Everybody Hurts

REM’s “Everybody Hurts” is one of those timeless songs from my childhood. Listening to it playing on my computer always evokes a feeling of emotional ache lined with hope. (cue waving lighters and cell phones) To take nothing away from such an iconic band of the 1980s and 90s, I’d like to reinterpret their message today and apply it to physical therapy and how we therapists understand and treat pain. (After all, this is a blog written by a physical therapist on behalf of her clinic.) So I ask that you extend me grace for the metaphorical leap I’m about to take. (Commence jumping now…)

We’ve all experienced physical pain of some sort–from a bruise or a stubbed toe all the way up to a rotator cuff tendon tear or herniated disc. At times it lasts for a couple of minutes, but some people struggle with pain all day, every day. Sometimes we can identify the cause, but other times the reason for our pain may seem nebulous and unclear. This confusion can add to stress/anxiety/depression/feelings of hopelessness that so often coincide pain, especially chronic pain.  But what exactly is “pain” and why does it occur? Whole week-long seminars and advanced degrees are based on understanding and explaining it, but I’m going to try to focus on pain as it pertains to my job.

First, a little physiology lesson: The nervous system is basically the roadway for the body; all communication between body parts happens because of the signals transmitted via nerves. A specific kind of signal carried from nerves in the body to the brain is interpreted as pain.  For the sake of time and hopefully lessening confusion, I want to divide pain into two basic categories: mechanical and chemical.

Mechanical
Let me explain this with an example: Grab your left ring finger with your right hand and slowly bend it backwards. At some point you’ll start to feel some discomfort and then pain. Continue to hold it in this spot and the pain will continue (although it might change in location or quality). Push the finger back further and the pain will intensify. Release the finger and as it returns to its normal resting position the pain will decrease and eventually disappear. Mechanical forces cause pain when they deliver a load or strain to a tissue beyond what that tissue can typically withstand. If the load approaches but doesn’t exceed the tissue’s capability for recovery, while there is pain, there is no tissue damage (like what happened when you bent your finger backward). If the load is excessive, however, the tissue is traumatized (ex: bruise, strain, sprain, tear, dislocation, etc)–which leads to our next type of pain…

Chemical
Cell or tissue damage initiates the inflammatory response and also results in the release of specific chemical irritants, which continue to accumulate in the traumatized area. When the concentration of these chemicals reaches a specific level they “irritate” the nerve receptors, which trigger the release of that specific signal our brain interprets as pain. (Side note: Certain inflammatory and infectious diseases and some chronic degenerative conditions can also produce chemical pain, but for our purposes, let’s just say that the majority of chemical pain is caused by trauma or damage to the tissue.) The buildup of these chemical substances over time can explain why we may experience a trauma (ex: a car accident) and might not feel pain until a day or two later.

So what’s the connection between physical therapy, pain and REM?  Whether you’re struggling with acute pain from a recent injury or chronic pain from something that happened a while ago, I would encourage you to make an appointment with your local physical therapist. Physical therapists are trained to evaluate and diagnose mechanical pain and the chemical pain that comes as a result. We will develop a treatment plan that includes not only long-term benefits but the management of your current pain. In the dark cloud that is physical pain lies a hope-filled silver lining. As Bill Berry, the drummer for REM, wrote, “Don’t throw your hand/If you feel like you’re alone/No, no, no, you are not alone.”

[Disclaimer: Pain is a very complicated subject and today I attempted to simplify it according to the majority of patients I treat. This post is in no way all inclusive in its description, nor is it meant to replace a visit with an MD, DO, or PT.]

The Effects of Hip Strengthening on Knee Pain

Sometimes my patients will ask me why they have exercises for their hips when it’s their knee that has pain. I’ve tried answering that it’s because “the hip bone’s connected to the knee bone…” but that doesn’t seem to be all too convincing (maybe it’s my singing). Simply put, the hip muscles, based on their attachments to the thigh bone (aka femur), drive and control amount of torque and strain at the knee joint . Research has produced several studies to support my and several of my fellow physical therapist’s treatment approach. The most recent study was published in the Journal of Orthopedic & Sports Physical Therapy.

