Movement Medicine and Patience

Every physical therapist is surely familiar with the following phrases heard daily in their clinics:

"How long will it take before I feel better?"

"I haven't been good about doing my homework, I have to admit!"

We live in a world where we expect nearly instant gratification.  Services are ordered up with a few taps of your phone screen.  Products are bought now and paid for later.  Patience, for many, has gone out the window.

Unfortunately, your body's incredible healing powers still require time.  There is no app for an instant pain-free existence.

But there are steps and measures that you can take to ensure that you're on an optimal road to recovery from an injury.  They include, but are not limited to, the following:

~Protecting and stabilizing an injury.

~Controlling pain through various modalities, including medicine, taping, massage, splinting, orthotics, to name a few.

~Getting educated about why you're experiencing pain in the first place.

~Working to improve mobility, stability and function in surrounding, non-painful joints while protecting an injured joint.

~Learning what movements are safe and which are provocative and detrimental.

~Building up tolerance and capacity through progressive loading once an injury has healed enough to be deemed safe and ready.

No matter from whom you seek help for treatment of a painful condition, your provider should aim to empower YOU, not make you become overly reliant on them to feel better.  To be sure, there are plenty of circumstances where simple self-care won't suffice.  Cancers need to be excised and radiated.  Fractured bones need to be set and casted.  Medications and injections may need to be used to control intractable pain and swelling.  Unstable joints may require surgical intervention.  But in many cases, the tools for healing are already in your possession.  You simply need to be taught how to use them.

If your doctor told you that you'd need to take a 10 day dose of a particular medication to help eliminate an illness, you'd probably think nothing of following those orders in an effort to get healthy.  Perhaps the home exercise programs that physical therapists design for every one of their patients should be called something else.  Maybe it's the word exercise that is anathema to many folks.

That is why I'm going to stop asking my patients if they've done their home exercises, and start asking them if they've taken their movement medicine.  Because if the restoration of pain-free living requires the exploration and implementation of movement, then failing to take ones medicine will surely delay positive outcomes.

The tools are there.

Seek expert advice to add the knowledge and encouragement.

Be patient with yourself and the healing process.

Do the work.

Take your medicine.

Those are your keys to success.

Be A Quitter

The last cigarette I smoked was on August 26, 2003.

It might be a bit surprising to learn that someone who endorses healthy living once smoked.  I look back and wonder why I ever did.  More absurdly, I didn't have my first cigarette until my senior year in college.  What kind of idiot does that?!  This one.

I never considered myself a full-time smoker.  I was more the annoying guy bumming butts from people at bars, when you were still allowed to smoke inside.  I don't ever recall feeling like I "needed" a cigarette.  My habit was more a byproduct of the people I was hanging out with and the atmosphere.  Therefore, I never really thought that I had an addiction to smoking.

Years passed like this.  Finally, on one of the last days of a great 10 day hiking trip in the Pacific Northwest, I woke up feeling like crap, dove into the ice cold lake, and swore off them.  That was that.

I consider myself lucky.  I realize how challenging quitting can be for most smokers.  If it was so easy, the tobacco industry in the U.S. wouldn't haul in $45 billion annually.

Writing a blog about the dangers of cigarette smoking is like writing to tell you that the sky is blue and that water is wet.  I understand that.  But a current patient of mine has me thinking about the issue.

Harriet is a very sweet 74 year-old woman who started smoking when she was 14 years-old.  She's suffering from (among other things) peripheral artery disease, which is an atherosclerotic condition of the blood vessels.  This disease causes extreme pain in her legs whenever she walks more than a short city block or two.  She then has to rest for a couple of minutes to allow the pain to dissipate, then repeat the process until she gets to her destination.  It's made her dread leaving her apartment just to do the basics in life.  Whenever she's in the clinic on a table, she has to be elevated or she cannot breathe well.  The crackling of her lungs earned from a lifetime of smoking makes simple respiration an exercise in and of itself.

Sadly, smoking is just about the only thing in Harriet's life that makes her happy.  I know she won't quit now, and I'm not asking her to do so.

I give a pass to folks from Harriet's generation.  She grew up in a age well before Surgeon General Luther Terry issued a report in 1964 highlighting the deleterious effects of smoking.  But young people who continue to smoke do so at their own peril, by conscious choice.

Several years ago, while working at the Department of Education, the therapists were holding a health in-service for the rest of the staff .  Somebody asked a fairly straight forward question:  "If people know that smoking is so bad for them, then why do they continue to do it?'

I responded, "If I told you that the next smoke break you take today will leave you dead by the end of the week, would you still go smoke that cigarette?"

