It's all worth it...

Clients sometimes ask “Do you like being a physical therapist?”  in which I reply, “Yes.”

My colleagues and I have worked with thousands of people from all walks of life and varying injuries.  In the time we spend with our clients, a few sessions to a few months or longer, the provider/client relationship is formed.  A lot of times we know you and your body better than your doctor does.  In time, the client must continue their path to wellness on their own.  Each of us often wonders where some clients have gone and how they have been doing.  It’s like visiting your old teachers from school.  In fact, I actually have kept in touch with one of mine from grade school.  In a recent conversation with her, she told me that she often wonders whatever became of her former students.  Each group of students she gets to know over the school year treating them like they were her own.  She certainly has seen me grow up and followed my path to adulthood with great pride. 

Every once in a while, a client drops me a note.  Usually the note tells me how they are doing and what they have done since graduating from physical therapy.  Sometimes we’ve gotten notes from the least likely of clients but nonetheless, the message inside these notes is well received with a smile.  I’ve had many a warm and fuzzy moments from these updates knowing what my clients had to go through to get to where they are today.  This same feeling is had by my grade school teacher from special connections made with former students who made the effort to keep in touch. 

Even the little successes during treatment sessions or even post PT gives me that excited moment for my clients watching them accomplish something they probably didn’t think they would ever do again.  In some ways, it’s like a momma bird watching their little one spread their wings and they take flight.  It is these instances that make my career worth it.

In the spirit of Thanksgiving, I’m thankful for all these moments.  I’m thankful for the opportunity to help someone who would benefit from my skills and empowering them to reach the next level.  I’m thankful for the trust and loyalty my clients place in me and my colleagues.  I’m thankful for the warm and fuzzy moments I get to share and experience in my career working with my clients.    I’m thankful for the many relationships that have been forged. I’m thankful for the lessons in personal and career growth.  Finally, I’m thankful for my friends, family and my health.  Despite all the little negative bits that life throws at us, it’s all worth it.

From the CMPT family to yours…Happy Thanksgiving!!

It sounds worse than it really is...

Often times, I have clients that get x rays or MRIs performed for further diagnostics on their conditions.  Usually, they get the results of the scans before they actually see their doctor for a follow up to go over the results to decide the best treatment approach.  When this happens, clients read the report with all the big medical words glaring at them and the next thing you know the client begins to think the worst of their condition.  They do frantic internet searches and read stories.  The worry sets in.  STOP!!! 

I have had to bring clients down from the ledge when I sense they are stressing over what all those big medical words are saying.  First, the films only give us a glimpse into what is CURRENTLY going on.  There is no timeline for how long said body part has looked the way it looks.  Unless you have had a series of films of the same body part over the years (which very few of us have had, I hope), it is difficult to determine if what the film is showing is the PRIMARY issue causing the condition.    Can it be a contributor?  Yes.  100% the cause?  Not so fast.  If you’re young and healthy, and it’s a recent traumatic injury, then certainly whatever is wrong, that is most likely the cause.  Secondly, there are many people out in the world that may have similar looking films, but be completely asymptomatic.  For example, a herniated disc or a disc bulge in someone’s low back, one person could be in complete agony while their age matched counterpart is happily going about their daily routine without issue.  It seems unfair, but what triggered your back to get angry?  What was the one thing that “broke the camel’s back”?  Third, each person has a unique set of psychosocial contributors which may aid or hinder a person’s recovery.  We are all individuals with different stresses, activities, jobs, ways of coping, lifestyles…to name a few.   Sometimes just knowing that there is something “wrong” can exacerbate the symptoms since now that is all you are thinking about. 

The lesson here, DO NOT freak out thinking the worst with the film reports.  Either wait for your doctor to interpret those findings or have your physical therapist read it over and translate for you.  PTs are capable of understanding all the medical jargon in the report.  How else do you think we can decipher what the doctors are saying?  Often times, all those big words make it sound worse than it really is.  There are few times where the outcome is completely unexpected and unfortunately we must be strong to confront the issue.  In these cases, it doesn’t hurt to get a few opinions on the matter. 