This study looked specifically at patellofemoral pain (PFP)–pain in front of, behind, or around the kneecap–in females (who have a higher diagnosis rate partly due to how our anatomy differs from males). Pain is usually felt with squatting, kneeling, going up and down stairs, or sitting for long periods of time. After ruling out that the knee pain wasn’t caused by inflammation in a meniscus, tendon, ligament, bursa, or the ITBand, the patients were divided into either the control group or the exercise group.

While both groups were allowed to take over the counter pain and/or anti-inflammatory medication, the control group was not allowed to exercise for 8 weeks. The exercise group was given very specific exercises designed to strengthen the hip abductors and hip external rotators. At the end of 8 weeks, results revealed a decrease in knee pain, an increase in hip muscle strength, and an increase in outcome measure scores for the exercise group. These gains were also sustained over baseline values at a 6-month follow up visit. The control group, however, failed to show improvement in pain or health status, and in most cases had a decrease in hip muscle strength.(Hey, if you don’t use it, you lose it.)

If you’re having knee pain, I recommend making an appointment with your physical therapist. After determining the cause of the pain, he/she will create a specialized treatment plan that might include hip strengthening as well as focus at the knee joint. After all, “the foot bone’s connected to the leg bone, the leg bone’s connected to the knee bone, the knee bone’s connected to the thigh bone…”

Life is like a crockpot.

This semester I have a PT student doing his internship with me at the clinic. When he heard that I have this blog he begged me for the chance to write a post (ok, so I might have made it part of his educational experience). I’m super excited to hear what he has to say–and you should be too. ~Karen

Hello, blog world. Ros Here. Just a little about myself: I am currently a 3rd year PT student from Los Angeles interning at MVPT (and loving every minute of it…so far). The staff is great, funny, and there’s never a dull moment. My Clinical Instructors (CIs), on the other hand, just plain terrible. That Jen is so unorganized and cold to me, while Karen never wants to help me with anything and just leaves me to treat patients on my own! Kidding. They’ve both been a great resource for learning and have made this internship an amazing experience thus far.

Apart from teaching me about ALL the aspects of becoming a successful Physical Therapist (and there are many), Karen has also imparted some useful cooking knowledge to me, this hopeless chef. We started with the basics – a crock pot recipe. Gotta start with the ingredients first: water, beef, potatoes, carrots, chopped onions, french onion soup mix, and some spices. Next, add to crock pot and cook for eight hours – pretty basic instructions that even a novice like myself could not screw up, and she promised it would taste delicious or “delicioso” as my other CI likes to say. Who would have thought that simple ingredients and simple instructions, applied over a long period of time, would result in a successful dish that can be savored and enjoyed by the person who made it for a week (unless you eat like me and it’ll be gone in just a few days).

Life is a lot like that crock pot recipe. In order to enjoy and savor it for a long time we need to make sure we add the right ingredients – a good mix of exercise, healthy diet, plenty of sleep, stress free lifestyle, friends and family, and a great staff for an intern doesn’t hurt either. Keeping physically active whether it be going to the gym, going outside for a run, or up to the mountains for some snow action is vital for everyone’s health and will prevent the slow progression of muscle disuse and decline in bone density as we age. Furthermore, eating healthy will keep your body functioning properly and will make it less likely for physiological problems to occur down the road. Getting at least eight hours of sleep every night will help your body heal and get adequate energy, therefore providing higher brain and body function and stop preventable accidents from happening where our body may get injured. Lastly, finding time to have a little fun with friends, family, and co-workers will keep stress from creeping into your life and may prevent pathologies from arising in our bodies that are stress related such as cervical pain and headaches.

Finally, it is important to remember that rotten or insufficient amounts of specific ingredients can ruin a dish even though all other aspects of a recipe are perfect. The same goes with life. All aspects of the crock pot life must be weighed evenly when trying to live a healthy lifestyle, for if one thing is rotten or out of place it can have a negative effect on the entire plate of life.

