But I Was Just Fine a Month Ago…
THE GREAT DECEPTION
A really friendly, energetic middle aged lady recently was at Peak Performance PT for her Low Back Pain and Radiating Leg Pain. We’ll call her Suzanna for the sake of our story. This is kind of like the old Mission Impossible where the recording would self destruct seconds after playing. Our HIPPA laws require confidentiality so rather than inventing a space age Memory Zapper that would pop out of this email to erase her actual name from your memory, it’s easier to just go the fictitious route.
I wanted to share Suzanna’s story with you because it’s a really common mindset out there that I think I can help you better understand. Suzanna had been going to the Health Club for years, doing classes along with weight machines and cardio machines. She felt pretty fit and really didn’t have any complaints.
But then her bubble burst and about two months ago she developed not only Low Back Pain but she was also getting radiating symptoms into both hips and thighs. That really stinks. The back pain is something many of us are familiar with. In fact, studies suggest that humans are 80% likely to have at least one episode of significant Low Back Pain in their life – to such an extent that it limits function.
Suzanna’s pains into the hips and thighs were a different thing though. That was a bit of a wake up call to know this wasn’t just some tiny little back pain episode that could be ignored. It’s especially hard for someone like her who enjoyed going to the club and being active so much. It was really cramping her style.
Recently during a treatment when I was sharing with her some of the shortcomings I’d found on testing, she said something to the effect of “But I was just healthy a month ago….I was fine. I was working out three days a week. How could I have all these issues when I exercised so much?”
BINGO! That was the Million Dollar Question.
She was flabbergasted. Maybe she was thinking that she put in all that time yet was being told her body wasn’t quite the Picture of Health ….that it wasn’t that idealistic example of what dedication and consistent hard work could result in. Maybe even in the back of her mind imagining her Health Club grown fitness served as a shining example to her peers of how good middle aged bodies could look and feel with a little work. Nope! Reality had set in and she was not a happy camper. She was frustrated, disappointed and then throw in a little confusion!
I can shed a little light on this for you and that day I explained the same thing to Suzanna. You see, when you do rhythmic activities like running or the elliptical machine, complex activities such as actual sports that require timing and reaction and especially contain significant components out of your control, or when you’re using both limbs (ie. both hands or both legs) simultaneously your body will do whatever it can to accomplish the end goal.
Whatever you “bring to the table” you will use. If you’ve got a little left sided hamstring tightness you’ll still run on that treadmill. Your body just adapts and cheats – or a nicer word to use is “compensates” around that tight hamstring. It doesn’t usually stop you from actually running, but it also isn’t the case that the exercise – the running in this case – will actually stretch out that tight left hamstring.
The same is true for an Aerobics or Boot Camp class, playing soccer or baseball or golf, being active in the yard at home, or having a physically demanding job. All those things are great activities to challenge your body and contribute to overall fitness. Your body will do whatever it takes to do what you tell it to do.
So Suzanna, all the while she was enjoying and relatively succeeding in all of her fitness endeavors, nevertheless, had a number of important limitations that little by little were adding up to eventually overstress her tissues….and, in the end, result in pain and inflammation that led her to seek out help.
I’m glad she came in for Physical Therapy. The Evaluation picked up some areas she needed to work on and she’s improving now that she’s doing exercises CUSTOMIZED for her own unique needs. I reminded her that it was critical that she specifically addressed the areas I found deficient because the generic exercises she’d been performing at the Health Club, things that were total body in nature and often rhythmic or alternating in nature, were just never going to help undo the asymmetries and imbalances she had.
Suzanna asked “Well how is anyone ever supposed to know these things are wrong with them? Who is going to find and fix these issues?” That’s where we step in as Physical Therapists. PT’s are uniquely trained in musculoskeletal evaluation and the non-operative management of those things that ail you. The Functional Biomechanics training that Mike Golisano, Karen Napierala, and myself have gone through helps us even more to be prepared to evaluate your Function and figure out the best ways to quickly get your body working the way you hope it can.
So remember – you can’t fix asymmetric physical deficiencies with bilateral or generic exercises!
Enjoying the “Thrill of Victory” and Avoiding the “Agony of Defeat”
Just a few days ago I was working with a patient, we’ll call her Pam, and spent some time talking about the pain she’d been having in her hip – especially about the flare up she’d had the prior weekend.
I asked her lots of probing questions, trying to piece together the details of how she’d gotten herself into trouble. Pam ended up being really insightful as she reflected on her answers.
