Got a minute?

Here is a link to a news release about a study showing that sitting docs have happier patients.  The simple act of sitting in a patient room instead of standing in the doorway gave the patients the perception that the doctor spent more time with them and increased the patient's satisfaction score of the doctor.  The interesting thing was that the sitting doctors actually spent less time than the standing doctors.  A patient"s perception is the reality that us in health care need to remember.

It reminded me of information I had learned from a lecture by Peter R. Kovacek, MSA, PT.  He talked about the importance of being a productive therapist with your patients and to not let distractions interfere with your treatment (like phone calls, staff, or other patients).  When comparing the productive therapist to a lesser productive therapist in his studies it showed that the productive therapist would spend less time with the patient, but the patient perceived that they spent more time them.  While the converse was true for the lesser productive therapist who was more apt to let distractions interrupt the patient treatment time, the therapist spent more time with the patient, but the patient perceived that the therapist spent less time with them.

In today's busy health care environment it often seems like there is not enough time to spend with our patients that we want too.  We often feel rushed and let distractions get in our way.  But if we take a minute and sit down to truly listen to the patient and what their story is and manage our environment to limit distractions, we might find that we can spend less time with the patient, while giving the patient more of what they need.  Sounds a lot like a "Win-Win" to me.

So if we remember the primary things a patient wants during the initial visit:

1. What is wrong with me?
2. How long will it take to get better?
3. What can I, the patient, do?
4. What can you, the physical therapist, do for me?

If we sit down and answer that info for them, we are often starting down a path that is centered on the patient which will help lead to a positive outcome for the patient.

Share any stories of when you noticed a health care provider "sat and gave you a minute" or when the opposite happened and they "stood and gave you a second".  Offer ways that you make sure you "sit and give the patient what they need".

Too many options to change?

I just got done with an excellent book – Switch: How to Change Things When Change Is Hard. It is about how to help you create change things when change is hard.  One point that I thought was interesting and very true is that often when it comes to change we don’t give enough detail to help others with change.   We give vague answers to the questions others have and nonspecific direction to take when it comes to helping them get through the emotional and cognitive changes needed to make the change.   Let me give an example that is probably all too common in health care.  A person sees their doctor and it is finally at that point – borderline high blood pressure, beginning signs of diabetes and cholesterol is too high.   So what happens, usually they are given a blood pressure pill and cholesterol lowering medicine and told they need to eat healthier and start exercising.   I’m sure the first two are specifically given in a prescribed dose with recommendations on type of medicine to take.  The second two are left very vague.  The person probably takes the medicine as prescribed exactly and hopefully tries to exercise and eat better.  But the eating better and exercise probably go by the wayside after awhile.

Does exercise and eating right not get followed up on because people don’t want to do them, or because they don’t know what to do?  The book Switch detailed an interesting study:  There was a jelly stand in a supermarket.  One stand had 6 jams to pick from, the other 24.  People bought more from the jam display with 6 items compared to the stand with 24 items.  There were too many choices with the 24 item stand, and we go through “analysis paralysis” and just choose not to get anything since it is too hard to pick with so many options.  So do people take their medication since it is specifically directed in one way to do it, where as eating right and exercising has a few million options?  It is an interesting thought, to think about.

Just think if the patient was told to go to the drug store and get a couple of medicines with no direction, would they do it?  What if they were given specific guidelines on exercise and a precise diet to follow on a daily basis, would they be more likely to follow?

I love this quote I picked up from a therapy conference from my good friend and fellow Physical Therapist Mike Muffenbier: “Study principles not methods, a mind that can grasp principles will create its own methods.”  I use this often, as I want to understand the principle of how an exercise works or a specific mobilization or facilitation technique in therapy and not just blindly use it.  I need to understand the science principles behind it, so I can expand its use to the patient’s specific needs.  But I am now seeing I have been guilty in the past, maybe not helping my patients, because I might have overloaded them with tweaks to exercise to show them they can create hundreds of exercises from a few basic ones with utilization of Tweakology^TM principles I have learned.  I now see that might be like being at the jam stand with 24 options.  If they do not understand the principles, I need to keep the methods easy to follow.  Especially since in today’s current health system I do not get to follow up as I would like and continually progress a patient’s exercise program appropriately.  Yes learning all the various tweaks is maybe better for you (24 options), then just a couple of exercises (6 options).  But if this increases the chance of the patient making the change and doing the exercises, 6 of them, is better than 24 they do not do. 

It's hard for many exerciser's or those that want to start to exercise with so many exercises to pick from.  But we have to understand where most people are, which is lost in the endless sea of exercise options without knowing what to do.  This causes "analysis paralysis" and many choose to do nothing.  Our current culture does not help it any, just watch a few infomercials, stop at the local gym or fitness section of a store and you can easily see how most are probably overwhelmed with too many options. Plus ask 10 fitness/exercise specialist and there is a good chance you will get 10 different stories of the "best" exercise plan. Which is best for me? How do I know how much and what type to do?  This one says it is better because it burns more calories, but this one builds more muscle, which is better?  Or do I need both?  What if I have a problem with this or that, can I do this or that exercise?  Do I need a fancy machine or is one trainer DVD better than another?  One can easily see "analysis paralysis" setting into the brain and the brain choosing to not do any of it.