Till next time,

Ros Katsman, SPT

Making Lemonade and Channeling Lady Ella

This past Sunday I returned from vacation, rested and ready to start this new year with a bang. Little did I know that on Wednesday morning (today) I would indeed experience a “bang” of sorts. (Side note, “little did I know” always makes me think of the movie “Stranger Than Fiction”.) This morning I was on my way to work, having left much earlier than normal because it was snowing pretty hard, when my car hit a patch of ice and I slid into the curb. Result: flat tire. Ugh. I don’t know how many of you have changed a tire, but imagine doing it while it’s snowing, on a side road that’s sloped and covered with snow and ice. It’s not pretty. Just as I had loosened the lug nuts and looked in the owner’s manual to find out where to place the jack (my dad’s advice ringing in my ears), two men stopped and helped me with the rest of the procedure. Traffic was really slow the rest of the way to work–I was lucky to accelerate to 25 mph–so I didn’t notice anything until I drove my car from the tire place after getting a new tire and wheel. My car still feels like it’s slipping on snow when I drive over 25 mph and I have to turn the steering wheel 45 degrees to the right in order for it to drive straight. Uh oh. I’m no car guru but I know those are bad signs. I made an appointment for tomorrow because I’ve heard mechanics caution against driving when the car’s wheels aren’t balanced or the alignment is off. They say it increases wear and tear on the car and can cause problems down the road that the car normally wouldn’t have to face, eventually resulting in costly repair work.

Our body works in a similar way. As Ella Fitzgerald sang, “Tain’t what you do, it’s the way that you do it.” If our joints aren’t gliding the way they were created to (too much, too little, in a slightly different direction, etc) it increases wear and tear on the joint (resulting in osteoarthritis at least). If some muscles are stronger or weaker than others (a muscle imbalance), it creates excessive strain or load on the joints, more than what they were created to withstand, resulting in pain and increased wear and tear. Sometimes you’ll just feel pain. Other times your arm/leg may feel “sloppy” and uncontrolled. Or maybe your neck and back feel “stuck” when you try to turn. Any of these symptoms are important to observe. If you’re experiencing something similar to what I’ve just described, make an appointment to see your local physical therapist sooner rather than later.  Ignoring these signs can lead to more problems and pain  (Read: more expensive solutions) down the road.Physical therapists are experts in being able to analyze how the body moves and teach their patients how to correct compensations and restore proper muscle balance/stability and joint mobility.

So, as it turns out, my car’s “slip up” this morning became the fodder for this week’s post. (At least, this is my attempt to make lemonade out of an otherwise sour situation.) Until next week, drive safe and move well!

“It ain’t what you do it’s the way that you do it…that’s what gets results”

Happy New Year!

So sorry for the posting delay; I’ve been spending the past 5 days with family in Florida. (and there’s still 3 days left!) Since I’ve been super busy painting, eating, laughing, telling stories, and playing with my niece I don’t have anything prepared. Luckily, a friend of mine directed me to this woman’s story. I found it truly inspiring–and appropriate given the proclivity of New Year’s resolutions about getting in shape/losing weight–so I wanted to share it with you all. Please take the few minutes needed to read her story. She tells it in a such a humorous and realistic way that I’m sure you’ll enjoy.

Feel free to leave comments or share your story of embracing freedom. And if we at Mountain Valley Physical Therapy can help make your 2012 resolutions* a reality, we would be honored to do so. (*As long as they do not involve learning French, finding the love of your life, or investing in the stock market.)  

If the first link didn’t work, here’s the website again: http://www.canyoustayfordinner.com/?s=my+exercise+history+part+3

I’ve Fallen and I Can’t Get Up!

Been feeling a little unsteady lately? Have you or someone you know fallen recently or more frequently than the occasional slip on the ice or trip over a dog toy? Does the thought of walking down stairs or over an uneven sidewalk make you so nervous you’re starting to avoid them? A significant chunk of medical costs for the older population in America are addressing fall-related injuries. I’m not going to get political here, but regardless of how the government and insurance companies decide to shape our health care it would make financial sense for us to be proactive, specifically when it comes to preventing falls. Here are some helpful tips:

Get your vision checked regularly. Vision plays a HUGE role in balance, which can be a complication as our ability to see things clearly changes over time. Make sure you get your eyes checked regularly and that your prescription is up to date.

Review your medications with your doctor. Many medications have side effects that can significantly lower systolic blood pressure, reduce mental alertness, or decrease gait and balance. Also, people taking multiple medications are at a greater risk for falling. Check with your doctor to make sure you’re taking the lowest effective dose and ask if any medications might put you at a higher risk for falling. If need be, look into the use of a cane or walker for added stability.

