. I really hate solving the same problem twice (Don't Repeat Yourself doesn't just apply to programming). When I got bored with my PT exercises, the answer was always to increase the difficulty. My doc would make me do the exercises:

  • Standing on one leg
  • At a more difficult angle
  • Longer
  • Slower

I actually found this pretty encouraging. Usually when I'm bored, I am also frustrated with my perceived lack of progress. This experience with PT helped me realize that that boredom is actually evidence of progress - I've mastered one thing, and I need to up the challenge.

8. The turning point feels like magic, but it's the result of a lot of hard work. It seems like the emotional cycle of change for me happens like this:

  1. Excitement!
  2. Small steps and daily habit-building.
  3. Frustration.
  4. Frustration.
  5. Frustration and boredom.
  6. CHANGE!

I have no idea why this is, but with nearly everything I've accomplished, the result happens in a way that feels instant. It's like my brain immediately forgets all the drudgery that went into it. One day my knee just stopped hurting. One day I had lost 60 pounds. One day I was out of debt. All those hundreds of hours of exercises or saying no to sugar or living on way less than my income seem to vanish into thin air once the results have become real. So, now, with my current goals, I try to just remind myself that the boredom, frustration, and daily hard work are all part of sowing. They're all seeds that I'm planting. Someday I'll reap the benefits. I don't know when, and I don't know how, but I will. And just like with all of these other goals, the daily drudgery will mostly fade away.