I figured Pam’s introspective discovery would ring true and be helpful to many of you out there, or to family or friends you pass this on to.
In Physical Therapy we so often have to deal with fluctuating symptoms that a patient offers. These changes from session to session – from day to day or week to week, can be a real source of confusion and oftentimes can lead you as a patient to poor decision making.
Pam had been seeing some really encouraging progress since coming to Peak Performance PT for her hip. It had actually been a problem for years and she’d had PT before but it mostly entailed typical standardized “hip PT exercises” that one might expect.
Her Physical Therapy Evaluation I performed ended up revealing some important specific issues that I felt would benefit from manual therapy techniques (hands on methods of promoting motion in the joints and/or connective tissues) along with some customized functional exercises (a weight bearing joint like the hip really appreciates exercises that look and smell like the “function” they do each and every day - vs. a generic “give the same exercises to everyone” list of lying down or sitting exercises with the foot off the ground).
Pam was feeling so good that one day over this past weekend she decided to spend a few more consecutive hours working than she had the prior weeks/months. It didn’t seem to her an impressive amount of work compared to “what she used to do” when she was healthy. (Does that sound familiar to any of you out there……”But I used to …” or “That’s nothing compared to ….”?)
Pam made a common fatal mistake – some of you have done, or maybe even right now are doing the same: a good few hours or days = “I’m better” or the opposite a few bad hours or days = “I’m worse.” But are you really sure you’re actual condition is “better” or “worse” – or are you just having a few good or bad hours/days?
Your answer to that question is critical!
Pam’s joy over feeling better lead her to recall years ago when hours of continuous work at her computer was no problem at all, and then mistakenly think her body was right back there too – in a healthier and prepared state, ready for hours of uninterrupted stresses.
Well, unfortunately Pam’s hip quickly reminded her a few hours later that her leap from the sense of “feeling better a few days” to literally being considerably better was a mistake. She needed more time of extended “better” days to add up to actually being able to increase her work by 200-300%.
Pam offered a great insight as to how that happened to her. Think about this a bit – it may resonate with you some.
She shared that “When you’re having bad days you feel like they’ll go on forever” and that it causes so much worry and concern and hopelessness. You get tired of always having to modify your activity, your work, your recreation.
What she said next was really interesting – I guess I never thought of it this way….she said “When you have good days you tend to not think they’re going to stay for long” and feeling that way makes you want to do what you can while you have the chance.
Are you feeling the hopelessness of pain or limitations that are holding you back from your normal activities? Have you had to cut back on your work activities? On your fitness activities? On your recreation, your fun?
You can really dig a big hole for yourself when you experience a few good hours or days and make the leap to thinking you’re all better and ready to roll. The opposite mistake is thinking that a few bad hours or days mean you’ve slipped backwards and the injury is literally worse. Keeping perspective can be really tough can’t it?
At Peak Performance PT we are dedicated to providing our patients with a thorough evaluation and designing a custom treatment program to help you get back on track. Every single day I find myself helping to remind patients to keep perspective on the fluctuations they might have in symptoms. You have to balance the attention to detail of those changes with a “big picture” sort of view – so you don’t make poor decisions that get you in more trouble down the road.
Pam hit the nail on the head for many of you…the frustrations and hopelessness over symptoms that are so slow to change can lead to a sort of time-sensitive pressure to “enjoy it while you can” when you do have a lack of pain.
Give us a call if we can help you or your friends and family with their injury or surgery.
And thanks “Pam” for that little bit of wisdom!
Farewell to our Office Manager, Robert Morrison
Peak Performance PT would like to announce that our Office Manager, Robert Morrison, is moving on to work his own business.
We thank Robert for his years of service and for contributing to our successes, and really also for helping you be successful.
He has helped tremendously by sharing with each of you what is going on at Peak Performance, developing and working our Annual Coat Drive to donate to our area youth and adults for their winter needs, and providing valuable tips and reminders through the excellent website and newsletters he is responsible for.
He has helped some of you with insurance or billing questions and explaining the ever-changing process known as health insurance coverage when confusions arose.
We believe that each of our staff plays an important part in your recovery, not just your actual Physical Therapist.
We couldn’t provide you the quality care we work towards without the diligent and caring efforts of each of our staff.
So please join us in thanking Robert for his work and wishing Robert the best in his new endeavors.
The Peak Performance PT staff remain excited about our future.
