Physical Therapy

Why TYPICAL Physical Therapy Didn't Help Your Pain

If you’ve ever trusted a physical therapist, chiropractor, or any healthcare provider but are still in pain….we are sorry!

We understand making a decision takes a lot of courage.

You open up about your pain and give your hopes for a brighter future to an individual who is there to support you. It can be a vulnerable process.

But unfortunately, there is always a chance for disappointment.

You may still be in pain, you may regret wasting your time doing exercises that didn’t help, you may resent that you spend so much energy into something that failed.

But I urge you, please do not give up. And I give this example to give you clarity.

If you needed a roof fixed on your house and you talked to one company, how do you know there is not a more qualified service out there?

The same goes for pain.

Just like any industry, there are specialists who are just poor at what they do….

Many are mediocre.

Only a few are exceptional at what they do!

Set high standards, and make sure you never tolerate anything but the best for your recovery. Your health and future are way too important!

For this reason, we have designed a FREE Discovery visit to On Track Physio to meet us before ever making a commitment. It’s our way of showing you the difference and expertise we have in this field!

Injuries vs. "Wobby Jobber"

This is a quote which really resonates with me as it relates to injuries:

“You have to listen when it whispers as opposed to waiting for it to yell!”

loud noises.png

The idea is simple: if you ignore minor aches and pains, they rarely just magically disappear.

Instead, they start to amplify by volume or intensity. Causing you to reach a painful threshold where a TRUE injury happens and more extensive intervention is required. The research actually supports this concept - but only if you know how to dig a bit deeper.

One study in particular is this Scandinavian study of patellar tendinopathy in junior basketball players. This study had 134 teenagers (268 total knees examined) and found that only 19 tendons presented clinically with symptoms.

However, under ultrasound diagnostic examination, 22% of the remainder of the group who had no pain, could be diagnosed with tendinopathy. In other words, "ultrasound tendon abnormality is 3 times as common as clinical symptoms or being in pain."

Knee evaluation.jpg

This study just looked at teenagers, who are markedly less likely to have tendinopathy than older individuals.

What if they did this study on middle-aged men playing hoops at the local YMCA. The point is that whether you have symptoms or not, you likely have some changes in your tissues.

Now to be honest, this study isn't particularly shocking to anyone who's looked at MRIs of asymptomatic (not in pain) individuals.

I’ve seen loads of x-rays, MRIs, and Diagnostic Ultrasounds in non painful people but according to their diagnostic image they have a rotator cuff tears or spondylolysis (stress fractures) or torn labrums or herniated discs. This list goes on and on…

The point I am making is that if we just treat a person’s image we are missing the boat.

It’s also a reminder that we often have several issues that might just be waiting to reach a painful threshold if we aren't cognizant of our training volume and intensity - and our movement quality.

The country background in me refers to these slight movement problems as a bit "wobby jobbered". In other words, something is a bit “off” and not necessarily a problem currently but could be a contributing factor to something down the road.

Maybe it's that cranky knee first thing in the morning, but feels good after you warm it up. Or, it's that stiff neck you get after a few hours of working at the computer, but feels better after your spouse massages your neck (ha yea right!). Or maybe its a shoulder that bugs you only when you bench press, but feels pretty good when you do rows instead.

Maybe it's seeking out some extra manual therapy in a specific area that we provide at On Track Physio. Maybe it’s a more individualized home program or warm-up to address movement issues. It might even be that you strategically drop particular exercises from your program at various points during the year.

If nothing more, understand that good training and movement teaches your body how to spread stress over multiple joints. Instead of that cranky knee taking on 90% of the load, we work on hip and ankle mobility and strength so that it might only have to be 30%. Spreading out the stress ensures that one area is less likely to feel “wobby jobbered”.

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Distribute stress requires you understand what quality movement actually looks like, and that's unfortunately where a lot of healthcare professionals fall short. Which is why we offer a Free Discovery Session to all new clients in order to experience the difference at On Track Physio!




5 Secrets for Decreasing Low Back Pain… Without Medication or Visiting the Doctor

Secret #1 – Don’t Focus Just on the Back

Low back pain is a very common problem, and is a topic that comes up often when people find out that I am a physical therapist. The problem with low back pain is that there are a number of different factors that could be contributing to the issue. Without a thorough evaluation, it is impossible to give a direct recommendation. Please don’t think that I am trying to weasel out of the question, but low back pain is probably the most complex area to treat and generalized recommendations get generalized results. With that being said, the purpose of this document is to give you useful information and take home points that can help give you some relief today! If you understand the functions of the segments above and below the low back, a solid correction program can be initiated.

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The picture above provides a simple summary of the movement capabilities in different areas of the body. Front and center is the low back, which as you can see, the main function in this area is stability. Above and below the low back are your hips and thoracic (mid) spine. Both of these segments require a great deal of mobility. If you think about this for a minute, it makes perfect sense. The joints with the greatest natural range of motion and degrees of freedom are intended to be mobile, and those with limited ranges are intended to be stable. If areas that are supposed to be mobile do not function optimally, then the body is going to have to create the mobility somewhere else. Most of the time this happens at the expense of areas that are intended to be predominantly stable (in this case the back).

Secret #2 – Start Moving

One of the biggest mistakes some people make after getting back pain is they stop moving completely because they are afraid of making it worse. The problem with this is that if you want to get out of pain, you’re going to have to start moving at some point. Doing absolutely nothing will do absolutely nothing to give you relief. It may sound obvious, but find different movements and positions that don’t cause as much pain then repeatedly get into those positions and movements until things start to ease up a bit. When your back or hip pain is affecting the way you walk, sit, get out of a chair or drive, its definitely time to do something so this doesn’t last longer than it needs to for recovery. Below is a very simple example that often times many people can start doing early on in their recovery process.

Secret #3 – The Easiest Way to Start Moving

I realize point #2 and #3 are the same thing. This was done on purpose, because I like action takers and people who are proactive about getting better. Now as prefaced in this guide, back pain can manifest itself in a variety of ways and a variety of intensities. So if your back pain is severe, be sure to start this exercise out slowly in a small range of motion and move on from there. If you feel your pain is worsening, please use common sense and stop (it should go without saying, that this exercise may not be for everyone). With all that being said, here is one of the easiest exercises I have found to start easing back pain and get someone moving again after treating hundreds of people over the years with back pain.

Secret #4 – Ease Back Pain by Reducing Compression on the Back

You are probably asking “how can I do this?” Or “how do I know if this is a problem?”

The simplest way of telling if you are naturally too extended or compressed in the back more so than normal is to lay flat on your back and look at your ribcage. If you identify a large rib flare on one or both sides, this could be playing a role in your back and hip symptoms. Below is a picture of what I am talking about.

Here is a simple exercise that you can do to help combat this issue and relieve some compression at the back. Note: this exercise is only scratching the surface on how we can address this issue.

Secret #5 – Movement Assessment

Having a trained eye watch how you move through different ranges of motion and see where limitations might exist in hips, spine, among others. This will often direct which set of particular exercises and potentially manual therapy techniques would be most important for your particular set of limitations. Sometimes generalized exercise and soft tissue work will not do the trick. This is why we at On Track Physical Therapy will take you through a movement assessment every visit and multiple times per visit. It allows us to be very targeted in what we do as opposed to throwing things out and hoping something sticks. This allows us to help you get off painkillers, get some sleep, and continue to move as fast as possible. If that sounds like something you’d enjoy, then let us know by filling out this quick questionnaire below and inquire about a FREE Discovery Visit.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Stop Daily Annoying Knee Pain Without Taking Painkillers Or Having Surgery

Knee pain is one of the most commonly treated and surgically operated injuries in the world. It impacts you daily by making stairs or frequent lifting a nightmare. It might be stopping you from playing a sport with your child or going for a round of golf with your buddies.  Maybe you have had an x-ray performed, and been told you have degeneration or arthritis in your joint? While x-rays certainly do not lie, they also do not tell the entire story.