The truth is that pretty much all of them are good we just need to move.  You need to follow the basic guidelines:

• stretch daily (a good Physical Therapist can show you 4 or 5 stretches that are best suited for you and your current fitness status)
• cardiovascular exercise 5-6 times a week for 30 minutes at moderate intensity (this should be an activity that you enjoy - walking, biking, swimming, etc.).  If  30 minutes is to long, start at whatever level you feel safe to do and add 2 minutes each week, until you can do 30 minutes.  Moderate intensity is a pace that you can do without becoming short of breath, but still notice that you get a little tired at the end.  As you can see this is a little different for everyone.  To go to higher intensity or time make sure you gradually increase with the help of a physical therapist.
• Strength training 2-3 times a week.  Do some basic total body and core strengthening exercises appropriate for your fitness level.  Again look to get some help from a physical therapist to set you up with a simple program that can be done in about 15 minutes.

This is a great basic exercise plan that will serve anyone well to improve their health and well being.  But you should consult an exercise expert like a physical therapist for some guidance if you have any medical concerns or want to expand your workout further. You wouldn't go into a drug store and just take medicine without a proper frequency, intensity, time and type without consulting your doctor and pharmacist, exercise should be looked at the same.

So do you sometimes wonder how much or what type of exercise to do?  Does it cause some "analysis paralysis" with you?  My fellow PT's, additional thoughts when helping set patients up with exercise programs?

It might not be just about fixing parts

There was a great segment on Good Morning America about back surgery this week, for those that didn't see it, here is the link - Back Pain Relief.  This patient is one of unfortunate millions in the world that suffer with chronic persistent pain.  I have the fortunate opportunity to be at course this weekend Explain Pain, presented by Adriaan Louw, a PT right here from Iowa (that's kinda cool, at least to someone that lives in Iowa).  It is based on the book Explain Pain by David Butler and Lorimer Moseley.  I have mentioned this book previously in a post Back Pain - Now What.  If you treat patients that have pain, or are a person in pain, I highly recommend this book.  It will help explain the biology behind pain, and if you really like this stuff (as I do) then this course is one to look at attending as well.

I will get into some of the mechanics of pain in future posts...but for now I want to pose some questions and thoughts.  As a Physical Therapist I was taught that there are very specific mechanical problems that are the cause to all injuries that we treat.  Don't get me wrong there is, but there is more to it than that as I have learned since graduating over 15 years ago.  We as human beings are an amazingly complex system (and we understand a lot of it, but by far not all of it).  Sorry to burst anyone's bubble that their doctor or physical therapist or whatever healthcare provider you see does not have all the answers.  If they say they do, my advice - RUN!!!!  Let's take a simple look at the body: There are just over 200 bones in the body.  Each of these bones come together to form joints, about 250-350 total depending on how you classify them. They are held together by multiple ligaments at each joint area.  The joints are moved and also held together by muscles. We have around 500-600 of them in our body, again depending on how you classify them.  These muscles are controlled by our nervous system.  It is just a little more complex, we have about 100 billion neurons (give or take one or two) in our brain controlling these muscles, along with all the other systems in our body.  Each of these neurons makes around 5,000 connections with other neurons to communicate all that we do.  Each connection is controlled by a multitude of neurotransmitters and other substances.  I apologize to the anatomist and neuro-scientist for this simple explanation, but I think that you get my point - it is pretty complex.  This amazing system allows us to function in our continually changing world we live in, hopefully in perfect harmony.  I like the analogy of a symphony, that our body plays a beautiful tune when everything is just right - it just happens to have more instruments than particles in the universe.  How cool is that!!!

So, when someone tries to tell you that they can fix your pain with just a fixing one thing as this women in the clip thought was lead to believe, be careful.  Again hear me closely, I am not saying that it may not help with your pain and fix a mechanical fault, but it could very well be due to more than one instrument not playing the right tune.  And the instrument you fixed may not necessarily be the right instrument.  But do not despair either and think if surgery or a drug or therapy can't fix me who can?  Realize your body heals itself every day and you usually don't have to do anything.  Have you ever got a paper cut on your finger?  Is it still there?  Did you have to put any thought into how to fix it?  Your body did it all on it's own, pretty cool!  Yes we might improve the environment a little with a band-aid and some triple antibiotic on it.  So does that mean I never need surgery or need to go to a doctor or physical therapist to help me recover from an injury?  No, not exactly, sometimes we need to help improve that environment for the healing to happen so something wrong does not happen and not allow the body do what it was designed to do.  But just something to think about...fixing something mechanically may not be the end to your pain.

We often compare our bodies to machines.  I do this often when educating patients to understand mechanical deficits that may be contributing factors to their pain.  (Realize I said "contributing" not "causing").   But as humans our bodies are far more complex than any machine.  Does anybody have a car or any other machine that repairs itself?  How about that has logic, reasoning and emotions?  Our body is far more complex, so fixing a broke part by replacing it, taking it out, strengthening it, stretching it, or giving it a drug may not be all it needs.

