Practical Physical Therapy

Whenever I talk to patients about their posture and that their injury or symptoms are in large part due to poor posture I always get an odd look. It’s one of surprise and as if to say “My mom told me to stand up straight, why am I paying you to hear this?” or “This has got to be more complicated than this.” I then take the time to explain how this can be.

I think everyone can understand the concept of stress and strain. Really, that’s all I do. I deal with stresses and strains. There are a couple of variables that we all deal with: load and time. How much load are you carrying and for how long. Depending on how you carry the load and for how long will predict how much stress or strain you will place on a structure or in this case a joint.

First we need to understand the principle of loads on joints. Joints hold up best if the load, a person’s weight, is spread evenly across them. It’s the scenario of the man who lies on a bed of nails. If he lies down on thousands of nails each nail only has to carry a small amount and therefore none puncture the skin. If he lies down on only one nail the load is too great and it punctures the skin. Another example is that of tires. If tires are properly inflated and aligned they make full contact with the road and will last much longer than if not. The problem is twofold. When loads are not evenly distributed they not only apply more pressure at that one point to wear the joint uneven they wear it down faster.

Our job when we get out of bed in the morning is to stay upright. Even when sitting we have to hold our trunk up against gravity. Joints are designed to take the impact of movement. As soon as the foot hits the ground a force is directed up. Newton’s law: for every action there is an equal and opposite reaction. When we stand up or start to walk the weight of our body is hitting the floor and therefore this same force is coming back to hit us. We have to do something with this force so it does not damage our structures (joints). When bones are properly aligned they share the load so no one joint is taking it all. (one nail vs many nails example). When standing or sitting there is little movement so the action is uncomplicated but nonetheless loads are being distributed. Let’s take a look at a few pictures:

As you can see in these pictures of the spine that load is not equally distributed. What the pictures don’t show are how the spine can get that way. In some cases there are deformities at the spine level that shift things but most often problems come from the foot up. In subsequent posts we will look at the foot and move up to see what postures may be caused by such deformities and then look at possible problems that arise as well as solutions for these

I met with a counselor last week that contacted me to initiate an exercise program or event for her clients who suffer from post traumatic stress disorder.  Her clients suffer from sexual trauma or other major events that has affected them and they have difficulty moving on.  She spoke about recall and memory and how it is not isolated to the brain.  She reaches out to her clients and helps them mentally work through their problems but sees the need to also work on the physical side to “re-write” pathways in the brain and body.  Most have a safety mechanism that allows them to “check out” in a sense so they will have times where they don’t feel that their body is their own. 

It was fascinating to me to listen to this.  I am a believer in the connection between body mind and spirit.  I have never met a patient that is in excrutiating pain and smiling, jumping around with movement.  I usually see just the opposite that when someone is hurting physically they take a protective posture, appear tired, feel weak and worn out.  I can see the connection between those who suffer from post traumatic stress and feeling pain physically or carrying their trauma physically and not just mentally.  I think we all exprience this with our senses.  The smell of cookies that reminds us childhood memories or touching an object and the texture takes us back to another time, hearing a song and being reminded of a person or event. 

The goal of the exercise is to develop new neural pathways to make connections with the body once again.  We will accomplish this by performing activities that are new or require a high level of concentration.  The program will run for 8 weeks.  It’s really not too difficult as we will have everyone partner up so you have to pay attention to someone else and then give exercises that involve the two people working together.  This will be done in a circuit in two minute increments with music playing.  Basically it will be controlled chaos. 

One of the counselors is doing a study so she will take surveys which we know are not the best indicators to see if we were successful but this is quite common with psychological studies.  Without knowing the results I am sure we will see a change. 

I have always thought of exercise and physical activity as the “silver bullet” but mostly for medical conditions such as obesity, diabetes, coronary artery disease and so on.  I had never thought about a psychological application for treatment of PTSD.  It makes sense and my belief in body, mind and spirit is further strengthened.

This is my first attempt at blogging so I appreciate your patience in waiting while I come up to speed.  I am a physical therapist in Auburn, Washington for Outpatient Physical Therapy.  I hope to make this blog informative to the layperson, the patient, the you know who you are: “I don’t understand all the medical terminology or what is being done to me when I see my doctor or physical therapist.” 

I enjoy the practicality of solutions.  After all, if the solution isn’t practical it is not used and therefore was a waste of time in the first place.  I believe that neuromusculoskeletal disorders, meaning problems that involve nerves, bones and muscles, can be solved or made better with good education and sometimes some fairly simple treatments.  Now this is not to say all problems are simple as there are many examples of complex situations.  I am a believer in trial and error and finding what works.  With that said I hope to open this site up to discussion to the community about “neuromusculoskeletal” conditions that exist.  A disclaimer is that I am an outpatient orthopedic physical therapist meaning my specialty lies in mostly sprains, fractures, low back, neck and general spinal issues, sports type injuries and those related to sedentary or “lack of physical activity” lifestyle.  I am willing to learn but want to express that my thoughts are my opinions based on current research and my experience.  Just because a suggestion or “treatment” did not work does not mean that is the only approach that can be taken and another one is surely there to try. 

I operate a Medical Gym working with people that have “orthopedic” and other medical conditions that hinder a regular exercise routine.  I have had success in working with people who want to become active but seem to run into obstacles that keep them from being so.  I have good success with weight loss and helping folks overcome problems due to obesity.  Tune in weekly for a topic of my or your choice (just leave a comment) on either a case study or general condition.