Fitting a Cane

One of the things I often see in the streets is folks with ill-fitting canes.  Most of the time, they have them sized too tall.  This may force their shoulder to rise up too much, put unnecessary pressure on their wrist, or both.  I've occasionally stopped and asked strangers (after identifying myself as a physical therapist) if they've ever been properly fitted for their assistive device.  Every time the answer is "no".  After allowing me to adjust their cane, they all reported that it felt better.

I'm amazed at how often people have come into the clinic with assistive devices they've received from the hospital or from their doctor's office with NO INSTRUCTION.  I suppose that many doctors just assume that people will figure it out intuitively.  But I've learned over the years that it's a mistake to make assumptions, and that even some of the most basic interventions should not be taken for granted.

Towards that end, here's a brief clip on how to properly fit a straight cane.  With the awful weather we've been experiencing in the northeast this winter, unfortunately there will be an uptick in people in need of such assistance.  If you or someone you know ends up with an injury that requires some "off loading" of a lower extremity, please view and share this.  I hope that it will help make what's already an uncomfortable situation less so.

Check the Trunk Before the Branches

I want to share a quick patient history that perhaps will save you from wasting your time and money in the future.

This is about a forty five year-old female with complaints of acute onset right shoulder and neck pain that had developed while snow boarding in Utah.  She had already been in my care for a left ankle issue when she texted from her trip alerting me to her new intense pain.  She was intent on coming back to New York to be seen immediately by her doctor.  In short order, she convinced her doctor to order an MRI and received an injection to the shoulder.  But she was NEVER ASSESSED BY THE DOCTOR!

Three days after receiving the injection, my patient was back in my clinic in the same level of pain.

After I put her through a series of muscle tests, there was ZERO pain provocation surrounding the shoulder.  However, both palpation (touch) and cervical (neck) motions caused pain to radiate into the spots in her shoulder and arm that she had reported to her doctor.  This afternoon, her MRI report came back which revealed that absolutely nothing was unusual.

The pain was felt by my patient primarily in her shoulder and arm, but in her case it was not where the issue originated.  Yet she underwent an expensive imaging examination and misguided injection with no positive results.

What's the point?  Your pain is a symptom that does not necessarily correlate to tissue damage in that same spot.  It can be referred from somewhere else.  Here's a quote about pain that I recently ready in Tom Myer's "Anatomy Trains":

"When a crime is committed, it's the victim that cries out, not the criminal."

If you find yourself with pain in your arms or legs, check the spine first.  Then work your way down from proximal (close to trunk) to distal (away from trunk).  The nerves that emanate from your spine branch out to reach all aspects of your body, providing both sensory and motor function.  Think of it as your body's switchboard.  Going right to the point of pain to treat would be like changing the bulb in darkened room without first checking the circuit breaker.  Check the source first, or you'll wind up frustrated, in pain, and in the dark.

A basic orthopedic examination ought to be the norm when you visit your doctor in pain.  But in today's hyper kinetic health care environment, you can't assume that will happen.  Instead, you've got to be your own biggest advocate.  Demand to be thoroughly assessed by your doctor.  If they don't lay a hand on you, consider that to be a red flag.  You will save yourself a lot of time, frustration and unnecessary costs by doing so.

Avoid the FOOSH

This post might best be filed in the "Stating the Obvious" drawer, but after witnessing several falls over the past week, I thought this might serve as a friendly reminder.

A couple of Sundays ago (January 18th), I stepped outside to grab the paper.  I nearly had by legs fly out from underneath me, but fortunately caught myself.  I didn't see any obvious ice on the ground, but it certainly was present.  Later in the evening, I saw numerous images of folks and cars sliding all over the place while enduring a nasty black ice event.  I knew that I would be seeing people in my clinic over the following weeks with injuries sustained due to these hazardous conditions, and unfortunately I have been correct.

A FOOSH injury is a fall on outstretched hand.  Your arms will shoot out reflexively when you lose your balance in an attempt to protect your head.  While you may avoid catastrophic injuries by doing so, typical injuries to the upper extremity due to a FOOSH would include wrist fractures, elbow fractures, humerus (upper arm bone) fractures, dislocated and/or separated shoulders, rotator cuff tears, and labrum tears.  All of these are painful and debilitating injuries, but pale in comparison to a more tragic outcome.  For you N.Y. Giants fans, you were likely aware that Ann Mara, the matriarch of the team, passed away this week at the age of 85.  As it turns out, she had slipped and fallen on January 18th and never recovered from her injuries.

Falls can happen any time and anywhere.  But the two simplest yet effective pieces of advice I can give you to avoid them in treacherous weather are the following:

1)  Give yourself more time!  If you keep your regular schedule during bad weather without giving yourself some wiggle room, you're setting yourself up for trouble.

2)  Wear practical footwear!  The young lady I saw fall this morning was wearing fashionable boots with 5 inch heels on them.  Fortunately she got right back up, but hopefully she'll rethink her shoes tomorrow.

Let fashion take a back seat when it comes to your safety.  Carry your professional shoes with you, or keep an extra pair in the office.  And slow down.  An ounce of prevention may save you the arduous, expensive, and painful experience of having to rehabilitate an injury.  And if it's fashion that's paramount to you, I'd suggest purchasing coats and pants that will match the slings, casts, braces and boots you might find yourself needing should you take a spill.

Take caution.  Be safe.  Stay upright.  Summer will be here soon enough.  Falling on the sand at the beach hurts a lot less.

American Sniper

Last weekend I saw American Sniper and left the theater in silence, along with the rest of the packed house.  Powerful is an understatement.

Last night, while celebrating my mother's 70th birthday, I was chatting with my brother, aunt and uncle about the movie.  While not everyone at the table had seen the movie, we all agreed to the incredible sacrifice our military men and women make.  Chris Kyle's bravery and dedication to his country were every bit as compelling as his actions during is four tours of duty.

This past week, I've read and heard a growing chorus of negativity aimed at Chris Kyle and American Sniper.  I simply don't understand this.  While we can hopefully all agree that a world without war would be ideal, the sad truth remains that it has, and likely will remain, a fact of life.  I can understand getting angry and upset at the politicians who make decisions to engage (or not) in war.  I CANNOT understand politicizing the actual folks sacrificing life and limb for our country.  I didn't know Chris Kyle.  Nor, likely, did some of the folks now trying to portray him in a negative light.  The only thing that I do know for a fact is that this man gave so much of himself for a cause he believed in.  For that, he and all the other people in the military have my utmost respect.

My brother Billy said something that really hit home during the conversation.  

"It's easy to say 'Thank You' to a veteran, and I'm sure they appreciate it.  But I think it would be better if we could actually DO something to express our gratitude."

What Bill said got me thinking.  As a physical therapist, I don't have the means to write meaningful checks to veterans' causes.  What I do have is my time, knowledge and caring.  Towards that end, I decided to offer men and women of the military free hour long consultations in an effort to say "THANK YOU" for all they have done.  

If you know of anybody who has served our country and is in need of physical therapy care, whether due to pain or impairment, please share with them my offer.  It is my small way of giving back to those who have given us exponentially so much more.  My contact information is below:

JAMES HORN

CHELSEA PHYSICAL THERAPY

& REHABILITATION

119 W. 23RD STREET

SUITE 1002

NEW YORK, NY 10011

(212) 675-3447