The More We Bend: The McKenzie Method

By: Jen Brown, DPT

As physical therapists we take courses to further our education and learn new treatment methods to enhance our patient care.  Following physical therapy school I worked in the hospital setting for a year in which time I lost confidence in my manual therapy skills and my ability to treat patients with low back and neck pain.   I knew I needed to take a course to enhance these skills and with our McKenzie Certified PT Brooke retiring, it only made sense that I took the courses.  It is a big time commitment to get certified in the McKenzie Method.  It is a series of 4 courses (2 are 3-day and 2 are 4-day) followed by a written and practical examination.

The McKenzie Method (MDT) was developed in New Zealand by a man namckenzie extension1med Robin McKenzie.   The story goes that Robin was not looking for a new treatment method but rather stumbled upon it.  It was in the 1950’s and Robin instructed a patient with low back pain radiating down a leg to lie down on a table and he would be back in the room momentarily.  When Robin re-entered the room, the patient was lying on his stomach on a table with the head inclined causing his low back to arch backward.  The patient informed McKenzie that the pain was no longer in his leg and it was the best he had felt in a long time.

Since then the McKenzie method has developed into a widely recognized technique to treat not only the spine but also the extremities.  MDT consists of assessment using mckenzie extension2repeated movements or a sustained position in a single direction to reduce pain and restore function.  The method is based on the concept of directional preference which is a certain direction of movement that the spine or extremity prefers.  In the low back it is usually extension, or bending backward.

I once heard at a course that a study found the average adult bends forward to some degree over 2500 times in a day and only bends back 100 times in a day.  Both bending forward and sitting places our spine in a position of flexion while bending back extends our back.  It is important to recognize that even a slight bend can have an adverse effect on the low back.  I have read that as little as 20 degrees of flexion of the lumbar spine can place up to 30% increase pressure on the discs.

Image a trip to the grocery store.  Let’s say you get 100 items and place them in your mckenzie extension3cart.  That’s 200 forward bends.  Then you get to the check out and you get the 100 items out of the cart and put them on the counter.  You’re up to 400 bends.  The items get placed into 15 bags.  Then you pick up the 15 bags, which are now heavier and put them in the cart.  That’s 430 bends but remember 30 of those bends have increased pressure on the disc due to the weight you are lifting.  Then you push the cart out to the car and load the bags into the car, another 30 bends.  You drive home (likely in a seated or flexed position) and then unload the bags.  You are up to 490 bends.  Now you have to take care of the groceries which are likely another 100-200 forward bends.  In mckenzie extension4just one grocery shopping trip you have bent forward nearly 700 times, not to mention the static bent time while sitting in the car, it is no wonder we have sore =backs.

We cannot fully avoid forward bending or even make it through the day without bending over, however, with safe body mechanics, posture awareness, and simple extension exercises we can significantly improve low back pain and prevent future episodes.

 

 

 

 

 

 

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10 things I, as a physical therapist, want you to know before having knee replacement surgery

By: Kristin Weller, PT

I don’t know exactly how many patients I have seen following their total knee replacements but in my 13 years as a physical therapist,  I imagine the number is in the hundreds. Each patient is unique, of course, but in general I find people have similar comments and complaints about their recovery. Physicians now days are doing a much better job informing their patients on what to expect post operatively and some even provide courses in the days leading up to surgery to help their patients prepare. As a therapist I have, at times, wished that I could also get my hands on these patients and educate them on what to expect from a rehabilitation perspective. If I were to have the opportunity, here are the Top 10 things I would want you to know:

