21 Random Thoughts.......

I'd like to share some of the things that I've learned after practicing physical therapy for the past 13 years.  They are in no particular order, nor is this an exhaustive list.  They're just a few of things that I find myself teaching people every day in the clinic. Or they are nuggets of information that I've picked of from experience and through reading and watching folks smarter than I.  Hopefully you'll find one or more helpful. 

1)  If you sit for most of the day, aim to stand up at least 3 times an hour.  If you can walk away from your desk for a minute, even better.

2)  With any exercise you're doing, check your alignment, posture and form.  Without these in check, your sets, reps and weight don't matter so much.

3)  If you feel the need to stretch a particular part of your body constantly, it may not be due to tight muscles or restricted joints.  There may be a reason that your muscle keeps going back to providing you tension after you've found temporary relief from stretching.  Do yourself a favor and find out why, or you'll be barking up the wrong tree indefinitely.

4)  Try to sleep on your back or side, if possible, for optimal spinal alignment.  Stomach sleeping forces you to hold your cervical (upper) spine in rotation in order to breath.  That's 6-8 hours of asymmetry a day that could take a toll on you.

5)  Movement and exercise opportunities are all around you every day.  "Exercise" does not have to involve an expensive gym membership and an allotted time.  Just keep moving, and your most valuable asset (you!) will keep serving you well into the future.  Take it for granted, and down the road it may only give back what you put in.

6)  If you want to help your balance, rather than standing on a wobble board or a BOSU, try taking your shoes off.  Allow all the rich proprioceptors to feel the floor.  If you were going to thread a needle, you wouldn't put thick gloves on, would you?

7)  If you ever experience plantar fasciitis (sharp pain on the undersurface of your foot primarily felt back by the heel), don't ignore your big toe.  You can roll out and stretch the undersurface of your foot and Achilles tendon all you want.  But if your big toe doesn't extend (bend upwards) well, then you may be missing something.

8)  Squat every day.

9)  Get down to and up from the floor every day.

10)  Have somebody take a picture of your full body in profile.  Musculoskeletal dysfunctions that are partly driven by poor posture can only be addressed by starting with awareness.  I see raised eyebrows every day when I show people their "before" pictures, which demonstrates their sense of "normal" posture.

11)  Pain is VERY complex and involves way more than tissue damage.  If it lasts more than 3 months (chronic), there's a great chance that more variables are at play.

12)  The most important thing that I can offer my patients is educating them and teaching them how to take control over their health situation.  It's not some modality that I "do" to them.  They play a part, but teaching folks how to optimize their healing environment and allowing time to do its thing matters more.  Empowering patients is the answer.

13)  If you ever experience pain in one of your limbs, know that the source might not be where you're feeling it.  You need to check the spine to rule it out first.  Otherwise, you may be futilely chasing pain and wasting your time.

14)  Don't ever be afraid to ask your healthcare providers questions.  Nobody is going to care about your health more than you.  Be your own biggest advocate.

15)  Be leery of the healthcare provider who seems to have an answer to everything.  It's impossible.  Rather, value those who are confident enough to say, "I don't know" but who get you an answer in a timely manner.

16)  If you're a runner, watch yourself do a single leg squat.  If your leg is wobbling all over the place and your knee is diving inward, you have some work to do if you want to make yourself a more efficient, less injury prone runner.

17)  MRIs shouldn't been the first stop when you're not feeling 100%.  If everyone with abnormal MRI readings was in some level of corresponding pain, I wouldn't say this.  But that just isn't the
case.

18)  In my field (and any, for that matter), there's really no excuse for not improving myself every day as a practitioner.  The barriers to learning are practically nonexistent with virtually everything accessible in the palm of our hands.

19)  There are no "magic bullet" solutions.  If you want meaningful, long lasting results, you've got to put in the effort.

20)  Beware of those who make declarations such as "Never do this" or "The best way to do that." (e.g., all the Crossfit haters out there).  The human mind and body are just too variable to speak in such absolutes.

21)  Life is too darn short.  Don't overthink everything.  There are many miles between caring and obsessing.  If you find yourself knocked off your plan, don't sweat it.  As long as you're pretty disciplined about your heath most of the time, you'll be alright. 

Again, random thoughts.  If you'd like any further explanation or clarification,  I'm happy to expand on any of the above.

Lacrosse Ball Shoulder Release

Here is a brief video that demonstrates a technique to address limited overhead reach due to tightness and/or pain.  There may be several reasons why this movement would be limited, but this specifically addresses tightness in the pectoralis major and minor (chest) muscles. 

One of the key elements of full pain-free shoulder movement is the ability of the scapula ("wing bone") to move  freely on the ribcage.  Sitting in a slouched position all day in front of a computer might hinder that freedom of motion.  Check out below what to do about it.