Life isn't meant to be lived in a sterile bubble without risk, pleasure or fun.  It's meant to be enjoyed.  But I don't want to see the young smokers of today one day suffering the way Harriet suffers.  She would be the first one to tell you that it's just not worth it.  And if you have kids and still smoke, remember that they'll be the last ones who will want to see you suffer.

It's never too late to kick the habit.  You're worth it.

Are You Lax?

When people come into the clinic, it's usually because they are in some degree of pain.  And that pain often impacts the way folks move.  It is my job a a physical therapist to help get people out of pain through manual techniques, modalities, exercise and education.  But it's also to assess and analyze peoples' movement competencies and to offer plans to help minimize their injury risk and maximize their performance.

Broadly speaking, healthy movement requires both MOBILITY and STABILITY.  Mobility is the capacity of each one of your joints to move through their maximal ranges.  Stability is you ability to control those given ranges via your muscular and nervous systems, in various positions and environments.

One of the things that I'm looking for when I assess my patients is whether or not their movement dysfunctions are mobility or stability-based.  It matters, because addressing a mobility deficit with a stability intervention (or a stability deficit with a mobility intervention) is likely going to have you spinning your wheels.  You may find short-term relief while not being able to make long-term, meaningful progress.

Here is a quick example.  If someone feels as though their hamstrings are constantly in need of stretching, yet they can easily reach their toes with their knees fully extended in standing or long sitting, then mobility isn't necessarily that person's issue.  Their hamstrings might feel consistently tight because they are constantly firing to offer missing stability elsewhere in the kinetic chair (e.g., the core/trunk).  In this example, the best approach would probably be to back of the constant hamstring stretching and instead to focus on stabilizing the deficient core musculature.  

Find out what is or isn't mobile/stabile first, and then you'll better be able to design a proper approach towards improving your movement.

Here's a quick way to see if you're a hypermobile individual, meaning that your joints (due to genetics) have plenty of mobility already and therefore do not require a mobility approach.  If you find that you can do these moves, the best approach would be to get to work learning how to stabilize your already mobile joints.

Free Advice

This past Sunday as I was walking out of Orange Theory, someone asked me to take a look at her ankle.  She had rolled it the day prior during a Tough Mudder race.  I obliged and gave her a quick assessment, offering her some advice about how to treat her simple ankle sprain.  As I was doing so, someone else stopped and asked me to take a look at his knee.  After giving him some advice on his sprained lateral collateral ligament, another person asked me to take a look at her shoulder.

I love what I do for a living.  And I love trying to help people feel and move better.  I will never say "no" when asked for my opinion.

However, as I have written in the past about offering "fly by" advice regarding painful conditions, it can be a tricky thing.  For one, finding the root cause of pain beyond the actual inflamed tissue can take some time.  Many questions need to be asked, followed by a thorough movement screen and an objective physical examination.  This usually requires some testing of people on a plinth (medical table).  It can involve exposing skin so that a joint can be assessed.  It can involve asking people to walk, squat, get up from the floor, etc.   Therefore, doling out solid advice on the run isn't always easy.

I don't ever want my response to people seeking my advice to be, "Make an appointment to come see me."  I don't want folks to think that I will only see them if I'm going to be compensated.  Many things can be assessed easily, with sound advice provided, in a five minute window.  But many cannot.  You deserve to have a thorough evaluation, not just a half-baked diagnosis.

As always, there's an answer to this dilemma.  And it involves a compromise (and offer).

I've decided to allot two 30-minute time slots to FREE assessments during my two days (one on Tuesdays/one on Thursdays) in my Garden City clinic.  This means that you'll have to come in to see me.  It doesn't mean that I want you to stop asking for advice.  Please, continue to ask away!  It just means that you'll get better advice by allowing me the proper time and space to best assess you.

So, if you or anyone you know has any nagging aches or pains that you'd like to have looked at, feel free to give me call.  You don't have to worry about seeing a doctor first or about dealing with your insurance.  Easy is the goal.

If interested, please visit my website for my contact information.  http://www.resolutionpt.com/  If you call, please be sure to alert Nancy, Pedro or Stephanie that you are seeking a FREE assessment so that you will be scheduled accordingly.

Movement As Medicine

Years ago, I said to my wife Kristen, "Exercise is my elixir."  I meant it half jokingly at the time, as I know that it sounds kind of cheesy.  But over the years, it's been repeated at times and I now firmly believe it to be true.

Yesterday, I was conducting the subjective portion of an initial evaluation.  During the Q and A, my patient unknowingly provided her own answer to her physical issues.  When I asked her if she does any sort of exercise, she responded, "I used to do a version of chair yoga.  And the was the last time my back felt good."

