Physical Therapy in the Safety of Your Home.

 

During the Covid 19 outbreak it is important to be safe. Follow social distancing guidelines and stay home as much as possible. But what are you supposed to do if you are in high levels of pain? What are you to do if your health is substandard and interfering with your vitality and function? Just wait it out til the end of this virus? I believe the answer is an emphatic NO! There are ways to stay safe and continue to work on health strategies. And there are reasons why this is important.

We have limited hours and reduced the number of appointments in person at the clinic, but we are still seeing patients for those who find their condition would worsen without our help. Here are some examples of people who found it important to come in to the clinic for treatment.

One person’s swelling was not being helped in any other setting, it was causing immobility, fatigue and pain. The person’s overall health was declining to the point of not being able to participate in usual daily activities or enjoy family and friends. An intensive treatment plan was finished just at the start of Washington’s stay at home order. The individual worked for a week independently, using compression, exercise and self-massage. But the swelling increased in the course of the week. It was application of professional manual lymphatic drainage that keeps it at bay and helps keep forward momentum with a home program. This is an example of need for care even in a pandemic. Not receiving treatment will result in loss of progress, increased disability and the need for more medical intervention that is more costly and in short supply during this time of crisis.

Another person with chronic digestive problems was having symptoms of a bowel blockage. Having experienced it before, the individual consulted their primary care doctor who said please stay away from the emergency room if you can. The risk to this person’s health was too great. The doctor’s recommendation was nursing the symptoms along at home and stay on a clear liquid diet. The last time something like this occurred, the person was on a clear liquid diet for 6 months. Visceral manipulation and manual lymphatic drainage are treatments that can help improve intestinal and bowel functioning. After one visit, the person is beginning to eat solid foods, that is after one week of symptoms.
These are examples of the imperative nature of physical therapy and the potential of the advanced manual skills we offer when provided in the context of skilled clinical reasoning.

But manual therapy is only one third of a well-rounded physical therapy treatment. We also provide prescriptive exercise training for the individual and self-care education. In fact, the manual therapy effect will not last without effective exercise and self-care skill development. Physical therapists are the ones that do this!!

Individual guidance on exercise progression and integrating self-care skills and routines into daily life are foundational to the treatment we provide at Therapy Solutions. In this time of Covid 19, we can very effectively provide this at a safe distance. And we are!!

We also have examples of patients receiving benefits during this time through telehealth.

For instance, a person with chronic health issues and multiple sites of joint stiffness and pain, is meeting weekly through telehealth for exercise instruction. The exercises are resulting in reduction in pain, better sleep, and carrying over into better function. There is even visible improvement in range of motion and muscle relaxation during the telehealth session. Therapy is able to continue and the individual’s health continues to improve. We are able to discuss self-care skills.

There are some great group classes going on virtually (and we are offering some!) But one on one with your physical therapist will be focused to your particular needs and get you farther faster. That is what we are trained for! A family member went through ACL reconstruction. After initially having individual care, they were then moved to group rehab. The family member decided to return to one on one and made exponential improvements under the specific guidance by an expert PT. We can do, and have done, that by watching and guiding you via a screen chat!

Telehealth and ongoing patient support through affordable online tracking has been a vision of Therapy Solutions for six years. The addition of Irene Luc, DPT, to our staff has accelerated that and brought the vision to reality in the past year. Through the combined efforts of Dr. Irene and Dr. Christina Rankin, DPT, we had most of our program in place when the pandemic hit. We can help you now from the safety of your home! Don’t put it off!

Because of the pandemic we are providing telehealth at reduced cash rates. We chose this over insurance billing to insure low cost and ease. [There is too much confusion and overwhelm in the insurance industry right now.] We will provide a superbill so that you can potentially get reimbursement from your insurance company and we can cut out the cost of doing billing to give a better rate.

Why you want to continue your physical therapy distantly during this time.