The Powerful Yoke of "Can't"

"You miss 100% of the shots you don't take."  ~ Wayne Gretzy

One day when I was in physical therapy school, my class took a trip to Blythedale Children's hospital in Valhalla, NY.  We broke up into groups and were assigned to observe various children.  My particular group sat with a young child of about two years of age.  He had a diagnosis of agenesis of the corpus callosum, which means that the bridge connecting the right and left hemispheres of his brain was not properly developed.  

After our morning of observation, the class gathered in the parking lot to discuss the child whom my group had observed.  She asked us what we thought the future held for this kid.  A few of us ventured forth with some answers, but were chagrinned to hear the professor offer her own grim analysis.  I remember experiencing a sense of helplessness hearing her words.  I'm sure many of my classmates were feeling the same way.

A few years later, I bumped into a former classmate of mine at a New York Board of Education event.  I was pretty shocked to hear what he had to say as we caught up.

"Do you remember the child at Blythedale who we discussed afterwards?  Remember how little our teacher expected of his future?  Well, I'm working with him now.  He's walking with assistance, speaking, and doing several other things that we were told he'd never do.  It's pretty amazing."

What resonated with me after my conversation with this classmate was how a negative prognosis could have hindered this child's progress.  But somehow, despite the opinion of our experienced professor, he was able to achieve.  Would not and could not had turned into can and does.

A couple of years ago, I had a patient who wore a similar yoke of negativity around her neck as she struggled with a "bad" back.  Just the term "bad back" alone had this early 40's patient believing that her body had betrayed her for life.  As I worked with her for the fist couple of weeks, I'd often hear the refrain, "My former therapist told me I can't do that."  Or, "My other PT told me that that will hurt me."  She had built up a wall of negativity and fear that was preventing her from making any progress.  She had allowed her current condition to completely dominate her, rather than finding a way to positively effect her own well-being.

My cousin John Leder and his wife Emily are two fantastic parents to their 5 year-old twin boys, Owen and Charlie and 2 year-old Maeve.  When the twins were born,  Owen developed complications.   John and Emily were told that Owen would be deaf, mute, and likely non-communicative due to his brain injury.  They were told that he would have spastic quadriplegia which would require him to be strapped into a wheelchair to prevent his limbs from flailing.  Potentially devastating news for newly minted parents.  

My Des Moines cousins were unbowed.  Over the past five years, I've witnessed from afar via video and email updates as Owen broke through barrier after barrier.  Here is a clip of Owen graduating from preschool with Charlie, where he says that he wants to be a doctor one day:  

Here is one of Owen playing soccer:

Had John and Emily listened to the can nots, will nots and never wills, perhaps they wouldn't have engaged Owen in all of his therapies and activities.  Perhaps they would have let him fulfill the low expectations set by the "experts" by simply keeping him "strapped" into a chair.  But they didn't.  They want Owen to do everything his brother Charlie does.  Whether he does remains to be seen.  But his parents are giving him the opportunity, which is all that matters.

I am not naive to think that by simply willing and wishing something, it will come to fruition.  What I am suggesting is that by planting seeds of doubt and negativity, you'll surely limit your opportunities for progress and success.  

Stop listening to all the "can nots" and ask "why not?" instead.

"Small Bite" Goals

Yesterday morning,  one of my patients was sharing his stresses with me.   He is burning the candle at both ends and therefore is feeling like a failure at all his endeavors.  He is especially resenting how much his work is pulling him away from his family.  I'm sure you've all been there yourselves.

I listened to him as we worked on his shoulder rehab and offered a suggestion. This morning,  I woke up to a "Thank You" email from him.   He told me that he felt much better after leaving work a bit early to go home to have a catch with his son. 

My advice was simple.  I told him to set a reasonable goal for himself.  Perhaps that is one night a week where he goes home early enough for dinner with his family.  Even if he has to work until midnight the other nights, he'll know he'll have his dedicated time set aside.  It'll ease his anxieties and enable him to work more efficiently.  Most importantly,  he'll get his time with his family.  Conversely, if he sets a loftier goal of being home every night for dinner, it will likely lead to greater work stress and possibly even resentment towards his family.

When I give patients a home exercise program, it's not more than a few things at a time.  I want the goals to be reasonable and achievable so that progress will result.  The same goes for other areas in life.  Lay down one building block at a time.  Feel good about it, and then build on it.  Don't feel as though you have to do it all in one day.  Otherwise, you'll inevitably end up disappointing yourself time and again.

When setting goals, consider taking "small bites."  While not only more digestible, they'll leave you feeling exponentially satisfied.