Physical Therapy - Practical Bodywork

Satirical Aerobics

For years I have had a dream.

It strikes me that most exercise videos are excessively earnest. Perky! Sincere! Cheerleader-esque!

There seemed to be few, if any, home workout routines for people with a healthy sense of irony, and a taste for the absurd. My people.

For too long I lacked the time, the equipment, and the chutzpah to make an ass of myself, without losing 30 lbs and an ankle brace or two.

But now–thanks to the unremitting skill and attention of Terry McHugh of NovaCare Physical Therapy, and Dawn of MotherHeart Studio–my chronic knee and ankle injuries are so well-healed that I can skip, sauté and bourreé to the satisfaction of all my kitchen appliances, and the total expense of dignity.

Because nothing hurts.

EXCEPT MY BROKEN, BROKEN HEART.

Get Your Body Back!!!

I always thought that personal trainers were for trophy wives. Which would not be me.

Plus, I hate gyms. I see no reason to subject myself to an environment full of clanking torture devices, fluorescent lights, TV screens, hideous music, sweaty odors and the sound of grunting. Not when the free, beautiful outdoors–for running, hiking, biking and dancing–is right there. The only reason I can think of to join a gym would be 1) unlimited pool access and 2) unlimited sauna access. No pool, no sauna, no deal.

Then my posterior tibial tendon gave out, and I was in trouble. Running was Right Out. Biking was fine, until it snowed. Even my favorite yoga classes were off limits–too much strain on the tendons.

Out of curiosity born of desperation, I tried a personal training session with Kate, of Bodywise Wellness. She has a private, quiet, stress-free training studio in the Northern Liberties, just a few blocks from Practical Bodywork.

Kate tailored a workout specifically to my concerns, my injury and my fitness level, which was fun, challenging and burned 647 calories, according to my Cardio Trainer.

The next day, I felt the kind of sore that feels AWESOME.

I started going regularly. She gave me a completely different workout every time. After three weeks, I was trotting up stairs, instead of dragging myself along by yanking on the banister. I dusted off my dance aerobic routines. I started getting more done, having more fun, and challenging my four-year-old to race me up the stairs.

After a workout with Kate, I feel that endorphin glow you get after skiing Tahoe all afternoon, minus the price of the lift ticket. That’s something I thought my ankle injury had taken away forever.

So I am sold. So sold, in fact, that I want to buy YOU a session with Kate.

Yep, you heard me right. Kate’s training is the bee’s knees, and the perfect complement to the kind of bodywork you get from me.

Because if you’re working through an injury, struggling with chronic pain, or just aching from too much stress, you come to me. You get yourself a structural myofascial package, because that’s the series that transforms your alignment, your energy level and your outlook, all at a sweet discount per session.

And from December 16 of this year through January 6 of 2014, when you buy a structural myofascial series for yourself or for someone else, I’m throwing in a gift certificate for a one-on-one session with Kate. That’s how awesome I think she is.

So if you’ve been thinking of making some personal transformations in the new year, this is the deal for you.

It’s also transferable. You can get bodywork for yourself, and give a training session as a gift, or vice versa. You can forward this article to your loved ones with the subject heading, “hint, hint.” You can give the gift of massage, and grab your training session as a reward for being so generous. You choose.

Happy holidays! Let’s thrive together!

Touchy Topic Tuesday: I Am Embarrassed To Tell You This, But…

…I’m wearing an ankle brace.

Turns out my crippled ankle wasn’t psychosomatic after all. According to my fabulous new podiatrist, I have posterior tibial tendon dysfunction, caused by the extra bone in my flat, flat foot torquing my gait and stretching the tendon until it is practically shredded. He says if I don’t wear this brace, I’m a candidate for surgical reconstruction of my entire ankle joint when the tendon gives way completely.

It took me awhile to assimilate this information.

Because it’s a lot easier to be the big, strong person who helps OTHER people with their frustrating pain and mobility problems. It is terrifying to admit that I don’t have all the answers, that I can’t fix everything, that most mornings I have a hard time negotiating my way downstairs, because my ankle won’t flex properly. It is hard to ask for help.

On the other hand, it’s great to be running up and down stairs again. A little support in the right place makes all the difference.

And knowing what I know about alignment, I am kicking myself for not recognizing the obvious. I was so focused on how the rest of my body was affecting my ankle, I failed to consider the possibility that the ankle was, in fact, the source of the problem. It’s a wonder my knee and hip and back aren’t completely wrecked; for this, I have yoga and foam rolling to thank.