1. Your best insurance is daily self-care. Even if you were to get sick, being fit and well can help you through illness.
2. Physical therapy can provide the best pain management because we teach you how to change your pain on your own.
3. Physical therapy can help you achieve life goals.
4. If you have trouble being consistent, that is a sign you need some help with it. Humans need each other. We always have and always will. No athlete achieved high levels of ability without a coach. You are no different!! You will make better progress in your physical goals with individual guidance.
5. Seeking help from a PT first has been the vision of this profession for twenty years. We can do medical screening and recommend more medical workup as needed. We can help you figure out how to navigate daily life with less pain, and how to integrate health practices easily. We are the profession to step in and be your stop gap during this pandemic
6. Physical therapy can help you not just get by, but rather, thrive in all circumstances.
7. If you are at home, now there may be more flexibility in your schedule to take on some new learning. Spending a little now could save you a lot later.

Throwing a pebble in the pond.

Therapy is like throwing a pebble into a pond. Hopefully it has a ripple effect in the life of the person seeking help. Most of the time we don’t know the long term effects of the various therapy sessions we offer (physical therapy, occupational therapy, counseling, acupuncture..).

As we approach the celebration of 20 years in business, I am curious what kind of ripple effect Therapy Solutions had for you. Would you do me a favor? If you received services at our clinic, would you let me know if we made a difference in your life? Did you learn something or experience something that changed the path of your life? Do you still use the tools we taught you? What effect has treatment had?

I have to say thank you to all the people who have trusted Therapy Solutions with their care. Getting to know people’s stories and helping through rough times has had a ripple effect in my life. I have immense gratitude for the opportunity to do this work!

Learning From Mistakes: The Kung Fu Fighting Chipmunk

I promised to share stories from the past twenty years that Therapy Solutions has been in existence.  The tale I have to tell is not one I am proud of because it is about a mistake I made. But I often learn from mistakes, and it is funny.

This happened in the first three years of the business.  One of the employees had recently broken up with her boyfriend.  He stopped in when she wasn’t there and brought a mechanized Kung Fu fighting chipmunk and some flowers (actually, I am sure of the chipmunk but only vaguely remember if the second item was flowers).  Another employee took it upon herself to confiscate the items, saying it would be so hurtful to our fellow employee to see these things and be reminded of this boyfriend.  This is where I made my mistake, I agreed with her and let her take the flowers home, while I took home the Kung Fu fighting chipmunk.  I know, stupid, right?!

A couple days later while eating lunch with the over-protective employee the recently broken up employee came in to ask if we knew anything about her former boyfriend stopping by and leaving a gift.  I froze.  We were caught!  We sheepishly admitted to it, and I returned the chipmunk.  She was not pleased.  I was embarrassed.

But as I said learning from my mistakes is a common mode of operation for me.  This episode taught me important lessons in communication.

1.  Don’t try to shield other people from the experiences that come to them in life.  Tell them the truth! Gently.  Kindly.  Be there for them.  But hiding the facts in the end can hurt.  And worse you can lose trust. Which leads to the second lesson.
2. I would rather be a person that can be trusted to tell the truth and to stand along side in difficult times.

In fact, the employee and her former boyfriend had chosen to remain friend sand it was a peace offering.  It was not something that would hurt her feelings. We were assuming.  Thus leading to lesson number three:

The old adage: when you assume, you make an ass of u and me.

I read, practiced and trained to improve my communication skills.  It takes time to acquire the skill of direct and open communication that is delivered with respect and kindness.   And it is worth it!  Resources that have been helpful to me includ:

The Awareness Wheel (public domain, see image)

Nonviolent Communication by Marshall Rosenberg (book)

Active Listening  This is an excellent tool to develop your mental ability to fully listen to another person.

The Victim Triangle by Lynne Forrest  This tool is first important to understand, then understand how you participate in this form of communication and finally find your way about by being clear about what you want.

To survive my mistake based method of learning I have also had to learn to release shame.  But that topic requires it’s own blog.  Cheers!

