Moving When It Hurts

Over the past 13 years and 25,000 Physical Therapy sessions, I have treated many patients who are afraid to move through pain. Let's consider the patient with chronic pain who has had pain for more than five years related to a work injury or a car accident. There is no question that they are experiencing pain, and in some cases they have severe pain. But some individuals get into the habit of fearing pain and therefore fearing any movement that causes pain. These people sometimes stop moving altogether. 

Have you met people who are sedentary all day? They can't work because they are disabled or retired or any other reason, and they literally can't, won't or don't do anything. They sit down or lie down all day. They only leave the house for doctor visits. They don't go out for leisure or social time or hobbies or anything at all. 

I encouraged a patient today to just start walking, even if it is for a few minutes at a time. Of course, she voiced concern that it makes her back hurt. So I explained that a walking program is not going to make her back worse overall. She will not gain more damage to her spine by walking, but she will cause more damage by the overall lack of movement of her spine. 

To clarify, this is not referring to patients with a brand new back injury or current flare-up. Most of you know someone who has "thrown his/her back out." In that situation, there may be a few days or weeks in which he/she can barely walk and cannot stand up straight. I would not tell that patient to start a walking program today. 

However, if someone you know has chronic pain but has stopped moving for many months or years, he/she likely needs physical activity. If you are not sure where to start or what movements are safe, come see your local Physical Therapist!

Proactive Companies Increase Employee Engagement

Have you ever felt the difference between customer service at Chick-Fil-A and Burger King? Have you ever felt the difference between grocery shopping at Publix versus Wal-Mart? Have you felt the difference between buying Christmas decorations at Hobby Lobby versus Family Dollar? What about Moe's versus Taco Bell? Or Disneyland versus the Sate Fair? I would propose that the better customer experience is at an organization that is proactive in its approach to managing, hiring, training, and supporting its employees. 

When I want to take my kids out for dinner, the most family-friendly fast food joint is Chick-Fil-A. There is a play house for the kids, the food is fresh and tasty, and they treat you like a million bucks. Whenever I tell people I shop at Publix, they say, "I love shopping at Publix!" Publix is known for its exceptional customer service, AKA "where shopping is a pleasure." The employees at these organizations appear to actually enjoy working there. They may be faking it, but to the customer, it counts and they feel better shopping where they are proactively helped, served, and greeted with a smile and positive attitude. 

Would you choose to work for an employer if you knew its average employee only stayed for three months? Or would you prefer to work for an organization in which employees stay for ten or twenty years? 

It takes more initial effort and cost to run an organization that cares about its employees. But the payoff is higher employee satisfaction, employee retention, and employee engagement. This yields better customer service and greater productivity. Isn't that the reason you have employees--to be productive and to serve customers? The more productive you are and the happier your customers are, the faster your customer base increases.

One way to be proactive from the top of your organization is to invest in injury prevention for your staff. I have never taught a group of employees that did not enjoy being trained on how to prevent work injuries. It is a win-win for the employer, the employee, and the customer. #PainTalks #WorkInjuryPrevention #ThinkLikeaPT

Www.PainTalks.org

Shoulder Pain responds to Neck Exercise

An old friend recently told me about her Physical Therapy for a Rotator Cuff Repair. She stated she had received 35 Physical Therapist visits, and her co-pay for each visit was $40. Her total cost out of pocket was $1,400.  She was compliant with all of her home exercise program, but she never gained back her full range of motion for her operated shoulder. She reported being diagnosed with frozen shoulder several months after surgery, during the process of receiving Physical Therapy since she was still quite stiff in her shoulder. Finally, she was discharged from rehab because her surgeon and Physical Therapist did not seen any further rehab potential.

As a McKenzie MDT practicing Physical Therapist, of course the first thing I did was assess her neck. I established baselines, which showed her right shoulder flexion (forward elevation) was 60%. She was lacking the ability to reach overhead. She reported having neck fusion surgery several years ago for disk problems in her lower neck. I showed her how to do neck retractions as an exercise, and she did 3 sets of 10 neck retractions in sitting. Then she stood up and we re-checked her baseline, which was active flexion of the right shoulder. Her new range of motion for right shoulder flexion was 90%.

To clarify, her ability to raise her arm overhead improved from 60% to 90% within two minutes of doing a neck exercise. Her next words were: "You helped me more in a few minutes than 35 visits of regular Physical Therapy!"

McKenzie MDT (Mechanical Diagnosis & Therapy) is a method of assessing spine and joint disorders in order to determine the source of symptoms and the mechanical (movement) solution. It is not uncommon for shoulder, arm, or hand pain to be originating from pinched nerves in the neck. Similarly, pinched nerves in the low back often cause leg symptoms in the high, thigh, knee, lower leg, foot, or toes.

#PainTalks  #PTfirst

How Pain Talks contributes to a successful business

1. Leadership: Pain Talks helps you to develop a plan for decreasing overhead costs associated with work injuries.

2. Culture: Pain Talks promotes a culture of safety.

3. Processes: Pain Talks helps to develop processes customized to keep work injuries at a minimum, which keeps your worker's comp insurance rates low.

4. Goals: Pain Talks helps with your financial and growth goals by lowering your healthcare and insurance costs.

5. Employee Development: Pain Talks teaches your employees proper ergonomics, postures, and body mechanics so they stay productive.