I can't tell you how many times over the years I've seen folks sheepishly squirm in their chair when I ask them whether or not they do any sort of exercise.  It's as if they knew that they were going to have a test that day, were given the answers in advance, but failed to put them down on the answer sheet.  Everybody knows that exercise is good for us.  It's the execution that's the difficult part.

My intent is never to shame anybody.  I understand that people have extremely hectic lives.  But when I hear over and over again the same stories about how people felt better when they were moving more, I know that it's something that needs further discussion.

If stagnation is the ailment, then movement is the medicine.

I think people need to change their mindsets about "exercise".  Don't feel that you have to join an expensive gym.  Don't feel that you have to go to the latest fad classes.  Don't feel that you have to keep up with the guy or gal next to you.  Don't give a crap about what you may or may not look like when you're exercising.  Don't think that you're going to make drastic changes in short periods.  Just find something that resonates with YOU!  The best exercise is the one that you like enough to actually do.  Set a small goal, do it, and then build on it.

This morning, my eyes opened about 45 minutes before my alarm was due to go off.  I was tired.  I was comfortable in bed.  But I got up and went for an unplanned run.  I still have my whole day in front of me, and I've already had my elixir.

One thing that I've noticed about exercise.  Not a single time when I finished did I ever think to myself, "I wish I'd never done that."  Not once.  In fact, I think the most gratifying workouts are the ones that I was least up for in the first place.

So give yourself the best gift and get moving.  You deserve it.

Two Tips for T-Spine Mobility

In today's world, our thoracic spines get no love.  Here is a lateral view of the spine so that you can see what area I am referencing:

The thoracic spine is our mid-back onto which our rib cages attach.  It is prone towards loss of motion due to our sedentary, desk-bound lives.  In addition to our time spent slouched forward at our desks banging away at our keyboards, we have thrown in our hand-held devices.  Now, when we're commuting home from work, we're reinforcing that forward head, forward shoulder posture often seen when sitting.  Over the course of time, the thoracic spine can get stiff and kyphotic (rounded forward).  I call it "going back into the technological womb.  In utero, we are flexed.  Then, as we develop through our motor milestones, we gain the ability to extend.  Modern life is undoing all that hard work we did as babies and toddlers.

So, why does thoracic spine mobility matter?  As mentioned, our rib cages are attached to the t-spine.  Good mobility in our thoracic spines will help make breathing easier.  Pretty important, right?

Another reason that it's important to maintain good t-spine mobility is to optimize healthy shoulder movement.  Our shoulders are ball-and-socket joints.  Think of a golf ball on a tee.  Optimal health of that glenohumeral (GH) joint and the rotator cuff (four muscles that control how that golf ball rotates on that tee) relies on proper mechanics of the scapula (shoulder blade) as it relates to the rib cage on which it sits.  I tell my patients that their scapulothoracic joints must be mobile yet stable platforms from which to "launch" their ball-and-socket GH motions (flexion/extension, abduction, internal rotation, external rotation, horizontal abduction/adduction).  The scapulothoracic joint is the "core" of the shoulder.  If one cannot move the thoracic spine well, then the scapula will have trouble getting into the ideal positions necessary to maintain healthy GH joints.

Try this experiment to see what I'm talking about.   Stand up and stand tall.  Now, raise your right or left (healthy) arm up overhead as far as possible.  See how far you can raise it by watching yourself in a mirror.  Next, take your arm and reach behind your back as you attempt to touch your opposite shoulder blade.  Ideally you'll be able to reach far enough to at least touch the inferior angle with your finger tips.  Now, try slouching forward at your mid-back and repeat those same two movements.  Was it more challenging?  Did you get as far?  Probably not.  This is an example of how a stiff, kyphotic thoracic spine can negatively impact shoulder movement.

Another reason one should want to maintain thoracic spine mobility is so that your lumber (lower) spine won't have to overwork.  When your body begins to lose mobility in an area where it ought to otherwise have it, then it will simply seek that mobility elsewhere in the kinetic chain.  Your bodies are great at compensating in order to get you from A to B.  It will sacrifice form for function.  However, while it's impossible to declare, "Because you move this way, injury X is bound to happen," it is safe to say that optimizing healthy movement patterns will help reduce your risk of injury.

For you folks out there who are desk bound, who have low back pain, or who are having trouble with your shoulders, please consider addressing your thoracic spine.  It is a big player in a lot of musculoskeletal pain and dysfunction.

Here are two quick and easy drills you can do to help keep your thoracic spines healthy:

FOAM ROLLING THORACIC SPINE

WALL FALLS FOR THORACIC SPINE

Give them a try, and use them in good health.