 

Suggestions for Transitions

I recently taught a yoga class series on transitioning, in this case, to the new year.  It was pointed out this is good contemplation for any transition of time.  And someone else suggested I summarize it in a blog. So, here you go!

Out with the old.

It is useful to take time in the day, at the end of a week, a month, a season, or the year to reflect on what occurred.  By doing so we have a chance to grow, lighten our load and create health.  Conscious release includes acknowledgement/honoring, gratitude, learning and integration.  This process makes space for what is ahead and lets our experience become support rather than a burden or something that hardens us.

My approach to consciousness is embodied consciousness.  How can I use the body to effect change in my heart and mind and connect more deeply to Spirit?  Asana (yoga postures) is a chance to physically practice these concepts.  There are many ways this could be approached and for this most recent class I emphasized use of the front and back of the body during asana (postures).  The front body supporting the back body, and the back body supporting the front body.

I did a search of my yoga books and the internet looking for opinions on what helps with release.  Other findings included:

Pranayama – breathing is of course very beneficial for cleansing the body.  Bastrika breathing, or pumping the lower abdomen while breathing in and out through the nose is an example of a cleansing breath.  Nadi Shodana (alternate nostril breathing) is also helpful.  It’s easy to underestimate the benefits of simple things like breathing. Here is some scientific proof!  Scientific evidence for health benefits of yoga breathing  (Int J Yoga. 2018 Sep-Dec;11(3):186-193. Implication of Asana, Pranayama and Meditation on Telomere Stability. Rathore M, Abraham J.)

Asana – twists and supported twists,  Simhasana (Lion Pose), Baddha Konasana (seated and reclined) , Biparita Karani (legs up the wall), balasana (child’s pose) and shavasana (corpse pose)

In with the new.

Once we have made space, we can welcome the new with intention.  Intention implies stating a desire but being open to how that desire is supported by the greater good and how it will come to fruition.  It requires deliberate thought and introspection.  When ego sets a goal, this implies a more limited perspective, bound by the individual’s gaze from limited body and consciousness.  Intention implies welcoming support from those around and also by the Divine.

There are four things required to meet the new and unknown with intention.  They are ease, perspective, embodiment (also could be called grounded or centered), and an open heart.

Use asana to embody these aspects by putting your attention to creating one of these qualities within a posture.  I found a lovely practice from yoga therapeutics taught by Beth Spindler called Spandana.  https://yogainternational.com/article/view/spandana-practice-for-yoga-therapeutics to practice creating ease.  Another definition of ease is suppleness in the muscles, they are strong but soft.

Drishti or eye gaze during a posture can remind us that we see from a limited perspective.  We can acknowledge that other perspectives exist and be willing to listen.

Listening with the body is a form of open-heartedness.  Physically we can work on mobility in the thoracic cage. Energetically we can become aware of the felt sense of the space about us.

Moving with a stable core and awareness of our body in contact with the floor helps us be embodied and centered.

Quotes on Intention

“Live less out of habit and more out of intent.” Amy Rubin Flett

“Focus on the powerful, euphoric, magical, synchronistic, beautiful parts of life, the universe will keep giving them to you.” Unknown

“Our intention creates our reality.” Wayne Dyer

“Circumstances do not make the man, they merely reveal him to himself.” James Allen

Questions to consider:

What are your hopes and dreams for the coming year?  Can you for this into an intention?

Where do you experience ease?

What is your habitual perspective/ Can you give a name to the ego voice you identify most strongly with?

What grounds you?

What are the ways you nourish your heart?

Happy New Year!  Sara Nelson, PT DPT, WCS, RYT

Acupuncture Can Help People Recover From Stroke

By Xiaoyuan Huang, L.Ac.

The World Health Organization (WHO) estimates that 15 million people suffer from stroke every year worldwide. Stroke is the third leading cause of death and the major cause of adult disability in the United States. Most people well know that acupuncture is very good at treating pain conditions. But do you know Acupuncture can also help people recover from stroke? Acupuncture is one of the most important treatments for stroke patients in China, Japan, South Korea, and other east countries.

