Talk about consistency (or lack there of)

So the last post discussed consistency, that is, consistency of care and your home exercise program.  What I have currently lacked is consistency in updating our blog!  The summer has been a whirlwind of activity full of racing and training and, of course, working with all of our wonderful clients.

As the fall season approaches, many of our dedicated active folks are aiming for fall races or events.  Whether it be a marathon, 1/2 marathon, a triathlon or simply a 5K run or just getting back on the wagon of sorts to fitness and wellness, I am sure there will be a few clients walking through our doors in the coming weeks trying to iron out the last kinks. 

Over the years, I've had clients come to me to "fix" there nagging injuries or pains in the 11th hour.  They have come in saying, "Well I am doing the (fill in the fall running race) in a couple of weeks...". I subsequently begin to ask all the pertinent questions regarding their condition to ascertain whether they should grin and bare it or bag it.  As an endurance athlete myself, I understand the ins and outs of this argument.  I also have the luxury of knowing whether or not I will do permanent damage to my overall health in the future.  While most of the time these last minute "fix me" moments are nothing to worry about long term, the client goes on to complete their event without issue or minimal issues.  I always try to be realistic and optimistic of the possibility of completing the event the client is looking to do.  Certainly a re-evaluation of goals is needed.  Keep in mind, there are also conditions that simply won't just settle down (even with treatment) in 2 weeks before the big race.  Disheartening, as it may seem, especially if the event is a big thing in your life (first time, a qualifier event, etc.).  Nobody ever wants a DNF (did not finish) in the results that gets etched into internet stone.  It's a pride thing.  Toe the line and hope your body doesn't balk at the idea of pushing yourself to get through the event or DNS (did not start).  I have encountered this moment for a major race in my triathlon career and opted for the former over the latter.  I reassessed my goals and just made an experience of it knowing my results would not be reflective of my potential.  It also motivated me to get back to that race again to compete and not simply participate.  My disclaimer as a PT to a client: do as I say, don't do as I do.  Obviously, everyone has a choice but be aware of those consequences.   

Usually the lesson in all of this: come in sooner and preferably as the problem develops (say within 2 weeks of onset), rather than hoping (and perhaps praying) that it will go away on it's own without appropriate care.  If it hasn't gone away by 2 weeks, seek advice from a health care professional (ie live person) and be weary of the internet.  Admit it, we're all guilty of trying to self diagnosis our conditions/illnesses.  Take what you get off the internet with a grain of salt and not gospel.  Your condition may not be entirely that "textbook" case.

Consistency

As with most things we do in our lives if we want to do better or get better at something, it’s all about consistency.  Physical therapy is no different than those passions and interests which drive us to improve in those facets of our lives.  With consistency, one will improve.  Sounds simple.  Harder to execute. 

Consistency with physical therapy treatment is key to making improvements when recovering from injury or helping to improve/return to the quality of life that enables each of us to enjoy it.  The consistency in care and the consistency in performing exercises as prescribed are vital to a good long term outcome.  Many patients fall short in fully committing to themselves and the process of proper physical therapy care.  It is human nature these days to want to be fixed “yesterday.”  Unfortunately, our bodies don’t return to normal in a day or a week most of the time.  Physical therapy is a process.  For many, it may take months to return to full function.  For a few, it may only take a few weeks.  With the right attitude and commitment, you will and can get better.  A half-hearted commitment, only to discontinue care after a few weeks, will not yield the results that you may want.  There are no miracle cures as much as we would like to think there are.  You only have one body, it’s best to take care of it so you can enjoy the better things in life!

Rolling with it...

Self Massage

Why should I consider doing it?

Ok, what is self massage?

Consider it the poor man’s massage in self care to body maintenance especially if you are an active individual or recovering from injury or other soft tissue conditions contributing to your pain.  As physical therapists, we help guide our clients to actively participating with their PT treatment programs.  Soft tissue dysfunction can affect how we move and in some cases cause more harm than good. 

Without getting overly technical about the physiology of the soft tissue structures, the thing people need to know is that PAIN IS NOT NORMAL!  Pain is your body’s way of telling you something is wrong.  Seek professional help from a live person (like a physical therapist or an orthopedist) to determine if the problem area is more serious or if it can be managed with a little guidance and expertise from folks who see musculoskeletal conditions day in and day out.  The longer you wait to address the problem, the more chronic it becomes and the longer it takes to remedy as your body begins to accommodate a new normal which isn’t always a good thing.