So what's everyone's thoughts?  Can we or should we be able to "fix" everything by working on the mechanical parts?  It may be a different way of thinking for some of you, but I think we need to make changes to truly help so many people in pain.

Expert Practice

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I had a great opportunity to attend the Advanced Clinical Instructor Education and Credentialing Program through the APTA.  One portion that I really enjoyed was going over a few studies that looked at Expert Practice in Physical Therapy see here and here.  It made me look at myself to see if as a clinician was I working toward becoming an expert physical therapy practitioner.  Hopefully the other health care practitioners reading this will reflect on their own practice to see how they measure up.  If you need a health care practitioner, check to see if they measure up, if not you may want to look for one that does.

Common things found in many clinicians that did not differentiate average from expert, as one may think, were things like:  having a certain number years of experience or working specifically in a specialty area, caring for their patients and commitment to professional growth, and utilization of opportunities for continuing education.  While these are good qualities they did not differentiate an average clinician from an expert clinician.

What they found was what they labeled a Patient-Centered Approach in Expert Clinicians.  This is when the clinician made sure the patient was an active participant and the therapist primary goal is to empower the patient.  This was done through collaboration between therapist and patient through patient education and establishing a good patient-therapist relationship.  The expert clinician shows a high level clinical reasoning that is centered around patient needs.  They use their strong knowledge base along with skills in differential diagnosis and continual self reflection.  This knowledge base is grounded not only in academic knowledge but field experience in other areas outside of physical therapy.  Their knowledge is also used extensively with the use of movement observation.  The expert practitioner has a love of clinical care with non-stop inquisitiveness about life long learning.   They also have amazing humility even with their high level of expertise.  Their patient clinical style is one that patient education is central to their practice.  They individualize their treatment interventions to the patient, you will see every patient getting a different treatment based on evaluation of patient needs body, mind and spirit.

I have started reflecting more before, during and after each patient intervention to see if I am moving more toward patient-centered care approach.  I having been trying to keep in mind a few quotes when setting up patient intervention treatments:

• "Everything should be made as simple as possible, but not simpler." (Einstein)
• "You know you’ve achieved perfection in design, not when you have nothing more to add, but when you have nothing more to take away." (de Saint-Exupery)

So what are you challenging yourself with to become more of an expert in your practice?

What are we evolving too?

I want to share some scarry thoughts about evolution.  I don't want to argue the point of whether we evolved from other species or were created by God, but more too the fact that everything evolves over time.  I think we can all agree to this.  Society, culture, communication, warfare, travel, etc all evolves over time.  We are living creatures and we are constantly changing and evolving.  Our amazing nervous system with our brains as the master controller of everything, is primarily engaged to keep us alive through evolving daily.  Step in the fire pit, your nervous system quickly notifies you of the danger and motivates you to get out before serious damage happens.  It evolves to make sure next time you walk around the fire pit and don't make that mistake again.  In fact only mobile creatures need a nervous system, typically the more advanced in movement the more advanced the nervous system.

So when we read a report such is this: Middle-Age Americans Les Mobile Than Ever.  It is very troubling.  Let me share an example:  The sea squirt is a very studied creature especially in neuroscience.  It has 300 neurons (we have about 100 billion neurons in our brain - so a little bit more advanced, but bare with me), each one has been logged on what it does and the complete DNA profile exist for this creature.  Because of the small number of neurons and being mainly transparent it makes it great from a research standpoint to study.  We have learned that it uses it's nervous system to help it survive until it reaches a resting place and attaches itself.  Then it starts to eat it's nervous system, since it is not moving anymore, it does not need it and eventually basically acts like a plant.  So what is happening to our nervous system and brain when we are less active?  Are you aware of more and more research that exercise can boost brain function?  Check out Spark: The Revolutionary New Science of Exercise and the Brain.  Do you want to avoid alzheimers or parkinsons?  Increasing your exercise can reduce your risk of getting these horrible dieseases as you age.

Here are some great guidelines to follow from the American College of Sports Medicine.
- Health benefits of physical activity aren't related to weight. Consistent with the message of the Exercise is Medicine program, physical activity is good for the mind and body irrespective of weight.

- Kids should accumulate at least 60 minutes of activity per day.Muscle- and bone-strengthening activities are important for children in addition to cardiovascular exercise.

- More is better. Any activity is good activity. But the more you exercise, the more benefits you'll reap, decreasing your chances for chronic conditions such as heart disease, and high blood pressure.

- Energy balance is important. Consuming more calories than are expended through activity equals weight gain. All activity, however, counts as expenditure, from purposeful exercise to simply taking the stairs (rather than escalator), and walking. Ten-minute bouts of activity can count toward the daily total.

- Older adults need exercise. No age is too old to begin a physical activity program. Older adults with chronic disease should work with a health care provider to determine limitations and the right kinds of exercise for their bodies.