The moment that mortified me the most was when my podiatrist said EXACTLY THE SAME THING to me that I say to my own clients. “You need to take care of this now, so you’ll be massaging people for longer.” Ouch. I can spend my life telling people that self-care is not a luxury, but am I walking my talk?

It seems to me that the people who give the most to others are often the least willing to give to themselves. Are you one of them? Think about how many people are depending on you, at your job, in your family, in your relationships. If something happened to you–like, say, you stopped being able to climb stairs, or walk more than 30 feet, or started getting regular migraines, or collapsed under intolerable strain–how would this affect them? How does it affect them when you’re exhausted, anxious and in pain? Are you more likely to become impatient, angry or detached?

And if a child of yours were forced to endure the same level of pain, stress and fatigue you put yourself through on a daily basis, would this be okay with you?

Well, then.

The Five Stages of Healing (Bodyworker Edition)

Like a lot of other practitioners, I tend to suffer from bodyworker machismo. I spend my days treating other people’s pain, and ignoring my own. Which is exactly what I advise my clients not to do.

Recently, I hurt my foot. The technical description of what I did was tearing the plantar fascia on my right heel, after changing my running gait from heel-strike to ball-strike, and then doing yoga with a calf muscle in spasm. But that wasn’t my experience. My experience was that I got out of bed one day and my foot hurt.

So, for your edification and amusement, here are the five stages of Macho Bodyworker Healing.

1) Denial.

All I need to do is warm up, give my foot a rubdown, and it will go away. Like, in ten minutes. In a day or two. In a couple of weeks. Don’t mind me, I’m walking very slowly today. I’ll just stop running until this gets better. Dammit.

2) Bargaining.

I can’t afford to get this treated. I know all about plantar fasciitis, from that two-year bout with it I had, a decade ago. It’s not THAT bad. I’ll stay off of it for a weekend, roll my feet, wear my arch supports. Do some self-treatment on my gastrocs and soleus every morning, and evening, and several times during the day. See? All better!

3) Desperation.

It’s not getting better. I can’t afford to be crippled for two years, again. I can’t afford NOT to get this treated. I’ll call that Rolfer, what was his name? Brian Stern! He’s expensive, but so what? I’m crippled! My body is my livelihood! I have to keep up with two kids in the Franklin Institute! Help!

(Brian Stern is excellent at what he does. He restored considerable articulation to a pair of malformed ankle joints which were rusted stiff. Also, he is warm, approachable and sympathetic. Don’t you hate it when you go to a doctor, in desperate pain, and you get the sense that you are a boring nuisance to said doctor, and to most of his staff? That’s one nice thing about bodyworkers–most of them genuinely like people.)

4) Resignation.

Okay, that was great. My foot still hurts, though. I’d better do the foam roller every day, twice a day, and some gentle yoga. In fact, I should not skip the yoga even when I stop hurting. Because that’s what started this problem in the first place.

5) Exhibitionism.

All better! Mostly. I can walk right-left, right-left again, instead of thump-drag, thump-drag. I’ll do the foam roller for another week before I resume running. Meanwhile, I’ll describe this process in excruciating detail on my blog, so that others may learn from my foolish suffering.

Foam Roller Therapy: Why It’s Awesome

Practical Bodywork is thrilled to bring you this guest post by Jesse James Retherford of TAO-Fit.com.

Anyone who knows me is aware that I am a huge advocate of foam roller therapy, and for a good reason: it works. In my personal and professional life I have found that foam roller therapy is an incredibly valuable practice. It is an absolutely vital component of a well designed holistic fitness and health routine.

What is Foam Roller Therapy?

Foam roller therapy is simply one of the best methods available to treat and prevent injury. If you don’t own or spend any time using a foam roller (the main tool used in foam roller therapy), then get one. Start. A foam roller is, in my opinion, one the best investments of time and money you can make when it comes to your long term health and fitness.

Foam roller therapy is the use of a foam roller for self massage. There are many different kinds of self massage tools out on the market. Finding the right one can be a confusing and expensive process. I prefer to keep my tools super simple, inexpensive, and effective. The self massage tools that I most often recommend and use are a Trigger Point Grid foam roller, lacrosse ball, golf ball, and a softball.

Foam roller therapy helps break down dysfunctional tissue caused by poor movement patterns, i.e. poor form. It increases joint function, mobility, and range of motion. It reduces acute pain, speeds up recovery and healing, and it reduces injury.

