Movement is the medicine for pain

In 1921 a woman named Mary McMillan, who had treated wounded soldiers in the First World War with exercise and movement when the standard treatment was bed rest, founded what became the American Physical Therapy Association. Her idea, radical then, is now the foundation of an entire profession: graded movement is the treatment for most pain, not the thing to avoid until the pain is gone.

Sixty years later a New Zealand physical therapist named Robin McKenzie found, almost by accident, that a patient with back pain who lay face down on a treatment table in a position everyone said was wrong got up pain-free. He built a method on it: for most back and neck pain, there's a direction of movement that makes it better and a direction that makes it worse, and the treatment is to find the better direction and do it, often. For most people with low back pain, that direction is extension, bending backward, which is why the McKenzie prescription is ten press-ups from lying face down, several times a day.

The key is the whole idea of exercise rehabilitation, and it reverses what most of us were taught. Pain says stop. Rehabilitation says: pain says adjust. Find the movement you can do without making it worse, do it, and let the body relearn that movement is safe. The research on this is as strong as anything in medicine. Rest is for the first day or two. After that, rest is usually the problem.

That's a key for the second month because sixty days of movement have probably surfaced something, somewhere: a knee, a shoulder, a back. The answer is rarely to stop. The answer is a physical therapist who finds your direction and gives you a graded path back.