Complaining about your doctor running behind

I read a blog that is written by physicians.   There is a lot of really good information on this site KevinMD    One of the more recent guest posts was about physicians running behind for their appointments.   It is a great read and something that everyone should take into consideration when they go to see their physician.

You can read the article here.
http://www.kevinmd.com/blog/2011/10/doctor-time-care.html

Meet our new physical therapist

Scott Ringle PT, DPT


Scott is our new physical therapist.  He graduated from Ohio Northern University in 2006 with a Bachelor of Science degree in Biology while having a minor in Psychology with a pre-physical therapy emphasis. He worked two years as a rehab technician in Kenton before returning to graduate school. While in graduate school he continued to work part-time in this position. Scott graduated from the University of Findlay in 2011 with a Doctorate of Physical Therapy degree. He has completed clinical rotations in a variety of settings including acute care, neurological rehabilitation, as well as outpatient orthopedics. Scott has worked with a wide range of patients in regards to age (adolescent through geriatric) and condition (sports injury, post-stroke, back pain, post-surgery, and many others). He has special interest in the areas of sports injuries, orthopedic surgery, and spine care.  Scott is focused on delivering evidence based care in order to provide each patient with optimal outcomes including injury prevention, improved mobility and motion, reduction in pain, and overall restoration of function.


Welcome Scott, we are so happy to have you here.  

Really, your kid is having back pain?

I just finished reading a few posts about kids and back pain.   Jeff Cubos writes that children should not have back pain.  He gives 3 reason why he thinks kids have back pain now.  Facebooking, skinny jeans and inactivity.  No surprises here.

Facebooking or sitting at computer, video game, or watching TV:

Prolonged sitting is one of the most deleterious activities most people engage in. After only 3 minutes of full flexion of the spine ligamentous creep or laxity occurs which persists even after 30 minutes of rest!

What this means is, after sitting for 3 minutes the ligaments that support the spine continue to stretch.   This is why bending over to pick something up after sitting leads to low back pain.   Also, watch how your kids sit with the big hunchback of their upper spine and their head forward.   (C posture)   If you look from the side they look like a C.  How do you think they spend most of their day?  Sitting in classes, standing hunched over, head down walking and texting, playing video games, and sitting at a computer.  They spend most of their day in this position. This is the posture we typically associate with being old.   Remind your kids that is what they look like now.   Take a picture of them and show them how they look.  What do you think it will look like in 5, 10, 20 years?

Skinny Jeans or baggy jeans that are too low:
Why does this affect back pain?

Typically, when a client compensates we see a dysfunction at the joint either below or above the joint that is painful (remember, a symptom is nothing more than a presentation of a problem. It tells us something is wrong but it does not tell us what is wrong)….When one presents with low-back pain…an evaluation of the hip (for both strength deficits and mobility restrictions) should also be performed.”

If the hips cannot move, something has to compensate for that lack of movement, usually that is the spine.  This is why with so many of our low back patients we look at the hip and work on moving and strengthening the hips as much as we work on the spine itself.

Inactivity:
This really is self explanatory, but Jeff chalks it up like this:

For one reason or another, kids just don’t move these days. Maybe its because of “facebooking” or maybe its because their jeans are so tight, but for whatever reason, kids are inactive. Can’t blame school. School has been around for a long time. But after school? If you’re child is complaining to you of low back pain, simply take a picture of them while they tell you it hurts. More often than not their speaking to you in this position:

Make it a point to get your kids active.   Even better, go out and get active with them.

Back to School

Well, it is that time of year again.   The school year is starting.   It seems like wonderful time for parents as they get the house back again.   The kids are not quite so happy, as they have to return to school.  As you return your children to school they will be looking to get a nice new back pack.   Make sure not to overload them.  Improper backpack use can cause injury, especially to children with young, growing muscles and joints. A study found that 55 percent of the children surveyed carried backpack loads heavier than 15 percent of their body weight,the maximum safe weight for children recommended by most experts.  Mke sure they use both of the shoulder straps

Recommendations from the American Physical Therapy Association include:

Wear both straps. Using only one strap, even with backpacks that have one strap that runs across the body, causes one shoulder to bear the weight of the bag. By wearing both shoulder straps, the weight of the pack is better distributed, and a symmetrical posture is promoted. A backpack that has padded, contoured shoulder straps will also help reduce pressure on the chest and shoulders.