6. Passion: Pain Talks keeps your staff healthy so they can continue to work with passion for your company.

7. Effective Management: Pain Talks helps your management to be proactive in the costly area of healthcare.

8. Organization Moving in Same Direction: Safety is one of the foundations of a successful business. It is an undercurrent below your day to day activities.

9. Minimal Employee Turnover: Pain Talks improves employee engagement. "Engaged employees are 46% more productive" (Psychology Today).


"Successful businesses and teams include: Leadership. Culture. Processes. Goals. Employee Development. Passion. Effective Management. Organization moving in the same direction. Not having a lot of employee turnover." (Tyler Robertson).

A More Efficient and Cost-Effective Form of Healthcare

Soft tissue injuries and musculoskeletal disorders are most effectively treated by a Physical Therapist. So why does it take so long to get patients to Physical Therapy to receive treatment? Most patients see multiple physicians and receive multiple other treatments before even receiving an order for Physical Therapy, but in the end they eventually are referred to P.T. because the other treatments are not fixing the source of the pain.

There is a better way!--Physical Therapy first (#PTfirst)! The military has seen the value in this concept, so if a current soldier in the US Army starts to have knee pain, he sees the Physical Therapist (P.T.) first. The P.T. does an assessment and decides if he needs Physical Therapy, imaging, medication, or a referral to a specialist. If he needs therapy and gets better with P.T., then no other referrals, treatments or MD visits are required. It was the most efficient and cost-effective form of healthcare because it was assessed first by the most appropriate medical professional.

Some large corporations have learned the value of Physical Therapy first for their employees and dependents. Michelin is a perfect example, and they are setting the standard for optimal healthcare for treatment of soft tissue injuries. Michelin contracts Physical Therapists to be on-site for prevention of work injuries and for rapid assessment and treatment of musculoskeletal disorders. Healthcare costs are sliced by utilizing Physical Therapy first. Reach out to me at www.PainTalks.org to find out more!

Training for a Long Run

Photo: National Library of Ireland. 

My sister recently called me, asking: "Am I just too old to run 12 miles?" She is in her early forties, and she exercises daily for at least an hour. She is in excellent shape, and her heart and lungs can more than handle a 12-mile run. So why did she call me?--because she tried running 12 miles on concrete without having trained, and now her knees and feet hurt. Every summer, she vacations at the same beach, and every year she walks or jogs the same 12-mile stretch from the condo to town and back. Last year, she jogged this path, and she came back with knee and foot pain, so she decided it must be her tennis shoes that need replacing, but she never told me about this problem.

A year later, she ran the same route with her newer sneakers, but again she hurt herself, so that is when she called me. What was my advice? "You are not too old to run that far; you just need to train for it!" It would be like training for a half-marathon, which is 13.1 miles.


How Physically Fit Individuals Should Train for a Long Run:
(For someone who exercises regularly and is in good health)
1. Start a walking program on the type of surface you are training for (sidewalk, trails, road, beach, treadmill, track, etc).
2. Increase your walking program progressively until you can walk briskly for 45-60 plus minutes.
3. Start a walk-jog training program. Walk a few minutes, then jog a few minutes, and continue repeating. At first, walk more than you jog.
4. Progress to more jogging than walking.
5. Progress to all jogging.
6. Increase your jogging distance and/or speed.
7. Steadily increase your distance by a little more each week until you reach the desired distance.

Additional tips while Training for a Long Run:
1. Incorporate some cross-training into your weekly exercise routine, so try cycling or Zumba or swimming or any other exercise you enjoy.
2. Add some strength training, especially for your lower body large muscle groups.
3. Do not push through injuries, but if you start to feel pain, back off a little on your training and do exercises that are pain-free.
4. Warm up for at least five minutes before jogging.
5. Stretch after your warmup and after your jog.
6. Do long runs only once per week and shorter runs during the week.
7. It is not necessary to run every day, but it becomes addicting! So your body will tell you that you have to run that day. If you want to run almost every day, decrease your pace, distance, or run on an easier surface such as grass.
8. Change your shoes every 300 miles or as soon as you feel more support is needed.
9. Interval train. On some days, run sprints or faster paces for brief bouts of time.
10. Add plyometrics training to your exercise routine. Do plyometrics exercises once or twice per week. Do these after your warmup but toward the beginning of your workouts.
11. Do back extension exercises regularly. This will help your spine to stay healthy and aligned and will decrease the risk of pinched nerves in your back.

Postures and Low Back Muscle Strain

Photo by Larkery

One cause of low back muscle strain is having an unhealthy spine through habitual poor posture. If you sit all day in a slumped position, your low back is loaded into a forward or flexed position, and the muscles of your back are continually stretched. As a result, you may be more likely to strain a back muscle from light tasks such as loading/unloading the dishwasher. 

Not only does slouching affect your back muscles, but it causes your disks to bulge backwards. The more pressure from bad posture, the more likely your disks cannot realign properly. This leads to pinched nerves, which shoot pain or other symptoms down your leg(s), such as sciatica. 

On the other hand, those with a healthy spine (through repetitively good posture and exercise) may tolerate light tasks but strain their backs when doing more strenuous work such as moving furniture. It is important that both individuals practice good posture and body mechanics in order to avoid straining the low back during routine daily tasks, and especially during difficult physical activities.