- In general, a doctor's clearance is not needed to begin a moderate-intensity physical activity program . However, those with risk factors for chronic diseases or any orthopedic injury should seek medical advice from a physician and physical therapist before beginning physical activity. The key to remember is moderate-intensity exercise.  Too many people take on high intense exercise and get injuried.  Remember this: Git Fit so you can Run, Don't Run if you are not Fit.

- Pregnant women need exercise! Healthy for both mother and baby, physical activity is recommend during pregnancy and post-partum. Seek a doctor's advice and meet with a Women's Health Specialist physical therapist to ensure safety, though.

- Guidelines might need adaptation for those with disabilities. However, physical activity holds numerous benefits for this group, including increased quality of life and mental health.

- Strength training is important. Both young and older adults benefit from a regular program of resistance training, done at least two days per week.

- Progression is key. For those getting started, increase the duration or frequency of moderate-intensity physical activity first, before increasing the intensity.
 
Hopefully for the evolution of the human race, we can reverse these horrible trends and not evolve ourselves out of existance by destroying our nervous system because we don't exercise (maybe the Disney Movie WALL-E was trying to predict something that might actually be happening).

Health Care Reform? What's next?

Well who has read the new Health Care Reform Bill?  Nobody has glanced through all the pages?  Well I haven't either, there are more important things to read...like Pinkalicious to my 5 year old daughter at night for her bedtime story.

I think only time will tell what it will mean to American Health Care.  I do have faith that we have some of the greatest clinical practitioners in many areas (Physical Therapy being one that I am obviously most biased towards) and that patients will receive excellent caring and compassionate care.  But I often wonder if we may see more a shift toward health care providers being more educators and teachers to patients and families.  With the increase in people supposedly accessing the system with all people covered, there may be delays in care.  And when one does get in to be seen, there may be increased time between appointments.  I'm thinking of Physical Therapy for example, typically most patients in the outpatient setting I am in are seen 2-3 times per week.  But if there is more patients to see and most likely not an increase in staff, we will have to decrease the number of times each week the patient is seen to allow access for the additional patients.  The patient and family will take on increasing responsibility to know and understand their injury or illness along with what they need to do for their care.  While in many ways this can be a great thing for people to take increasing ownership in their healthcare, but will they?

Also with growing new research in neuroplasticity, The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (James H. Silberman Books).  We are learning the amazing capabilities of our brains to continue to change and relearn things even after severe brain damage.  These changes for stroke, traumatic brain injuries and others are amazing to our once thought of a very static brain that once injured did not have much chance for recovery.  We are now learning with gradual properly graded therapy, significant changes in their function can be achieved far beyond our previous expectations.  The big thing that is needed is patience and persistence in the treatment approach.  I am not sure the health care system will be willing to pay for either.  But patients and families can be trained to carry out this treatment on their own with monitoring and ongoing training from qualified health care providers.  The delivery might look different, but it may actually get better.

While I don't know exactly what health care reform will bring, as none of us do (even though most everyone has an opinion), I do know the brain does change itself and it is was created for survival.  And spending time with my daughter reading books is far more important than worring to much over health care reform.

I'm curious to hear others thoughts on what the changes may mean to health care in America?

Interesting thought about ankle sprains

An article came out in USA Today Vulnerability to ankle sprains varies with age.   I wanted to add a few interesting thoughts from a Physical Therapists perspective.

1. This is something I have noticed with ankle sprain injuries for many years and in some ways seems kind of strange.  Why is there more sprained ankles in basketball (40%) compared to soccer (8%)?  Granted I don't know in this study if it is matched to the percent of those actually playing the sport, which could skew the percentage if a higher number of people possilbly play basketball compared to soccer.  But think about this:  basketball is always on a flat surface and players often times wear hightop shoes and brace or tape their ankles, compared to soccer which is usually on a grass natrual field, with tiny not very supported shoes and they are always moving around a round ball on the ground.  From the outside one would think that soccer would probably see more sprains.  Or, because soccer players actually train in a more challenging situation that they are better prepared to reduce the risk for ankle sprains.
2. I thought another interesting statement in the article needs to be looked at deeper as well:
• "The good news is that most ankle sprains feel better in a few days and heal completely in a few weeks. But previous studies suggest 60% of people who have one sprain will have another or will suffer long-term instability, weakness or pain."
• My question is do they heal completely?, if 60% will suffer long term difficulties.  I would like to think that this is not healing completely.  If we take simple knowledge of tissue damage, we need to see that complete healing probably takes longer than a few of weeks.  This is true probably for most injuries.  I am afraid we don't allow the body go through all the stages of healing and work to fully rehabilitate from an injury like an ankle sprain usually.  There is loss of strength, flexibility and proprioception after an ankle sprain.  Unless we work to retrain all of these appropriately we are most likely looking at further problems.  Also we need to look to see if there was a movement impairment that may have been the cause behind the injury.
• An example I can give is a patient I had once that I saw the day after her ankle sprain and talked to her about acute treatment (RICE - rest, ice, compression and elevation).  Then importance of working to normalize her walking as soon as possible.  She came back about a week later and said she was fine and did not think she needed any more therapy.  I asked her to try and stand and balance on that one foot.  To her amazement (not mine) she couldn't!  I explained what all happens after an ankle sprain and that just because the swelling and pain was down, did not mean that it was completely healed.  So after a couple more visits over about 4 to 6 weeks and instruction on proper exercise progression to regain strength, flexibility and proprioception her ankle was fine.