Running...mechanics and form matter

UPDATED from 2014: My work revolves around biomechanics and how it influences our musculoskeletal system.  I did not come from a running background.  I played ball sports and splashed in a pool (swimmer) as a youth.  Running would seem like it would be part of human nature.  For some yes, I think most of us less so.  From my own personal experiment of tweaking my running mechanics, addressing my own imbalances (muscular), and adopting a different training method, I can say that despite my training load for Ironman races, I have happily staved off the dreaded injury bug through most of them (12 in the last 9 years as of 2017). 

In my own assessment, I was a subtle heel striker and an upright runner.  This meant I was “riding the brakes” as I was running and “muscling” through my run, instead of allowing gravity to assist me in my forward propulsion and having my foot land under my center of gravity versus in front of it.  There was never a run of more than 10 miles where I felt like I wasn’t hit by a truck the next day.  The recovery would take days.  In my search of ideal running form, I happened upon an opportunity to attend a running clinic by one of the many “running gurus”.  After having skimmed over many of the “gurus” out there, they are all pretty much aiming to achieve the same type of form (a midfoot strike) just approaching it slightly differently.  I began to apply this “technique” in my runs and with time and a lot of patience to alter my neuromuscular patterning, it started to pay off.  I felt better after runs (even the long ones of more than 10 miles) with little or no leg soreness just fatigue.  I was running faster and best of all, I was not experiencing any of my previous “injuries” that I had dealt with before.  This all took place BEFORE I changed my training methods.  This was not a short term process.  It took a ton of repetition and focus to make the changes, but for me, it was TOTALLY worth it.  To this day, I still go through my mental form awareness checklist (this is something I made up for myself).

These are the same techniques I use with my running clients who quite often come to me with the typical running injuries (anterior knee pain, IT band syndrome, plantarfasciitis, “shin splints”).  That’s why you see a PT…to have them fix what you broke or , at least, help point you in the right direction.  I am a firm believer that it isn’t WHAT you do that hurts you, it is HOW you do it. The majority of the injured runners I have seen are heel strikers to varying degrees and usually run for fitness or recreationally.  They also typically have a muscle imbalances (many of us do) that need to be addressed.  Once the pain is managed and they have implemented the appropriate strength and flexibility exercises, only then do I reintroduce running activities to them.  I have encouraged many of them to make changes to their form so as to minimize their risk of injury with great success.  Many of them find that it feels “easier”.  And soon enough they go about running injury free. 

Some clients swore off running because their knees hurt, I had them play with their running form.  Their old ways had their knees hurting within a mile.  Trying out the tweaks had them running pain free immediately.  I advised them that they had to keep working at it (the form) so their body “reprogrammed” itself to run in this “biomechanically” efficient manner.   

For those that have been told, running is bad for your knees, that’s a bad rumor.  There is nothing in the literature that DIRECTLY correlates running to “wearing” your knees out sooner or causing osteoarthritis.  I won’t go into details about this now.  I will just reiterate what I said earlier, it’s not WHAT you do that hurts you, it’s HOW you do it. 

On the flip side, I’ve seen some top end runners and their form at first glance seems to be unorthodox relative to their elite counterparts.  If they haven’t had injuries, then certainly don’t change what works.  The old adage of “if it ain’t broke, don’t fix it.” 

Of course some of you maybe thinking well what about the shoes?  That’s a topic for another day, so stay tuned!

That darn IT band...

I would say the one time an injury has stopped me in my tracks (training and almost racing) was my last bout with IT band syndrome.  I was preparing for my first 70.3 World Championships triathlon.  About a month out from the race on one of my long training runs, I started to feel that dreaded sore, achiness rearing its ugly head on the outside of my Lt. knee.  Like most athletes, you keep running and assess as you go along the run (otherwise, it’s a LONG walk home).  I knew what this pain was from the other two times I had experienced it (separate bouts on each knee).  About 2.5 miles from home, the pain grew to be too much, and the thoughts of the race entered my mind.  I came up lame.  I run/walked the last bit to make it back home.  It was bad.  The outside of my knee was so sore having pushed it and I limped into the office later that day.  