1) The overwhelming majority of patients that I see do very well following their total knee replacement and say that they were happy they chose this option for their arthritic knee pain once they have fully recovered (6 months – 1 year usually!). I hear the same horror stories that you do but the reality is that compared to the successes, the failures are minimal. So relax, if you have knee pain that is interfering with your daily activities and your physician is recommending surgery, you should feel confident in your decision.
2) Before your surgery there are things that you can work on to help in the rehab process. In fact, if I had it my way, I would see every patient for 1-2 visits BEFORE surgery to give them some advice and get the started on an exercise program. Typically, when someone has severe arthritis in their knee they not only have pain but have knee stiffness and weakness. When you go in for a pre-operative appointment talk about the benefits of 1-2 visits of therapy prior to surgery with the surgeon OR they themselves may even be able to give you a couple of exercises to start on that will give you a leg up in your recovery.
3) Following surgery you will most likely have an inpatient physical therapist in your room asking you to put weight through your leg and stand up. Don’t worry, you can do it! In the past, it would have been days that you would have lied around and recovered from this surgery but research has shown that putting weight through a bone actually improves healing time and increases bone strength.
4) In addition to standing up, you will be asked by the inpatient physical therapist to move your knee. Bend, bend, bend…straighten, straighten, straighten. After any surgery, your body begins to heal and form scar tissue. To generalize, scar tissue can form in two ways: 1) in a way that restricts movement or 2) in a way that allows movement. For a short time period after surgery, your scar tissue is malleable (can be molded!) before it becomes fixed. Movement in these early days and weeks following surgery allows you to mold the scar tissue allowing the free movement you will need to achieve your goals. In my experience patient’s usually have difficulty with either bending OR straightening their knee following surgery and if this is you, don’t worry, just do those exercises and your good outcome will be waiting for you.
5) There will be pain. I know I just told you in my first point that you are making the right decisions but not all right decisions come without pain. Although, I have never had a knee replacement, I have listened to and aided in the recovery of many many patients. I liken their stories and complaints to having a newborn (something I have done 4 times!). At first you are totally focused on the pain, it keeps you up at night and you just can’t do the things that you want to do because it’s always there and needing your attention – all things a newborn does :). My best advice is to take the pain medication as prescribed (especially when starting therapy), do your exercises through the discomfort with the guidance of your therapist and remind yourself that this pain will go away as the knee heals. The right mind set will help tremendously with your recovery.
6) Inpatient physical therapy, Home physical therapy, Outpatient physical therapy…what’s the difference and what is best for me? Very generalized, here is the difference:

  • In Patient
    The purpose of inpatient physical therapy occurs in the hospital and is to get you to be able to safely leave the hospital: in and out of the car, walk the distance needed to get in to your home and practice stairs if that is what your living situation calls for. Everyone should have inpatient therapy following their surgery.
  • Home
    Home physical therapy is needed in certain situations. If a person has difficulty safely maneuvering in their home and it is difficult for them to leave their home because of their recent knee surgery then home therapy is appropriate. You will work on what is needed to get in and out of your bathroom, in and out of your shower, up the stairs to your bedroom, etc… The need for home physical therapy can depend on the type of house you live in, your age and even what season it is as winter snow and ice can be a factor in determining your ability to safely leave your home.
  • Outpatient
    There are a good number of people who walk out of surgery able to safely maneuver around their home and these people are the ones who get to come right to outpatient physical therapy. The goal in outpatient therapy is to return you to the activities you did before surgery and before your knee arthritis became debilitating. This depends on who you are and can range from being able to stand to prepare a holiday meal for your family, to returning to work or returning to a regular exercise regimen.