My advice if you suffer an ankle sprain, do not think it is fine just because the swelling and pain are less in a few weeks.  See a physical therapist to get proper treatment to make sure that you do fully rehabilitate from an ankle sprain and reduce the risk of reinjury.  If you do play sports you are at higher risk for ankle sprains, so as part of your training do specific functional exercises to reduce your risk of injury.  Talk to a physical therapist to learn functional training exercises that you can do for your specific sport.

picture by: By Suzy Parker, USA TODAY

Effects of good health practices on therapy outcomes

I wanted to share with my readers something I have been working on to give to our new patients that come in for Physical or Occupational Therapy at our clinic.  I wanted to give the patient some additional information on other things that can help their outcome with therapy.  Here's what I have put together so far, let me know what good and bad you see in it.

Welcome to CRMC Physical Medicine and Rehab, maximizing your outcome from your Physical or Occupational Therapy treatment is our goal. Here are a few additional things you can do to help maximize your outcome, if you are not already doing them.
Stop Smoking. You probably already know that smoking affects your lungs and heart health in detrimental ways. And if you are a smoker it is not easy to quit, so talk to your doctor or therapist about options to help you quit. With the lungs and heart it affects the oxygen uptake in the lungs and narrows our arteries decreasing the blood flow to our muscles and organs. With decreased oxygen and blood flow our muscles are not getting the energy they need to repair them and work optimally. Smoking also has an effect on brain neurotransmitters (chemicals in the brain) these help our brain and nervous system function optimally. When our nervous system and brain are not working optimally it effects how our muscles work along with other systems in our body. It also affects our metabolic system (the part of our body that breaks down food and medicine into parts it can use). So our body does not get the food and medicine it needs in the same way those that do not smoke do. There are other side effects of smoking, but these are some of the primary effects that will reduce your optimal outcome with therapy and effect your healing from your injury.
Get proper nutrition and water intake. Our body uses the food we eat to help repair any damage that has been done to it on a daily basis. The better the food choices we make the improved healing abilities our body will have. Please consult with your doctor, dietician or therapist if you want specific information to help you eat better. Generally following the web site info at http://www.MyPyramid.gov is a good guideline. Water intake is also important as most of our body tissues, especially muscles and fascia (the tissue that holds all of our muscles together). Our muscles and fascia are primary reservoirs for water storage; if they are dehydrated they will become stiffer. Take a sponge as an example – when the sponge is dried up it is stiff, when full of water it is more flexible.
Get adequate sleep. Our bodies require 7 to 8 hours of sleep each night. Some people “think” they do can go on less, but every major study done on sleep always points to the body needing 7-8 hours of sleep (more if you are a child) to function optimally. Lack of sleep will affect brain function and attention. These can affect our muscles and nervous system to not work as well. Also it has been found to decrease healing when we have a lack of sleep. Unfortunately pain can be a factor in inhibiting our sleeping, so talk to your doctor or therapist if you are having difficulty sleeping due to your injury.
Decrease your stress levels. This like sleep is a double edge sword for some of you with an injury, as the injury is the cause of your added stress. Small amount of stress is good for the body as that is what makes us stronger by “stressing” our muscles. Unfortunately prolonged or too much stress puts our body into distress, which is what is detrimental. Our body uses its sympathetic nervous system to respond to stress. This system increases activation of our peripheral muscles, raises our heart rate, and over activates our nervous system making us more sensitive to everything. This is helpful in short durations, such as needing to run away or fight in a dangerous situation, but long term can cause negative effects due to increase in the chemical, cortisol, in our system which affects our brain and nervous system as well as immune, respiratory, cardiac and digestive systems. It can also lead to increase in depression, anxiety, and increase in disease (you are more likely to catch a cold when over stressed). We need an equal balance of our parasympathetic system (the opposite of the sympathetic system) to keep our body systems working properly. The increase in activation of your nervous system is one reason why when stressed your pain will most likely be more. Talk with your doctor or therapist on techniques to help improve relaxation and decrease stress.
Understand your injury and know what you can do to make it better. There is power in knowledge. We will do our best to try and explain why you are having the problems you are having, but please ask questions if you don’t understand. While we will do everything we can to help you for the half hour or hour that you are in therapy, but you will need to help yourself the other 23 hours out of the day, so in many ways you have a larger impact on your health than we will.
Make every effort to make your scheduled appointments. Obviously there are things that might come up that limit your ability to make an appointment, but we can only maximize your outcome if you come to your appointment. It is your body and your health, while we appreciate the opportunity to help you recover; you ultimately hold the key to helping that become a reality.
This is a short summary of the few effects other health practices have on your outcome with Physical or Occupational Therapy. If you want more detail on any of them talk to your doctor or therapist. We look forward to working with you to maximize your optimal movement and achieve efficient function with your body as you rehabilitate from your injury.

