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31
Jul

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30
Jul

Contract-Relax

This is a technique they taught us in PT school for stretching muscles and it works, I used it all the time. I used it on orthopedic injuries. I saw regular muscles that had tears and pops and strains and stuff. I never used this on a spastic muscle and have no idea if it would be helpful. You don’t see a lot of spasticity in orthopedics. In 4 years of practice I saw zero. I also have no spasticity so I’ve never had to deal with it myself. I would guess that this technique would do nothing at first in spastic muscles but maybe it would be helpful after a few years when the spasticity has calmed down somewhat? Again I have no idea – that’s an educated guess. But here is the technique……. So when stretching out a muscle – let’s use the hamstrings as an example, everyone has tight hamstrings. Ok so, BEFORE the stretch you have the patient purposely contract the muscle then ask the patient to relax. Doing this “tricks” the muscle into relaxing fully when maybe it wouldn’t have before. So I used to do this all the time, especially on people who had trouble relaxing. For the hamstring example here’s what I would do….. When a PT stretches out hamstrings it looks weird. The PT will get between the patients’ legs – again, weird- place the foot on their shoulder and ask the patient to try to straighten out the leg as much as possible then stretch. Stretching the hamstrings means taking the foot in the direction of the head until some tension in the muscle is felt. I would say to the patient “push your foot down on my shoulder but keep your leg straight.” This contracts the hamstrings at the hip joint. Then I would say “ok relax” and go into the stretch again. It works,it was effective. Again, no idea if it will help spastic muscles.

29
Jul

Foot Pain

I’ve given out this exercise 3 times recently to people who asked me about pain in their foot.   Two of those people have confirmed that it fixed the pain, I’m awaiting feedback from the 3rd person.  So I thought I should put it on my blog for all the world to see.  Here’s the exercise……..

http://jessephysio.wordpress.com/2013/04/17/quick-tips-on-how-to-improve-ankle-dorsiflexion/

Ignore the person on the floor and the mobilization band wrapped around the heel.  Get a chair and do this movement.  Bend your knee up on the chair and lean forward.  If there’s a pinching sensation at the front of the ankle, that’s ok, you actually kinda want that.  Try to lean into it a little bit, then back off and do it again at least 10 times every 2 hours.  That pinching should go away in time as should the pain in your foot.  Not examining/evaluating your foot makes giving out this exercise kinda risky BUT I’ve seen it help a lot of people.  So disclaimer: don’t do this.  If pain gets worse, stop.

28
Jul

Strength

Recently I realized the enormity of what I have done.  I was not 2 years out from a massive stroke (3 of them), which completely depleted me of all strength and energy, but somehow I mustered up the strength to leave my terrible relationship that everyone who didn’t know the truth thought was so great.  And I didn’t leave to go live with another guy or live with my parents, I’m living alone.  This, despite multiple people in my OWN support system telling me that I shouldn’t leave.  Jesus, I guess you can’t knock me down, although someone certainly tried with the strokes.

26
Jul

Sacroiliac(SI) Dysfunction

Ok, the SI joint…… The SI joint is the joint that connects the top/back of the hip, the ilium, and the last part of the spine, the sacral spine.  So there are 2 sacroilac joints.  In PT school, we were taught all kinds of ways to determine if these joints weren’t matching up properly.  So when the right ilium is rotated too far forward for example, the right leg might be longer causing a leg length discrepancy.  When someone has back pain, it’s common to look for problems with the sacroiliac joint.  But when I became certified in Mechanical Diagnosis and Therapy, I learned differently.  The Mckenzie people said that sacroiliac pain is usually some kind of referred pain from the spine, that it’s rare to have an actual SI dysfunction.  I tend to agree with that.  I think most pain is spinal related.  However, I had one patient who had ankylosing spondylitis and there is no question that his SI joints were causing him pain and shifting position.  It’s really common in patients with this condition, and pregnant women.  Pregnancy causes all of your ligaments to become a little lax so the ligaments connecting the sacrum to the ilia are looser than they should be causing shifting of the bones.  So watch out for this Vicki and Elizabeth.  🙂  If you think your SI joint is causing problems, there are all kinds of muscle energy techniques that you can do.  Then the goal is to keep the thighs parallel.  So no crossing your legs, no W sitting, no sitting indian style(is saying indian style still PC to use?)  I hope that’s not offensive.  So whatever one thigh is doing, the other thigh should do the same thing.  After a stroke, I can see this being a problem.  I myself never had this problem but after a stroke your muscles don’t work well causing the bones to do weird things which might stretch out the ligaments.

