In physical therapy or in any movement training, context is king. If you understand context, you will have a major key to success—shout out to the real.
Now let’s break it down.
You may have heard your physical therapist say, “it depends,” once or a million times. From a patient perspective, the phrase can be frustrating to hear, especially since you’re asking for advice. But trust that you’re in good hands because your physical therapist understands context. For example, I often encounter the following situations: “My back hurts and I sit all day at work. I’ve heard sitting is the new cancer, and I’ve been told to switch to a standing desk” or “I’ve been told to never squat again because the MRI showed a herniated disc.” One, it sounds like both patients are dealing with Sith Lords.
Two, well, it depends in either situation.
In the first situation, sitting is not the context; “all day” is. Sitting itself is not a harmful position. After a long day walking at the museum, I’m that person that gets into the subway car before people get out, so I can find a seat. Why? Because I’m a jerk and it feels good to sit after standing all day. Now would the patient benefit from having a standing desk, too? Yes, the patient can alternate between the two setups and, thus, change the context.
In the second situation, we need more information, but squatting is not the context; the programming likely is. Squats itself are not a harmful movement. Outside of the gym, humans squat every time they get in or out of a chair. We cannot eliminate an essential movement forever without first understanding the context, which depends on the type of squats or form, the frequency and intensity of squats, the onset of pain, etc. From there, a plan can be formulated to incorporate squatting movements (if no contraindications for loaded squats are found) in non-painful positions, which involves changing the context, and progressing to the formerly painful version. Or the plan may be to find an entirely new squat (i.e. safety bar, goblet, zercher, etc.) that still allows you to achieve your fundamental goals.
When your physical therapist understands the context of your pain or dysfunction, you become the padawan.
When you understand that it depends all the time, you become Jedi.