Physical therapy for muscles and tendons makes sense: if you have a weak muscle from an injury or atrophy, exercising it can strengthen it while things like stretching and manual therapy keep it relaxed until it is back to full strength.
But what about things like recovery from stroke, or balance issues? They are not caused by muscle weakness, the nerves are the issue, how on earth can therapy help with this?
Well, in therapy we rely on something remarkable, and that is the plasticity (or adaptability) of the brain. You see the adage that you cannot teach an old dog new tricks is fairly false in regards to the nervous system. We are built with an amazing amount of “backup” systems in our body that can often take over lost functions, learning how to perform our “old tricks” utilizing different parts of the body.
The way our brains work is fairly direct: we try something, we fail, our brain tries to make a correction, and we try again. Once the brain figures out which correction works best, it continues to refine this into a learned skill we do not even have to think about (our muscle memory, as it were). It then communicates those messages through specific pathways to our muscles, which then perform those actions (anything from fine control like handwriting and staying upright, to large skills like stepping or walking). If an area of the brain or those pathways are damaged, however, we can actually often relearn those skills using another portion of the brain, or with different pathways by practicing in a new way. It will often seem like you are learning something you have always been able to do all over again, because in essence you are! This means that while you will often eventually be able to perform these skills well, they may look different (handwriting can drastically change, but that’s just because you’re learning it new and differently too!).
Loss of motor skills can also occur from disuse. The brain tends to de-prioritize memories and skills that we do not use anymore, and specific guided practice can help re activate or re learn these lost things, as is often the case with things like balance or stability!
Our job as therapists is to understand the different pathways that our brains use so that we can create a novel version of a practice that takes advantage of a new area, and with this new kind of practice, you can often see some amazing progress. We’re more than just muscle-heads!