Going to physical therapy for various ailments is something I’ve done most of my life because I’ve always been involved in some sport or another. I remember my first stint as a high school gymnast, when I was dealing with sore ankles and their tendency to twist. I can still picture the therapist with a caliper measuring my ankle range of motion and being floored by how far I could turn my foot from side to side. That explains their twist-ability, and mind-numbing ankle exercises involving a giant rubber band were prescribed.

In grad school, when I was training for my first marathon and running more than I ever had before, I developed severe IT band tightness, and my dad had to cover the $20/week co-pay to see a PT (too rich for my grad school budget). It was the first time that the PT exercises I was doing did not directly work on the point of pain. I learned that running injuries tend to arise out of imbalances, tiny ones, that non-runners would go their entire lives without noticing. It is only under the constant pounding and movement that these little glitches can cause big problems. A slight tilting of the pelvis, a drop of the hip, glutes not firing, all can build up over time. Like a grain of sand in a car engine (is that a thing? I’m trying to find a metaphor).

Since that first IT band issue, I’ve had other various injuries and niggles stemming from imbalances. Right now, I’m dealing with a strained calf. The pain and tightness are localized to high up in my lower leg, nearly behind the knee. My therapist starts out by working on the tight spots, with the most painful massaging. The exercises I do, though, have nothing to do with my calf. They focus on getting my notoriously lazy left glute to wake up, and my spine to stay neutral and not tipping into a swayed back, and my deep core muscles to stabilize these new adjustments.

Ideally, these are exercises I can continue doing, in order to prevent future imbalances.

Being in PT also makes me think about the difference between physical therapy and mental therapy.

I’ve done mental therapy, both one-on-one and in a group setting, and there are many similarities: the symptoms aren’t always the causes, it’s important to treat both the symptoms and the causes. When I’m doing physical therapy, I can almost immediately feel a difference in how I feel. Learning the underlying causes is fun, like a puzzle, finding out how the body is put together so that an imbalance here causes pain there. The leg bone is connected to the thigh bone.

Mental therapy, though: treating the symptoms is immediately relieving, I suppose. I consider these tools like meditation, going for a run, having a heart-to-heart with a loved one, journaling. Things that make me feel “better” in the moment. And they do feed back a bit, to prevent symptoms from popping up. But they are salves for the present.

Finding out the underlying causes is sometimes fun, a lightbulb moment. But it can be a bit of a bummer, to then realize that simply knowing that I’m bad at asking for what I want because I never wanted to rock the boat as a kid, isn’t enough to make that feeling go away.

So then the exercises to address those underlying causes. That’s the rub. There is no immediate difference. Diving into the causes involves going back in time, almost an impossible task, and treating the six-year-old who built a neural connection to associate self-worth with praise (for example). It involves crying and being exposed and feeling dejected. It does not involve feeling “better,” which unfortunately is the way we think we should feel if we go to therapy.

I’ve been contemplating getting back into a regular therapy routine, which I’ve been putting off a bit because (1) I’ve been feeling pretty good and (2) I have to look for a new therapist. But I worry that without doing preventative maintenance, without putting myself through some of the difficult exercises, I’m not really getting to the root causes. It also means I don’t have a very good resource for when I do get “injured.” Although bedside manner is of course important for PTs, I somehow feel more comfortable calling someone out of the blue based on a recommendation from a friend to fix my body than I would to fix my brain. So, when something goes wrong, it’s hard to find someone if I haven’t been working with them already.

I realize some of the words I’m using are dangerous: feel “better,” get “fixed.” Unlike the body, there is not an obvious “normal” for the mind. Sometimes I’m not going to feel “good,” but that’s “normal.” And the word “fix” can be a metaphysical exercise: am I fixing a part of my brain that isn’t normal, but if I’m fixing my brain aren’t I changing a fundamental piece of who I am, and isn’t who I am normal, so there’s nothing to fix?

It’s enough to make my head spin.

Is that a cause or a symptom?