I'm curious to hear what everyone thinks.  I know in today's age of Twitter and 140 characters for communicating or articles that should be 500 words or less this goes beyond that, so let me know if you think it is too long or not long enough to cover in detail enough.  Also, for the normal healthy individual most of these are common practices, but unfortunately most of my patient clientele does not meet these criteria.  I am a believer that if you can plant seeds that change is possible.  So I am excited to see comments on what others think.

Lessons to learn from Olympians

With the close of the Olympics I wanted to blog about lessons learned from the games.  I saw a great article at the beginning of the games about Six Things We Can Learn from Olympians.  I had one I wanted to add to the list and would love to hear comments from everyone what things they have learned.

I often wonder in today's day and age and the emphasis put on individualism, if we forget how important it is to have good coaches.  Watching the Olympians you realize that you are truly watching the best athletes in the world at their specific sports.  Their physical feats and mental concentration is amazing.  But behind every athlete is a set of coaches, trainers and others that have prepared them to go for the Gold.  So if the greatest athletes in the world need a team of coaches to allow them to perform at optimal levels, why don't each of us also look to find some coaches to help us in our life.  Do we look for people and advice from experts to help us with our body, mind and spiritual growth and development.  Our bodies, minds and spirits are constantly changing, the question is how are they changing?  Is it for better or worse?

As a physical therapist, I enjoy the opportunity daily to help coach my patients to improve their physical health and optimize their function.  Hopefully we can all find coaches to help us on a regular basis to improve our body, mind and spirit and not have to wait until injury or ill health to search out a coach to help us.

What other lessons have any of you came away with during these Olympic games?

Back Pain - Now What?

Estimates are that 9 out of 10 people will experience back pain at sometime in their life.  Having back pain is the fifth most common reason to visit a doctor in the U.S.  So with such prevalent numbers of occurrences, one would think we would be pretty good at treating it and have some consensus on the best methods.

Sorry, I'm not going to be able to cure everyone's back pain that reads this posting, but hopefully give you some valuable insights into finding your answers.  Also I am not going to argue for the best method to fix their back pain.  Obviously there are lots of "so called" experts that through their marketing and advertising can convince you they can cure it all in just a few simple steps.  But if this was truly the case I don't think we would see the numbers of occurrences staying the same as we have over the decades with no large changes in reduction.  Remember as health care providers we have specialties that we are trained in to solve problems.  A physical therapist, like myself, is going to use exercise and manual therapy (hopefully not many modalities such as ultrasound and electrical stimulation, as the research is not very good they actually provide much change).  Chiropractors will use their manipulation skills.  Surgeons will use surgery.  Physicians will use medication.  A massage therapist will use massage.  Acupuncturist will use acupuncture.  We are going to use what we know, and believe that is what you need.  So don't be surprised if you see a surgeon and he suggests surgery and when you talked to a different health care provider they didn't suggest surgery.

The other upsetting part is that there are some usual standard care guidelines, that research has shown to be most effective are not always followed through with by many general care practioners as found in this study.  And as pointed out in another study sometimes we have become to dependent on imaging to try and diagnosis everything.  While diagnostic imaging has made great advancements in the last few decades and has given us pictures of inside the body, we need to remember that the picture doesn't always tell us all the answers.

So what should you do if you have back pain?  Find a health care practitioner that you can trust and is up to date with current standards of care.  They should be open to other methods other than their own to assist you in your back pain.  They should be able to give you detailed explanation as to why you are having pain based on their findings from their evaluation as well as other tests such as imaging.  They should be able to back up everything they plan on doing with current research (check to see if they read current research, if not I would be cautious).  Realize that most back pain is not seriously life threatening, yes an inconvenience, but not life threatening.  It can usually be treated with conservative measures and not surgery as pointed out in this study.  If you do suffer from persistent/chronic low back pain I suggest that you learn to understand more the mechanisms of pain further.  I would suggest viewing Neil Pearson's 3 part webcast or get the book Explain Pain.

Talented And Gifted - Tag your it!!!

My 13 year old son, Tyler, confirmed my longstanding disappointment with the Talented And Gifted (TAG) program in schools.  If you don't have such a program in your school district be glad in some ways.  What it is for those of you who may not be aware, is a special program for kids in school that are excelling in a subject.  They are taken out of class to participate in the TAG program where they are challenged above the other students in their class.  While in general principle this is very good. As there have been studies that show some of our best and brightest students drop out of high school since they are not challenged enough so they drop out.  The problem lies for the many students, like my son, who don't get pulled out of class for TAG.  How would you feel if you weren't labeled talented and gifted.  Unfortunately to many of us have been told that at some time and we unfortunately believe it, thus preventing us from fully achieving our maximum potential God had planned for us.  While Tyler stated he was happy for his friend that got called out of class to participate in TAG, but he admitted he was sad that he never got called out.  While I tried to reassure him he was extremely talented and gifted in many ways and listed many of them for him, there was already some damage done to his self esteem.