We continue to see an increasing base of referring physicians and surgeons but especially have seen a growing number of word of mouth referrals from prior patients like yourself.
So many of you have also offered your heartfelt and sincere words of thanks and success stories as well.
Thank you – I know that your words of encouragement and successes have been uplifting to prospective patients searching our website for information about Peak Performance.
We look forward to serving you and your family and friends in 2012!
Mike Napierala
Owner, Peak Performance PT
You can leave a message for Robert at the bottom of this post if you would like to do so.
You Need To Have A Short Memory
I just had a neat conversation with a patient the other day that reminded me of a perspective I’d like to share with you.
This very nice teacher who was in for knee problems, we’ll call her Sylvia, wanted to resume her fitness workouts. She missed the feeling of being active, feeling stronger and more fit, having more energy, and not to mention the calorie burning benefits of her cycling escapades.
Sylvia was accustomed to 3 hour rides on the weekends. That’s awesome to be able to go out and enjoy the outdoors for that long on a bike. Not everyone can do that. Sylvia was feeling better and really eager to get back on the saddle.
BUT, here’s the problem. She still did have knee symptoms and we weren’t sure how long she could tolerate biking for, especially outdoors where elevation changes would come into play.
Here’s Sylvia’s take on it…..”So should I just go out and ride for 40 minutes or so and see how it goes?”
Wow! Forty minutes. Is she serious? Are you wondering the same thing I was?
I asked her “When’s the last time you successfully rode for 40 minutes?” She looked at me puzzled a bit. I could almost see her musing in her head….”Mike knows I’ve been in PT for over a month or so – how could he be asking a dumb question like that?” and prior to that her symptoms were even worse before she started PT.
In actuality it had been a long time since she’d proven she could ride for 3 hours, let alone just even 40 minutes. But that prior success was her best memory. It was her only reference point.
Or at least the one she was choosing to recall.
Don’t we all do that when we’re hurt or recovering from a set back?
You kind of think back to when you were at your very best and define that as who you physically are.
That right there is a set up for disaster.
Because you and I both know what happens next.
When you say “But I used to ride for 3 hours”…then your next thought is “Then I’ll just go out for an hour or two and see how I feel”.
Sylvia needed a Shorter Memory!
With a short memory….maybe back to only a week or two, she’d realize that she had only been on the stationary bike for 5-10 minutes and proven she could do that without symptoms.
So, if she were going to try to resume outdoor cycling then maybe choosing what – maybe let’s say 15-20 minutes max might make more sense.
My piece of advice for you today is this.
- BE WIMPY!
- Yes, that’s right…I said be wimpy.
Think of it this way…
If you’ve been away from some particular activity for some time then you’ve got to Have a Shorter Memory.
Don’t think way back to 3 months ago or a year ago “When I used to do…..” but rather think back to just days or a week or two ago. If you don’t have recent evidence of SUCCESS doing some specific amount of that activity then you MUST start with tiny, WIMPY, amounts of whatever it is that you like.
You shouldn’t go out and play singles tennis for “only” a best of two sets but rather just hit some balls around for 15 minutes.
It’d be better to go swim a two laps then rest and repeat it a few times rather than go swim non-stop for 30-45 minutes with your training partner.
It makes more sense to see if you can cut just a part of the back lawn and take a break than to start in the front where you won’t let it remain unfinished (even if you start hurting).
If you or your loved ones have some musculoskeletal ailments that are holding you back from what you enjoy, now is the perfect time to call us to see if we can help you address them before you miss more of this beautiful end of summer and fall weather in pain. We’d love to help you get back to Peak Performance!
A Cure for the Summer Blues
“The Summer Blues” – well, that could mean different things to different people, but here’s one way of looking at it.
Your family and friends are all out having some “Fun in the Sun” but the problem is you’re stuck at home or sitting back watching everyone else due to an injury or nagging pain.
For some of you, or your loved ones, you play anyways. You go out and participate even though in the back of your mind you can hear that little voice called your conscience saying “You know you shouldn’t be doing this right?” or “Do you think this is a good idea?”
Yeah, most of us have been there at one time or another. It’s no fun missing out on the action. In fact, I just did myself in for a bit not too long ago.
My knees were finally feeling better, I was assistant coaching my son’s U16 AAU basketball team and there weren’t enough kids at the practice to do our typical full court drills. But with the Head Coach and I there we were able to do a half court 4 on 4 game.