In fact, one study by Katz and fellow researchers showed that getting physical therapy first helped 60%-70% of knee osteoarthritis patients avoid surgery.  

Another study of 180 patients with osteoarthritis were separated into three groups: two different types of arthroscopic surgery, and a placebo (fake) arthroscopic surgery. Interestingly, the two arthroscopic surgeries were no more effective than the placebo (fake) surgery.

Staggering information isn’t it? That’s a lot of money to throw at a surgery with questionable outcomes. Not to mention you probably will have to go to therapy after surgery anyways. Fortunately to both you and me “arthritis” is a normal change in the body that happens over years of accumulated stress and as a result can often be improved through conservative measures.

Why Does My Knee Still Hurt?

The knee often takes the brunt of the force for lack of mobility or control in the hip or ankle. The degrees of freedom in the knee are much less than the ankle or the hip. If motion limitations exist in the hip or ankle, the knee will start creating wear patterns as a result. This wear pattern typically presents itself in some form of faulty orientation of the knee. The body will always take the path of least resistance. So if the hip and ankle orientation are not optimal due to restrictions, this creates a twisting mechanism at the knee as it tries to adapt and accommodate for other structures that are not functioning at optimal capacity.

As you can imagine, this makes the knee much less adaptable and resilient.

Maybe you have had a previous injury to the knee? If optimal function and adaptability was never restored in the knee afterwards, then the overall level of resiliency to injury of the knee will remain low as well.

So how do we reduce pain in the knee so you can squat, go up and down stairs, and walk without that annoying pain?

1) Perform exercises that will get the muscles around the hip strong. This program is often much trickier than going to the gym and working out. Remember we have adaptive changes to deal with that have occurred in the body as a result of dysfunctional or overused movement patterns (most likely both).

Because the body currently has a very low level of resiliency we need to be careful of the amount of load applied to the knee. This is one reason why a low impact endurance program can be very beneficial such as riding a bike 10-30 minutes a couple times per week at about 75% effort. In fact, a lot of research has actually shown that endurance training can increase pain tolerance.

But ultimately, we need to gradually start to load the knee again in a functional way to improve tolerance to activity. We can do this by improving hip function, this will help take some of the stress off of the knee. Here are a couple options that may be helpful. 

As part of a physical therapy treatment, we can perform different manual techniques such as dry needling that can help modulate pain. However, if we never address other limitations above and below the knee joint, the pain may remain or linger much longer than necessary. This is why a detailed assessment is required, so specific interventions can be given to restore optimal function and abolish pain.

Looking at the way you move through different ranges of motion and see where limitations might exist in both the hip and ankle. This will often direct which set of particular exercises and manual therapy techniques would be most important for your particular set of limitations. This is why we at On Track Physical Therapy will take you through a movement assessment every visit and multiple times per visit. It allows us to be very targeted in what we do as opposed to throwing things out and hoping something sticks, which unfortunately is what many other providers do. This allows us to help you get off painkillers, get some sleep, and keep an active lifestyle. If that sounds like something you’d enjoy, then schedule an appointment or a FREE discovery session to take things for a test drive.  

References

Katz, Jeffrey N., et al. "Surgery versus physical therapy for a meniscal tear and osteoarthritis." New England Journal of Medicine 368.18 (2013): 1675-1684.

Moseley, J. Bruce, et al. "A controlled trial of arthroscopic surgery for osteoarthritis of the knee." New England Journal of Medicine 347.2 (2002): 81-88.

Jones, Matthew D., et al. "Aerobic training increases pain tolerance in healthy individuals." Med Sci Sports Exerc 46.8 (2014): 1640-7.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Physical Therapy for Total Hip Replacement

JuJu's Story

Ann Arbor, Mi - Below is a video of a physical therapy session just 8 weeks out from a Total Hip Replacement on the right. She attended physical therapy 1x per week, with an extensive home program. As you will see, she is already moving around like a champ! Strength Training can benefit you at any age when prescribed properly and applied at correct dosages.

The best part about this is when she tells me that she can walk 3 miles without any issues. She is looking forward to walking on the beach in an upcoming vacation. And my personal favorite was this story: while on a boat with her girlfriends, no one could pull up anchor on the boat. So she stepped up and pulled it out for them first try!

JuJu was gracious enough to write this about her experience at On Track Physical Therapy:  

“I was referred to Greg by my personal trainer, Mike. Greg has treated me for elbow and knee issues, however the biggest, and most important issue, was my total hip replacement.  Greg and Mike worked together before my surgery to make sure my muscles were strong, and ready to take on the challenge.  I passed the physical therapy test at the hospital the very next morning after surgery, and was released that day! The PTs at the hospital were very impressed with my strength and ability to walk quickly.  
Greg came to my house and helped my husband and me get situated with my living situation.  He showed both of us how I needed to move, get on the bed, sit in the chair, get up, etc...
When it came time for me to attend physical therapy at the gym with Greg, he was amazing! As my first session was about to begin, I was very anxious, but Greg led me through simple exercises, and as the weeks passed, my PT sessions felt like full workouts.  I was walking three miles a day by seven weeks post-op.  
Even after a minor setback, Greg knew exactly what he had to do with my situation to make me whole again. He is so good at listening, and he takes the time to assess a situation completely before he begins therapy.   At my eight week doctor appointment, my doctor was so impressed with my ability to sit, stand, squat, and walk without any stiffness or holding on to anything.  He was thrilled that I was walking three miles a day and trying for more.  He said he'd see me in TEN MONTHS!!  My doctor was very pleased with the re-evaluation Greg sent, especially the very clear format that he used. Greg is really good at what he does, and if you follow his exercise program at home, like I did, you'll be back on track in no time at all!  All of this was achieved with sessions that were required to get the job done.  Greg doesn't have you come in just so he can make a buck. So, the name ON TRACK PHYSICAL THERAPY is not a misnomer by any means!”

Appreciate the kind words JuJu! 

Did you have a hip replacement? 

Are you still having trouble with a previous hip replacement in the past? Do you still walk with a limp? At On Track PT and Performance we offer a FREE Discovery session to show you how we are different, and can help you and your specific goals!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

The Keys to ACL Rehabilitation

Here is what you need to know about your physical therapy to return faster, stronger, and more explosive than ever!

Most likely the ACL surgical process will be performed with one of two methods:

1.       Autograft– The surgeon will reconstruct the ACL tear with a segment of your patellar tendon or a graft from your own hamstring.

2.       Allograft- The surgeon will reconstruct the ACL tear from a cadaver’s tendon.

Early Stages of Rehab

Establishing full range of motion is imperative after ACL surgery to a successful return to sport. Your physical therapist should be checking this frequently, and you should be working on it constantly. A big part of this stage is restoring basic movement patterns again, such as the ability to squat without off loading your surgical leg. Many people struggle with this without realizing it. If you are just handed a sheet of paper to perform exercises and nobody with a skillful eye watching over you, that's a problem! The game changer in these early stages are finding a way to actually build muscle. At On Track Physical Therapy, we are the first in the area to start utilizing a technique called blood flow restriction training. This type of training has been proven through research to build muscle with very low loads (using bodyweight only). No other training technique has been shown to do this.