23
Jul

McKenzie

I spent the first 4 years(and the only 4 years) of my career as a physical therapist becoming certified in this technique.  After I became certified, 6 months later I had a stroke.  Regardless of the MAGNITUDE of stuff I’ve learned in the last 2.5 years since my stroke, I still think that this is the best way to treat back/neck pain and should be the go-to form of treatment initially for cases of back/neck pain, especially acute cases.  HOWEVER, and this is something I’ve learned in the last few years – Mechanical Diagnosis is not the be all and end all form of treatment for the spine.  There is a whole crapload of other stuff that SHOULD be done.  If mechanical treatment is not yielding the results you want, try something else.  And sometimes other things should be tried quickly, not after weeks of failed McKenzie exercises.  Anyway, the founder of the McKenzie method, Robin McKenzie, died a few months ago.  This makes me sad.  😦  RIP Robin.  Robin’s #1 piece of advice was about having proper posture.  No matter how the back and neck are being treated, posture should be thoroughly addressed.

23
Jul

Blog

It may seem like I put a lot of work into this blog, but I don’t.  These blog posts kinda write themselves, appear in my head, then I transfer them from my brain to the computer.  I guess the blog post writing area of my brain was not affected by the stroke. Anyway, it’s almost as if something else is writing through me, I’ve never experienced anything like this, it’s weird.  Is this how you writers feel?

21
Jul

Prognosis

There was a search term on my stats page that said “prognosis after cerebellar stroke.”  Ehhhhh……. There really is no prognosis.  If you didn’t die, great good for you!  Welcome to the club, now the fun begins!!  I remember in the first few months after my stroke I was obsessed with searching on the Internet for stuff about cerebellar or posterior stroke recovery.  That was still when I didn’t know that I didn’t know ANYTHING about recovering from a stroke.  There is no prognosis after a stroke, doctors especially can’t give you a prognosis.  They can’t tell you what you’re going to recover – don’t listen to them.  Trust me, don’t.  Your prognosis is directly proportionate to how much time you put into getting better.  Read this.

21
Jul

Boys

Boys are stupid.  Why are you so stupid boys?

19
Jul

A Therapist’s Job

Rebecca wrote a blog post in response to one of mine, so I’m writing another blog post in response to her response.  I talked about patients not doing their prescribed exercises at home, which is called non-compliance in the therapy world.  I commented on her blog post this…..”It’s all about wanting to feel better and taking personal responsibility for your health.  And sometimes that involves hard work that isn’t much fun and that you don’t want to do.”  She replied something about a therapists job being to make the exercise more meaningful to the patient or something.  I highly disagree with that.  That is soooo not a therapist’s job.  A therapist’s job is to tell you what to do in order to make you feel better.  Then it’s up to you to do it.  It’s about taking personal responsibility for your health.  A therapist’s responsibility is not to modify an exercise to make it more fun and meaningful.  Modifying an exercise is PART of a therapist’s job when necessary, but it’s not our main job at all.  And modifying a functional activity is a totally different thing.  It is our job to provide a thorough explanation of why these exercises are being prescribed then again, it’s up to each individual patient to decide for themselves if the prescribed exercises will be helpful and up to each individual patient to do them at home.  If you’re not thoroughly explaining the exercises and making the patient understand why they’re meaningful, THEN you have not done your job.  If I’ve learned anything from this experience, it’s that if I want to get better, it’s up to ME.  I have to take responsibility for myself and do the hard work even and especially when it sucks.

