I get headaches. Can physical therapy help?

If you’ve looked at any list of maladies that physical therapists say they can treat you will undoubtably see headaches on there.  I remember when I first started PT school and I saw headaches listed as something that is treatable with physical therapy I was a little sceptical.  I figured it was probably some fringe aspect of PT, a little bit of hocus pocus.  How could you treat a pain inside your skull with physical therapy?  Come to find out headaches are very treatable with physical therapy, and the results can happen rather quickly.

It’s important to first point out that there are different types of headaches and only a certain type of these are treatable with PT.  Headaches that have a musculoskeletal origin are the ones where we can help the most.  That means your headaches is caused by some issue(s) involving the muscles, joints, ligaments, bones, nerves, or other tissue in your neck, jaw, or head.  Irritation or restriction of movement in any of these structures could irritate a nerve or blood vessel that goes to your head, potentially causing headaches.  Poor posture can be a contributor to headaches and is something we can help correct.  A big key in finding out if physical therapy will help comes during the initial evaluation.  If the therapist can provoke your headache during the evaluation, or causes a headache to come on soon after, there is a great chance we can help.  If you have no change in your headache during or after the initial evaluation and several treatment sessions, there is a high probability that your headache is not caused by a musculoskeletal problem.

Headaches due to chemical/hormone issues or more internal issues such as pathology within the brain itself will most likely not benefit from physical therapy.  Be wary of a clinician who claims he can treat all types of headaches.  Within a certain subset physical therapy is very helpful.  But if it doesn’t fall within the musculoskeletal realm talk to your doctor about your headaches.  He or she will direct you down the path you need to go to find answers.

My manual therapy training from the International Academy of Orthopedic Medicine (IAOM) has enabled me to accurately diagnose the specific issues in your neck that might be causing your headaches.  I am certified in manual therapy techniques for the spine and have had good success in helping people with their headaches that are musculoskeletal in origin.  If you live in Spokane feel free to give my a call at Thunder Physical Therapy at (509) 465-5400.  I would be happy to talk to you and answer any questions you may have.  You never know, getting rid of your headaches may be easier than you think!

Should I stretch before or after exercise? Or should I even stretch at all?

I think it can be safely assumed (for us men mainly) that stretching is something we all agree we should do but don’t do it enough.  Ask the average guy if he can bend down and touch his toes while keeping his legs straight and I bet you he can’t.  Ask the average female the same question and I bet she can.  Is this good or bad?  Should you even stretch at all?  Sure we all did the obligatory warm up stretches before our high school events but other than that it really wasn’t talked about much in school.  It was one of those things we all knew in the back of our minds was important but really didn’t know how to put into practice.  So, what’s the deal with stretching?

Is stretching good?  Yes.  Having overall flexibility in all of our joints is a good thing.  This is allows our joints to move throughout their entire range of motion.  If you are unable to move a joint through its entire range of motion you are most likely too tight and need to stretch.  Also, keeping our muscles, tendons, and ligaments flexible aids in the overall health of the tissue.  One common injury in people who are too tight is a severe strain or perhaps even a tear in the muscle.  A slip on ice or another type of quick, sudden movement can cause a forceful overstretching of one or more of the above mentioned tissue.  If this tissue is too tight to begin with a severe injury could result.  Perform a quick evaluation of your joint mobility.  Can you move your arms and legs throughout their ranges of motion without restrictions?  If you can’t you may need to start stretching.

Can you be too flexible?  Yes.  Generally this is not a problem most of us have.  However there is a subgroup of people who can become too flexible.  Sometimes it’s due to genetics and you don’t have much control of it.  But some people really like to stretch, and in the process can put themselves in quite a conundrum (that is my big word for the day).  Joints that are too loose can cause undue stress to the ligaments in a joint.  Ligaments are a type of connective tissue that attach from one bone to another.  If your muscles are too loose your ligaments will be under more stress when you push your joint to its end range of motion.  This in turn could stretch out your ligaments.  People that are very flexible tend to have more bony issues as well, as there is a higher propensity (another big word!  I’m on a roll!) for the bones in the joints to collide against each other.

Can you stretch too hard?  Yes.  I had a patient who I gave several stretches for her to do at home.  After a week or two of faithfully doing her stretches she wasn’t getting better, in fact she was getting worse.  After talking a bit I realized she was stretching way too hard.  She had the “no pain, no gain” mentality that if it didn’t hurt it wasn’t getting better.  Once we talked about how much pressure to correctly apply she began to do much better.  As a general rule you should feel the stretching sensation as you stretch, but it should go away rather quickly after you are done, and the stretched muscle should feel better.  If you develop pain right after a stretch that continues to worsen you stretched too hard.  Talked to your physical therapist about it and they can help you modify the stretch.