Middle Stages of Rehab

Starting to include single leg activities to restore hip, knee, and ankle control through ground based movements. This is essential, as research has shown that these factors play a very important role in preventing an ACL tear. Also during this stage, your physical therapist should have access to equipment that allows you to start gradually loading the body through true resistance training to stimulate further muscle strength and work capacity. If all that you are doing in therapy is using stretch cords, leg press, a bosu ball, and bodyweight exercises you cannot achieve the strength needed to compete and become injury resistant. Remember you also have 3 other limbs that are not injured, so you can be training these body parts at the same time.

Final Stages of Rehab

Starting to create an environment that is specific to the sport or sports you play. This is extremely important as it will best prepare you for the demands of your sport. Your physical therapist better have a good understanding of the demands an athlete takes while competing. They also need a facility that has the room available to create an environment most conducive to your individualized rehabilitation. This stage should really focus on power output and dynamic exercises. Your therapist should have a way of measuring this capacity and compare it between your surgical side and non surgical side. This information gives you the best summary on if you are truly ready to return to sport. 

If you are having ACL surgery or still struggling with regaining full athleticism post surgery, be sure to pick up your free report today. Click on the image below for your FREE download.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Ankle Rehab Update

The video below shows how I measure ankle mobility in the clinic with the foot on the floor and controlling the ankle to prevent pronation (arch flattening out). It's great for assessing how ankle mobility could be influencing ankle sprains, plantar fasciitis, knee pain, back pain, etc. 

Related Article

To measure your own ankle mobility, simply assume the kneeling position shown in the video.  Rock your knee over the foot to touch the wall measuring how far your big toe is from the wall with a simple tape measure.  The heel must stay down and arch not allowed to collapse. The goal is 4 inches!

Below is a video showing a correction I will commonly use in the clinic.

Click the picture below and learn how to revover FAST from an ankle sprain!

Core Stabalization Progression

The Wall Press Abs exercise is an excellent way to learn how to create protective stiffness in the spine. When performed correctly it will help create stability through your low back and aid in creating increased mobility through your hips. Being able to dissociate between the low back and hips/pelvis is a region where many people with hip or back pain struggle. 

By pressing your arms into the wall you will help engage your abs. Holding this position, then taking a breath in then exhaling and allowing your ribs to drop down will activate you oblique muscles further. Then maintaining this position of ribs down inhaling and exhaling will incorporate your diaphragm which is a muscle and spinal stabilizer as well.

Finally you will begin to move or extend your legs out which will continue to challenge core control while you work hip mobility. Below are the progressions from easiest to most advanced.

Physical Therapy - Ann Arbor, Mi

So what should Physical Therapy look and feel like? There are many things to consider when choosing which physical therapy clinic is right for you.  Over the next few weeks I’m going to offer a few suggestions for things to think about, or even ask other therapists about, prior to beginning a course of physical therapy.

Some things should be fairly obvious such as will you see the same therapist each visit? How much time each visit will I spend DIRECTLY with my therapist (not supportive personal)? How many visits per week? and so forth.

What I want to discuss are the things most people would not normally consider (in fact, most therapists and physicians aren’t thinking this way either!)

1) Movement Based Approach:  my previous blog entries Don’t Put Fitness on Dysfunction and Movement Proficiency and the Ankle describe how looking at patterns of movement are critical to narrowing down where the cause of the pain is coming from.  Just because your back hurts doesn’t mean it’s the back’s fault.  Your back may just be the victim of poor hip mobility below and poor Thoracic and ribcage mobility above just to name a couple.

A simple model I discuss in those previous posts is the Joint-by-Joint model of alternating mobility and stability requirements.

Following the traditional physical therapy model, you’re probably not going to find the connection (Instead the pain in the low back is generally the only focus). Don't get the wrong impression. It's not that the low back does not deserve to be treated to reduce pain and inflammation.  That absolutely must be done! But if that is all that is addressed, then chances are your low back symptoms will be back sooner than later.

The Selective Functional Movement Assessment is a quick and effective way to determine the person’s most dysfunctional movement pattern.

The object is to determine which pattern is the most dysfunction, and then break that pattern down into it’s component parts to find the impairment.  So for example, if someone cannot touch their toes, it could be a lack of mobility in the spine, hips, hamstring, or even a lack of core stability and poor breathing mechanics.  Your therapist must have a way to find that answer!

If you’ve ever been to physical therapy for your back, I can almost guarantee you were told you must stretch your hamstrings. Am I right?

Well if you can’t touch your toes, of course your hamstrings will feel tight.  Lacking mobility in your spine or hips will limit your toe touch and make it seem like your hamstrings are tight.  It’s probably only the hamstrings 25% of the time at the most.

Unfortunately many people are spinning their wheels in physical therapy because they are not working in the right place at the right time. I can’t tell you how many people have told me that they have failed a trial or two of traditional PT, injections, massage, etc.

2)  A Soft Tissue System:  at On Track Physical Therapy I use the IASTM because of the great results I’ve had treating all types of soft tissue injuries from tendinopathies. From plantarfasciitis, to contusions, scar management, and more.  I also utilize Dry Needling to address soft tissue dysfunctions. Granted this treatment is not for everyone, but it defiantly could be a viable option.

Some sort of soft tissue release may be needed to allow for a window of opportunity to access greater movement. It is the exercises job to then lock the new movement into place. Very often even above and below the site of pain there will be significant soft tissue restrictions that should be addressed.  As I mentioned earlier, using a movement based approach will allow a physical therapist to pin point restrictions. This way time is not wasted treating irrelevant areas.

For example, we know from the literature that very often trigger points in the gastroc/soleus complex (calf) will contribute to plantarfasciitis and even radiate pain to the bottom of the foot.  Limitations in hip extension and glute strength will also contribute to the condition.  Is your therapist looking that far up the body?

So what difference does all this make?  Ultimately it can be the difference between actually ‘fixing’ the problem or just addressing symptoms.  When we can ‘fix’ the problem (the ultimate cause of your pain), we may never see you again and that’s a good thing.  When only the site of pain is addressed, very often you will find yourself back in the Dr. office and back for another bout of physical therapy a few months down the road.

At On Track Physical Therapyour goal is to ‘fix’ the problem, and to give the patient the tools necessary to prevent a recurrence.  Contact us anytime with questions about our methods, and how we can help you if you’ve been unsuccessful with other methods of treatment in the past. This is why we offer a Free 15 minute consultation to address any of your concerns!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

(Part 4) The Setback, The Comeback, and Staying On Track!

Learning The Value Of Physical Therapy – A Patient’s Perspective

Let’s Recap:  Last week you heard about my successful experience with physical therapy, and how I was ready to ride off into the sunset. You can read Part 3 HERE (or maybe you missed Part 2 and Part 1).

This week I talk about how I thought I was good to go, acted like I was invincible, needed a reality check, and finally put an end to all the madness!