19
Jul

Abs

Everyone wants 6-pack abs.  Having keg abs is much more common though, unfortunately.  Because of all of the breath work  that I do and focus on the diaphragm and getting it stronger – oh my God it’s a good workout for the abs.  The abdomen is in constant use.  It whittles away fat from your waistline.  As a physical therapist, I would have told you 3 years ago that you can’t spot reduce.  And I still think that’s true for all other areas of the body except for the waistline.  I’ve done it.  I’ve spot reduced in an area that almost everyone wants smaller.  Not you Vicki, I think you want your waist to get bigger right now.  🙂  You learn a hell of a lot when you get sick and you have no other choice.  As for sit-ups and crunches – protect the spine.  To do this, don’t do regular sit-ups, ever.  That’s really bad for your back.  You know that machine at the gym that’s for your abs where you sit and bend forward against resistance?  This.  DON’T DO THAT THING!!!!!  Do crunches and these stabilization exercisesThese exercises are weird and require a blood pressure cuff but I love them and used to use them all the time .  And do these things.  If you have an exercise ball, try these, some of this page is in a different language and it made me laugh.  Try to keep the back straight.

17
Jul

Weather

Last time I put up a Grumpy Cat picture I was grumpy about it not being sunny in Pittsburgh.  Well, the sun came.  Oh did it come.  Now it’s hot as H-E-double hockey sticks here and the humidity hits you like a brick wall when you walk outside.  And there was thunder today, but no rain!  What the?????  Make up your mind Pittsburgh weather!  Oh I forgot, when it comes to weather, Pittsburgh has multiple personality disorder.

This picture made me LOL and it suits me well.  🙂

b13

17
Jul

Ankle Pumps

Ankle pumps just means lifting your foot up and down.  I used to tell patients that were going to be flying on a plane, along with getting up every once in a while and walking, to do a whole bunch of ankle pumps.  This is to help prevent a blood clot from forming by using the muscles which in turn makes the veins work better and manually pumps the blood.  When you are sedentary for a long time the blood can pool and form a clot.  And when on a plane something about the altitude makes it easier for blood clots to form.  Now, I had a blood clot which I had absolutely no indication was there and it went to my brain and caused a massive stroke at the age of 30.  Shit happens.

16
Jul

Scapular Winging

This is so not a neuro thing, but I found myself doing it today in my neuro OT.  So you’ll want to pay attention to this.  The scapula is the shoulder-blade.  Do you ever feel like your shoulder-blade pops out a little too much?  I feel that way all the time.  That’s what PTs call scapular winging.  Press against a wall like the lady is doing in this picture and if your shoulder-blade sticks way out that’s scapular winging.  The muscle that controls this is called the serratus anterior.  So in order to stop your scapula from winging get this muscle strong by doing ceiling punches, push-up plus, and this thing.  And get your rotator cuff strong.  The reason my scapula winged out during OT is because I was concentrating so hard on what I was doing with hands I was paying no attention whatsoever to my backside.  When I kinda scanned my body I realized that my shoulder-blade was popped out so I guess I have a weak serratus anterior.

15
Jul

The Lumbar Spine

I know a lot about the lumbar spine, the low back.  I think there’s no question I couldn’t answer about the spine, especially the lumbar spine.  There are 5 lumbar vertebrae.  When looked at from the side the lumbar spine is concave.  This is called lordosis.  If your low back doesn’t go in a little bit, you’ll probably have some low back pain.  Mine doesn’t.  My low back is what is called a “flat back” and has no curve to it.  HOWEVER, I’m obsessive about my posture so that keeps the back pain away.  Also, if your spine is really inflexible you’ll probably have pain.  A healthy spine is a flexible spine.  The way that I used to treat back pain seems really weird to most people, but it’s insanely effective.  I used to make all of my patients with low back pain read this book.  POSTURE!!!!  I just wanted to say posture.