So how often and when should you stretch?  If you find you are unable to perform any of your daily activities because you are too tight then you need to stretch often, every day would be good.  The biggest changes that have occurred with stretching are in regards to stretching before exercising or participating in any type of athletic event.  Like I stated earlier, a lot of us have memories of gathering around and stretching before a high school football or basketball game.  I remember we had a synchronized routine that involved a lot of yelling.  I guess we were trying to psych ourselves up and intimidate our opponent.  There has been some research that has come out stating that it is more beneficial to stretch after an activity rather than before.  Aggressive stretching temporarily desensitizes the muscle, slowing down its ability to quickly contract in response to stimuli.  This could actually lead to injury if you are running and slip or get pushed.  If your muscles are unable to quickly respond to an unexpected stimulus you could strain, sprain, or perhaps tear something far worse than if your muscles were able to respond quickly.  Instead of stretching before an activity it is suggested that you warm up, that is you jog, jump, or do some gentle movements that will help get the blood flowing and your cardiovascular system ready.  This will prepare you much better for your activity.  The time to stretch is after activity.  At this point your muscles are nice and warmed up.  This will allow them to respond better to stretching.  Since you are done with your activity it doesn’t matter that your muscles will be slightly desensitized after stretching, the hard part is over, now it’s time to relax.  One of the most important things when stretching is to NOT bounce while performing the stretch.  Just have a steady hold and count to 30 and relax, doing this 3-5 times per muscle group.

There are a vast array of stretches out there for you to choose from.  Whether they are good or bad depends on what you are desiring to stretch and if you have any physical issues that might become a problem if you stretch a certain way.  This is something that can only be addressed in person.  I would be happy to help you with that if you have any questions.  Feel free to call me at Thunder Physical Therapy at 509-465-5400 if you have any questions.  So go out there, warm up, play hard, and then stretch!  Even though you won’t be able to intimidate your opponent before with some awesome coordinated routine you will be more prepared to beat them when it counts.

The highs and lows dealing with patient expectations.

The first minute or two of a patient’s first appointment with me is always the most telling.  In these first few minutes I begin to get a sense of what the patient expects out of their time with me.  Some don’t know what to expect, as they have never been to a physical therapist before.  Some have seen a physical therapist before and had either a good or bad experience.  That expectation is at times brought with them when they see me.  The hardest type of expectations for me to deal with are those of a patient who has a preconceived notion of what physical therapy is and expects to be treated in that way, whether it is a notion that I agree with or not.  Some my patients have no expectations at all, as this is their first time in physical therapy.  Their doctor told them to go but that is all they know.

Patients I see who have had a previous experience with physical therapy present an interesting dilemma.  If they saw me at an earlier time this of course makes things much easier, as we all ready have a relationship that we can build on.  Patients who I haven’t seen previously but had a good experience are usually very cooperative in their care and understand the benefits of physical therapy, as it has helped them sometime in the past.  It is my hope to build on their previous good experience, showing them how physical therapy, and more specifically, my approach to physical therapy, will help in returning them to a pain-free and fully functional life.  If they have had a bad experience in physical therapy they usually look at me with scepticism, thinking that since physical therapy didn’t work for them the first time around that it won’t be any different this time.  This makes my job a little harder.  I hope that by providing a thorough evaluation and explanation of their condition as well as being professional yet approachable that I will knock down some of the barriers the patient my have from their previous experiences.

Those types of patient expectations are pretty standard and if there are any issues are resolved without much fanfare.  The expectation that I find the hardest to come to terms with is when a patient has had a previous physical therapy experience  at a different clinic (usually a good one) and expects me to provide the same type of treatment as before.  Sometimes they come to me and say “I want the heat and the electrical things.”  And that’s it.  Or they come in and ask “Do you do massage?”  Well technically yes but probably not like they are expecting.  Or “my last therapist didn’t make me exercise, why should I now?”  Nine times out of ten they are asking sincerely and without malice.  They were treated a certain way and benefited from it and now expect the same from me.  This is where it can get a little sticky for me.  If what they are expecting is in line with what I think they need to get better I will do it.  However, if what they are asking for is just a band-aid or does not mesh with my treatment plan and overall physical therapy philosophy I will be more hesitant to do what they are asking for.  At this point it is up to me to convey my thought process to the patient in a concise, understandable, and professional way.  If I do this the vast majority of patients have no problem with my decision and are thank me for being up front with them.  Every once in a while I have a patient who isn’t satisfied with my explanation and half heartedly continues therapy or quits all together.  And this is the tough lesson I have had to learn over the years.  You can’t please everybody.