Prior to what I refer to as “The Setback”, I had taken big steps to improve my overall health. The PT I worked with was also a fitness trainer, and I didn’t’ hesitate to hire him for this venture. He understood my ability and history of injury, and took this into consideration when developing a fitness regimen. Everything was going great for about six months. I had lost 50 pounds, gained a lot of strength, and was feeling awesome! This was the best shape I had ever been in, and I was starting to feel “invincible”.  I started doing too much, too often, and taking things too far………

The Setback

After a few weeks of being “invincible”, I woke up one morning feeling a very familiar pain.  My right arm was aching and I felt some pain in my back and neck area. I didn’t panic right away….. but then three days passed and the pain was still there. Now I started to panic. The thought of re-living that pain was terrifying to me. My anxiety went from 0-100 in a matter of days, and the pain started to increase. I saw the physical therapist, and he did a brief evaluation. He didn’t seem overly concerned, and thought I had just overdone it with exercise. He encouraged me to do the PT exercises and stretches again for a few weeks.  This calmed me down, but that would be short-lived. I did what he told me to do, but I was full-on freaking out and things started to get worse. The pain was similar to before…….but different…… not as consistent in level or location, and I didn’t have any weakness……. but range of motion in my neck was decreased (the pain I had before was constant and unrelenting). My fear and anxiety about the pain returning took over, and I threw myself back in the ditch!

I went back to the physical therapist and insisted I had another herniated disc. I had been in pain for over two weeks, and was starting to feel like I was in a vicious circle. He agreed that my range of motion was decreased and something was going on, but not for the reason I thought. I argued with him about my previous MRI, cervical disc problem, and my pain. He had me sit down to try to explain something to me……. but I didn’t get what he was saying.  All I heard was “Your body has an alarm …. blah blah blah…. brain thinks there is a problem……blah blah blah……not a herniated disc.”  It sort of sounded like he was saying the pain was all in my head. I was certain it was caused from the disc issue, and I didn’t have a clue why he would be thinking anything else. Did he not believe me?

I got home and started thinking about what he said, and of course went on the internet. I found myself on websites that talked about something called “pain science”. I didn’t grasp this concept, but I was intrigued.  I saw him again for another appointment, and we talked more about pain science. He explained that he DID believe that I was having pain, but my clinical symptoms weren’t consistent with a herniated disc. He used some different analogies that made more sense to me, and went into more detail about this “alarm” going off. I still was having a hard time with the concept that this pain wasn’t necessarily coming from the area I was feeling it, but I was determined to find a way to understand this.

The Comeback

It was time to move on to getting me out of trouble yet again. This PT was standing there by the ditch, but he wasn’t going to pull me out this time. He was going to throw me a rope, and make ME pull MYSELF out! He gave me a “reality check” and said I needed to get my fear and anxiety under control if I wanted to change what was happening. He gave me more information on pain science, as well as reputable websites and professionals who had written about it. I read some very good books on the subject, and realized that I was the person in the books……..and the light bulb turned on!

My pain was definitely real, but was being magnified by my brain “thinking” I was in danger, and not from an acute injury. My prior injury had “sensitized” my neurological system, and pushing myself too far with exercise alerted my brain that I may be in danger, thus setting off this alarm. This was why my pain was so inconsistent and would wax and wane depending on what I was doing, or my emotions (and also why no weakness was present).  Sometimes the brain can be a little too protective and respond with pain even if there is not an actual injury, this is because it remembers the previous injury. (Pain science is a whole other blog post!)

Grasping the pain science concept and knowing that I didn’t have an acute injury reduced my symptoms significantly, but there was still work to do. My neurological system had gone haywire, and it would take some trial and error to reset it. I did the exercises and stretches, got my anxiety under control, and the PT did some manual therapy.  Before I knew it, I had pulled myself out of the ditch and turned the alarm off.  It would still take a little time until I got the hang of this “alarm” in my brain. My neurological system was really sensitive now, and I had to be careful not to flip the switch.  I tried going back to my fitness routine, but every time I did, it would trip the alarm and the symptoms would return.  I finally realized I needed start over and do what the PT said and what I had read in the pain science books…….“graded exposure”. I needed to start out very slow, take small steps, and work my way back up. This drove me crazy, because I had no patience and wanted to be back to the level of fitness I was at prior to the setback.  It took an entire year, and there were bumps along the way, but I finally got there!

Staying On Track

It took me almost two years to fully appreciate the value of physical therapy and how it improved the quality of my life. There are so many lessons learned, that I have lost count! This experience forced me to develop patience, which I definitely needed. I learned to understand my body, how it works, and that I need to listen to it when it is trying to tell me something.  I learned that doing things the right way might take longer, but I will get a better end result. I learned that anxiety and emotions can have a big impact on me physically. I learned that I need to participate in my own healthcare, and what I want in a healthcare provider. I learned that physical therapy is an excellent choice as a first-line treatment for pain and movement problems, and it will ALWAYS be the first place I go before considering other interventions.

I could waste time thinking about what I should have, could have, or would have done differently, but I’m not going to do that. The fact of the matter is, there are a lot of times that “You don’t know.....what you don’t know”.   You find out things along the way that help you make better choices. You can’t go back, only forward, and use what you have learned in the future. I wouldn’t go back and change any of the events that happened, because then I wouldn’t know what know now.

I ended up meeting that physical therapist by happenstance, and I feel like I dodged a bullet because of it. There are several different unpleasant scenarios that could have played out here. I could have had an unnecessary surgery gone wrong.  I could have ended up dependent on prescription pain medications or injections. If I hadn’t learned about pain science, I may have ended up as a chronic pain patient, living in a terrible vicious cycle. Instead, I went to physical therapy and met a smart PT who helped me learn how to help myself. I am very grateful for that, and now I have a healthcare professional I trust who I can use as a resource.

If I have to be totally honest here, I’m pretty sure I initially went to physical therapy out of pure spite towards that neurosurgeon, because he said it wouldn’t work. This will probably be the only time in my life where being spiteful actually worked in my favor! Regardless of how I got there, I made it to that first appointment, continued going, and learned the value of what physical therapy can do for a person.  I may have shown up on that PT’s doorstep looking like a “train wreck”, but I left that experience with the information, education, and tools that are going to help me stay “on track”……..and the rest is history!

(Part 3) - PT Tow Truck "Versus" Skeptical Train Wreck Patient

Learning The Value Of Physical Therapy – A Patient’s Perspective (PART 3)

Let’s Recap:   Last week I talked about my interactions with all the healthcare providers who rode with me on that awful merry-go-round, and why I eventually decided to jump off of it(Read Part 1 and Part 2).

I am now sitting in this ditch holding the “Referral” for Physical Therapy. I stopped popping the pills prescribed at the ER because they didn’t really help, and turned me into a zombie. I was back to using Motrin and frozen bags of vegetables to help control my pain.  I have now had enough healthcare experiences to know what I DON’T value, and am ready to find out what I DO value!

It was time to get this show on the road and call the physical therapy clinic. I explained the situation, and the receptionist said they treat patients with my type of problem all the time. Wait……what? This seemed WAY too easy, but I liked what she said. This literally was like the feeling you get when your car is broken down, and the tow truck finally shows up to help get you out of trouble.  My “PT Tow Truck” was on the way, but would it really be able to pull me out of that ditch?