Make sure the backpack fits. It is important to pay close attention to the way a backpack is positioned on the back, and the size of the backpack should match the size of the child. Shoulder straps should fit comfortably on the shoulder and under the arms, so that the arms can move freely. The bottom of the pack should rest in the contour of the lower back. The pack should "sit" evenly in the middle of the back, not "sag down" toward the buttocks.

I hope everyone has an enjoyable and safe return to school this year.  

Gardening in the near future?

Well, with all the rain we have had, I'm not sure many people have been able to get their gardens started.  It seems like it has rained everyday since April 1.  (I did read that it rained 25 of 30 days in April).  Anyway, if you are anxious to get started with your gardening, remember that all this rain may take its toll on you.  By not properly warming up and being ready to peform gardening activities, you may injure yourself if you are not ready.  Here are a few tips I wrote a few years ago.  Always good to refer back to these.

Warm Up: You wouldn't play sports or work out without warming up, so it makes sense to warm up before doing something as physical as gardening. A quick walk and some gentle stretching can work wonders before hunkering down to the flower bed.

Change Position Frequently: Prolonged static positions can be damaging. When doing a lengthy task, change positions frequently. If you're working close to the ground, as in weeding, you can sit, kneel, half-kneel, and get on all fours. Vary your position to give your back a break.

Shift Tasks or Take Breaks: Rotate through your tasks so you're not doing any one thing for too long. Weed for 10 minutes then switch to raking, then to clipping, then back to weeding, etc. If you've only got one job to do, then just make sure you take a stretch break and/or change position every 10-15 minutes.

Use Good Body Mechanics: Always make sure to avoid bending in your back, especially when lifting. Keep your back straight, tighten your abdominal muscles, and bend at the hips and knees. Don't lift too much at once. Break large loads up into several smaller loads. Use a smaller spade when digging. And move your feet to avoid unnecessary twisting in your back.

Use Ergonomic Tools: Lighter-weight tools ease the load on your back, and tools that allow you to stand instead of bend over are back savers as well. A quick search can find websites that sell ergonomic gardening tools, like Gardeners.com.

Happy Gardening

Early Physical therapy for back pain. Yes it really helps!!!!

Well, not that I needed more literature to bring to you about PT and back pain, but here is another article that supports early physical therapy for back pain really helps.
This was a thesis project that was completed in Sweden, so the terms may be a little different, but the results speak loudly.   Her thesis was written to look at immediate treatment by a physiotherapist (PT) with or without referral from a physician compared to being on a waiting list for 4 weeks. 

"We saw that both groups improved after the treatment ended. The group that had been given early access to an examination and individualised treatment maintained their improvement after six months, while the group that had been held on a waiting list were more likely to suffer with recurring back pain," says Nordeman, who draws the conclusion that early examination and treatment by a physiotherapist as soon as a patient asks for care could be important for reducing low back pain in the long term.

Early treatment for low back pain is important as this can help alleviate pain sooner and for a longer duration of time.   Low back pain affects 80% or more of the population.  Many time low back pain is recurrent and this typically stems from multiple injuries to the same area.  

Even though this was a thesis study, the results are similar to what physical therapists have been saying for a long time.   Back pain is a common problem in society.  Check with us to see if you need to see your physician prior to coming to therapy.   Ohio law does not require a prescription to be evaluated by a physical therapist, but your insurance company may.  Let us check for you.  See a physical therapist to help with your back pain!

Golf Fitness Update

So over a month ago (more like 2 months ago), I started working harder on my golf fitness.   I have been placing my emphasis on improving hip motion, middle back motion and improving my hip rotation strength, core strength and shoulder blade or scapular strength.   I was able to finally get to the golf course last week, hitting balls on Sunday at the range, and playing 9 holes on Thursday.    Needless to say, I need to work on my short game!!!!   I actually felt pretty good on the course.   My emphasis on posture has improved the consistency of my swing and ball contact.   I notice no real change in distance, but accuracy has improved.   I also had no back pain after playing. 
The golf swing is a dynamic human movement.   Repeated golf swings can take it toll on the body.   Most golf injuries in the professional golfer come from overuse.   Most injuries for the rest of us are in the form of poor mechanics.  Body mechanics, swing mechanics and no regular customized exercise program are three of the biggest causes of injuries.  
Poor body mechanics includes hip limitations, mostly rotation, thoracic or middle back rotation and extension limitation, poor core stability, and shoulder motion limitations.  
There are 3 components  that are necessary to have an improved golf swing. 
1.  Strength, and specifically core strength is necessary to keep your body from having extra movements during the golf swing and maintain spine angle during the swing.  If you lack core strength, you will have difficulty with consistent contact.  This would include early extension, sway and slide.  
2.  Flexibility is important for the golf swing.  Soft tissue restrictions in your hips, spine and shoulders can alter the swing plane immeasurably. If you are unable to rotate properly on the back swing or the follow-through, your body will compensate for the loss somewhere else, causing stress and strain on joints that cannot handle those loads. 
3.  Balance, is directly related to deficiencies in both stability and mobility. Poor strength and/or flexiblity, will affect weight shift, which may cause golfers to fall forward or rock back on their heels. This leads to poor position of the club head at impact and you spray the ball all over the course. 