 

The Tools
There are a multitude of specialty massage tools out on the market.  I have no affiliation with any of them, nor do I endorse any one particular tool.  I will not go into detail as to use of the tools here.  I am giving a basic overview of the more popular massage toys available.  I have tried many of them and recommended many of these tools based on economics and ease of use.  Clients usually want ease of use and ease of cost on the wallet. 

The simplest of tools…the almighty tennis ball.  Just firm enough, small enough and maneuverable enough to be used almost anywhere.  Great for first time users and easily found in the store.  They come in 3 packs which is great.  The busy traveling client can keep one at home, the office and one for travel.  For a localized massage like your upper back, neck, glute or your hamstring…the tennis ball fits the bill quite nicely. 

Tennis ball not firm enough?  Try a lacrosse ball.  It can do anything the tennis ball can do with less give.  Still not firm enough?  I’ve had clients go as far as using baseballs and softballs to perform this form of localized self massage as well. 

Next up, the foam roller.  There are a lot of choices in this department with varying firmness, colors, sizes, and prices.  There is the standard foam roller, the rumble roller (has little “knobby teeth”), and the TP trigger point roller (the original quad roller and the “grid” roller).  Most folks can tolerate the standard firm foam roller with a few tears and maybe a few grumbles of choice words, and it’s the most economical.  I would say about 90% of the clients I ask to invest in a foam roller for their self care activities will be swearing a lot when they first use it especially on their IT bands.  Rest assured with consistent use it will feel better.  Foam rollers come in a “short version” or the “full size” 3 foot version.  They can be used to roll on a multitude of body parts: front/side/back of the legs, your backside, and your back (upper and lower segments). 

For those needing something a bit deeper and firm, try the Rumble Roller or the TP trigger point products.  Great on the leg muscles and the back.  However do know that cost will go up with the fancier toys.  These tools are not for the novice users.  They provide a fairly firm platform to get an effective self massage.  They also travel well and fit into your luggage with minimal space usage.  If the foam roller is just not doing it for you, then your next best bet is to give these products a worthy try as they will “dig a little deeper.”

With the rollers, you do have to have some degree of upper body strength to maneuver on them and even a little bit of flexibility and coordination.  The majority of folks should have little difficulty as their limiter will be their upper body strength.

Another great tool that travels well (though be aware that it must be in your CHECKED luggage), is “The Stick.”  I have heard from clients that their “Sticks” have been confiscated by TSA since it exceeds the length restriction and is deemed a weapon.  I guess you could use it as a weapon but it’s made of plastic and I doubt that it would do that much damage.  Nonetheless, it is something to be aware of if owners plan to carry on their “Stick” TSA may take it.  So what is it?  “The Stick” is a kind of like a rolling pin except it is made of hard plastic rings on a “stick” with handles on either end.  You use your hands to roll the stick on yourself (legs mostly) and apply as much or as little pressure as you want.  I have found this tool to be great for travel (when packed appropriately) and used on the legs.  I prefer the rollers as I tend to be (self admittedly) get lazy trying to use my hands to roll it on myself.  With the rollers I use my own body weight to create the force necessary to “massage” myself.

So why mention these tools in the first place?  Let’s face it, if everyone had a bottomless bank account to get deep tissue work on a weekly or even daily basis, there would be a lot of busy sports massage folks earning a very nice living.  The reality is that most of us don’t have that type of disposable income.  BUT are these tools effective?  Yes, with consistent use to insure ideal body maintenance.  They do help with the flexibility and pliability of the muscle tissue as well as improved mobility of the connective tissue associated to help keep the tissue happy as we go about our daily grind.  Massage is great for improving blood flow and lymphatic flow to aid in flushing out our body’s waste products and bring in healthy nutrients to optimize recovery.  It also helps to physically break down any problem areas to normalize the tissue.  With that said, skilled hands are better, but self massage is better than nothing.  Happy rolling!

 

Oh my aching back!

Tis the season for shoveling snow.  One of the dreads of winter is the aftermath of all the serene white flakey stuff gracefully falling to a peaceful landscape of calm; you are left with cleaning up mother nature’s mess so as to resume some sense of normalcy in the days after.

Shoveling snow as we have all been warned is not something to be taken lightly.  Even for us “fit” folks, we get sore after moving and clearing the white stuff off our driveways, cars, front walks and steps.  It’s not an activity that ANY of us are accustomed to doing unless you actually perform manual labor for a living.  As much as I try to perform the correct maneuvers to shovel, I inevitably end up with a sore back for a couple of days afterwards.  I see my neighbors out shoveling and the bad form makes me cringe with each scoop of the shovel. 