When I first became a therapist I would take it very personally when a patient didn’t like my treatment plan or decided that we weren’t a good fit.  To some extent I still do take it personally, but now I see it through a different lens.  I want to tell you this.  If you come to Thunder Physical Therapy in north Spokane and see me I will give all my effort in getting you better the best way I know how.  I am open to discuss other treatment ideas that I am not familiar with and perhaps incorporate them into your treatment plan.  But if you are asking me to do something that I am uncomfortable with I would ask that you allow me to treat you the best way I know how.  When I treat you I want to treat you well and with expertise.  If you ask me to treat you in a way I am not educated  in you won’t be getting my 100% effort.

I hope that doesn’t sound too harsh.  Situations like I mentioned above are rare.  I can can count on one had the times that a patient and I have not been able to come to an understanding on a treatment plan.  Please ask me questions.  Ask me what my thought process is on how I treat you.  The more you know the more likely you are to try harder and be consistent in your treatment and home exercises.  That makes you and me happy.  And that is something we can both agree on.

Water physical therapy. Who benefits and should I do it?

Aquatic, or water, therapy is a great tool in the physical therapy world.  It can be of immense help to patients, providing much needed pain relief, strength, and cardiovascular training.  Though pool therapy is very beneficial for a certain patient population, a patient needs to have a good discussion with their doctor or physical therapist to weigh the benefits and drawbacks of aquatic therapy.

Some of the benefits of water therapy are quickly obvious.  Being in the water is gentle, it unweights you, taking pressure off of sore joints.  The resistance the water provides as you move through the water helps build muscle mass and gently taxes your cardiovascular system.  Water therapy is especially beneficial for patients who suffer from debilitating arthritis.  These patients typically have no cartilage left in their joints.  Movement of these joints causes the bones to grind against each other, resulting in pain.  However, once they are in the water the pressure through the joints is decreased, meaning they can now move the joint with less grinding.  The deeper you go in the water the more pressure is taken off.  This provides a great way for arthritic people to keep strength and motion in a joint without  causing pain and more wear and tear.

Another group of people who could benefit from water therapy are ones that have severe weakness in one or more of their extremities.  The weightlessness that water provides can aid in movement of the weak extremity.  As long as the patient has even the smallest ability to contract the muscle, they may be able to move their extremity through the water, whereas on land they wouldn’t be able to as it is too heavy.

Though the pool is beneficial for many people, there are certain groups that would not benefit from water therapy.  People with osteoporosis is one such group.  Osteoporosis is a weakening of the bones.  One of the things that helps counter the effects of osteoporosis is weight-bearing exercises.  Bones responds to pressure put on it by developing more bone.  This is exactly what a person with osteoporosis needs.  Gentle pressures applied through the bones in a safe way is needed to keep the bones strong.  Performing exercises in a near weightless environment will not help in this regard.  Exercising in the water will keep the muscles strong but the bones will continue to weaken, potentially causing more damage down the road.

Another aspect of pool therapy that we need to consider is it’s functionality as it relates to daily life.  Pool therapy, as it relates to physical therapy, was designed to help get people moving that were having difficulty exercising on land.  As stated above, there are many benefits for a severely de-conditioned individual using pool therapy.  However, once they reach a point where they can reasonably perform the exercises in the water a transition to land based physical therapy needs to happen.  The reason for this is that we spend the vast majority of our life on land, in a weight-bearing position.  So this is our end goal: to get you moving on land to allow you to function in your daily life.  As great as the pool feels, you can’t live your life in the pool.  The pool serves as a means to an end.  Once the aquatic physical therapist feels that you are able to tolerate exercise on land they will recommend you transition to land based physical therapy.  From that point on the focus continues to be on regaining your functional ability.

Now you may be wondering about people who take water classes at gyms as a way to stay in shape.  The rationale given above is strictly in the realm of physical therapy and how aquatic therapy is a part of that.  What type of exercise people do on their own, outside of physical therapy, is a different topic in and of itself.  Everyone is unique and their situation needs to be viewed as such.  So talk to your doctor and physical therapist.  They will be able to guide you in the right direction.  Perhaps aquatic therapy will be for you.  Perhaps it won’t.  But understanding the reasoning behind it will help you and your therapist arrive at a better decision.