Acupuncture can benefit the following symptoms that people with stroke-related conditions are dealing with:

• Problems with movement and balance
• Problems with sense of touch or ability to feel
• Pain, numbness, or tingling in limbs
• Speech, language and swallowing problems
• Vision problems
• Urinary or bowel problems
• Memory and cognitive problems
• Emotional problems.

 

How acupuncture can work in post-stroke? Recent studies of acupuncture treatment in stroke shows the mechanisms:

• Acupuncture treatment can improve blood flow.
• Acupuncture can improve the elasticity of the cerebral arteries and improve blood supply to the brain lesion.
• Acupuncture can improve the basic electrical activity of cortical cells, causing the clinical symptoms of stroke patients improved rapidly.
• Acupuncture can improve the body microcirculation, promote recovery of limb function.
• Acupuncture can lower blood lipid and improve immune function.

 

When is the best time for acupuncture treatment for stroke?

The best time to start acupuncture treatment for stroke rehabilitation is determined by the type of the stroke. It is better to start acupuncture treatment as soon as possible for an ischemic stroke. However, a few days delay is suggested for hemorrhagic stroke until the bleeding blood vessel has clotted before the acupuncture treatment.

If you are suffering from and struggling with stroke or have some post-stroke conditions, please give acupuncture a try, you will not be disappointed!

How To Stay Young

Years ago, I started having arthritis symptoms.  My doctor recommended I see a rheumatologist.  As a physical therapist, I had treated people for similar symptoms who had seen a rheumatologist and got on medication but didn’t make lifestyle changes.  That experience made me want to work on modifiable behaviors before taking the radical step of medications.  As a result of working on lifestyle factors, I have made immense improvements.  I am not alone.  Many people have had great improvements in their health by developing better habits.

This isn’t about a choice between medication or self-care.  Self-care is not optional; it is a necessity if you want long-lasting good result with medication.   Self-care doesn’t have to be hard or confusing.  This is the four-part program that worked for me:

Eat strategically.  There are differences of opinion on healthy eating.  But all agree, learn to love your vegetables!   Drink water! Stay away from processed foods (excess sugar, fat and salt).  The research is incredibly strong for a whole food, plant-based diet.  Consider carefully, if you are willing to take expensive medications with serious side effects over simply eating whole foods, perhaps that’s a big part of the problem.

Alleviate the effects of stress. 

Even under ‘normal’ circumstances of modern living, we have so much incoming stimulus, our systems are on overload.  To alleviate stress (1) Learn how to have a good night’s sleep on a regular basis. (2) Explore your psychological landscape with a counselor.  Mental health counseling is way under-utilized as a tool for good health.  For instance, it offers some of the best tools for pain management.   This is why Therapy Solutions, a physical and occupational therapy clinic, has a counselor on staff.  (3) Develop mental discipline.  This comes through meditative practices.  An example of an effective meditation tool is Richard Moss’ Mandala of Being (www.richardmoss.com).  This tool helps the individual to develop a sense of the present moment and recognize when thoughts are pulling them away and causing an increased stress reaction. (4) Play.  Have fun. Take time for leisure. Really.

Move!  Move 150 minutes per week.  Better yet, move 300 minutes per week.  Move!  Moving helps brain health, cardiovascular health, mental health, pain conditions, everything to do with being in a body is helped by moving.  Dance has been shown to be one of the greatest tools for good health.  But just walking out your front door and around the block is helpful to your health.  And there is everything in between, qi gong, gyms, yoga, bicycling, and more.  Sometimes we need help to find what works and that is where physical and occupational therapy comes in.

Bodywork  Bodywork refers to all the different methods of manually working on the body, this can be a basic massage but also can be acupuncture, manual lymphatic drainage, myofascial release, craniosacral therapy, visceral manipulation, chiropractic, sound baths and more.  Fascial release methods happen to be my favorite way to assist a change in the body because they assist with mind-body connection, and a more lasting change in the tissues compared to other forms of body work.