Create a safe home environment. Many falls occur because of environmental hazards at home. Things like objects left on the floor (kids/pets/shoes/etc), poor lighting (especially around stairs or a threshold), lack of grab bars in the bathroom or bedroom (if appropriate), loose throw rugs, and unsteady furniture are easy to identify and remedy. Correcting these things will make the home a much safer place for you and your loved ones.

Shake your groove thing! Studies have shown that people who are physically active are less likely to be at risk for falling. As we said in PT school–you got to move it, move it! There are so many options here–Silver Sneakers exercise classes, Zumba, Sit-and-Be-Fit TV shows, water aerobics… So get up off that thing and dance til you feel better!  Come on, baby, let’s do the twist! Walk 500 miles…and then walk 500 more. (But don’t go walking after midnight unless there’s plenty of lighting along your path.)

Many people experience a loss of balance or stability as they age. While things like vision and reaction time decrease over time, don’t let the accumulation of birthdays force you to take up residence in a rocking chair. Your local physical therapist can help create a balance and strengthening program that fits your needs. There is still room for improvement and steps you can take to decrease the risk of falling for you or someone you know.

 

 

Less of a Soap Box, More of a Phone Book Platform (but the thicker one)

“How am I supposed to find time to do all of these exercises?” “Things are really busy for me at work/at home/with the [insert sport] season/with the kids right now.” “Oh yeah, I forgot to do that exercise.” “It’s really hard to learn how to exercise every day.”

These are some of the responses I hear from patients every day when I ask them how their home exercise program (HEP) is going. And I get it to some extent. Life is fast-paced and demanding–and especially during the holiday season. Having been a patient several times myself I understand how going to physical therapy and being consistent with daily stretching and strengthening exercises seems like something that can be put on the “I’ll get around to it if I have time at the end of the day” list. (Of course, when I first went to PT at the age of 14 I had a crush on one of the staff members at the clinic so visit compliance was never an issue! My HEP on the other hand…) As one who has been on both sides of the treatment table, I have seen how they really ARE vital to your recovery. There are techniques that I and other physical therapists can do that are impossible to perform on yourself (believe me, as a PT/patient, I’ve tried). Likewise, a physical therapist can work on you in the clinic but if you’re not doing the proper exercises every day between visits, all that hard work is a waste of your time and money. I once heard it described this way: Attending your PT sessions is the ship and your HEP is the crew. If these two aren’t working together you won’t be sailing anywhere!

Don’t wait til January 1 to decide to change how faithful you are to your rehab. Here are a couple of tips I’ve given my patients and tips I’ve used for myself:

• Schedule in advance. It’ll be easier to plan the rest of life’s events for the next two weeks if you already have your PT appointments made. Waiting to see if you’ll have spare time later on is rarely successful.
• Learn and utilize your reminder system. If you’re a list person, include your HEP on your “To-Do” list. If you’re an auditory person, leave yourself a message to do your exercises. Set the alarm on your computer or phone to go off until you’ve done your exercises for the day. Write it on the calendar. Whatever works for you to remember other things in life, use that technique for your HEP.
• Buddy System! It worked on elementary school field trips and it’ll work for PT. Find an exercise partner, whether he/she is in PT as well or just trying to stay in shape. Studies have shown that people who exercise with someone else are more consistent and more productive.
• Stay consistent. Try to do your exercises at the same time of day or associate them with a certain daily activity (before breakfast, during your lunch break, after showering, before you pick up the kids from school, etc).
• Multi-task. Once you have become more familiar with the exercise, practice it while doing other tasks. One patient told me she did her standing hip exercises at work while talking on the phone. Another does exercises during the commercial breaks when watching the evening news. When I was trying to improve my balance, I would stand on one leg whenever I brushed my teeth. If you can associate an exercise with an activity you already do during the day, you’re more likely to be consistent. Plus, incorporating them into your day is easier than trying to carve out an additional hour in an already busy schedule.

Bottom line: If you give your PT visits and your HEP a high value, your schedule will be able to accommodate and you’ll notice a quicker recovery time.

We physical therapists genuinely care about you, our patients. We want you to get better, to have less pain, to be more functional, to enjoy life more. We will do everything in our power to help you along the rehabilitation journey. You owe it to yourself to do the same.