My physical therapist says I need to have 2 to 3 treatments a week. Why?

Once you have been referred to a physical therapist, or you decide to see one on your own, the PT will perform an initial evaluation. At the end of this first session the therapist will most likely recommend that you set up some treatment times for the next several weeks, usually to the tune of 2 to 3 visits a week.  At this point an interesting dynamic happens…

If the patient is retired or is not working, whether that be a personal choice or due to an injury, and they have to pay little to no money out-of-pocket, it usually isn’t hard to get them to schedule for 3 visits a week.  However, if the patient has a busy schedule and/or a high co-pay,  co-insurance, or deductible, it can be a little harder to get them to schedule on a consistent basis.  We can usually get 2 visits a week on the books but it’s a little tougher to get a firm commitment.  Perhaps they will commit to 2 visits for 2 weeks but if they don’t see any improvement they may stop, as it’s costing them $30, $40, $50, or perhaps more each visit.  As much as we can beg and plead for more time to get the patient better, they just won’t commit to further treatment due to the high cost.  You know what?  I totally get it.

Once I think about it, if I had to pay a $40 co-pay, or even a $20 co-pay 2 to 3 times a week for a month or more, I would have second thoughts on whether I should follow through with treatment or not.  That money adds up fast!  If you’re like me, you hold on to your money tightly.  I worked hard to earn it and I’m not going to keep spending money on something that perhaps isn’t helping!  So what are we as therapists and you as a patient to do when we come upon this problem?  Is there a compromise?  I think it’s best to look at the reasoning each side has and then come to a mutual understanding somewhere in the middle.

From the physical therapist perspective, coming to treatment consistently 2 or 3 times a week is beneficial in several ways. Consistent, repeatable treatments allow for the body to build upon the gains that were achieved the previous treatment session.  Once we’ve started working on getting the healing process going on whatever your issue may be we want you to come back to treatment rather quickly, so we can continue to promote healing by gently increasing stresses to the tissue.  There are multiple research articles that concur that repeatable treatments helps to progress the healing process faster.  That is why people work out multiple days in the week.  They must continue to push their body so they can improve in their chosen activity.  Getting treated just once a week is like treading water, you’re not going anywhere fast.  By the time you come back to therapy any gains that you achieved last week will most likely be lost.  This prolongs the overall length of treatment and in the end could end up costing you more money.

On the patient side of things the two most common reasons I hear for not wanting to schedule multiple visits in a week is time and money.  Some people have very busy schedules with work, driving kids to after school activities, and various other appointments.  There is only so much time in a day, and trying to fit another appointment in, one that might cost money and cause some pain, usually isn’t a priority.  The aspect of cost unfortunately is quickly becoming a more serious issue as the economy continues to stagnate and insurances are covering less, requiring patients to pay more.  If cost is a concern to you, please let us know and we will do everything in our control to make it more manageable for you.  It is at this point where value comes in.  Do you see value in coming to physical therapy?  It is up to the physical therapist to show you the value of physical therapy and explain why it will be helpful to you.  I wrote about this in another blog post titled “Does physical therapy have value?”  Physical therapy is an inexact science.  Every injury does not follow an exact path towards recovery.  We can give you time frames on how long you can expect before you injury completely heals, but these are just estimates.  I’ve had plenty of patients with the same type of injury who heal up much quicker and much slower than expected.  We will do our best to give you the most accurate information we can so you can make the best decision.

After going over the results of my patients evaluation with them and educating them on various aspects of their condition, we get down to scheduling.  If they still have doubts or questions I tell them “Give me two weeks to convince you.”  Most people, regardless of scheduling or cost are willing to try therapy for two weeks.  Why two weeks?  Well, I tell my patients that they may or may not notice any changes in the first week of therapy.  Sometimes patients have more soreness and pain as we begin treatment.  Just like being sore after working out for the first time in a long time, the body takes a while to get used to all the attention the injured part is receiving.  Going in to the second week of treatment the initial soreness has usually worn off and improvements should start to show.  I don’t expect the patient to be completely healed in that time (though if they are that’s a bonus!) but they should at least begin to notice some type of change, whether it’s a decrease in pain, an increase in motion, or another indicator of improvement.  I think that is a reasonable expectation that both therapist and patient can agree on.  My thought is that if you are not noticing some type of improvement after two weeks something needs to change.  Maybe it’s a new treatment technique or change in the overall treatment plan.  Regardless something needs to happen.  The therapist should never be the reason you are treading water!  Usually it never comes to that because after two weeks the patient notices an improvement of some kind, making both of us happy!