Who is responsible for the health care crisis?!

By Sara Nelson, PT, DPT

We have all felt the pinch of growing insurance premium and copay/coinsurance. If you have tried to get help for a medical condition recently, you may have noticed increasing red-tape to try to get an appointment.   Despite attempts to cut expenses, the per capital cost of health care in the US has reached $10000 per person.  Other first world nations are spending far less and still living longer than we do.  Health care expenditure in the US is 17% of the GNP.  Clearly something is amiss.   This is a complex problem that can’t be fully addressed in this article.  Blaming the Affordable Care Act is over simplification.  To begin to understand the problem, get to know the players and the roles they play.

The medical system.  The practice of medicine has pressure from different directions.  Some of the changes and costs come from the risk of law suits.  Care is provided to reduce the risk of legal action.  In addition, attempts to streamline care to be more efficient has taken away from the personal relationship of the doctor and patient.

Insurance companies.  These groups are trying to remain profitable by requiring more information up front before they will pay.  This means longer wait times to make an appointment, more paperwork to use your insurance benefits, and having this third party in on making decisions on your care.

Big Pharma.  We are the only first world nation that allows marketing of pharmaceuticals on television.  This has planted a message in all of us that your health problems can be fixed with a pill. These companies have strong lobbies that pressured congress to bar Medicare from negotiate prices on drugs.  So we end up paying more.

Big Food.  Packaging food so it appeals to our taste buds sells more food.  Putting sugar, fat and salt in food will trigger the brain to create more desire for the food.  Processed food sells, and has contributed to a disastrous epidemic of obesity and chronic illness.

Public Health Policy refers to community and government initiatives that encourage healthy behaviors, or not.  Policies that favor cars over walking and bikes contribute to inactivity and poor health.

You! These may all seem bigger than you but ultimately each individual influences the cost of health by making choices that will keep them as healthy as possible.  If we all eat healthy, whole foods, that’s what the stores will sell.  If we become more active in our lives, government and business will respond to requests for products and services to make being active easier.  If we ask our doctors what we could do to replace medication, they will start talking to us about how to do that.  This will bring health care costs down!

By 2025 it’s expected that 49% of the population will have a chronic disease.  Many of these would be prevented or diminished in their effect if we all took action to make healthy choices now.  You can start today to make a dent in health care costs!

Healthy or Health Nut?

By Sara Nelson, PT, DPT

Years ago, we had someone come through our physical therapy clinic for treatment of a chronic condition.  The process of treatment and self-care training for the condition were explained to the individual.  We included what we offered to help alleviate the condition and what skills were taught on how to manage the condition independently.  The person called back later to cancel appointments and say she didn’t want to do self help.

We have successfully convinced ourselves that health behaviors are not needed, that the powers of drugs, procedures and surgeries will compensate for inactivity, stressful living and poor food choices. I believe that the people providing those services would agree procedures and pills support healthy living, not replace it.

The fact of the matter is that the chronic conditions we suffer as a society are on the rise, and although some are living longer, they are suffering more. While our general health is declining, insurance companies are putting their foot down on reimbursements for treatment of chronic conditions.  They point out that originally insurance was meant for catastrophic events, not the expected effects of aging.

If you are interested in enjoying life and feeling good most of the time, you are going to have to do something about it.  The time for action is now.  Start today to develop health habits that will in the end cut your health care costs and make your day better.

Getting started is hard for most people.   Find a group that fits you and your goals.  Group exercise will provide you with the motivation and fun you need along with safety and accountability.  Group instruction provides you with the information you need to feel good.

A new development in the fitness industry, is fitness for people who are chronically ill and don’t feel up to the typical gym.   We have several options around town.  Don’t let illness or a lack of motivation keep you away.  Often starting with physical therapy is a good entry into an individualized fitness program.  In answer to the title question, you don’t have to be a health nut to be healthy, you just have to make a positive choice today.

