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.

When Can I Work Out Again?

I don't consider myself to be an overly conservative physical therapist.  It would be easy (and somewhat lazy) for me to simply ask my patients to rest while they heal.  But people come to see me (or other health care providers) because they want to be proactive about expediting their return to pain-free function.

As a physical therapist, I employ modalities and interventions that aim to decrease my patients' pain and restore their motion, motor control, and normal function.  But one of my most important roles is to identify and correct the root of what caused the injury/pain in the first place.  In many cases, the location of pain does not correlate with the cause.  To quote from Thomas Myer's Anatomy Trains, "In a crime, it's the victim that cries out, not the criminal."  What that means is that people can often get to work right away addressing the impairments that may have caused their pain in the first place.  It's an important concept known as "active rest."

Patients always want to know when they can return to their sport/activity/exercise routine.  I totally get that.  I would want a time table too.  But it's impossible to give definitive time lines.  Nobody has a crystal ball to read the future.  One thing that I am always imparting on my patients is to take the long view.  I little bit of activity modification in the short term, while frustrating, will lead to long-term meaningful results.  Remember, this does not mean complete rest!

Patient's who are unwilling to dial back their training volume and/or modify their routines should not be surprised when their injuries continues to flare up.  It's akin to picking at a scab.  Just when your body has laid down scar tissue, you go right back to aggravating it with the same offending activity.  One must recognize that you can't just "push through the pain."  Rather, modification is called for.

This modification can come in many forms.  Here are some examples:

-Complete avoidance of a specific activity (without absolute rest)
-Bracing/taping/strapping
-Decreasing load with resistance training
-Limiting ranges of motion
-Working in different planes of motion
-Decreased training frequency/volume
-Working on other non-painful joint dysfunctions in the kinetic chain
-Making ergonomic changes at work and home
-Use of an assistive device
-Use of modalities such as heat/ice
-Use of anti-inflammatory medications
-Dietary changes to enhance healing

One of the simplest pieces of advice I give on a daily basis is, "If it hurts, stop!"  Pain is a warning sign of a threat either real or perceived.  You would be wise to heed that warning.  In the clinic, I discuss pain as "yellow light discomfort" vs. "red light pain."  The former entails experiencing a low level of discomfort that does not get worse, or even improves, through repetitions of a given exercise.  The latter entails intense pain felt immediately when commencing an exercise or that quickly ramps up through a set.  That "red light pain" is a definite STOP sign.  Ignoring "red light" pain with a "no pain/no gain" approach is not a wise course of action.

So, if you find yourself in pain, don't avoid seeking attention for it out of fear that you'll be asked to completely stop all activity.  You're better off finding out why it occurred in the first place, and then developing an action plan to deal with the cause.  Remember, MOST rehabilitation courses will allow you to take an active role in your recovery rather than that of a couch potato.  The goal is to get yourself moving without pain as quickly as possible.  You just have to be smart and patient about it.

Physical Therapy Direct Access

As a physical therapist, a major part of my job is patient education.  Whether it's instructing someone in exercise, a self-care technique, or proper body mechanics, my objective is to empower a patient towards wellness.

Part of patient education is spreading the word about the latest research, evidence, and best practice.  It's also about teaching people about how best to navigate the perpetually complex world of health care.  Sometimes, folks don't know where their point of entry should be when they get hurt or begin to experience pain "out of the blue."  Recently, I've spoken with several people who were surprised to learn that they did not necessarily need a prescription to initiate physical therapy care.

On November 23, 2006, physical therapy became a direct access discipline in New York State, following a nationwide trend.  What that means is that you may walk into any practitioner's office (who has at least 3 years of experience) for an evaluation.  You may be seen for up to 10 visits or 30 days (whichever comes first), before requiring a prescription from a physician, podiatrist, dentist, or nurse practitioner.  A physical therapist possesses the knowledge and skills necessary to recognize from a first visit if a patient needs to be referred on to one of the above prior to initiating care.  But the reality is, many musculoskeletal issues do NOT require a screen from a doctor prior to beginning physical therapy.  Usually, the doctor will simply write a prescription for PT with the instruction to return in 6 weeks for potential imaging should the more conservative approach of therapy not produce adequate results.

Now, I am not suggesting that should you experience a trauma, you should skip the ER an head right to a physical therapist's office.  Usually the first step in those cases is an x-ray to rule out a fracture.  But barring a trauma, one should consider contacting a local physical therapist first.  He or she will conduct a thorough subjective and objective exam that will help narrow down the issue.  They will also be able to provide a plan of care to address it.  This may save you an office visit elsewhere.