I hope that clears it up a bit.  There is no perfect answer to this question, as there are so many factors involved.  But I will tell you this.  If a therapist demands you come 3 times a week for 4 weeks, ask them why.  If they can give you a good answer backed up with solid reasoning, and you are willing, then go for it.  If they say “because I said so” or something to that effect I would look elsewhere.  Your time and money are important.  Make sure you see a therapist that understands that and that wants to provide you with something of value.

Spokane Personal Injury | Facebook Is Evidence

Reblogged from Spokane Personal Injury:

Every lawyer recognizes that destroying evidence prior to trial is wrong and unethical. But what about destruction of a Facebook page prior to trial? Turns out, removing photographs or altering a Facebook page can result in the trial court issuing heavy sanctions.

In Lester v. Allied Concrete Co ., a wrongful death lawsuit pending in Virginia state court, lawyer Mathew Murray instructed his client to remove 15 photographs from his Facebook page.

Read more… 126 more words

I know this isn't physical therapy related but I thought it important for all to know. A lawyer friend of mine posted this on his blog. Makes you think twice about posting stuff on Facebook!

A look at the clinic.

I thought it would be fun to take some pictures of the clinic and post them here so you would be able to see what kind of facility we have.  I also want to add some descriptors about some of the equipment we use to give you a better idea of what we use it for.

This is the front desk and waiting area.  It will be just to your right as you come in the front door.

If you look straight ahead after coming in, you see the treatment area.

So now we will go around the room and I’ll describe each piece of equipment and some of the ways we use it.  As you walk into the treatment area and take a right, just around the corner you see in the picture above, you come across this hunk of metal.

It’s called a free motion and it is one of my favorite pieces of equipment.  Those arms you see can be positioned up, down, side to side, and any spot in between.  It’s great for working your stabilizers as well as well as almost any other body part you can think of. The blue half dome thing on the ground is a bosu ball.  Try standing on it while doing your exercises and we’ll see just how good your balance really is!  I like using these to challenge people’s balance and stability.  Hanging on the wall is a BAPs board.  It’s great for ankle strengthening and mobility.

Just down from the free motion machine is our treatment tables.  All three of them have hydraulic high/low capabilities, which really helps get you at the right height for what I need to do.  The closest two tables are brand new and can bend and move in all sorts of crazy ways.

Just to the left of these tables is the evaluation/mechanical traction room.  Your first visit will take place in here, as it affords us a little more privacy to talk and evaluate your condition.

The white box in the middle of the picture is the mechanical traction unit.  We hook the rope that is hanging from it to another device that we set you on to apply traction to either your low back or neck.  The table is made specifically for traction, as it will move with you when traction is applied.  It may sound a bit torturous but the vast majority of people we use traction on feel great!  We will talk extensively about the pros and cons of traction and any concerns you may have before I even would consider putting you on it.

Just outside of the evaluation room, along the back of the treatment room is our theraband table.  As you can see, we have a variety of choices, from very easy to hard.  The band comes in a roll and is easily cut to the desired length.  We sell it for a $1 per foot.   The black cylindrical thing to the left of the table is a foam roll.  This feels great on your middle back area, I use it a couple of times a week!  We have them for sale as well if you would like one.  The room on the other side of the window is our break room.

To the left of the theraband table is a simple and under rated piece of equipment, the calf stretcher!  Most of us have very tight calves and don’t even know it.  Tight calves can affect our gait and can actually cause pack pain.  I have most of my back patients stand on this for 5 minutes or more.  Though the first minute or two is somewhat painful they are surprised at how good they feel afterwords!  Plus they like trying to find the hidden objects in the picture that’s hanging from the wall. It helps keep your mind off the pain!

You are now looking at the wall opposite the treatment tables.  This equipment is used mainly for workman compensation patients as we try to get them back to work.  We can use the sled to mimic push/pull activities, with varying amounts of weight.  The boxes can have weights put in them to practice lifting.  The counter heights can be raised or lowered to practice placing objects at various levels.  All in all it’s a pretty handy work station.  There are usually plenty of grunting and groaning going on back here.

Next to the all the grunting and groaning is a much more calm piece of equipment.  Thera tubing, like the therabands, comes in different resistances.  At the ends of each tube is a handle.  We can attach the tubing to the silver vertical rack, allowing for resistance to be given at various angles.  This works great for gentle strengthening of stabilizers and multiple body parts.  I start a lot of patients on this who are unable to tolerate the free motion.  It is also a whole lot less intimidating.