Post-Natal Care

Prenatal care for expectant mothers is provided automatically.  However, after the baby is born there is seldom any assistance to help mom return to her pre-baby state.  In Physical Therapy world, we think every new mom deserves post-natal care!  This was understood centuries ago, when postpartum care was given to mothers and newborns in India in the form of massage.

It is still a good idea today.  If you are expecting a baby, here are reasons to continue with professional care after you have your baby:
1.  Get your body back faster — Carrying a baby distorts the actions of your core muscles from the abdominal wall, back, respiratory diaphragm and pelvic floor muscles.  For instance, a separation of the abdominal wall, known as diastasis recti, can lead to back problems.  This can be helped with proper rehabilitation.  A physical therapist specializing in pelvic health can help you on the road to recovering your body sooner and preventing future problems.
2.  Prevent organ prolapse.  The effects of carrying the baby, delivering the baby and the ensuing lifting and carrying baby after delivery can contribute to dropping of the pelvic organs (bladder, uterus, and rectum).  This is correctable with the proper exercise and guidance.  As much as one third of surgical repairs of bladder prolapse fail, and this may have to do with the need for behavioral and muscular retraining.  A physical therapist specializing in pelvic rehabilitation may help prevent the need for surgery in the future,  in this early post-partum stage.
3.  Restore normal bowel and bladder function.  It is not uncommon after having a baby to have some problems with urinary or fecal leakage.  Physical therapists can help you correct this through behavior and muscle retraining.
4.  Return to sex with less pain.  We get very little guidance on how to return to sexual intercourse after having a baby.  A physical therapist can give you some tips to avoid pain with intimacy.
5.  Address pain before it becomes a constant.  Postpartum can mean continued back, hip, pubic and sacroiliac joint pain.   A busy mom may put her own pain aside to meet the demands of new motherhood and all its responsibilities.  It is important to address pain right away.  There is no need to suffer.  If a c-section was necessary, addressing the scar tissue can help prevent future problems as well.
If you don’t learn how to correct some of these issues, they can follow you for decades!  Consider including post-natal Physical Therapy care as part of your health care in the pregnancy, birth and post-partum experience.

Limitless!

By Sara Nelson, PT, DPT

As a physical therapist, I see a lot of people with physical problems that appear insurmountable.  Through the years I began to believe that some people just couldn’t move because of their pain or limitation.  I looked for ways to help them survive within those limitations.  This view is common in the medical world.   My son taught me this is an erroneous view.  My son is an Ironman.  If you don’t know, that is a competition in which participants swim 2.4 miles, Bike 112 miles and finish off by running a marathon (26.2 miles).  I was so concerned he would hurt himself when he did his first Ironman, he hadn’t even run a marathon.  He showed me that with proper pacing, fueling and self care, you can do almost anything.   He finished that Ironman and has gone on to do four of these races.  His wife was able to use his guidance and her own consistent effort to participate in and finish an Ironman herself, with 11 months of training.  She accomplished that with no joint injuries, and having not been a swimmer.

There were lessons for me as the observer of these accomplishments that I have put to use in my own life and passed on to my patients.  As a result, I am seeing people over come significant problems.  These lessons include (1) be careful what you believe about your body, you may be putting unnecessarily limits on yourself, (2) Pushing through injury and forcing limitations will NOT help you achieve physical goals.  Learn to work within your capacity and with your body to expand your abilities, (3) Modify workouts or take a break when you are hurting, until you can find the path forward where your will and body can work in harmony to achieve a goal. (4) Proper ‘fueling’ is absolutely necessary to go the distance.  In other words, practice healthy eating which includes adequate hydration and nutritious food eaten at regular intervals. (5) If you hurt, do something to feel better.  Self care is a powerful healer, and it includes massage, Epsom salts baths, learning about your body and how it works and how to help it heal, and more.

When I ask my son what he learned from the experience, he says he has learned that you can’t let your thinking intimidate you.  No matter how far you have to go, you only have to take one step at a time.

If you need help knowing what steps to take, talk to a physical therapist!