7) Biased opinion coming from an outpatient physical therapist…if it is safe for you to come to outpatient therapy, the earlier, the better. Outpatient therapy clinics are better equipped to help you quickly meet your goals. I have been a home physical therapist before and know the limitations that exist. There is more equipment and treatment options available in a clinic. Also, I’m not sure if research has proven this or not, but I truly believe that there are emotional and cognitive benefits to getting out of the house which are beneficial in your recovery from surgery.
8) There will be swelling. Most likely for 3-6 months. The amount of swelling varies patient to patient based on a variety of factors but there are some things that can be done by everyone to limit the swelling. It is important to limit swelling for a lot of reasons. In therapy, swelling can limit your return of full range of motion. Imagine one of those long skinny balloons used to make animals for the kids. Imagine one of those balloons that is half full of water and then imagine the balloon completely full of water. Which would be easier to bend in half? The less water, the more mobile the balloon would be and this is the same for your knee. How to limit the swelling? Ice AND elevation. Some people think elevation means propping a pillow under your knee while you sit in your recliner watching TV. While probably comfortable, this does little for your swelling. Your knee needs to be REALLY elevated to a level above your heart. To achieve this you need to lie down and use multiple pillows. Listen to your therapist, she will make sure you are effective with this and make sure you are doing the proper exercises to activate the muscle pumps that reduce swelling also.
9) A walker is not a bad thing. Neither is a cane. One of the first things you will be handed when you start inpatient physical therapy is likely to be a walker. This walker will go home with you. Get used to it, it will probably spend weeks to months with you and guess what? There’s nothing wrong with that. Patient’s seem to be in a hurry to walk “normally.” The problem is that you shouldn’t walk “normally” until you can actually walk NORMALLY. Moving off of a walker or cane to early can cause severe limping which can injure a back or a hip. I don’t gauge progress of my patients based on what type of assistive device they are using. Lastly and most importantly on this topic, it is imperative that you are safe. A fall can be catastrophic to your recovery and you could end up back in surgery. Listen to your therapists advice and you should have a happy and safe recovery.
10) It is RARE to “ruin” your knee replacement surgery. Outside of a traumatic fall or car accident this is a very stable surgery in my experience. It is COMMON to have bad days following good days and good days following bad days. If you are having a bad day it does not mean that you ruined the knee replacement. A conversation with your therapist or physician should ease your concerns and typically patients coming in for treatment and exercise on their bad days leave feeling better.

If you are scheduled for a knee replacement, I hope you feel more encouraged than overwhelmed after reading this. If you are considering a knee replacement I hope you feel more educated on your expectations and recovery after reading this. If you have already had a knee replacement I hope that maybe you can relate it to your own journey whether it be with a chuckle or a cringe 🙂

 

 

 

Age to Age We Fall

By: Karen Carlson, PT

A few years ago I missed the bottom step carrying a plate of cookies to the lower level in my home. I fell and fractured a metatarsal in my right foot. Besides the embarrassing fact that I fell in front of a room full of people and the cookies were plastered all over the wall, the fall came at a very unfortunate time, as do most injuries. I was in the middle of planning my daughter’s wedding and this was just something I did not need. So, why did I fall? First of all, I forgot to remove the reading glasses I was wearing to read the cookie recipe. Yes, my eyes are not as good as they used to be and I can no longer brag to my husband about my many years of 20/20 vision. Secondly, slippery socks on carpeted stairs is never a good idea. Lastly, I just don’t think my balance recovery time is as good as it used to be.

Many changes happen to our bodies as we age: body parts that used to be higher are now lower; smaller parts are now larger; larger parts are now smaller; we lose hair where we want it to grow and grow hair where we never expected it to be. Our daily activities change, resulting in a gradual loss in flexibility, strength, and balance. This all sounds awful; but it doesn’t have to be. Some things we just have to embrace and other things are fixable or at least maintainable. As of late, I have been paying particular attention to balance and this has carried over into the pursuit of a good balance program for our clients at Grand River Physical Therapy.

Recently, all of our therapists have become certified in the Otago Balance Program. This program is designed for the older adult, but we can help people with balance problems at any age. If you are concerned about your balance or have fallen or are fearful of falling, give us a call. Set up a free 15 minute assessment with one of our therapists to hear more about this program and to see how we can help.

Let’s all age as gracefully as we can and prevent those fall related injuries.

Stay safe and enjoy every day.

Did I just tear my Roter Cup? Or is it Rotary Cuff? What is it anyways? Who Knows? WE DO!

By Jen Brown, DPT

You are helping your mom move furniture so she can clean the floors. One more piece of furniture needs to be moved before you can sit down to enjoy a homemade lunch. You bend down, lift, and feel a sharp pain in your shoulder. Could you have injured your Rotary Cuff?