The day of my first appointment, I showed up on the PT clinic doorstep looking like a “train wreck”.  I was in pain, hadn’t slept in weeks, anxiety ridden, and probably hadn’t showered that morning because squeezing a shampoo bottle proved to be too exhausting due to weakness. I’m a skeptical person by nature, had now developed some trust issues, and didn’t have the best attitude walking into this PT clinic. You can imagine my dismay when an extremely “youthful-looking” young man approached me, stating he would be my physical therapist.  I was thinking “Great…. I got the new guy…. it figures!”  I remember quickly scanning the walls for a diploma or license with his name on it. Sure enough, it was hanging right near the clinic entrance.  Nobody my age or older had been able to help me yet, so I decided to let him take a crack at it.  I’m sure he had an opinion about me as well, and probably thought “Great….. I have to deal with this anxious, possibly un-showered, skeptical, train wreck patient today…. perfect!”  This physical therapist would have his work cut out for him………

At the first visit, he spent over an hour actually listening to me, asking questions, evaluating me, and performing different tests and therapy techniques. He didn’t seem alarmed with my diagnosis, and that worried me. I pressured him about the MRI results and what the other specialists said, but he still remained calm. He explained that “WE” were going to work on getting the pain under control, addressing the weakness and movement limitations, and see how things go. I was anxious and skeptical, and questioned everything he said and did. He performed something called “cervical traction” on my neck that day, and this helped my pain. He said this “pull” on my neck was creating some space between the cervical vertebrae. He also had me do some weird-looking exercises and stretches that I was to start doing at home. I wasn’t a fan, and didn’t want to look dumb doing these. He ignored my unwillingness, and encouraged me anyway. I reluctantly complied and did these stretches, chin-tucks, sliders, and side-bends. I have to give him credit, because he held up pretty well considering my behavior.  I felt better after that first appointment, but the pain would start to return that night, and my next appointment was two days away.  He had a plan though, I was included in it, and this was a nice change.

At the next few visits, we did a lot of the same things, and it was the hands-on therapy and cervical traction that helped my pain the most. He was able to help my “new” primary doctor get a home traction unit for me to use in between visits, and this provided a lot of relief. It was now about a week and a half into treatment and I was starting to feel better and was making progress. My pain was reduced, I could sleep again, and I was starting to “buy in” to physical therapy.

We talked at each visit, and I would ask A LOT of questions. He did his best to explain the in’s and out’s of my condition and the therapies he used. I took the knowledge he shared, and researched the internet for more information. I was starting to understand my condition, what caused it, how to treat it, and how to prevent the symptoms.  Years of improper movements, incorrect posture and body mechanics, mismanaged stress, and a bit of genetics all piled on top of each other to help create this problem. I was learning that these physical therapy techniques were the key to recovering, and that I would have to be an active participant in the process if wanted it to work.

Now that the pain was better controlled, it was time to work on the weakness in my right arm caused by nerve compression in my neck, and also treat the underlying cause of my movement limitations. He added strengthening exercises to my regimen, and still made me do those weird exercises at EVERY appointment AND at home.  He explained that the exercises were re-training my brain to know that it was okay for me to move my neck and head in certain directions, but I still looked ridiculous doing them! He would assess my progress at each visit, try new therapies and exercises, and see which ones were working the best. I was always expected to hold up my end of the bargain, and do a home program in between visits.

He then started a new hands-on therapy, which had me thinking he might be off his rocker…… It was a soft tissue therapy called “IASTM”.  He used an odd-looking metal tool with lotion to sort of “brush” in different patterns along my back, neck, shoulders, and arms. He explained this would “Increase blood flow and reduce my sensitivity to stretch” allowing me to move better in these areas.  I couldn’t see how this would work, but I skeptically let him proceed with this therapy at my visits.  As it turned out…. this actually worked quite well.  I never realized how “restricted” my range of motion had been, until I was backing out of a parking spot one day, and it dawned on me that I could turn my head all the way to the right to look behind me. I hadn’t turned my head this far in probably 10 years!  It was now becoming very apparent that this PT knew what he was doing. My skepticism and anxiety diminished, and he gained my trust as he was pulling me out of that ditch. 

Guess what?  Six weeks of physical therapy went by, andI consistently got better without prescribed medications, injections, or surgery………. The hands-on manual therapy, cervical traction, weird exercises, and stretches worked. The pain was gone, strength was returning, and range of motion had greatly improved. This therapist not only addressed my acute situation, but also the underlying soft tissue problems that had built up over the years, and I now felt better than I did even before my initial symptoms started!  I was quite puzzled as to WHY physical therapy was only mentioned to me as a last resort, and was told it probably wouldn’t work?  PT should have been my first stop……… not the last.

I was thankful I gave this physical therapist a chance to help me, and also restore some of my faith in the healthcare system. I had just experienced first-hand, the value of physical therapy.

I was now ready to put this all behind me and ride off into the sunset, but my neurological system had OTHER plans, and this would not be the end of my story just yet. I would throw myself back into that ditch for a moment, get a BIG reality check, and then hopefully put an end to all the madness! There was another lesson to learn before I would completely grasp how valuable physical therapy really was………

Fun Term Of The Week - Train Wreck:  A chaotic or disastrous situation that holds a peculiar fascination for observers.

UP NEXT WEEKThe Setback, The Comeback, and Staying On Track

Stay Tuned for the Final Conclusion of this 4 Part Series!

Learning The Value Of Physical Therapy – A Patient’s Perspective (Part 2)

To Recap: Last week I covered why I wanted to write about the value of physical therapy, and how my flawed mentality got me into hot water. You can read part 1 HERE. This week, I get down and dirty about my ride on the “healthcare merry-go-round”, the people who joined me, and the making of my mess.  Again, I want to reiterate that these were just interactions I had with healthcare professionals along the way. I’m sure their intentions probably were to help me, even though it may not have seemed that way at the time. Their specialties all have a place in healthcare, but they aren’t going to be the first place I stop at in the future!

merry_go_round.jpg

Just a little snippet on my HMO insurance…..I’m not going to say much on this subject, as HMO pretty much speaks for itself. It’s a revolving door of referrals, authorizations, and denials. It’s like walking around with a pebble in your shoe or a thorn in your side, making everything just a little more difficult than it really needs to be. Everyone should try an HMO once in their life…. just for the experience! Moving on to the Primary Care Doctor.…

Two years prior to my injury, I had started having consistent pain in my neck, head, and back area. I was on a steady diet of Motrin for this. I work a desk job, and eventually it was just too hard to sit and work.  My “quick fix” medication wasn’t cutting it. Over the next year, I went to my primary care doctor three times. She diagnosed me with head, neck, and back pain…. and for some reason a urinary tract infection?  I got antibiotics, muscle relaxers, and was told to keep taking Motrin. No mention of what might be causing the issue, or any other possible solutions. Why she ever thought I had a urinary tract infection, I will never know ha ha. This interaction wasn’t really good or bad. It just wasn’t “anything”, and produced no results. She was satisfied with the status quo. The only thing I got out of this was a “referral” to the chiropractor, which was my idea. I’m on the merry-go-round now, but really bored because it’s going slow and nobody is on it with me.  Moving on to the Chiropractor….

One year prior to my injury, and after obtaining the coveted “referral” required by my HMO, I started seeing a chiropractor. I got x-rays and was told I was in “bad shape”. I was subluxed and degenerated, and needed to start treatment ASAP. I jumped on board with this, went three times a week over the next year, and it did provide some relief! This treatment still kept me in that “quick fix” mindset. Each visit was only a few minutes, got adjusted, and back to my day.  I was now dependent on this for relief, just as I had been on Motrin. Hey, at least I had someone on the merry-go-round with me now, and we were having a pretty good time….. at least for a while!

The day of my acute injury, I had gone in for a regular adjustment, but this time I didn’t get relief and it caused me pain. It was a severe “pinched nerve” feeling in my neck and back. I was told not to worry, and that they could fix this.  I was still “all in” at that point, and wanted to see if they could help me, but this would be the beginning of my mess.

