Monday April 14, 2014
In the corner of my clinic there is a small whiteboard where we write the date and some timely messages to our patients. More recently my colleagues and I have been writing inspirational quotes on the board, and our patients have really enjoyed reading the quotes. Some of the recent quotes have been:
- "Don't quit. Suffer now and live the rest of your life as a champion." Muhammad Ali
- "To give anything less than your best is to sacrifice the gift." Steve Prefontaine
Each day we try to add a different quote, and our patients are starting to look forward to a new inspiration when they come to physical therapy. The problem is we are pretty busy each day, and we don't always have time to brainstorm or search the internet to come up with good motivational quotes.
We need your help. Do you have an inspirational quote that helps you through tough times? Are you a patient in physical therapy who finds motivation and inspiration in a special quote? Are you a PT who knows a few good quotes that can help your patients through the tough times?
Please comment below and share your favorite inspirational quote that I might use on the whiteboard in the clinic. Your motivational quote today me become someone's inspiration tomorrow in the PT clinic.
Related: Stay Motivated in Physical Therapy
Sunday March 30, 2014
Achilles' tendinopathy is a common problem among runners. It causes pain in the back of your lower leg just above the heel. Often the pain is accompanied by a small lump of tissue that can be felt in the tendon.
Notice that I called the problem tendinopathy and not tendinitis. You see, tendinitis translates into "inflammation of the tendon." Many histological studies find that no inflammatory cells are present in the Achilles' tendon with chronic tendinitis. So the name tendinopathy has been adopted to more accurately reflect the condition.
Regardless of what you call it, Achilles tendinopathy can be a big pain, and it can keep you from running or participating in normal recreational activities.
So what do you do to treat Achilles' tendinopathy? Try the Alfredson protocol.
The Alfredson protocol involves performing two exercises, the eccentric heel drop and the eccentric heel drop with knees slightly bent. Here's the kicker: the protocol calls for performing the exercises for 3 sets of 15 reps, twice daily. For each exercise.
So that means to treat your Achilles' tendinopathy you should perform about 180 eccentric heel drops each day. Recent reserach published in the Journal of Orthopaedic and Sports Physical Therapy indicates that performing the exercises with a "do as much as tolerated" modification to the protocol yielded the same results as performing the 180 rep Alfredson Protocol. So the choice is yours.
Do you have Achilles' tendinopathy? If so, check in with your doctor or PT, and then start some eccentric heel drops via the Alfredson protocol. Let us know how it works out for you!
Source: Stevens, M. and Tan, C. (2014) Effectiveness of the alfredson protocol compared with a lower repetition-volume protocol for midportion achilles tendinopathy: a randomized controlled trial. JOSPT 44(2) 59-67.
Sunday March 30, 2014
When I was a hockey player in college I suffered a shoulder injury when I got check into the boards. My shoulder hurt for a week or so, and then I was back to normal.
Or so I thought.
After I graduated college and started getting a bit older, my shoulder would often feel loose and unstable. It would sometimes pop out of place when I reached for something. When I was in physical therapy school, we learned about shoulder special tests, and I found that I had a positive apprehension and relocation sign. A visit to an orthopedist and an MRI later, it was confirmed: I had a torn labrum.
I elected to have surgery to fix the problem, so I had an arthroscopic repair of my labrum. I went through PT, and things have been going well with my shoulder. I have had 100% function with my shoulder for ten years now.
But one thing remains: my sulcus sign.
The sulcus sign is a sign of a loose shoulder joint. To find out if you may have shoulder instability, you can perform the sulcus test. Here's how:
- Sit or stand comfortably.
- Bend your elbow and have a friend gently but firmly grasp your arm just above your elbow and give a little pull down.
- If a small notch appears in the area where your arm meets your body, you have a positive sulcus sign.
Now don't worry if you have it and don't have shoulder pain or loss of function. But if you have a feeling like your shoulder is loose, have pain in your shoulder, and have a positive sulcus sign, perhaps it is a good idea to visit your local PT or doctor to get it checked out.
Sunday March 30, 2014
I recently posted a blog about my patient who was facing a painful lumbar fusion surgery because he had low back pain and sciatica for about two weeks that was limiting all of his motion. He was unable to sit or stand without terrible pain down his leg.
At his first physical therapy session, I found that he was able to centralize his symptoms to his low back with a simple exercise and postural correction, and 5 days after his first appointment his right leg pain had significantly improved.
More recently, I saw this patient in the clinic, and he reported that his right leg pain was virtually gone. He did have one episode of his leg pain, and it came on at a very inopportune time.
My patient was preparing to give a presentation at work, and he was making final preparations. Just before he was set to go into the presentation, his right leg started hurting. He learned that whenever he feels the pain in his leg, he could do his press up exercises to centralize his symptoms and he would be fine.
So when his leg started hurting before his presentation, he needed to find a place to lie down on his stomach and do some press ups. The only acceptable location: the restroom. Ugh.
My patient reports that he went to the men's room and set some paper towels on the floor about where his knees, hips, and hands would contact the floor. He started cranking out some press ups to centralize his pain, and he reports he was able to go into his presentation pain free soon after the bathroom press ups. We shared a laugh as we talked about the implications about exercising in the men's room. What if someone walked in? What about the hygiene aspects of what he had done?
We laughed as he said it didn't matter that he was exercising on the restroom floor. He needed to take care of his condition quickly so he could do his presentation, and the restroom was the only suitable location.
Perfect. My patient was armed with the right exercise to rapidly take care of his condition so he could do the things he needed to do. Fancy machines like inversion tables or traction wouldn't be effective in this situation. He needed rapid relief, and he got it with his PT exercise.
His story reminds me of a story told by Robin McKenzie in his book Treat Your Own Back. This story was also told to me at many of my classes that I took during my training in the McKenzie Method. It goes something like this:
McKenzie and his wife were traveling on vacation one day, and as they were driving they came upon a car on the side of the road. This happened long before Robin became known in the PT world as a spine guru. He pulled his car over to the side of the road to offer assistance, and when he came around to the front of the car, a man was on the ground performing press ups.
McKenzie knew it must have been a patient of his, and he inquired about the man's well-being. The man told McKenzie that he was just doing his exercises as instructed.
"Just checking." said McKenzie, and then he casually walked back to his car and drove off.
The point of the story is that the man doing exercises in the road found the right maneuver to manage his pain. He felt the need to do the exercise to manage his pain no matter where he was. Just like my patient performing press ups with the paper towels under his hands in the restroom.
One important component of a physical therapy program is to learn what you should do (and shouldn't do) whenever you have a painful condition like back pain or sciatica. Your PT should be able to teach you simple solutions that you can apply whenever you are hurting to help you rapidly improve your condition and help you return to your previous level of function quickly and safely.
Even if it involves performing press ups in the restroom.