You have spent the whole weekend repainting your house. Sunday night comes and your shoulder is throbbing in pain. Maybe it is your Rotator Cup?

We have heard it all; anything from Roter Cuff to Rotator Cup and everything in between.

It is actually your Rotator Cuff and is a fairly common injury seen in our clinic. The rotator cuff is a complex of four tendons that extend off muscles in the shoulder. Tears of these tendons are called Rotator Cuff tears. The four muscles are the subscapularis, supraspinatus, infraspinatus, and teres minor.Rotator cuff

– Subscapularis works to internally rotate the arm. It is the motion that allows you to reach behind your back to tuck in your shirt. It is located deep inside on the front of the shoulder blade.

– Supraspinatus works to help raise the arm out to the side. It is located on the top of the shoulder blade and is the most common tendon affected.

– Infraspinatus and Teres Minor work together to externally rotate the shoulder. It is the motion that allows you to reach behind your head. They are located on the bottom of the shoulder blade.

Together the muscles of the rotator cuff work to stabilize and compress the humeral head. The shoulder is a ball and socket joint. The shoulder jointshoulder blade provides the socket and the humeral head is the ball. The rotator cuff’s primary purpose is to hold the humeral head in place when you move your arm.

Signs of a rotator cuff injury include pain, decreased mobility of the shoulder, and weakness. These are often secondary to inflammation deep in the joint from the injury.
⦁ PAIN – Rotator cuff injuries often can cause pain in the front, back and side of the shoulder. The pain is usually described as a dull ache at rest and sharper with overhead activity. It can also be severe at night.
⦁ DECREASED ROM (Range of Motion) – Inflammation in the joint can lead to pinching of the tendon making it hard to move the arm.
⦁ WEAKNESS – If there is detachment of the muscle from the bone during the rotator cuff injury, the shoulder will be weak, especially with overhead activity.

overhead activityCauses of rotator cuff injuries vary from falls, to repeated overhead activity, to chronic wear and tear or degenerative changes. As we age our tendons lose blood supply and quality and are therefore more prone to tear.

PT Can Help!

Whether you have had surgery for a rotator cuff tear or have experienced a strain of your rotator cuff Physical Therapy can help. Improving motion and strength in the shoulder can significantly help improve symptoms.

Other treatment options include anti-inflammatory medication, steroid injections, ice, and possible surgery. Surgery is typically recommended if conservation measures fail or if there was a traumatic or acute tear of the tendon.

Typical Rehab for Rotator Cuff Repairsshoulder pulleys

Patients typically begin physical therapy at 2 weeks post-operative. You are usually in a sling for 6 weeks and are allowed to begin to move the arm on your own. Physical therapy lasts 12-16 weeks.
⦁ Phase 1: 0-6 weeks post-op – passive motion only; meaning the therapist moves the arm, the patient does not.
⦁ Phase 2: 6-12 weeks post-op – active motion phase in which the patient is moving their own arm through exercise.
⦁ Phase 3: 12-16 weeks post-op – focuses on strengthening of the rotator cuff. Despite being discharged from physical therapy at 3-5 months following surgery, final complete healing is not completed until near 1 year post-operative.

PT Is Important!
Physical therapy is vital following a rotator cuff repair of any degree. Even if you find that your pain is minimal and you feel your motion is good, physical therapy is still important. Passive range of motion (PROM) of the shoulder, performed by the physical therapist is essential to prevent the patient from developing stiffness or adhesive capsulitis (AKA Frozen Shoulder) of the shoulder. When there is a lack of movement in a joint, scar tissue and other adhesions can build up and block movement.
Attending physical therapy for the first 6 weeks allows for someone in the medical profession to monitor the incision site, supervise the correct use of the sling, as well as educate the patient on exercises to perform at home. In addition, regular physical therapy appointments also results in immediate feedback, continued modification to home exercises, and motivation which are all vital for optimal recovery.