Next we have another special piece of equipment, the treadmill with the unweighting system!  Like some of the other equipment, this can look a bit daunting at first.  Yet when used properly it’s hard for the patient not to smile in amazement.  Here’s how it works.  You stand on the treadmill and we put you in a vest.  Using the knobs on the left, we adjust the air pressure so the cord that is attached to the vest begins to pull upwards.  This partially “unweights” you, providing relief to your back, or anywhere in your leg, depending on effect we are looking for.  If you have a pinched nerve causing radiating pain down your leg, this might help relieve that.  If you have trouble walking due to a hip, knee, or ankle problem, this might unweight the joint enough to allow you to walk normally.  Movement is good for the joint, as it helps restore blood flow and helps with synovial fluid production.  And now we have a way to do it with less irritation!

Next to the treadmill we have a stationary bike, which I’m sure we are all familiar with, so I won’t belabor the point.  After that we have the upper body ergometer (UBE).   This is great for upper body range of motion and endurance training.  If you have an arm, upper back, or neck problem, you might be on this at some time during your treatment time.

After the UBE is one of my favorite machines, the NuStep.  As you see in the picture, you sit in the seat and then move your arms and legs in a reciprocal motion, like in walking.  What’s great about the NuStep is that this is done with your back, pelvis, and hips in a supported and partial weight-bearing position.  A lot of people who have pain in one of these areas are able to get on the NuStep and move with less pain.  The different ways we are able to adapt the machine with seat position, arm position, and resistance makes it very accommodating.

On the other side of the NuStep you’ll find a trampoline with medicine balls of various weights.  Patients throw the balls on the trampoline and catch them when they bounce back.  Shoulder patients use this, as well as patients who need more advanced work on their stability and balance.

Next we have the this behemoth of a machine, called Body Solid, or more commonly the universal.

Most of our patients probably won’t be using this.  I use this at the end of rehab for patients who have to return to manual labor jobs.  We can really ramp up the weight on this, putting good stresses through whatever area we are working on.  If you are able to work out on this, you’ll be able to handle whatever work throws at you.

In the middle of the treatment room we have a couple of other fun pieces of equipment.  This is the back system, and it is amazing at stretching out your back, shoulders, and legs.  It might be hard to imagine that by looking at the picture, but trust me, it works.

Next is one of my favorite machines.  It’s called the Shuttle.  Though you think it might just be for doing squats, it does so much more.

I really like putting some of my back patients on this.  As you can see, you lay on your back and put your feet up on the black vertical platform.  The headrest can move up or down depending on your height.  What’s so nice about this machine is how the resistance in applied.  Behind the foot platform there are up to eight bands that you can put tension through.

Laying on your back takes most of the load off of your spine and legs.  Then, with only very little tension applied, I have the patient push through their legs, like they are standing up.  Then they slowly come back down, stopping just before they hit the beginning point.  This is repeated over a period of time, usually 5-10 minutes.  This gentle up and down motion causes a subtle pumping motion to occur in your disc and vertebrae.  This helps with blood to flow to your back.  There is limited blood supply to your spine, and with injury and/or compression, that blood flow can become compromised.  The blood can pool in the veins that lie next to your vertebrae, called the venous plexus.  This pumping mechanism that occurs when on the shuttle helps to restore normal blood flow to the area with little to no irritation to the back.  Patients are surprised at how well they feel when they are done using this machine.  Of course we can use this to strengthen your quads and hips as well.

Behind the shuttle is Mr. Bones, along with some more odds and ends we use in the clinic.

Well, there you have it!  A tour of our Thunder Physical Therapy north.  If you have any questions or comments, please feel free to ask!  The examples I used in explaining how we use our equipment wasn’t exhaustive, nor do they work perfectly in every circumstance.  However, when used properly they are very beneficial in getting you back to life.

How reliable is imaging in diagnosing the problem?

All of us sooner or later will have a X-ray, MRI, or some other type of imaging done on a part of our body.  Being able to see an image of our body is of great help in getting an accurate diagnosis and treatment options.  However not all imaging is created equal.  And there have been times when the recorded image misses something important  They can also make conditions seem worse than what they really are.

It’s important to match imaging with your symptoms and history.  I’ve had patients who come in and tell me that they have 5 bulging discs in their lumbar spine and that they will never be able to work again because of all the bulges.  But when I see the patient walk into the clinic I don’t see them in any obvious signs of pain.  They can sit down and get back up with no issue.   They can bend down and tie their shoe or pick up their purse without thinking twice.  If they truly had 5 bulging discs in their lumbar spine (which is the entire lumbar spine) that were symptomatic, there would be no way that they would be getting around as they do.  This is an example where too much knowledge without an explanation can be a bad thing.