Wait, the PT isn’t supposed to be limping around at the office, but I was.  I rested it (little to no running in the 4 weeks prior to the big race), and did all the things I knew to do to hopefully be able to run on race day.  I continued swimming and cycling during this time.  I wasn't worried about my fitness going into the race.  Finally, race day came (you don’t pass on the opportunity to race at world championships) and in the back of my mind I had no idea how my leg would react.  The swim and bike went great, 4 miles into the half marathon run, not so good.  The dreaded soreness reared its ugly head and my run was relegated to 9+ miles of walking/run-hobble.  Frustrating to say the least.

The off season would start and it was time to get healthy (injury free).  I continued treating myself and weeks later I was able to get back to running.  Even then I started to dive deeper into what am I doing mechanically while I’m running that is causing this to repeatedly happen?  With some research under my belt, I started to change my running form into something that would be not only more efficient, but mechanically sound.  I’m a physical therapist.  My life revolves around biomechanics it all made sense to me.  My athlete side just wanted to be able to run again and improve.  Since I made those changes in my running form, I have had few injuries and more importantly no more IT band problems.  To this day, I still do the things to help reduce my risk of developing IT band syndrome: strength exercises, stretching (even I’m guilty of not doing this regularly), foam rolling (same with this one), and being very aware of my running form.  This was only the beginning of training and racing smarter, not harder. 

Therapist heal thy self...

As an extremely active person, I often get asked by clients if I get aches and pains.  Of course I do.  Out of our practice, I am the resident endurance athlete in the house.  My colleagues claim to live vicariously through my athletic endeavors, or they think I am just crazy for what I do for “fun.”  As a competitive long/ultra distance triathlete for the last 10+ years, I have had my fair share of injuries, aches, pains and frustrations.  I have also managed a fair share of sports injuries growing up.  This is not meant to imply that I was clumsy or injury prone, stuff happens. 

Thankfully with the right training methods (training smarter, not harder-very important as an aging athlete) and the right coach (takes the stress away from writing up a season’s worth of training so I can focus on more important things like helping my clients), I have been able to stay relatively injury free for the last 6 years.  So what happens if something hurts?  I try to find the source of WHY something hurts.  For me, it could be technique, bike fit, muscle imbalances, to name a few.  Once I have figured out the cause of my annoyance (rarely have these “injuries” prevented me from racing or training), then all is well. 

With triathlon, my injuries are typical of the runner, and cyclist, but not so much swimming.  From ankle sprains (at least a half dozen on each ankle), ankle fracture, hamstring tendonitis, hamstring strain, hip flexor issues, sciatica, low back achiness, calf strain, peroneal tendonitis, epicondylitis (from weight training), turf toe, possible stress fractures in my foot, IT band syndrome (3 bouts)…not necessarily an exhaustive list, but these were a good number of conditions that I managed to get through during my early triathlon years.  My last 5-6 years in triathlon, I have had very few, if any, injuries.  WHY?  Between therapist heal thy self, and adopting a different training method, I have been able to keep my body moving and racing with minimal loss of performance.  In fact, I am finding that as I am getting older, I’ve actually been pulling off faster times (on some of the same courses).  I guess it also helps that I’m a PT.  My background knowledge gives me insight into what is going on with the body at a much more intimate level than most others.  I actually apply many of the same treatment methods to myself as I would to clients with similar conditions that is assuming I can reasonably access my body region.  If I am unable to work on myself, then I recruit the help of one of my esteemed colleagues for a helping hand (pun intended). 

In future posts, I will highlight some of the injuries I’ve had the “pleasure” of dealing with first hand.