BBBFRO: A Reflection from Brooke

As I’m fast approaching my retirement date I am dealing with a variety of feelings and questions: how will I deal with not doing something that I’ve loved doing for the past 35 years? How will I get through my days without seeing the people that I’ve grown to love – that have become my friends, my family? How will I manage not being called “Princess” or “Precious”? Then there are the more obvious questions: Will we manage financially? Will I get bored? Will I be able to earn Kohl’s cash? Will I need to donate plasma every week? My pending retirement also causes me to reflect on what lead me to get into physical therapy and my experiences during the past 35 years. It began in 1957 when I was involved in a serious car accident with my parents and one of my brothers. My mother suffered a C6-7 spinal cord injury leaving her paralyzed, a quadriplegic. I grew up helping my dad take care of her and unsurprisingly developed a desire to go into nursing. In high school, I enrolled in an allied health program which not only trained me to be a nurse’s aide, but allowed me to spend time in the various areas of the hospital. It didn’t take long for me to realize that physical therapy was what I really wanted to do. For awhile I thought I might go into research, so I got a degree in physiology at UC Berkeley. Subsequently, I was accepted into the PT program at the University of Washington in Seattle. While going to school, my summer job involved working in a research lab at the Hanford Nuclear facility. I dealt primarily with rats, literally, and evidently held the record for the most rat bites! Those mean buggers scared me and they knew it. Between the bites and the mounds of calculations involved, I determined that research was not for me!

After graduating, I was hoping to work in a rehabilitation facility seeing spinal cord injured patients, but God had different plans for me. My first job was in an acute care hospital in Orange, CA which involved primarily orthopedic cases – I never enjoyed orthopedics when I was in school, but gradually developed a love for the field.

My husband and I moved from CA to Denver, CO where I was employed in a private practice clinic and also did home health care. My family and I moved to MI in 1997. I spent 5 years homeschooling my two children before returning to work. While looking for a new job in 2006, I stumbled upon Grand River Physical Therapy Specialists, called the clinic to see if they needed a therapist, was interviewed and soon hired. Except for an 8 month “respite,” I’ve worked there ever since. As my career in physical therapy is winding down, I can say without hesitation that GRPTS is the best place that I have ever been employed. The caliber of the staff is outstanding! The owners, Karen and Gail, treat their staff exceptionally well. The focus there is to provide our clients with great care while in a compassionate, friendly (and often entertaining) environment. I am so thankful that the Lord brought me to GRPTS. I will miss working regularly with such an amazing staff and treating those who come there for therapy. Hopefully, I will be able to fill in when needed … or when allowed!

My new campaign: BBBFRO!!! (Bring Brooke Back From Retirement Occasionally!)

With gratitude and love,
Brooke Cheney, P.T.

A Therapist’s Recovery

By: Sandy Herron, PT

18 months ago I had foot surgery. I know – really. A healthcare professional with an illness or injury. Unheard of! Healer heal thyself! Well I tried. As a physical therapist I knew there was a lot that can be done to improve foot pain. I stretched. I exercised. I wore good shoes (even when they didn’t look great with my outfit). I used ice, heat and took medication. They all helped for awhile but eventually they didn’t. My foot hurt from the moment I got out of bed in the morning until I got back in at night. The fact is I had a structural problem that PT couldn’t fix. It happens. We can’t fix everything.

So, I had surgery. My foot was very flat and unstable. My ankle rolled inward. I had a huge bunion. My surgeon was great and explained what would be done and what to expect. I was in the cast for 8 weeks and in a boot for 4 more to allow proper healing.

When that phase was done I began physical therapy myself. My foot was very swollen. It hurt. It was stiff. It was weak. Ice and elevation as well as compression socks helped limit the swelling and pain. I began range of motion exercises to get my foot moving again. Moving my foot in circles, up and down, side to side everyday three times a day to help loosen it up. Strengthening with resistance bands and balance exercises helped me to stand and walk easier. Concentrating and walking without a limp or turning my foot outward helped return me to walking normal. Reminders from my fantastic co-workers helped too since sometimes I didn’t even realize I was limping.