One week into my mess, I had went every single day for adjustments, but the pain was getting much worse. I couldn’t sit, couldn’t sleep, couldn’t work, and was losing strength in my right hand. Taking 800 mg of Motrin barely made a dent.  He took another set of x-rays, and seemed very concerned. He stated my x-rays looked much worse than at my initial evaluation one year prior. My heart dropped into my stomach, he got nervous, and I got scared. Was it the adjustments that caused the problem or was it a coincidence? I didn’t really know, it didn’t really matter, and I just needed help. I told him I thought I should seek other medical care since things were getting worse. He then became somewhat defensive. Maybe he was offended that I wanted to get another opinion, or thought I was accusing him of something.  I expected him to offer some suggestions, but that didn’t happen. This interaction became all about him, and not about helping the patient anymore, so that relationship was over! I was on the ride alone again, and it was spinning faster.  Moving on to the ONLY place that my HMO doesn’t require a “referral”…. the Emergency Room…

Two weeks into my mess, I still have severe pain in my neck/back/arm, numbness and tingling, and the right hand was much weaker…. off to the ER! This ER doctor examined me, and sent me for an MRI. A few hours later, he briskly informed me I had a herniated disc in my cervical spine (neck) that was pressing on some nerves, which was the reason for my intense pain and weakness. He gave me a script for pain medications and steroids. He also handed me a card for a neurosurgeon, and stated I needed to see him ASAP. I spent the next week popping pills, flipping out, and of course searching on Google for all the horrible things that could happen. This interaction provided me six things… a diagnosis, three medications, a business card, and a lot of anxiety!  That doctor could work on his “diagnosis delivery” skills, but he did his job that day, and I can’t fault him for that. I’m freaking out now, and my ride has really picked up speed!

Moving on to the Neurosurgeon and the PM&R doctor…..

Three weeks into my mess, I have worked myself into an anxious frenzy, have my “referral”, and now I’m seeing the neurosurgeon. This was my least favorite interaction. He examined me and reviewed the MRI. After just a few minutes, he very bluntly said he could “fix” all my problems by drilling a hole through the front of my throat and shaving off the disc that was pressing on the nerve. I almost passed out, and then started to cry. I told him I didn’t want this and asked what else could be done. His demeanor quickly changed to irritated and angry. He spent the next 10 minutes reprimanding me and talking down to me like I was an idiot for asking questions. He said he was busy, had other patients to see, and flippantly commented, “You can TRY physical therapy, but it probably won’t work,and might make it worse.”  He then said he would have his PM&R doctor see me. I didn’t know what a “PM&R” doctor was, or why I needed to see one. I’m still crying, had failed to wear my waterproof mascara, and now looked like a complete disaster!

This new doctor walked in with a consent form for an epidural injection in my neck, and a “referral” for physical therapy.  Nobody asked me if I wanted an injection, or told me what it was really for, and I was having NONE of it that day! They spent about 15 minutes with me, treated me like an idiot, and then expected me to just blindly agree to their interventions. My thinking was this….

If you can’t treat me with common respect, then why would in the world would I trust you to cut into me with a sharp instrument or stick a large needle into my neck?

I left that appointment upset, exasperated, still in pain, confused.... and crying all the way home ha ha ha. If I wouldn’t have been in so much pain, I would have tried throwing both of them off the merry-go-round! This interaction, while extremely negative, was probably the best thing that could have happened to me at this point, but I wouldn’t realize this just quite yet……..

Wait… hang on a second……Everyone was offering me “quick fix” solutions for my problem, so why am I so upset!  Adjustments, surgery, injections, medications…… so what’s the problem here?  The problem was that nobody was really explaining my condition to me, what was causing it, what the interventions were all about, and what the consequences may be. They didn’t spend enough time with me or give me enough information. This was my spine, there were nerves involved, and I couldn’t afford to make a wrong decision based on limited information.  Was there something else I could be doing to help myself?  Were these my only options?  I had lasted three weeks with this pain, and figured I could go a little longer if it meant finding answers to my questions. I needed to stop just going along for the ride, and take some control of my own situation. I closed my eyes and jumped off that spinning merry-go-round. I ended up landing in a ditch, but made sure to keep a tight grip on that interesting piece of paper the doctor had given me that day……… the “referral” to PHYSICAL THERAPY.

Fun Term Of The Week - Merry-Go-Round: A continuous cycle of activities or events, especially when perceived as having no purpose or producing no result.

UP NEXT WEEK:   PT Tow Truck, Skeptical Train Wreck Patient, and the Weirdest Exercises I Have Ever Seen…….Stay Tuned for Part 3!

Learning The Value Of Physical Therapy - A Patient’s Perspective (Part 1)

Who, What, and Why?

A 43-year-old female who was in her usual state of health until……

When I sat down to write my personal healthcare story and how I came to really understand theimportance and value of physical therapy, I got my notes out and read through them and was like “This story is like some sort of bad reality show or TV mini series, did all this stuff seriously happen?”   Yes……Yes it did… and you can bet that I am glad it is over. It has been a few years now, so I can laugh about it and roll my eyes, but when it was happening it wasn’t so funny. I am writing this series of blog posts for several reasons.  First off, I want to help people understand the value of physical therapy and why it should be considered as a first choice treatment for pain and movement problems, and I also want to encourage others to be their own advocate when dealing with their health. Our body is like our “vehicle” for life, and we can’t trade it in for a new one. We need to be aware, educated, and informed about our body, how it works, and our healthcare options. If I can help even one person avoid a bad ride on the “healthcare merry-go-round” like the one I was on, then it was worth my time to write this.   The other reason I am writing this is to help physical therapists understand how a patient may have ended up on their respective doorstep looking like a “train wreck”, and the patient’s frame of mind that got them there.  Trust me….I’m pretty sure they didn’t get that way on their own!

Getting started on writing this was harder than I thought.   When this injury happened, I didn’t go straight from Injury to Physical Therapy.  Instead, I took a not so enjoyable trip down Pain Boulevard, Frustration Street, and then had an unfortunate ride on the Healthcare Merry-Go-Round.  PT will always be my first stop in the future, before other interventions, but I will get into that a little later. There were a lot events and interactions that influenced how I feel now. Learning the value of something is a process and not instantaneous. There is trial and error, screwing up, asking questions, falling down again, and then getting back up and brushing ourselves off.  Sometimes we need to learn what we DON’T value first, before we can really understand what we DO value. Because of this experience, I have completely changed my entire outlook on the healthcare system, the role of providers, and where my responsibility lies in this as a patient. Now that I have my groove back and I’m in the swing of things, I can honestly look back and really see what happened, how it happened, and why.  It’s a good thing I have a great sense of humor, because I wouldn’t be able to write about this without that, so here we go!

My First Problem.... A Flawed Thought Process…. What Was I Thinking!

I’m in my middle 40’s now and looking back, I realize that the root cause of my problem started way before my acute neck injury. It started a long time ago with a flawed thought process ingrained in not just me, but in society as a whole.  We seem to always want a “quick fix” for everything so we can get on with our life, but we shouldn’t be approaching our health like a “Quick Lube Oil Change”. This flawed thought process carried over into how I viewed my health and how I thought about doctors. When I went to the doctor, I expected them to fix my problem on the spot so I could get on with my day. Usually within 5 or 10 minutes, I had a diagnosis and prescription. I also took to popping Motrin and Tylenol on a regular basis as a quick fix for pain or discomfort. I never really had any big problems, so normally this worked pretty well…….until it didn’t. I also didn’t really know anything about my doctor other than she only spent about 10 minutes with me, handed me a prescription, and I paid my co-pay and left.  Hmmm… I’m pretty sure I have spent more time picking out paint colors for my walls, than I ever did thinking about my own healthcare. Is it possible that this was a dumb thing to do on my part?  The polls are in, and yes, it was definitely dumb!