I never get in the way of a patient's instinct to go to see a doctor for something they are concerned about.  By all means, if that is your gut feeling, go for it.  I am simply sharing this information to let you know what the law is and how the system works.  Knowledge is power.

*******While direct access states allow for people to initiate physical therapy care as a first step, you should always check with your insurance company to see if they require a prescription for care*****

Interview With Nutritionist Cristina Rivera

Over the years, patients have asked me questions about nutrition.  While I have some foundational knowledge regarding the topic, it is certainly not my forte.  Whenever I feel that I cannot directly help someone, I want to be able to refer them to the proper expert.  A recent inquiry spurred me to reach out to Cristina Rivera, with whom Resolution Physical Therapy shares a floor at 585 Stewart Avenue in Garden City, NY.  Cristina was kind enough to agree to a brief interview with me, so that she can share her insights on several topics in her field.

Here are Ms. Rivera's credentials, as listed on her website http://longislandsportsnutrition.com/:

"President of Nutrition In Motion PC, Cristina Rivera is a Registered Dietitian as well as a Board Certified Sports Nutritionist. Her clinical work at NYU Hospital of Joint Diseases, Memorial Sloan Kettering Cancer Center, as well as Bellevue Hospital has given her a diverse and skilled background in medical nutrition therapy.

As a certified specialist in sports dietetics, Cristina has worked with various college and high school sports teams to design specific meal plans for athletes during training season and competition days as well as for the off season. In addition, she has served as a consulting Sports Nutritionist for the New York University athletic department and currently consults for the Coca-Cola Company. Cristina has been featured in Shape Magazine, Seventeen Magazine, Time Magazine, Women’s Running Magazine, Women’s Day, and on NBC and ESPN.com."

I hope you enjoy!

I Wonder What Happened to Tiffany?

There are many reasons why I love what I do for a living.  One of them is the perspective that I feel I've gained through working with my patients.

I'm currently working exclusively in the world of outpatient orthopedics.  Up until 5 years ago, I was also employed as a physical therapist in the New York Department of Education, primarily working with children with multiple handicaps.  It was a very different daily experience from what I now see in the clinic.  These kids weren't necessarily going to see an end to their need for care.  Progress, if any, was slow and difficult to measure.  In my years working at PS 79 in East Harlem, I learned to be patient.  I learned about the incredible hardships that parents and caregivers have to go through on a daily basis just to get through the day.  I also met so many awesome kids along the way, each of whom had something unique to offer.

While working at the D.O.E., I also began working as an early intervention provider.  This is a program that was established in the early '90's with the intent to help children with developmental delays "catch up" before reaching their school years.  Services are generally delivered in the child's home.  Ninety percent of my cases were in either East Harlem or the Bronx.

The first child with whom I worked was a little girl named Tiffany, who lived in the Kingsbridge section of the Bronx.  She was a sweet little girl who lived with her grandmother and several older siblings.  The man of the house was her brother Dante, who seemed older than his actual age of sixteen.  There were also other adults who would be present at various times, some faces new, some familiar each time I'd make my twice weekly visits.  I never really knew who they were, but assumed that they were family or friends.  I was always welcomed into their home with a warm smile and treated very kindly.

I saw Tiffany for months, working on her motor milestones.  I watched her learn to walk and climb stairs independently.  We worked on her coordination through various games and activities.  My favorite memory with Tiffany occurred during a massive blizzard on President's Day in 2003.  I trekked up to the Bronx because I wanted to take her outside to play in her first ever snowstorm.  Months after that, when we went out to work on skills in the park across the street from her apartment, she would point to the spot where we built not one but two snowmen (one bigger one for me, one smaller for her), and fondly recall the memory.

One day I received a call from the case coordinator.  She had some very disturbing news about Tiffany.  She had been abused and had tested positive for a sexually transmitted disease.  

Tiffany had yet to turn 3, the age at which children age out of the early intervention program.

The case coordinator told me that Tiffany was removed from the home and placed in a foster home for the time being.  She asked me if I would be willing to stay with her though in order to provide some sense of consistency during this period of transition in what was already a tumultuous young life.  I agreed to continue to see her.

The next week, I navigated my way to the foster home, which was double the previous commute.  The foster mother seemed like a very nice person, and the apartment was well kept and clean.  Tiffany seemed as happy as when I had last seen her.  So we continued where we left off.  Things seemed as good as they could be under the circumstances.