Foam roller therapy gives you access to the powerful healing of deep tissue fascial massage, all at a very low price, and at any time of day, every day. Integrating foam roller therapy into your weekly routine will help you not only prevent pain and injury, but treat and quickly recover from an injury. It speeds up the recovery process between workouts and reduces the total amount of time you spend lame from an injury. Using a foam roller after a hard workout is like injecting pure recovery directly into your tissue. It allows you to have a challenging workout routine, while at the same time, minimizes the pain and injury cycle.

Want to read something that goes into a bit more detail about how foam roller therapy works? Want to learn how to do it? Read this.

When is the best time for Foam Roller Therapy?

Just about anytime is a great time for foam roller therapy. You can do it in the morning. You can do it in the evening. It’s great before a workout. It’s great after a workout. An important time for foam roller therapy is when you hurt. The best time for foam roller therapy is when you don’t hurt, because it really does help prevent you from hurting in the first place.

This is what this looks like for my clients: I often have a client who comes in for a workout session complaining about some minor pain in their knee, hip, back, or shoulder. These can be very frustrating sessions for the client. Whatever kick-butt workout I had planned gets ditched, because I don’t teach or train clients to exercise through the pain. If your knee hurts, then you can’t lunge or squat. If your shoulder hurts, then you can’t push or pull. The rule is: if it hurts to do… don’t do.

rollingquads21-300x128 — Rolling your quads: scrumptious!

What does a workout look like if we can’t work out?

These are actually my favorite sessions to teach! I love it when someone shows up in pain. Pain time is learning time. These sessions are an opportunity to show them where their pain is coming from. I can teach them how to treat and heal themselves. Instead of going through their regular workout, I pull out the foam roller and show them what and how to work on themselves specific to what they are feeling. I show them where the pain pattern is originating and how to help break it down.

Then we get them back on their feet and have them do the same exercise that was causing the pain. Nine times out of ten, they can perform the exercise with no pain. In the rare case that the pain doesn’t go away, I pull out the massage table and do deep tissue fascial massage. I follow up with corrective exercises to train their body to stabilize and move without pain. These are the most valuable sessions I offer. Teaching people how to move efficiently without pain. And more importantly, empowering them with knowledge, understanding, and tools in which they can integrate into their personal routine.

Foam roller therapy is a powerful tool in your fitness, health, and wellness arsenal. With consistent practice you can perform roughly 80% of the massage work that I do… on yourself. Eighty percent! That is powerful stuff. It means feeling better, better movement, getting more out of your workouts, improved posture, less time in pain, less time on the massage table, and you get more out of a professional massage since you are doing so much of the work on your own. When combined with a holistic training program, the benefits of foam roller therapy is well worth the effort.

This is from an email I recently received:
“I am told by 2 surgeons that I need hip surgery due to bone spur on right hip. Also have tight IT band. I am trying to avoid surgery and be pain free… Since I stumbled onto your website and started to do the foam rolling on all body parts I am pain free… Last surgeon said I have a tight IT band. Physio was targeting just the IT band and after reading what people have posted about rolling everything it made sense. I have been doing physiotherapy for close to a year and this is the first time that I have found relief.”

uglyface-300x199 — Rolling your IT band: not so much!

Interested in learning more? Check these out:
Foam Roller Therapy For Beginners
How To Treat and Prevent Injuries
Foam Rolling The IT Band
A Common Cause Of Sciatic Pain – Self Treatment
Self Treatment For Plantar Fasciitis

In the interest of full disclosure, I am an affiliate for Trigger Point Therapy. This means that if you purchase one of their products after clicking one of these links, I will get a small commission. That said, the only reason I am an affiliate for their products, primarily The Grid, is because I believe in it 100%.

Jesse James Retherford is a coach and therapist in Austin, TX. He helps his clients heal from the dysfunction of chronic pain and injury, recover and rebuild pain free posture and function, and propels them into the best condition of their lives so they can thrive physically, mentally, emotionally, and spiritually in all aspects of their career and life. Find out more and sign up for his blog over at www.TAO-Fit.com

After the Fall

Recently a new client, Susie M., booked a four-session package sight unseen. “When I read about your ankle, I knew you were the one for me,” she said.

Susie sprained, and possibly broke, her right ankle four years ago. There was some confusion as to whether there was a bone chip floating around in there or not; what was certain was that she hadn’t been able to work out since. The ankle was chronically swollen and painful even after four years of treatment, including physical therapy and six months of myofascial release. Doctors had given her steroid injections to ease the swelling, but these did nothing but cause burn marks at the injection site.

