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Paul’s Ladder – Body IQ Case Story

Paul’s journey to become his own rehab specialist through individualized discussions and reflections, teaching him his own motor system and how to safely regain range of motion, strength and coordination.

Perched high up in a tree scouting for wildlife, Paul decides to adjust his position. The cottonwoods of Alaska make for excellent climbing. The branches tend to be spaced almost like rungs on a ladder. He secures his pack over his shoulder and stands up. He reaches to grab the next branch, then finds a lower rung for his right foot. As he begins to transition his weight, the branch he is pulling on snaps, almost instantaneously the branch his foot is pressing into breaks as well. With little notice, other than the sound of cracking branches, he lands solidly – on his butt. Falling more than 20ft. Wham! One moment he is climbing and enjoying the wilds of this land, and the next moment he is being faced with a reality that he isn’t sure he can move his legs.

Just months after this fall that resulted in multiple spinal fractures, Paul reviews his week of activities with me. With a hint of a hidden smile he begins to tell me about climbing a ladder for the first time. We have been meeting weekly since he was released from the hospital. Day one he is mostly frozen in a turtle-shell back brace and taking only a few steps with the support of a walker. Over the next five months the bulk of our time together is spent in education. As a Physical Therapist I watch him move, test his strength and I give him lots of exercises to do at home. When we meet in person I may even do manual therapy to help integrate his systems. However, these are not the things that make our interactions special nor are they the most valuable for his ultimate recovery. What I appreciate most about our sessions is the actual understanding he is gaining. He is learning how to be his own rehab specialist. Through specific, individualized discussions and reflections, I teach him how to read his own body. He is learning his own motor system and how to safely regain range of motion, strength and coordination; when to push, when to hold steady, and when to pull back. We have also spent time discussing our body’s pain system. Understanding pain’s role and how our experience of pain works can help us determine how we want to respond, rather than simply react, when we feel pain.

To truly recognize the greatness of this one moment Paul is about to share while on the ladder, let’s review a few specific facts about the fundamentals of pain. Pain is a multidimensional experience. The experience itself is initiated by our central nervous system in response to the perception of threat. Sometimes this alarm will sound – we will feel pain – when we are not actually in any danger of injury or re-injury. Like our other senses, the experience of pain relies on context. Our brains quickly gather many layers of information both from our internal environment and our external environment. It will ask questions like, have we been in this scenario, posture, movement, or location before? Do we have a sense of safety or fear? What is familiar? What isn’t? And on and on. Most of this investigation takes place without our conscious awareness and in the blink of a moment.

Back to Paul, during this particular week he thought it was time for him to try climbing a ladder. He went up rung by rung just fine. Then on the first rung of the descent he felt a moment of sharp pain, so he paused stepped back up a rung he was on and took a breath. He said to himself; there is no reason why I shouldn’t be able to do this activity. Then tried again. This time he descended the ladder without any issue and went up and down a few more times without any struggle during or after the activity.

Can you picture what happened neurobiologically here for Paul? Rewind to the last time his body was in a similar position. One hand up, a foot reaching down and the initial transition of weight – WHAM, landing on his butt, fractured spine, huge rescue effort to get him from the remote wilderness to a hospital and then another hospital, 9 hours of surgery, 5 months of

Actually, it makes a ton of sense that his nervous system says, “WAIT, hold up a second, are you sure this is what we should be doing right now? Remember last time!!” How does his nervous system actually communicate that message of “WAIT,” You may ask?  The answer is with this rather beautifully designed experience of pain. On the ladder, how does Paul respond? He steps back and takes a breath, calming his stress system and potential reactivity. This reassures his whole system that he is standing on a stable surface. And, he has already gone through the movements and nearly the same strength required to descend the ladder just minutes before as he climbed up without any issues. His pause and internal monologue are perfectly scripted. His brain and nervous system can now feel confident he is not under threat but instead, he is indeed safe. Now, he can go down the ladder pain-free.

For many people recovering from life changing injuries, impairments or disease these little moments of alarm can alter the course of their rehab. If Paul hadn’t understood what was potentially happening in his system and he may have reacted with fear. He could have frozen on that ladder, allowing his stress system to take over, ramping up the need to protect and likely the sensation of pain. This may have led to a fall or another rescue to return to safety. If any of this had happened, his nervous system would have good reason to become even more sensitive and protective. This would likely make many daily tasks difficult to perform with fear and pain joining more and more often.

Paul’s story is such a beautiful demonstration of our ability to choose a path of fear and reactivity OR a path of calm rational response, each with a very different outcome. What helps us most in moments like these? Having a foundation of education and understanding.

I felt a deep sense of pride while he is sharing this choice of a rational response – How lucky am I to get to walk this healing journey with this individual!


Disclaimer: All personal identifiers have been purposefully removed or changed in order to respect privacy.  However, some of these stories may be about your neighbors or community members or you may think some of them sound familiar.  No story has been printed without permission.  I ask that if you are reading this and think you may know “who” the person is just let that be and pretend you couldn’t possibly know.  Please do not open a conversation or make a comment to them unless they are the first to do so.

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