With all that said, what are some ways to help minimize injuring ourselves while we dig out from Mother Nature’s fury?

·         Lift with your legs.  Time and time again this has been repeated.  Think of a squat, brace your abdominals to protect your back, bend the knees to scoop and then face the direction you will be placing the snow. 

·         NEVER twist and fling the snow.  This will almost guarantee you will probably hurt yourself in the long term.  This is how people ultimately herniate or bulge discs in their low back.  Bend over, twist and fling.  BIG NO-NO.

·         If the snow is heavy, scoop smaller loads.  Let’s face it, snow can get heavy if it’s wet and packed down.  Add that to the bend and twist; it’s a recipe for disaster.

·         If the forecast calls for A LOT of snow, try and go out more frequently.  2-3” of snow at a time is a lot easier to move than 6-8” in one go. 

·         In the aftermath, don’t wait too long to let the snow melt off.  It just gets heavier.  The sooner you get to it, the sooner your cleared areas melt off and dry with the sun shining (we hope).  If the forecast calls for continued sub-freezing temps, even more of an excuse to clear off the snow.  If it refreezes, now you’re dealing with ice, which is harder to clear out.

·         OR avoid it all together:

o   Put your kids to work or hire the neighbor’s kid.  Although, I would clear your own car first.  DO NOT take your shovel or a broom to the roof of your car if you at all care about damaging your vehicles paint.

o   Invest in a snow blower.

o   Move some place where it doesn’t snow (Hawaii sounds nice about now).

Shoveling snow can certainly be a chore and a nuisance if it does it a lot.  For those who already have preexisting low back issues (80% of the population has suffered from low back pain at some point or another), be extra cautious.  Shoveling is a strenuous and repetitive activity.  Most of us are unaccustomed to this type of activity and will most likely be sore to a certain degree.  If that soreness, lingers past 3-4 days after, you may have over done it.  If at 7 days, the pain persists and has not managed to go away, it may be best to seek out your friendly PT or orthopedic to get things checked out.  For more serious issues (and you’ll know), shooting pain into the legs or sharp pains to the low back which leaves you unable to move for days, get into the doctor ASAP.  They can prescribe medications that will help subside some of the symptoms, then get into see your PT for further management and resolution of symptoms.  Stay safe and keep warm…spring can’t come soon enough!

"Magic Tape"

We’ve all watched the Olympics on TV and I’m sure many of us saw a good number of those world class athletes with some elaborate tape job on their body. So, what’s the deal?

For those in the PT field or in athletic training rooms, we know this tape as “kinesiology tape.”  I have used this tape on myself for many issues I have developed over the years.  I have also used it on clients if it was deemed appropriate for the client and the condition.  What is it and what does it do?

Kinesiology tape is a non compressive, non restrictive taping method used by physical therapists and athletic trainers to compliment ongoing treatment of an injury.  Depending on the goal of its use on the body, it can be used to modify muscle tone or movement, provide feedback to the brain from the body, and /or improve blood/lymphatic flow while decreasing pain in order to facilitate healing.  It acts as a sort of second skin layer.  The elastic properties of the tape and its application provide the “magic.” 

There are also several brands of kinesiology tape out on the market.  They all have similar characteristics of the original kinesiology tape, but not all tapes are created equal.  I have tried many of the tapes out on the market.  The elastic properties are similar (but the weaves are different), the adhesives used are different, the quality of the materials are different and subsequently, their effectiveness will be different.   I tend to gravitate towards the higher end original tape.  The feel, the elasticity, the materials and adhesives are well made and not overly done.  It truly feels like second skin.  For my clients with possible adhesive allergies or sensitive skin, I would only use the original.  I would be weary that the adhesives of the other brands would be a little too aggressive in terms of “stickiness.”

As far as what the evidence says: recent studies have shown that the use of kinesiology taping methods used in conjunction with manual therapy techniques (the very same techniques we use for our clients) are beneficial in reducing pain and returning clients to their activities sooner than exercise alone.  There are a number of studies that have shown the benefits of manual therapy techniques and exercise over exercise alone.  However, as with many things, there are limitations to these studies such as the limited number of subjects utilized and the intertester consistency (the PT).  These studies at least provide a basis for adding “tools to the toolbox” when it comes to treating a client/patient effectively.  There is no “cook book” recipe for how to treat any one person.  Each person will respond in their own way to treatment.  It is up to the PT to determine whether one tool or method is better than another to yield the desired results.  Be aware that not everyone is necessarily a candidate for kinesiology tape.