As soon as I started work, I noticed that the anatomy train leading from her swollen ankle, up the right peroneal compartment, threading through her hip, and crossing the body to her left shoulder was bunched, knotted and compressed. There were so many adhesions in her right peroneals that I suspected the swelling was almost entirely a result of impaired circulation. Muscles and fascia don’t operate independently of the circulatory system; if they are compressed, they’re compressing everything around them.

After her first session, Susie declared, “I think you released more in one session than happened in six months of myofascial release.” She reported sharp pains in her left leg, hip and groin during the next few days, but on her next visit the swelling in the right ankle was 80% gone. She kept coming regularly as things unwound, and every week there was a different issue to confront, but ankle pain was not one of them. After four years, she was able to go back to the gym.

This re-confirms a long-held observation – that if one part of your body is injured, the trauma doesn’t just stay in one place. The body quickly redistributes strain to deal with it, but once the original injury heals, your body is still out of balance. This imbalance can then create a whole host of other problems unless it is addressed.

(“Confusion,” oil on linen, 36″x 48″, 2008 by Stephanie Lee Jackson, www.stephart.com

The Body Remembers

I am so thankful for the treatment that I received!!! I walked in the office a horrific mess, and Stephanie showed her concern and learned what the issue was that I was having and in four short weeks, my body responded to the gentle, yet firm work that she was putting into it. My recovery was felt within the first visit, and continuously improved with each visit.

—Camille A., on Yelp.com

More than a year ago, Camille was struck by a car while she was crossing the street on foot. Most of the impact was sustained by her left hip. She underwent a plethora of treatments at the time, and reduced her pain to almost nil. Then one afternoon she ‘turned her head the wrong way,’ and it all started up, worse than before.

When Camille first came to me, she was stooped at nearly a 60 degree angle. She couldn’t lie prone with her back straight; she couldn’t lie on her back at all. She was in continuous pain in all positions. and I was concerned that she had problems outside of the scope of my ability to treat.

But she’d been to chiropractors, MDs and physical therapists, and the most recent chiropractor recommended massage. So I worked on her in the most non-invasive manner possible, adjusting positions to compensate for her pain. The entire left side of her body was in an extreme state of spasm, particularly her left piriformis and adductor muscles.

After her first session with me, she felt some relief, and decided to book a Crisis Intervention package. I didn’t find evidence of active trauma, such as inflammation, a slipped disc or scar tissue, so I simply encouraged her spasming muscles to calm down.

And ultimately, this seemed to be all that was required. By the end of her treatment, she was moving normally, the spasming had ceased, and she was nearly pain-free.

As I told Camille (and as I wrote to her lawyer, at her request), my belief is that she was suffering from post-traumatic stress. Memory of trauma is actually stored in our cells until it can be safely released; sometimes the smallest twitch is all that is required to re-activate the signal.

What does this mean, for clients and for therapists? Well, the good news is that it’s not permanent. Over time, and with patient engagement, the tissues will literally ‘release’ both the memories and the pain.

But at the same time, it’s important to remember that not all pain can be resolved by actively ‘fixing’ a problem. Some treatments, such as drugs and surgery, can make it worse. All too often, people take a hammer to a problem that merely needs a bit of unwinding.

Physician Heal Thyself

Piriformis_muscle

Image via Wikipedia

–guest post by Sujatha Ramakrishna, M.D.

Having a family full of doctors can be such a mixed blessing. Most physicians are aware of the pitfalls of being related to someone who knows way too much about every little ache or cough.

When I was a fourth-year medical student interviewing for residency positions in psychiatry, I met up with the department chair at UT Southwestern in Dallas, whose wife was also a physician. I guess he must have gotten bored with the usual interview questions, or perhaps he took one look at my transcript and decided there was no way was he accepting me into his program, because the discussion took a personal turn.

He asked me what it was like having two physicians for parents, and hinted that certain issues had arisen over the years with his own children. My response was simply, “Well, when I was a kid, and I got sick, they either didn’t care at all … or they totally freaked out.” He just about died laughing at that one. It must have sounded incredibly familiar to him. Perhaps that answer meant that I would have gotten accepted into his program after all.

Now I am a grown-up shrink, and I still have a family full of doctors who provide ample advice, both solicited and unsolicited, for every ailment imaginable.

A few months ago, I got up quickly after sitting in an awkward position on the edge of my couch, and I thought that my right leg was asleep. Well, walking it off, of course, was the solution. Only … whoops! I had foot drop. For those of you who don’t know, this means that when you try to walk your toes drag the ground. Flashback to those med school classes, trying to remember what that meant. Was I having a stroke? A compressed nerve? Hysterical paralysis?