All of these components can be addressed in physical therapy.    This entire chain can be affected because of poor mobility or stability in certain areas.   How can physical therapy can help?   Physical therapy will help find the different areas at fault.  Then, starting a treatment program to address these areas will help improve you golf swing mechanics.   Better mechanics means a more consistent swing.   A more consistent swing, means better direction and more greens hit.  Then, work on your short game and putting to improve your scores.   (I cannot help you with that)   As a matter of fact, that's what I need to work on myself.  Golf pro, here I come!  Here's to lots of fairways and greens!!

It's time to start. Are you ready?

Well, I'll be honest.   I have been lazy, Lazy for awhile now.    I blame it on not golfing.  Since I have not been on the golf course in months, (since September) my workout routine disappeared probably about as quickly as my golf game disappeared.   After the warm weather over the weekend, I realized, golf season is coming quickly.  Hopefully, within the next 4-6 weeks.   (yes I'm optomistic that by late March, I will be playing a few holes working into rounds of golf by early to mid April.)  Anyway, I have found that with lack of workout routine, my strength and flexibility has disappeared.  I have to start getting back in the swing (sorry couldn't resist) of some sort of exercise routine.  In previous years, I have been doing core performance exercises.   They are great for strength, stability and flexibility of the spine and hips.   I found that I was hitting the ball further and was without pain when I was done walking 18 holes.  But, like most exercise routines, I get bored, and am looking for something new.   Luckily, I found something else to work on at TPI (Titleist Perfromance Institute).  Exercises very specific for golf, with some video, and tips to help.  There are specific exercises for mobility, stability, posture, balance, strength, cardio-vascular, and power.   Knowing where my specific problems are with golfing, (poor starting posture, flexibility, poor transition balance), it gives me some options to start working on the weaknesses of my golf game. 
The other nice part about TPI is they offer different levels of certification to become an instructor for them.  Level 1 is basic, and Level 2 more advanced.   I am considering going to the basic course, but it will not be until later in the year (August or September), so I will not be much help to teach the TPI program now, but can still help with other strength and flexibility issues that you may have now.  I am planning on bringing TPI to our clinic next winter. 
I will keep you informed how my routine works.  For now, I need to get motivated to get started.   I plan on doing that tonite. 
   

Back pain, 2011

This was posted on Health Beat by Maggie Mahar.   I liked it so much I took the post and have added some comments of my own. 

Dr. Nortin Hadler, author of Worried Sick: A Prescription for Health in an Overtreated America and , more recently, Stabbed in the Back: Confronting Back Pain in an Overtreated Society. I admire both books because they are so well-written and richly referenced..

Hadler is Professor of Medicine and Microbiology/Immunology at the University of North Carolina at Chapel Hill and Attending Rheumatologist at the University of North Carolina Hospitals.
His commentary on “The Predicament of Backache” is adapted from, Stabbed in the Back. It puts my posts on spinal surgery in a larger context, illustrating how “cutting” is not always a cure for life’s problems


The text starts off with some basics on back pain that therapists hear on a regular basis.

To live a year without a backache is abnormal. Here, I am speaking of the commonest form of low back pain: the backache that bedevils working-age adults who are otherwise totally well. This is a pain that does not involve the legs, and that comes on suddenly, seemingly without cause.

Low back pain is one of many recurring predicaments of life, like heartburn and heartache. To be well is not to be spared. To be well is to have the wherewithal to cope till the pain goes away, cope so well that the episode is not even memorable.