It’s a good chance that if you took a MRI of a random person off the street, they would probably have a bulging disc somewhere in their back, most likely in their thoracic spine.  But if you were to ask the person if their back bothered them they would say that they feel great and don’t have any back pain at all.  Disc herniation (I use this word interchangeably with bulge) are a fact of life.  Most of us have them and don’t even know it.  It is only when they are symptomatic that they become a problem.  People read the words “disc herniation” on their MRI report and fixate on that.  What is just as important is the word that comes before it: mild, moderate, or severe.  Can a mild disc bulge cause pain?  You bet.  I am not minimizing the seriousness of having a disc bulge.  But we must look at the entire clinical picture when trying to find the pain generators.

After further questioning, the patient I mentioned above who had the 5 disc bulges showed me exactly where their pain was.  After getting a detailed history and looking at the MRI together, several things came to light.  Yes, he had 5 bulges, 2 in his lumbar spine and 3 in his thoracic spine.  One of the bulges matched perfectly with his symptoms and pain distribution.   The other lumbar bulge was due to an old injury and was no longer an issue.  The 3 bulges in his thoracic spine were never symptomatic.

This is an area where I think physical therapists can really be of service not only to patients, but to other healthcare  practitioners as well.  The reason is simple: time.  Doctors see a lot of patients in a day.  This doesn’t allow for much in the way of detailed explanations and question and answer time.  Doctors do the best they can but given the constraints of their schedule there can still be unanswered questions.  At Thunder Physical Therapy the patient is in the clinic for an hour to an hour and a half.  The vast majority, if not all, of the time is spent with the therapist.  This allows for plenty of time for both the therapist and patient to ask questions and to come to a more accurate understanding of the patients symptoms.   As physical therapists we are one of the few healthcare professions who are given this much face time with a patient.  Rehabilitation takes time and we need to make sure we take advantage of it.  We have an opprotunity that not many other providers have.

And this issue isn’t just confined to the back.  I’ve had patients who have a shoulder MRI that shows a rotator cuff tear.  Yet they have full motion and little to no pain.  Do they need surgery?  The MRI says perhaps.  Reality says perhaps not.  The same is true of X-rays and other types of scan you may receive.  The take home message here is this: Yes, the imaging is important.  But don’t let that be the only tool used to diagnose your problem.  The imaging needs to be used in conjunction with your history and clinical presentation.  Once all the data has been gathered an accurate diagnosis can be made.  Then comes the fun part – fixing the problem!

A quick disclaimer.  The examples I’ve used above are relevent to physical therapy involve imaging of musculoskeletal conditions.  Scans of any other type are a whole other issue that I have little to no experience in and am not qualified to offer an opinion on.

Dealing with foot pain and other physical therapy thoughts

I attended a continuing education course this past weekend in Idaho on the foot and ankle.  The course was put on by the International Academy of Orthopedic Medicine (IAOM-US), which is the group that I have my manual therapy certification through.  I was excited to go to this course and learn some good manual therapy techniques to use on my foot patients.  There was also some personal motivation for me as well.  I was born with flat feet, very flat feet.

Growing up I went through several trials of wearing orthotics in my shoes.  They only made my feet hurt more.  I stopped wearing them as I became more active in sports.  However, the constant running, jumping, and twisting that I was daily putting my feet through began to take a toll.  By my senior year of high school I was chugging ibuprofen like candy and getting my ankles tapped, just to make it through practice.  A visit to the doctor came with the realization that I was going to have to make a major life choice: keeping playing all the sports I loved but yet were horrible for my feet and end up having foot surgery, or stop participating in any activity that caused my feet to hurt.  If I did that the thought would be that I would stop all the trauma in my feet and be pain-free.  Well, I chose option B.  Sort of.  As anyone who grew up playing sports would know, it’s hard giving up something you are passionate about and that feeds that competitive desire.  Soccer, football, basketball, racquetball, track, baseball, ultimate frisbee; I loved them all.  How do you give all that up overnight?