Patients (me included) have come to expect quick fixes for all our ailments. We have so much available to us, and we have become accustomed to expect a medication, injection, or surgery to be the first thing that we, and many healthcare providers, go to in order to solve all our problems.  It’s just become the normal way of thinking and the normal thing to do. Until you actually have an injury and are in pain, you may not think much about these options. Being in pain affects your emotions, which then can affect your decision making skills. When my injury occurred, I immediately wanted an instant fix. I was in a lot of pain and wanted it to stop. It wasn’t until later, through physical therapy, that I started to realize I had some control over my situation and could play a big role in my own recovery, as well as prevention of future problems. (More to come on this).

Obviously you can’t just do a “quick fix” all the time, and you need to find out what the underlying problem is so it doesn’t keep happening, causing a more serious issue. Think of it like if the pipes in your house kept leaking and you never looked at why. For years and years you just keep plugging up the different leaks, but then one day all the pipes burst and you are standing there wondering what the heck happened!  On the flip side of this… you also don’t want to rush and replace all the pipes in your house immediately, just because you found one leak. What you need to do is find someone who is knowledgeable, honest, has common sense, and will be willing to refer you to a better plumber if he is not sure how to fix the problem. What you don’t want is someone fixing something that isn’t broke, creating more problems, or making absolute claims on how to fix things after being in your house for two minutes without even doing an inspection of the pipes.

There are plenty of wonderful healthcare providers out there, but there are also plenty of mediocre and not so good one’s as well.  The problem is that healthcare is sometimes like trying to navigate a maze with a blindfold on, and finding those great providers or treatment options isn’t always easy. Let’s be honest here, healthcare is a “business” driven by “numbers”, with the patient sometimes left holding an empty bag. Don’t even get me started on insurance companies!   Yes…. I am somewhat to blame here for being a clueless patient and thinking anyone with a credential after their name was an expert.My flawed mentality eventually got me into hot water, but I’m not taking all the blame on this one! I had plenty of people with this same flawed thought process keeping me on sort of a “healthcare merry-go-round.  They kept depositing quarters for my ride until I eventually had enough sense to throw myself off it, landed in a ditch, and had to call the PT tow truck to help me get out of trouble.

With all that being said, I want to make it clear that next week when I tell you about the ridiculous details of my healthcare story, I am not trying to throw anyone under a bus. Whenever you learn a life-lesson, there is ALWAYS a back story… and a back story you will get. Sometimes you just have to say how it all went down!

Fun Term Of The Week – Quick Fix: An easy remedy or solution, especially a temporary one which fails to address underlying problems.

UP NEXT WEEK…… The Merry-Go-Round and The Making of a Mess…. Stay Tuned!

Movement Proficiency and the Ankle

What are the basic movements that someone should be proficient with to train or compete in athletics? What are some ways to address these movements in my training?

There are quite a few movements I feel are quite necessary to move well enough to keep injury risk low and to enhance speed, power, jumping ability, etc.  I’ll get into all of them in time, but for now I’m going to spend more time on the ‘Big 3’ from the Functional Movement Screen.

1.Deep Overhead Squat

2.Hurdle Step

3.In-Line Lunge

These are larger patterns with many component parts but what it really comes down to is we need a great deal of mobility from certain joints and stability from others

Mobility – ankles, hips, thoracic spine, and shoulders

Stability – knees, lumbar spine (a.k.a the Core), and scapulae

As you can see from the pictures above, a great deal of mobility is required from each of those areas I listed.

This is simplifying things a bit but if you do not have the requisite mobility then there is no way you will move well in these patterns and the way you run, lift, jump, and throw will be compromised.  We also know that poor mobility leads to poor ability to stabilize the joints listed above as the body searches for compensatory strategies (ways around those stiff joints).

Let’s use ankle mobility as an example.  From a half kneeling position, you should be able to get your knee 4 inches past your toes while keeping the heel down.  See the picture below (the stick in line with the big toe forces you to take the knee outside the stick).  Full ankle mobility will allow the rest of the lower extremity to stay in great alignment while running, lifting, etc. If the ankle is stiff, the foot will pronate (flatten out) and the knee will cave inward all in an attempt to work around the ankle.  All the athlete is thinking is “I have to run fast” so the brain will find a way whether it is right or wrong.  Over time this leads to instability at the foot, knee, possibly even higher up the chain, and ultimately decreased performance and injury.

Ideal = knee 4

So if you find yourself struggling to move through the ‘Big 3’ patterns discussed above, ankle mobility should be the first place to look.  So what to do if you’re short of that magic 4″ past the toes?

–  self myofascial release – rolling a lacrosse ball along the bottom of the foot and foam roller/massage stick to the calf

–  stretching for the calf with the knee extended (traditional calf stretch with hands on the wall) and with the knee flexed to get the soleus/Achilles (as in the picture above or standing knee to the wall)

If those just aren’t cutting it, or you experience pain in front of your ankle, then you may have some joint and/or soft tissue issues that will not be solved by just exercise.  Then it’s time to see your physical therapist or chiropractor who has the ability to address these areas.  Here at On Track Physical Therapy, I use techniques like IASTM and Dry Needling which have been shown to quickly improve range of motion. We then follow this up with specific exercises to build control through the newly acquired range of motion to help lock the changes in.

As with any intervention, be sure to go back and re-check the patterns when you are done.  As ankle mobility improves then your squat, hurdle step, and lunge should all improve as well.  Maybe not to ‘perfect’ yet because there a number of other components involved here, but definitely will have you on the right path.

ACL Prevention. The Importance of Youth Coaches

For top notch ACL rehabilitation in Ann Arbor, Mi contact On Track PT and Performance.

Calling all you coaches, athletes, therapists and trainers out there, it's time for us all to face facts; we've failed as an industry in protecting our clients from ACL injuries.

Even with all the BS "ACL Injury Prevention" programs specializing in reducing the incidence of non-contact injuries, the most recent statistics show an INCREASE in ACL injuries in active populations.

Time to stop patting ourselves on our backs (coaches and researchers) and realize that what we've been doing over the last two decades to combat this monumental problem is just not working.

You know what will work and has been a proven track record for hundreds of years? Old school, traditional strength and conditioning. Maybe try and master that, ingrain some sound movement patterns in your athletes and just maybe then they can stay on the field long enough to make a dent in their athletic potential.

Full article available  via DrJohnRusin.com by Dr. Greg Schaible.

Low Back Pain - Ann Arbor, Mi

Ann Arbor Physical Therapy Low back pain is one of the most common ailments in the United States. A number of contributing factors can play a role in this type of dysfunction. One of the most common reasons that your back may hurt is due to your hips. More specifically the lack of range of motion in your hips. In a study published by the Institutional Journal of Sports Medicine titled Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. The authors found that typical range of motion in the hip lacked -4 degrees of extension from a neutral position. In those subjects without low back pain, they had 6 degrees of hip extension available beyond neutral. All totaled, this is a 10 degree difference in hip ROM. These findings are common in individuals for a number of reasons. One in particular is the tendency for people to sit for long periods at work, school, or home which puts your hips in a flexed position (opposite of extended). This is a video of one technique we use at On Track PT and Performance to help improve hip extension through neurological inhibition.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Get PT First

Often times when a patient walks through the door, I’ll ask them “How are you doing today?”.  Many times I’ll get the response “fine”, “feeling better”, or something else that leads to a nice conversation. Sometimes the response is much more blunt however “Well if I was good, then I wouldn’t be here.”Touché! Hopefully your medical professional has some sense of compassion and empathy toward your situation.