I have commented recently on the importance of posture, strength, and mobility and how it affects our everyday movement.  Our bodies will naturally adapt to the outside forces around it, to be able to continue to function.  After awhile, sometimes it does not matter, it just hurts. 

Low back pain relates to posture and movement. It hurts less recumbent. It hurts more slouched forward in a chair or propped up on pillows, let alone bending over. One is forced to choose between less pain and less invalidity. Compelling science says less pain is not worth it. Feeling useless just enhances the suffering without enhancing the rate of healing. Take an over-the-counter analgesic and get on with life as best you can.

I have mentioned previously that there are many people out there that will promise pain relief if you buy into their system.  Back pain typically does not start from a specific event, it is a combination of many events over time that eventually catch up with us. 

Low back pain will go away, but seldom overnight. Weeks are more like it, and months for a few. One should never despair. Nor should one feel so desperate that one grasps at straws. And there are many offering straws, many who would gird your loins, empty your pockets, push pull and poke you, offer you potions and pills, and attempt to excise the evil.

This response to back pain serves as an object lesson. We live in a time when science seems to be bursting with promise. Details of the very latest for diagnosis and treatment find their way into the headlines of print media and the features of broadcast media. We are told to expect cures. All of us respond with baited breath, some with speculative investing. Yet if we give way to the promise of cure, we risk compromising our sense of well being, our belief that we can cope. We succumb to what some call the medicalization of life, brought to us by an industry dedicated to the proposition that none of us are well.

I believe that physical therapists are better at coming up with dysfunctions that lead to back pain, better than any other health care professional.  That is my own opinion, and do not have any research to support that.   However, I do agree with the next comment, that there is no one specific "modality" that can decrease your pain.   It is a matter of finding the dysfunctions, and addressing them.   This is why PT's are the best qualified to treat back pain.  It is typically a multitude of dysfunctions that casue back pain. 

Realize that despite all the jargon, there is no one who can reliably pin point the cause of the common backache. Realize that despite all their theories and all you hear on the street, no one has a “modality” they can apply to you that can be shown to benefit you. All these helpful people are engulfing you and your pain in their frame of reference, in their belief system. You will no longer suffer alone. But your narrative of illness will change, as will your self-image, permanently. Despite these ministrations, you will not return to your prior state of well-being any more rapidly. If you return at all, you will greet any recurrence of the back pain with idioms that were taught to you. If all this is a pleasing prospect, go for it. But do so informed.

I really enjoy this final paragraph.   There is quite a bit of research that shows job satisfaction is a key indicator for return to work after a back injury.  A person's overall satisfaction with life at home will also contribute to their ability to cope with back pain and return to life.  I have learned recently that we continue to make destructive decisions, not because we like to, but because we do get something out of it.  Until you determine what you are getting out of your decisions, you will have trouble improving your coping, and therefore trouble treating back pain. 

Granted, for some of us, coping becomes impossible. Certainly, that could reflect the severity of the pain. But science informs us that another explanation is far more likely. It is not the pain, but other aspects of life that blunt our coping skills. Leading the list of confounders are adverse aspects of life at home or at work. If you can not cope any longer, find someone trustworthy to discuss the possibility that the pain is surrogate for some assault on your coping skills. In all likelihood, you coped with similar predicaments in the past. If you are unwilling to countenance the possibility that something in life is more a pain than the pain in the back, you run the risk of feeling so desperate that you submit to pills, potions, magical thinking or ineffective surgery before you come to grips with your psychosocial adversity. Surgery can not excise an intolerable job, nor can an intolerable home situation yield to manual therapy. Don’t let the pain cloud your thinking. Don’t let preconceived notions lead you astray.

Take care of your back, but understand when you do have pain, we will be there.   Sometimes to listen, sometimes to advise, and  when needed to treat. 

"Never underestimate the ability of spine surgery to make your back pain worse. . ."

Yes, I stole that from another PT.   But it rings so true.   The great therapists at Evidence in Motion continue to help get the word out to Physical Therapists and the public that back pain is best treated by. . . . . (I know your going to be surprised)  A PHYSICAL THERAPIST.  A recent post talks about the increasing rates of spinal fusion for management of low back pain.

I have also frequently commented on this blog (see here and here) about the outrageous nature of spine surgery, particularly lumbar fusion in managing low back pain.  Typically I use data to make my point.  Unfortunately I believe we have become immune to big numbers and what those number mean in terms of human suffering.  The numbers do not convey the darnage that is happening to real people day in and day out. 