After high school it was relatively easy giving up the team sports, as it was harder to find organizations that provided them.  But all the sports you can play at the gym or with friends still called to me.  But I would pay the price.  I would come home at night and at times could barely walk.  But I just couldn’t stop playing sports.  They had been such an integral part of my life since I could remember.  That’s when I found cycling.  I’ve always like mountain biking but it was always more of a side thing.  But I found that I could ride hard, pushing the intensity as far as I wanted to and I didn’t have any foot pain.  In cycling your feet stay attached to the pedals, so no jumping, twisting, or pounding occur.  I was ecstatic!  I had found a sport that I could push myself as hard as I wanted to and I could still walk afterwards!  It was a life saver!  Now I’m really in to road cycling, getting my training geared up for the upcoming racing season with my Baddlands Cycling Team!

I tell you my story because I believe any injury or pain you feel, be it in your foot or shoulder, is unique to you alone.  I’ve tried a lot of different treatment options for my feet throughout my life, some work great, some don’t.  The techniques I learned at this foot and ankle course have actually freed up my feet a little bit, allowing for more movement in some of the joints.  Perhaps there is hope!  When you come see me at Thunder Physical Therapy my goal is to provide you with a unique treatment plan that specifically addresses your issue.  Even if another person comes in with the same issue you have, your treatment plan will be a different.  Sure there will be some cross over, but you may need certain treatments that the other person doesn’t, and vice versa.

How does all this relate to foot pain?  I’m not sure but it seemed to blend well as I was typing.  Just be assured that I will treat you as an individual with a unique issue that is yours alone.  And together we will get you back to living life how you want to.  And if you do have a foot problem, I just may have a new technique I can show you!

Does a diagnosis of Degenerative Disc Disease, or DDD, mean a lifetime of pain?

Back pain can manifest itself in many ways.  Some of the more common forms of back pain come from  muscle spasms, poor posture, disc injuries, and work related injuries.  A diagnosis that seems to cause some consternation is degenerative disc disease, or DDD.  People who receive this diagnosis that are otherwise very healthy start to stress a bit when they hear the word disease.  Some of the questions I’ve been asked include: “Is it contagious?” and  ”Is it going to kill me?”  These people are legitimately concerned with how their back pain will affect their life.  Others seem to use it as an excuse to get out of work.  They say, “I have a disease, there is no WAY I will be able to continue working!”  Not true.  With a little bit of education, a couple of exercises, and perhaps some slight work modifications, one should be able to work and play for many years with little to no back pain, regardless of a diagnosis of DDD.

I wish they didn’t label it a disease.  When I hear the word “disease” I think of sickness, cancer, the plague.  You get the picture.  As this word naturally conjures up images of death and suffering, it is easy to see how people get all worked up when the word is associated with their health.  In reality, degenerative disc disease is a natural process that occurs to the spine.  A better word would be aging.  Unfortunately aging spine doesn’t have the same ring too it.  As we age, our back starts to wear out, just like everything else. (Yikes that’s a gloomy thought!)  The degeneration that occurs in our vertebrae and discs is natural and unavoidable.  In general the discs become stiffer and smaller, the vertebral joints can become arthritic.  This can lead to increased stiffness and pain with normal activities.  Now, how much degeneration there is in your back is dependant on several things.  Lifestyle and occupation have the biggest effect on your back’s level of degeneration.  People who have heavy manual labor jobs and/or live an accident prone life tend to have much more degeneration than a person the same age who is active yet gentle on their back.  The back of a person with a very high level of disc degeneration due to lifestyle should  be given a different term: degradation.  A back like this is literally breaking down.  It has been stressed to the max and can no longer handle the strain of normal daily activities.  I prefer this term because it more accurately describes the issue going on.  In general terms, degeneration means your back is wearing out, but in a somewhat normal and predictable way.  Degradation means your back is shot.  There are real issues due to excess trauma and use that fall outside of normal wear and tear.  Excessive is  another good word to describe this type of back.

So, is there hope?  Of course!  One of the most important things to know about your back is what I call the do’s and don’ts.  This list of things you should and shouldn’t do will be unique to each individual given the type of back pain they have.  Learning about types of pain, what type is harmful to your body and what type is not, is of huge help in learning the do’s and don’ts.  Check out an earlier post of mine,  “No pain no gain! True or False?” for a more detailed look on types of pain.  Once we have established what type of activities are helpful and which are harmful it is a simple matter of application.  Establishing a daily routine of 10-15 minutes of exercises specific to your back condition is usually all it takes to slow down the degeneration process and allow you to be an active participant in life with little to no pain.  Of course there are the ones who don’t follow the norm, and that’s okay!  Those are the ones where I really have to think about, and I like that!  So, if you live in north Spokane, give me a call.  I’d be happy to help you start living life again!  Our clinic is called Thunder Physical Therapy, and our phone # is 509-465-5400.