We’ve all had those moments when things just don’t seem to be going right.  It doesn’t always have to be a health related issue.  Maybe it could have been that your car broke down and you had to take it into the shop.

Is it convenient? No

Do you need your car? Yes

If your check engine light comes on, you have two choices. Ignore it and hope for the best, or address the problem. If you have a leak in your plumbing, you find a plumber.  If you have a toothache, you go see a dentist. If you want to win a bobsled race, you need a good driver.

Do you dig where I'm coming from?

As a Physical Therapist we have the expertise and knowledge to treat a variety of musculoskeletal disorders.  Pain is much like a check engine light, it’s signaling to your brain that your body is perceiving a threat to the system.  The cause of this threat is often related to multiple different reasons. The underlying issue could be big or small, and if ignored it could lead to much greater problems.  As a Doctor of Physical Therapy, we are uniquely trained to assess and treat many of these issues. We are also trained to recognize red flags which may signal to us that we need to refer to another medical professional with a different expertise.  Your body is the vehicle that drives you, and I encourage you to pay attention to the “signals” that your body is sending.  Unlike a car, you cannot trade your body in for a new one when it breaks down.  Find a health professional that you trust and be proactive in your health.  Take care of your body.

 

When Pain Happens

Here's a riddle. Nobody wants it, but everybody has experienced it at some point in time. It acts oddly and seems to come on for no rhyme or reason.  It is vastly misunderstood by the general population as well as healthcare professionals from all fields.

You guessed right, the answer is pain.

If you are reading this post and currently in pain, I genuinely am sorry and have empathy for your situation.  But understanding pain is the first step in combating it, so you are in the right place.  My goal is to educate people on pain. In my profession I deal with pain every day, so in order to treat it, I need to do my best to understand its complexity. I have learned a great deal about the subject of pain from books by David Butler and Lorimer Moseley. These two guys are at the forefront of the research on this subject.

So what is pain?.......  A short but loaded question.

First let's get some context. The body is constantly gathering information from sensory receptors about the body's internal and external environments.  It is also interpreting how these two environments are interacting and how they relate to one another. All these signals are ultimately sent to the brain to make heads or tails of the information. These inputs can range from actual tissue damage, chemical changes, past experiences, emotional/psychological distress, lack of sleep, hunger, your mother yelling at you, or seeing a snake on a plane.

Snakes on a Plane

The brain's job is to then interpret all of these signals and determine if a threat is present. If the body perceives there is a threat, a number of different responses are possible.  One of the possible responses is pain.

Pain is felt as a survival mechanism to encourage you to take action. However, it does not always mean damage has actually occurred.

Consider this example Lorimer Mosley gives: A fractured wrist is often very painful until it is put in a cast. Once casted, the pain is almost always gone quickly thereafter.

Interesting!

The problem with this is that we know that bone will take 6-8 weeks to fully heal (depending on age and other factors).  Yet, pain is no longer present, and in some cases instantaneously gone once placed into a cast.  So why is this? Very simply, the need for protection is now gone because the cast acts as an external protective device.

In this example the pain is gone but damage is very much still present. The opposite can also be true. The body can be in pain, but no longer damaged.

We must consider other factors such as social influence, past history, fear, future consequences, stress to name a few. All these signals can trigger the body to feel it is under threat and notify you via pain. For this reason you can experience pain with no tissue damage at all.  I’m sure you have heard the term phantom limb pain.  Even though the limb is gone, the body still has the ability to sense pain in this area.  This reinforces the fact that if you can experience pain without a body limb, then tissue damage is not necessarily a prerequisite for pain. Furthermore, just because you are experiencing pain in a particular area does not mean that is in fact the source of the pain.  This is why it is important to find a clinician who does not focus solely on the area of pain, but looks for other areas of dysfunction which may contribute to the brains overall perception of threat.

Another possibility is that tissue damage could have very well occurred which initially started the pain cycle.  However, because the body is great at healing itself at the cellular level. It is also possible that the tissue may have healed. Yet the brain still has the perception of threat because non-threatening inputs were never sent up to the brain to override the previously painful threats.  This may explain why people often feel pain long after normal tissue healing time has passed. This is also why it is important to not treat pain with pain.

Here is some research that backs the theory: tissue damage does not equal pain. Jensen and colleagues performed a study titled: MRI of lumbar Spine in People without Back Pain. They found that 52% of people without back pain had at least one bulging disc or MRI abnormality.  Templehof and colleagues performed a study titled: Age-related prevalence of rotator cuff tears in asymptomatic shoulders.  The authors found that 23% of people with asymptomatic (non painful) shoulders actually had a rotator cuff tear. These are just two examples. Numerous other studies could be cited to help support that tissue damage does not have to cause pain.  

So the next time you experience pain, please understand that there may be a number of contributing factors. Remember that pain is perfectly normal, it’s your body’s alarm system. Pain can be present with or without tissue damage. Providing the body with novel non-threatening stimulus's to remove the body’s need to produce a protective response is a great place to start if you are currently experiencing pain.

Let's take the example of elbow pain, lateral epicondylitis a.k.a tennis elbow. It's not uncommon for lifters to experience elbow pain. I have noticed it becoming more prevalent now as people spend more time on their tablets using their fingers instead of a mouse.

Holding a tablet in one hand, and constantly using your fingers to swipe, type, navigate, etc. will place your wrist/elbow musculature on constant stress. Over a prolonged period, this can be perceived as a threat to the brain. Especially if you are lifting heavy weight in conjunction and require a high volume of grip strength for your workouts.

So applying the knowledge we learned about pain, and how it may or may not relate to tissue damage.  Here is a very simple and extremely effective solution to a lot of cases.

1st) Reduce the threat. In this example altering body mechanics while using a tablet and modify your workout routine with less grip intensive activities for the time being.

2nd) Provide a novel and nonthreatening stimulus.  In this example, I will use a wrist extensor stretch.

While this exercise may not seem like much, it's very effective when applied correctly.  Flexing your wrist and turning it to the side obviously places a stretch on the outside of the elbow or to the wrist extensors.  In addition, you are also placing some tension and loading a nerve which flosses through the tissues at the elbow called the radial nerve.

So we now have our novel/nonthreatening stimulus.

3rd) Here is the kicker. You can do all the above, and get zero results unless you get this third step correct.  You MUST perform the novel/nonthreatening stimulus frequently.  To the tune of every 1-2 hours for best results.  Here is why it's so important.  When the body is in pain, it is very good at making memories of pain.  This is because the body is very protective over itself, and rightfully so.  The only way to reduce the threat is to perform a stimulus frequently enough that if no longer feels the need for protection.

This example can be applied to many other pain scenarios as well if you follow the steps correctly. 1) Remove as many threats as possible while in pain 2) Pick a novel/nonthreatening stretch or exercise 3) The exercise should be simple enough so that you can perform it frequently throughout the day (in some cases every 1-2 hours).