My simple thought is, why can't they find at least one talent and gift in every child and pull every child out at sometime for a TAG program.  Could you imagine the child that unfortunately may never be looked upon as talented and gifted by their parents being able to go home and tell them they were pulled out of class to participate in a TAG program.

Another program that could use improving is the Presidential Fitness Award.  While again a great idea for rewarding children to partake in exercise and fitness, but why not create something that everyone could succeed in instead of just a few?  Check out a program proposed by Gary Gray, PT called Free2Play.

It's hard to believe programs like StrengthQuest by the Gallop Organization wouldn't work.  Or implementing more exercise into school to help with improved test scores, check out this short news story about exercise in school - Pumping up the Brain.

As Michelle Obama has pledge to help fight obesity.  I can only hope that some of these initiatives that promote increase self esteem for our children, who are all Talented and Gifted, in academics and fitness can be used.

While this probably seems like a lofty goal, I thought it was fitting to post on the night of the opening ceremonies of the Winter Olympics and the 30 year anniversary of the Miracle on Ice.  I remember as a 9 year old listening to those words "Do you believe in miracles? YES!", and yes I always have.

So do you believe in miracles?  What ideas do you have to share on how we can improve our youths school system to help them succeed?

New Year remodel project

Well I was busy last weekend doing a little home improvement project and remodeling our master bath.  Ripping out the old outdated tile and cabinets and replacing them along with a fresh coat of paint.  So it got me thinking to see how everyone is doing one month into your personal remodeling project of your body, that is if you set any New Year's resolution to eat better and exercise more...most of us did.

It is hard to stay the course with diet and exercise even if we know it is important to help us live a longer, happier and healthier life.  Even though there is lots of research with study after study continuing to show the benefits of exercising to help improve our life.  But it is complicated to do the right thing and not as simple as having will power to do it.  An interesting study looking at people sticking to diet plans, which is usually just as hard for most as sticking to our exercise plan, had some interesting points.  It showed that the more complex your plan the more likely one would be to stop doing on a regular basis.  To take a quote from Gary Gray, PT a mentor of mine - "We need to get to the simple side of complexity".  Yes the proper diet and exercise programs can be made extremely complex especially when listening or reading some of the things that are out there, but huge gains can be made when sticking to a thought that follows the 80/20 rule.  You can get 80% of your benefits from exercise and diet by sticking to the easy 20% of simple principles in exercise and diet. Check out a few of my past posts on these core principles of exercise and diet.  Here is a great 10 step idea to help with weight loss success with your diet that can help as well.

Also for those that have gone so far and are obese we need to realize that this is a medically complex problem that needs serious attention.  We need to realize that often times an obese individual has an addiction problem and needs outside help to get going the right direction again.  Why people get obese is a very complex and individual for each person and not easily changed.  There was a great article to pointed to this mind shift that needs to change if we are to help the obese get healthy.

So you know it can be difficulty, so how do you fix it? Check this article out on setting the record straight.  We need to exercise more and eat less.  But keep it simple and realize it takes patience and persistence and if you are struggling you may need some outside help, and that's okay! - we weren't put on this earth to be alone we need each other.

What are some things you do to help keep yourself on track with your personal body remodel?

One more reason to stretch

About a month ago I posted on importance of stretching not from a muscle flexibility standpoint, but from activating the proprioceptive system standpoint.

I wanted to point to another research article can-touching-your-toes-test-your-arteries?.  This makes simple sense, remember when we stretch we are stretching everything - not just muscles.  The arteries run through our arms, legs and trunk so if we stretch we are keeping them more flexible as well.  We have known for a long time that if the arteries get stiff, it can lead to heart problems.

Here is another study proving the importance of stretching for many reasons beyond our once simple view of thinking it makes the muscles more flexible.  Let me know some of your favorite stretches...

Basic changes can make Better Life

As you know if you have been following my blog that I talk about basic core principles for improved health.  Read another story, Better Life, of how basic changes in diet and exercise changed this person's life around.  It does not have to crazy methods or the latest fades, just basic principles.

You may want to check out a web site http://www.bluezones.com/, if you haven't already.  Check out this video clip it is about 20 minutes long.

Exercise and Farming

Growing up in the Midwest my entire life, I have an appreciation for farming.  While I have never lived on a farm or really did any work on a farm, you still can’t help learn a little about farming as it is a cornerstone to Midwest living.  The last 15+ as a physical therapist I have come to appreciate some large similarities between health through exercise and farming.  Let me paint some correlating similarities.

Farmers have to understand patience and sticking with a time tested traditions of growing crops.  Some things can’t be rushed or forced when it comes to having a successful harvest and many things need to be repeated year after year to ensure that success.  Farmers understand there are certain tasks that need to be done during every season and proper planning throughout the year are important to ensure a bountiful fall harvest.  And most definitely there is going to be some hard work and effort required during it all and no immediate results from all of this.