There is mounting evidence that having surgery for back pain leads to poor outcomes.  This is not meant to bash spine surgeons.   This is meant to inform that there are other options to having surgery, especially fusion, for your back pain.   Back pain is multi faceted.   Back pain does not just 'go away' with fusion.   There was a reason you had pain prior to surgery, and without making changes to your lifestyle, chances are your back pain will be unchanged.  Lifestyle choices, like so many other health problems can be a big factor in back pain.  (Smoking, overweight, no exercise)  But, how can I exercise or lose weight if I have all this back pain.   Well, that is the reason you need to seek out the help of your physical therapist.   I really can't help you quit smoking, but can help point you in the right direction.  Assessment of your flexibility, strength, movement patterns, and making changes to improve the areas that are deficient  are waht PT's do on a daily basis.  I have typically found most of my patients have weakness that affects their ability to support the spine.  They have poor flexiblity that creates poor movement patterns.  By improving the flexilbity and stability of the spine, force can be spread throughout the body, and decrease pain.   Its  is really wonderful hearing from patients how much better their back pain is with the start of exercise and strength program. 

Are you ready to start working on your back pain?   It probably won't get better overnight.   I do not have a magic wand.   I do have the tools to help you manage your pain and help provide long term relief.  Get started, see a physical therapist for you back pain. 

1000 Awesome Things about Physical Therapy

The great therapists at Evidence In Motion (EIM) are taking the idea by Neil Pasricha who authors a blog entitled 1000 Awesome Things into the Physical Therapy profession.  A list of 1000 Awesome Things about Physical Therapy is currently being developed.  These are ideas submitted by physical therapists from patients to be posted about the Awesome things Physical Therapy does for them.   Just to get you started, here are the first 6 that have been posted, There are sometimes little stories or comments that go with these.

1.  Walking Again, Sleeping comfortably
2.  Friendly, Caring place to be
3.  Realizing surgery and medication are not the only option
4.  Walking down the aisle

         "Awesome thing about PT, I was invited to a 75 year wedding anniversary. His goal was to be      able to walk down the aisle to renew their vows. He met his goal."

5.  Not complaining about pain all day
6.  Actually listening. 

"Thank you for being the first person in the

health care system to actually listen to me."

  I am so happy as a PT I get to be involved in so much of people's lives.   I hear about their families, work, and everyday life, and am so blessed to be a part of it.  I occassionaly need to remind myself when I get to explaining a treatment plan or therapy diagnosis that 'nobody cares how much you know, until they know how much you care'.   I hope I have listened well over the years.   Can you tell me something awesome about physical therapy that I can add to the list?  Let me know. 
 



Snow is falling, dont get hurt shoveling

As I sit here answering the phone about patients cancel their appointments because of the falling snow, I was thinking about shoveling all the snow. We have about 2-3 inches of snow right now, and the roads are getting slippery. But it makes me think about injuries that can happen from shoveling snow.
Some tips to try to avoid getting hurt.

* Lift smaller loads of snow, rather than heavy shovelfuls. Bend your knees and lift with your legs rather than with your back.

* Using a shovel that's too long makes the weight at the end heavier.

* Try to use a shovel with a handle that lets you keep your back straight while lifting. A short handle will cause you to bend more to lift the load.

* Avoid twisting as much as possible. The spine does not tolerate twisting movements well. Step in the direction in which you are throwing the snow to prevent the low back from twisting.

* Take frequent breaks when shoveling. Stand up straight and walk around periodically to move your spine out of the forward bent posture.

* Standing backward-bending exercises will help reverse the excessive forward bending that occurs while shoveling: stand straight and tall, place your hands toward the back of your hips, and bend backward slightly for several seconds.

* Take care not to over exert yourself. Take your time to shovel the snow. The cold weather can affect you, and if you are out of shape, can hurt yourself more.

*Last but not least, find a friend with a snowblower. This alsways make the shoveling much easier.

With proper precautions and the correct snow shoveling technique, injuries to the shoulders and lower back can often be avoided. If you or someone you know has back pain, consult a licensed physical therapist. Physical therapists are experts in restoring and improving motion in people's lives. They can treat pain without surgery, in many cases, and reduce the need for prescription medications, help patients avoid side effects.

Enjoy the snow. Stop by and see me if you do hurt your back.