Well, check that….games.
I knew in the back of my head I probably shouldn’t do this. Sixteen year olds and 26 year olds move around in a different time zone than most 45 year olds.
I figured I’d take it a little easy and let my “old school” veteran skills carry me through without killing myself physically. (Can you hear all the silly unrealistic self talk and denial of reality setting me up for failure?).
As the games progressed of course the “bonehead” side of my memory banks reminded me of the physical ways I was “used to playing”….making quick moves to the basket, jumping over people, etc.
So much for the “taking it easy” huh?
The frustration grew as I found it tough to keep up with my darn 16 year old son – who it seemed not that long ago could never get by me on offense and almost never stopped me from scoring.
Those days are now a distant past.
We ended up playing two games to 21 (a bit long of a game) and I seemingly survived for the moment. Unfortunately, by the time I woke up the next day I realized that playing hadn’t been so smart.
By that time I had no choice but to taste reality and the pain/swelling in my knee forced me to lay low for a while.
Two months later it’s finally feeling better. It took rest but also doing some appropriate PT treatment and exercises to help it turn the corner.
Don’t fool yourself, especially now of all times.
If you go out and try things you’re not truly ready for you may be taking yourself out of the FUN to come in the rest of the summer by making your problem worse.
Others of you might be saying – “I’ll just wait it out and work on it in the Fall.” REALLY – are you serious? You’d give up your summer and wait it out. No need!
Peak Performance PT can help you Cure your Summertime Blues by doing an evaluation and helping you make sense of your injury and find the best ways to get back to your good old self.
Why wait? There’s still time that if you address things now you can enjoy your summer without having to sit on the sidelines and be bummed as your family and friends are laughing and playing. They miss you. Don’t make the mistake I made by just ignoring reality and trying to play when you’re not ready – get your injury fixed and get back out there and enjoy yourself!
A Little Secret to Pain-Free Exercise
The other day I was talking to a patient about a topic I know can help many of you out there too!
She was telling me that doing lunges during her home exercise video was causing pain in her knee.
“Beth” had given up on exercising because she just couldn’t figure out how to get around the pain during and after completing her fitness routine.
Here’s a HUGELY helpful trick to increase your odds of success…………OBJECTIFY your exercise.
What the heck does that mean you say? Well, think of it this way – DEFINE your problem exercise in a bunch of different ways.
Doing this will suddenly give you a number of different TWEAKS you can do to try and downsize the stresses so that you don’t hurt.
Let’s take a look at the lunges that were hurting Beth as an example.
It’s hard to figure out what to change when you just think “lunges”. But, here’s what Beth needed to do….DEFINE IT…………how heavy, how far, how deep, what angle is the step at, how many, how much rest between…etc.
So, she said
- I put 90% of my weight on that leg when I lunge.
- I step out about 3 feet on my lunge
- I bend my knee down to about 90 degrees
- I step out to the front, the side, and backwards
- I do 60 lunges on each leg during my 30 min DVD
- Between every 15 lunges per leg I switch to upper body or core work for 6 minutes before resuming the lunges
Now Beth has a whole list of possible TWEAKS she can use to lessen her knee stresses during those lunges. Let’s take a look at some options….
- she reduced to only 70% of her weight on the lunging leg
- She stepped out only 2.5 feet for a shorter lunge
- She did a shallower lunge to only 60 degrees of bend
- She only did side lunges because those were not painful once she paid close attention
- She slowed down and only did 10 lunges where before she did groups of 15 lunges before a break
- She added some more core/upper body work between lunge sets so that her knees got 10 minutes rest before lunging again
Now of course each person’s example would be unique to only them and this is not specific to any of you out there. But it gives you a new set of thoughts as to how OBJECTIFYING your exercise in a number of ways can provide you with some previously unrecognized ways to downsize the stresses that contribute to your pain.
I hope that helps. If you have any specific questions about pains or troubles you’re having please call us. We’re here to help you!
And if you have any friends or family that you know could use this advice feel free to pass this along to them. Or better yet – have them give us a call and we can try to get them back to Peak Performance!
Mike Napierala, PT, SCS, CSCS, FAFS
BLOG: Do You Feel Lucky? Part II
Last time I told you about Bob…Remember him?
He was the business owner who came in for Physical Therapy because his back pain stopped him from concentrating on his business.
Bob’s symptom of pain was relieved in just 3 visits and he decided he was “good to go.”