Come spring the seeds are planted. Then the fertilizer (nutrition) and water need to be added properly throughout the season to ensure the plants to grow well.  We need the right amount and kinds of food and water in our systems to help us grow properly.  If we have too much or too little of either it can cause problems.  Soil samples are taken regularly to ensure the right combination is getting received by the plants.  We need to monitor and test our diet and water intake regularly to ensure we are getting the proper amount.  With all this work initially we see no results.  The field looks the same for many weeks even though the seeds have been planted.  I am sure this is how many of us feel with our exercise program.  We put in a lot of work and want results and often do not see anything right away.

But just as the farmer knows with having faith in this proven system if you plant the seeds and prepare everything properly, the plants will come.  We have to have that same faith in our exercise program.  We can’t quit, we need to have faith the process.  After awhile out of the ground pokes out a blade, and the farmer has proof the system works.  After awhile you will see some small changes, you have a little more energy, your clothes fit a little better and your spouse or co-worker might ask “Have you lost some weight?”  While we live in a society of instant gratification, we have to realize that health through proper exercise and nutrition will not give us instant gratification.  The system just doesn’t work that way.  There is no magic pill and you can’t lose the weight (in a healthy way) in 3 days by drinking a magic shake.  Let’s face it magic is all about an illusion, it is not real.

Our exercise program, just like farming has to be judged over weeks and months, not days.  It takes about 9 months for a baby to fully form in the womb, not a few weeks.  A baby takes about a year to gain the strength and coordination to be able to walk, not a month or two.  On the farm you reap what you sow. Just as in exercise, if you are diligent and consistent you will see results.

During the summer as a farmer you will the results as the plants grow and grow.  But you need to make sure the weeds don’t also grow and choke out your valuable crops.  Once we are seeing results we need to make sure we don’t get any bad habits (the weeds) or get away from what is working.  If you do this you will enjoy a wonderful fall and an amazing harvest.  But just as with farming it doesn’t stop after that, you have to do it all over again the next year.  Also just like in farming most farmers will change up their crops every now and then to make sure they don’t deplete the soil of its nutrients.  We need to every now and then change up our exercise routine to make sure we continually have successful outcomes.

So if you are looking to start exercising for the New Year, remember the principles of the farm to help you have success.  Also check this article out for more info on why sometimes that New Year’s resolution doesn’t stick.


Photo from biopowerlanka.com

Exercise - don't ever stop!!!

Just wanted to pass on a posting by Medical News Today - Don't let Arthritis put the Kibosh on all Exercise.  To often we have pain, injury or disease and think we should not exercise at all.  Sometimes this may be even mentioned to us by a healthcare provider, which makes me cringe a little.  These are things that mean we need to be careful about our exercise but not stop our exercise.  We need to pay even more attention to exercising then ever before.


Remember the definition of exercise is a controlled, repeated form of physical activity and movement intended to keep a person fit and healthy.  I think some people and even physicians to often think of exercise is pilling on the weights on the barbell and running a few miles.  We need to be smart a realize the exercise is medicine.  It needs to be dosed properly just like medication.  If you have pain, injury or a disease such as Arthritis, seek the help of health professional, like a physical therapist that help you make sure you are doing the right kind of exercises.


Just getting a sheet of exercises given to you by a health care provider or picking some exercises of the internet is almost as scary is going into the medicine cabinet and just grabbing a few pills and throwing them down if you don't feel good.


Don't stop exercising - just exercise a little smarter and with some help from someone if needed.

De-Railed - 5 Critical Lessons

Derailed: Five Lessons Learned from Catastrophic Failures of Leadership (NelsonFree)
There are 5 critical lessons that Tim Irwin summarizes in DERAILED to make sure we can stay on track and not get derailed.  I think being the first of the New Year is a great time to look at ourselves and make sure we are using these lessons to stay on track with many things in life such as our health and exerciser programs.

1. Character trumps competence
2. Arrogance is the mother of all derailers
3. Lack of self-/other-awareness is a common denominator of all derailments
4. We are always who we are...especially under stress
5. Derailment is not inevitable, but without attention to development, it is probable

We are only as good as our character.  Character is the aggregate of features and traits that forms the individual nature of ourselves.  We may need a repair or change of our inner traits to make sure they are leading us in the path to good health.

The largest failure of character is arrogance.  We need to be continually aware of any sign of this toxic trait in our character.  Continually look at your health and your exercise habits to make sure you are not thinking you have all the answers and have it completely under control.  It is okay and you should use experts to help you with your health and exercise programs.

It is important to continually monitor our habits to maintain self awareness.  You need to have regular medical physicals, dental exams and I think a functional movement screen.  Also do a food diary to monitor what and how much you eat.

We are who we are, if we want the maximum from our external healthy body we need to make sure that our internal mind and spirit are also healthy.  I continually work with patient's that have external physical injuries that are deeply tied to their internal mental and spiritual injuries that have never been rehabilitated.

Derailment of our health may sometimes appear to happen almost instantaneously, but usually is due to a series of choices over time that lead us to derailment.  We need to pay attention to our development by being continually alert and self-aware and make a life long commitment to learn, grow and prepare.  We have to be discipled daily to maintain good health habits to reduce risk of derailment.