We have utilized an array of hands on techniques to help our clients.  We also have used kinesiology taping, athletic taping and lesser known to consumers, McConnell Taping techniques to assist not only us as PTs but to help clients return to activity.  Anecdotally, a good number of clients respond well to kinesiology taping.  Technique and knowledge of the body, as with most things, is key in determining its effectiveness.  I personally have used the tape on myself for a few minor soft tissue “injuries”.  Whether it was placebo, or physiological or both, the tape did the trick to allow me to continue training/racing. 

Did you do your homework?

AKA did you do your home exercise program?

This is a question I ask clients constantly.  The prescribed exercises are absolutely critical in terms of making meaningful improvements and empowering clients to take ownership of their injury or condition.  The clients that follow through with their home exercises are more likely to have better outcomes and resume the activities they have been limited from.  Clients that sporadically or fail to comply with the exercise program will find their progress slow which can lead to frustration.  The home exercises are not only given to supplement what is done in clinic, but to allow the client to take control of their condition and understand how to manage it.  I like to think of my relationship with my clients as a team rather than a supervisor and a subordinate.  I will do my part to help manage your condition, while you do your part to reach the common goal (pain free and return to doing whatever you want/need to be doing activity-wise).  Please DO YOUR EXERCISES!  Otherwise, we (your PTs) have to turn into your nagging mother every time you come in for treatment and we have to give you that look.  The more compliant you are with your homework, the better the prognosis and overall outcome.

Another common question I am asked regarding home exercise programs, “how long do I have to do my home exercises for after I stop seeing you?”  The short answer: forever.  The funniest answer I ever heard, “Everyday until the week before you die.”    Ok, just a little PT humor.  In all seriousness, I advise clients to continue with their home exercise program and incorporate them into their gym activities if they go to the gym.  For those that don’t, then yes, you need to do your exercises several times a week.  Think of it as maintenance.  If the exercises have become WAY TOO easy then I recommend following up with the PT to have revisions made to the program as you may have “outgrown” your existing program.  Yours truly even makes sure to do my strength and flexibility exercises for my now resolved injuries.  For me, I DO NOT ever want to have to experience those pains again if I can help it. 

If you need a transitional gym/medical exercise program, we can help you with that.  After all, we know your body best after having the opportunity to work on you and with you to get you moving again.  If you need help with progressing your prescribed exercises once you have left us, then we can help you do that too.  Think of this as preventative or proactive medicine.  Your body is a living machine, it needs preventative maintenance to insure everything is in working order.  Failure to keep the maintenance up, then something is bound to “break" and when it does, don't wait get it checked out!

It’s a new year which means RESOLUTIONS!!!!

As everyone recovers from the holidays and we start a new year, most folks will make resolutions or goals to accomplish in the new year.  Usually they revolve around, fitness and wellness goals.  Hopefully, amongst those goals is one to “fix” any body parts that aren’t moving too well so that you can successfully achieve the bigger fitness and wellness goals that you have set for yourself.  You only have one body and it’s best to take care of it.

So, before you run off to the gym to get back into shape and work off any holiday guilt, do you have any lingering injuries or nagging pains that are still bothering you that you should probably address FIRST?  It is time to RESOLVE those aches and pains and get to the heart of what is really going on.  If the pain hasn’t gone away past its initial stages, then you have entered the chronic stage (which can be defined as anything past 3 weeks or so).  This is the stage where you have probably begun to compensate your movement patterns, avoided the provoking activities, and gone into the “hoping it’ll get better” mentality.  The only problem…it hasn’t gone away and you’ve let it go for months!  Enter your PT and your doctor.  They are a wealth of knowledge when it comes to figuring out what is going on with your body.  The internet is not.  It can be, BUT self diagnosing can be dangerous.  It may lead you to thinking you have one pathology when you really have something else.  It can also prolong the process of healing and receiving the correct treatment for the condition.  Physical therapists and orthopedic doctors have YEARS of training and education to understand what is going on with your body, and how to treat it appropriately.  The last thing you want to do is overanalyze or become a hypochondriac thinking you have a catastrophic injury when it may simply be a tendonitis OR you think you have something minor like a tendonitis and it’s really a significant tear or something else.  We all have to face it sometimes, that the nagging pain that hasn’t gone away needs more than just what you may have self educated and treated based on what the internet said or someone “who once had a pain similar to that once.”  Save yourself the grief and get in to see your PT or ortho sooner rather than later.  The longer you wait, the longer it’ll take to correct.  Even PTs and doctors have to give in and get treated by colleagues sometimes. 

Happy 2015 and here's to a renewed healthier and happier you!!