I wanted you to realize that just because your pain has gone under the radar that sometimes many of the same problems that REALLY CAUSED your problem to begin with are still lurking inside, ready to little by little, cause your “injury” and eventually your pain to come back again.
It often takes just a few more visits to shore up a solid home program to help you address some of those underlying PROBABLE SUSPECTS that we find in our evaluations. Keep in mind, we can’t always address or even find those causes initially until your pain is reduced enough.
But if a patient like Bob feels so great with his pain lessened and then stops Physical Therapy before we can more fully address those PROBABLE SUSPECTS, then I’m afraid that someday down the road he’s likely to have to see me again for the same thing.
I think Bob was hoping he’d luck out in the future and that everything would stay alright.
In a similar case, John stayed pain free for the first four weeks after he left. Then one day, as he was bending over to pick up a piece of paper, his luck ran out! You have heard this story from someone else I am sure, because it is something we hear a lot too. “I just bent down to pick up something small and insignificant and then BAM!
The good news is with some strengthening, and some education, John and Bob won’t need to rely on luck anymore. They would have the tools, skills, strength, and knowledge now to keep their backs symptom free!
So the old adage “do you feel lucky today….well do ya?” …. save that for Clint Eastwood, and arm yourself with what you need to maintain your function and keep yourself pain free!
BLOG: Do You Feel Lucky Today…Well, Do Ya?
Do You Feel Lucky Today…Well, Do Ya?
Some of you might recall that famous phrase from a Clint Eastwood movie. I recently had a patient that made me think of that well remembered saying. Let me tell you a little about his story.
A number of weeks ago I saw this very nice but distressed gentleman, let’s call him Bob. Bob owned his own business and he was the primary worker…if he wasn’t working then he wasn’t earning money to pay the bills. That’s a ton of responsibility and a definite source of stress when an injury rears its ugly head and tips over the cart of normal life. He came in to me with back pain, a shifted trunk (his shoulders were sitting maybe 4-6″ shifted off to the left), and significant weakness in one of his legs. It was a pretty classic presentation for a lumbar disc problem.
Bob did extremely well with his treatments, even having some relief during the evaluation itself. He came in two more times and each time had progressively more relief. We were both excited and encouraged by his terrific improvements. Bob was doing his home exercise movements like clockwork and he was doing a super job of avoiding the bending type of movements that brought on his pain originally. But, he did still have that weakness in his foot/ankle (indicative of a nerve root being compromised, most likely by compression from an angry disc).
As Bob’s symptoms improved over those first three visits it became obvious that his work duties, which required lots of repetitive bending over and some lifting for hours and hours each day were very likely a huge contributing factor to the back pain and leg weakness that he’d developed. Short of being hit by a car or falling down the stairs, very often these sorts of “injuries” are not new and sudden onset problems, though they might feel like they “just started two weeks ago out of the blue.” Really they are just the exact opposite. More likely they’re the old proverbial “straw that broke the camel’s back” scenario.
Think about it. Day after day, Bob is bending over – his back rounded over, not using his hips very effectively due to tight hamstrings…not able to engage his gluteal (that’s BUTT for us simpler folk) and hamstring (back of thigh) muscles very well because the low back has been constantly called to cheat for the hips all those years…a weak core in general, not able to support the spine well. Remember, we’re not talking just about a few times of bending over wrong here people. We’re talking years and years. Think of literally thousands of times – that spine bending over to do his job. You can just imagine the spine and it’s discs looking down at the hips saying “Why don’t you guys help us out a little – you’re killing us up here!”
Well, here’s the seemingly good news – Bob is feeling super! He never even came for his fourth visit. He called and cancelled because he had no pain. At his third visit his foot/ankle strength had improved to “only” a 20% deficit, a nice improvement in a short time but still an obvious sign of nerve injury. But – he had no pain so he felt like he was good to go.
I am glad that Bobs symptoms went away, but the concern I share with all of you when you are in Physical Therapy is the same as I shared with Bob that day. “Lack of Pain does not equal the presence of function” Pain is only one symptom. To you it seems like the worse symptom possible, but not to us. Bob didn’t allow us to take the time to address the weakness, the poor body mechanics, the loss of nerve function (a huge problem even if no pain), or his repeated forward bending stress. In otherwords… the “probable suspects!” Bob banked on the fact that when his pain was gone…..he was cured! There is more to this story. Tune in next week and we will see if Bob really was lucky.
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