After a couple of months seeing Tiffany in her new home, I showed up one day to find some marks on her arms.  They were cylindrical in nature, and she had several of them.  There was not much mystery about what caused them.

"Tiffany, what happened to your arms?" I asked.  "How did you get those marks?"

"A cigarette," she replied, matter-of-factly.

I felt a pit in my stomach.  What stuck me was the nearly nonchalant manner with which she responded.  This poor kid hadn't even gone to school yet, and had seen more abuse than ANYONE should ever have to endure in a lifetime.

After confronting the foster mother (who of course denied any wrong doing), I reported what I saw to the care coordinator, as the law obligates me to do.  I never saw Tiffany again.

Tiffany is 16 years old now.  I wonder how her life has turned out to this point?  I wonder is she found a safe place to live, where she could simply grow from the toddler I knew her as into her early teens.  The odds were certainly stacked against her, based on the tragic accounts of abuse she endured at such a young age.

Working with children with special needs, and meeting a kid like Tiffany, taught me a lot.  It has made me realize how fortunate I was growing up.  It reminds me of how lucky I am now.  It taught me that every person with whom I work has their own unique back story, and that I won't necessarily know what's influencing their current condition.  It taught me that while the potentials for reaching our goals are limitless, not everyone's starting lines are equal.  

I hope and pray that Tiffany gained her stride after stumbling out of her starting blocks.

Advice on the Fly

Yesterday, my barber asked me about some pain he has been experiencing behind his knees for the past few weeks.  He knows what I do for a living, and I had helped him in the past by offering him advice for some shoulder pain with which he had been dealing.  After asking him a few questions and quickly palpating his knees, I suggested that he stop in next week so that I can give him a proper evaluation.

I truly enjoy being asked for my professional advice, and get great satisfaction when I can help someone feel better.  I don't ever want people to hesitate to ask for it, either.  However, there is something that folks should be aware of when they ask for advice outside of the clinic.

There are essentially two categories of mechanisms of injury, traumatic and insidious onset.  Injuries caused by traumatic events are often easier to dole out advice for since the event can easily be described by the person.  However, it seems that the majority of conditions that I treat in the clinic are of the insidious onset or overuse variety.  The latter take more evaluative skills and therefore require more time.  The subjective portion of my exams alone usually takes at least 10-15 minutes, sometimes longer.  Next, we go through the objective portion of the evaluation (gait analysis, SFMA, muscle testing, ROM testing, reflexes, palpation, etc.).  Depending on the complexity of the case in front of me, a full hour is often required to properly assess a patient.

So, when I'm asked in passing, or at a party, "I have pain in my ________, what do you think is going on with me?", I'm somewhat hesitant to offer my advice.  It's not unwillingness to help, but rather fear that I'm not giving you the best advice possible.  I am certainly not suggesting that you must always make an appointment to come see me.  I don't like "selling" health care as if I'm trying to sell a car.  But when I feel that a two minute session on the street isn't enough, I'm going to let you know.  It would be a disservice to you otherwise.

The next time you are in the presence of a doctor, chiropractor, physical therapist or other health care provider and you have a question about a condition you're dealing with, consider the setting.  Please do not misinterpret what I'm writing as a "DO NOT APPROACH" sign.  We all want to help.  It's just that we want to help to the best of our abilities.

If you see me around and have a question you want answered, ALWAYS ask me!!  You also shouldn't hesitate to shoot me a message online.  I promise you that I will help you as much as I can on the spot.  If I feel that you need more attention and evaluation, I will let you know.

I love being a physical therapist and truly enjoy interacting with people.  If you're reading this, you already likely know me in some capacity and shouldn't be shy to ask me questions.  I'm here to help!

A Fine Motor Mess?

Here's an advertisement I saw on the Long Island Rail Road this morning:


I know that ads are designed to grab our attention and provoke thought, and this one did just that.  But instead of viewing Tivo's offer as an enticing opportunity to speed up television viewing by swiping past commercials, I just saw the crappy message it delivered.

Last week I spoke with a kindergarten teacher who told me that she has noticed a marked decrease in her students' fine motor skills ever since the advent and omnipresence of Ipads and other touch devices.  She told me how kids are struggling to grip and utilize pencils and crayons as they simply don't have the strength and coordination to do so.  She lamented that children struggle to hold a book and turn the pages!