Med school was 20 years ago, as was my last neurology rotation, so of course I had no idea. But I knew that Google would save me … hmm … “damage to the peroneal nerve.” Ok, that sounded reasonable.

But wait, it wasn’t so simple. I also started having twinges under my right seat bone, with radiating pain down the back of my thigh and around to the front of my lower leg. Not good. I had to cancel a trip to Texas, because I had been planning to drive but couldn’t sit for that long.

That’s when all hell broke loose.

My mom the family practitioner called me up, and suggested all sorts of narcotics and muscle relaxants that I could take. She said that if I came down to Texas my sister the radiologist would get me a free MRI. My cousin the orthopedic surgeon asked me if I had back pain, and wanted to know the positional nature of the symptoms.

My aunt the pathologist told me that the real problem was that I needed to acquire more padding on my ass, and suggested having a mojito to get that process started ASAP. As a side note here, one of the really wonderful things about belonging to an Indian family is that you get updates on how much weight you have gained or lost every time you see them, even if the scale says that you haven’t gone up or down 2-3 pounds in the last five years.

My uncle the vascular surgeon, after having a few scotches at that same gathering, started off with a recommendation for a nerve removal, assuring me that yes he had done neurosurgery rotations back in the 1970s (!) and finished with the brilliant idea that a total leg amputation would be a more permanent solution and also earn him more money.

My father the emergency room physician had the most practical advice of all, which was simply, “Don’t drive to Texas.” Words to live by.

Fortunately, another cousin of mine and her husband are physical therapists. I showed them where it hurt, and they immediately said, “Aha! Piriformis!” I said, “What???” We either hadn’t learned about that one in anatomy class, or I had forgotten. More likely than not the latter.

Basically, the problem was a tight muscle which was compressing the nerve. They showed me a stretch that would relieve the tightness — sitting on the floor with my knees bent, crossing the right leg over the left, and using my left hand to pull my right knee towards my left shoulder.

Soon the party at my cousin’s house turned into a mini-yoga class for everyone, which was hilarious but also more therapeutic than any advice that I had received from any of the physicians. I did the stretches that they showed me every morning, and I haven’t had a problem with that nerve since then.

Obviously I am lucky to have such a caring family, and their intentions were nothing but the best. But this story is a great example of how maybe we doctors are too quick to turn to pills, diagnostic equipment, and the knife in every situation. When those things are not indicated, we have few other resources to fall back on.

Back in the old days, doctors didn’t have all the fancy tests that we have now, so they had to spend a lot more time listening to and observing the patient in order to make their diagnosis. You might even say that the close personal relationships which they had with their patients were their best diagnostic and therapeutic tools. We could all use a lot more of that these days.

Why Are Rehab Centers So Ugly? (Part I)

That’s a rhetorical question. I may never know why rehab centers are ugly, because I’m not going to physical therapy school, and you may never understand a system until you’ve worked within it.

While I was researching a career in physical therapy, however, I interviewed at several institutions where physical therapy takes place. I vowed that I would not attempt to redecorate any of the environments in which I found myself, or even bring up the issue; this vow lasted about fifteen minutes.

I used to believe that hospitals, doctor’s offices and cubicles at Pacific Gas & Electric were the nadir of modern working environments, with the exception of meat packing plants and third-world sweatshops. Then I interviewed at X Physical Therapy Center in Philadelphia.

Whoa, nelly.

The above image is not the center that I visited; it is infinitely nicer. Note the elements of actual color, however frigid; the matching furniture, the plants–possibly not even fake. Flickering fluorescent lights, however: check. Acoustic tile, check. Windowless basement, check. Bare walls, hideous floors, musty odor, uncomfortable furniture, people wearing scrubs: present in force.

If this were a movie set, it would represent an Argentine military prison, circa 1977. Your mind is not clueless–it walks into a place like this and knows you’re about to be tortured. If relaxation is a healing state of mind, you will not achieve it here.

I doubt this is an accident. Why else would they all look like this? Maybe they do it to signify that This Is Serious Medicine, not snake oil, like all that ‘alternative medicine’ BS. Perhaps they wish to demonstrate that they aren’t wasting your premiums on interior design. Possibly the Western healthcare establishment is entirely oblivious to aesthetics.

But, just possibly, it’s about power. Because beautiful places send signals of their own: you are important. You are cared for. You are healthy, wealthy and safe.

Conversely, fluorescent cubicles are where the Little People must work, play, live and die. Ugly=Low Status. It’s as if our culture expects that sick and injured people understand, in their bones, that they are second class citizens. By getting sick, you have sinned. If you want to rejoin society, you must endure Purgatory.