I'm not preaching here.  I know this technology is here to stay and is the new norm for today's kids.  My own spend time on tablets each day, although we do our best to limit it.  (I wonder why many leaders of the tech industry limit or forbid their own kids from using the very devices they peddle to us?  (http://www.nytimes.com/2014/09/11/fashion/steve-jobs-apple-was-a-low-tech-parent.html) What do they know that we don't yet?  But I digress.).  I'm just suggesting that we continue to give our kids (and ourselves) the opportunity to hone and refine our fine motor skills before they evaporate.

What are fine motor skills?  They are precise movements of the hands, fingers, eyes, lips and mouth.  Gross motor skills involve the bigger movements of the trunk and limbs and include activities such as walking, running, climbing, throwing, kicking, etc.  Traditionally, physical therapists deal in the realm of gross motor skills, while occupational therapists deal with fine motor acquisition.  Crossover  exists between the two as both disciplines deal with human movement, which is sadly taking a hit with the progression of technology.

Why do these fine motor skills matter?  This past weekend, if you live in the Northeast and have kids, you undoubtedly spent time dressing and undressing them to go out to play in the snow.  Hats, gloves, buttons, buckles, laces, zippers all needed manipulation.  I'm sure many of you struggled and wished your child could have taken care of it for themselves.  But beyond children's ability to dress themselves lie numerous other enriching opportunities which require fine motor skills.  How about the manual dexterity needed to manipulate the strings of a guitar or keys of a piano?  Or the grasp needed to throw a ball?  Or the ability to write with good penmanship?  Or to be able to manipulate a paintbrush to create a piece of art?

Movement, both fine and gross, has helped define us for millennia.  As technology moves us forward in many aspects, let's not allow it to move us backwards in others.

Tips for the Snow

The first "big" snowstorm is looming for us here in the Northeast.  It's like the Superbowl for the meteorologists as they breathlessly predict snowfall accumulations so varied in scope as to leave us scratching our heads.  Do we really need to prepare, or will this be like last year's false alarm when NYC transit was shut down over 6 inches of snow?  Fear sells, and I suppose the same applies to the weather.

But this post isn't about sensationalized weather reporting.  It's about an ounce of prevention.  I am accustomed to working with people every day who are already in pain.  But if I can share a few tips and reminders that might prevent you from getting injured, I'd prefer to do just that.

So, here are a couple of things to keep in mind as the snowpocolypse/flurries bear down on us:

• If you have to shovel, protect your back by bending at your knees and hips.  The discs that separate your vertebral bodies and provide cushion and movement are more vulnerable to injury if you're lifting with a rounded back.  Your erector spinae muscles (which extend your spine) will fatigue quickly if you're over relying on them to do the heavy lifting.  Use your glutes, quads and hamstrings to power your legs and spare your back. 

• When shoveling, alternate sides so that you'll reduce the risk of developing an overuse tendonopathy (irritation of your tendons).  Set a number and change hands and sides evenly so that you spread the load and demand.  With a heavy snow and a long driveway, you might be going at it for a while.  Be smart about it.

• Shoveling snow can be vigorous exercise.  We are coming off a season where diets and exercise typically have gone south for a while.  Just take it easy and recognize that you may be more deconditioned at this time of year than you think.  Take breaks if you have to.

• Beware of black ice!   Last year, I stepped out of my front door to retrieve my paper.  My feet nearly shot out from under me as I flailed to regain my balance.  Black ice can be very deceptive.  All looked normal as I stepped out without first assessing the path.  But I was lucky that I didn't crack my head open.  I remember going into my clinic that day and telling my office manager, "We're going to have several post-surgical patients for Colles (distal radius in forearm) and shoulder injuries within 2-3 weeks."  I wasn't rooting for it, of course.  But I knew that the treacherous conditions were going to cause numerous F.O.O.S.H. (Fall On Out Stretched Hand) injuries.  Sure enough, we had an influx of just such patients over the next month.  Take care, wear sturdy shoes, and take your time!

• Offer your help.  If you live in the suburbs and you know that your elderly neighbor can't clear their own walk, consider giving them a hand.  If you're in the city and see someone struggling to navigate those treacherous corner crossings (usually several days post-storm, when massive puddles of slush make things especially hairy for older folks), consider offering them your arm.  It might slow you down for a moment, but it'll feel good to get a "thank you" for your efforts.  Falls for the elderly typically come with outcomes that are much worse than for younger generations.

Go out and enjoy the season's first flakes this weekend.  Have fun, but take good care.   And remember, you'll be back on the beach in no time!