Yes, there were days I would get discouraged. This was not going fast enough. I have a lot to do – get back to work, take care of my house and my kids. I don’t have time to be laid up! But with a little determination and hard work as well as patience I told myself I could do this. That’s what I tell my clients after all. And I did.

As I got back better I got back to work and I began walking for exercise. At first it was painful but not like it was before surgery. This was muscle soreness. It ached and burned when I did too much. But using ice helped. At first, I could only walk for short distances but gradually I could go further. By 6 months I was walking 2 miles 3 days a week. Yes! I did it!

But now I had a new goal. In high school and college I had been a distance runner. I had given it up 15 years ago because it hurt my foot. Now my foot was good as new. Why not try? So when my surgeon said OK I began running. Again, it was slow progress and at times painful. But again with patience, determination and hard work I was going to do it.

But I need good shoes to get started. proper footwear is so important not just for running but any activity and even daily work and household chores. Good shoes protect your foot from injury. They cushion your joints when you stand, walk and run. But I had special needs feet. I needed someone who knew good shoes to recommend a good model. I went to a sporting goods store where they measure for a proper fit. I told them what my goals were and the problems I had had in the past. They helped me choose a good supportive shoe. Good shoes should support your arch (whether it’s high or low or medium – whatever your shape is). It should fit the width of your foot. It should bend where your foot bends but not be floppy and bend every direction. It should not be overly stiff either to strain your other joints. It should be comfortable even if it is not pretty. Mine were orange. But OK – silver lining, I wouldn’t get hit by a car running because surely everyone will see those bright orange things!

So out to the road I went to run. I followed a training plan and gradually improved my distance and my times. It was exhausting. I was sore. But it got better each time I tried. There were times that I overdid it. I strained my quad. I developed tendinitis in my ankle. but again following my physical therapist advise – I used ice. I stretched. I strengthened my weak spots. And back to the road I ran.

Soon I was running a 5K for the first time in 15 years! I did it! Over the first year I ran five 5K races. Each time it is easier and my time improves. I am not as sore. I do not fatigue as easily. My mental health has improved too. I have more energy and feel happier. Life is good! With a little hard work, determination and a good pair of shoes I am now fully recovered and have achieved my goals. Physical therapy has been a big part of my accomplishment. I still have to do my stretches and watch my form but consistency counts. And with that I am sure I can accomplish more goals. Like running my first 10K ever.

How We Started And Why We Keep Going

By Gail Braun, PT

My name is Gail Braun and I am one of the owners of Grand River Physical Therapy Specialists. This is my first time putting my thoughts out there on a blog, so please bear with me.

The year was 2000, and circumstances were setting me up to make the choice to seek a new job, or go out on a limb and start my own private practice with a close friend from physical therapy school. This was definitely Not on my bucket list, but after weeks of talking and praying Karen and I decided that the opportunity of continuing to practice therapy in my hometown was to important to both of us to not push forward. We knew how we wanted to treat patients, but needed to find the where to fit our needs. My husband kept saying, “why don’t you look at the old racquetball club”, but for some reason I continued looking everywhere but there. I had to admit a couple weeks later that he was absolutely right. We spoke with the owner, initiated the lease, started cleaning the building (sat empty for a few years), and pretty much on my 40th birthday we opened our doors! The first few years kept us extremely busy, between setting up insurances, treating patients, designing forms and more forms, fixing a leaking roof, fixing freezing pipes, and shoveling icy sidewalks. We had two therapists, a front office person, and a PT technician out in the gym. We sometimes were flying by the seat of our pants, but had a passion for helping people that seemed to keep us going. The UPS driver that delivered to us those first 3 years informed us on the day of his retirement that he thought day one we would never survive. (80% of start up businesses fail) He decided that when we were still going strong year 3, he knew that we were here for the long haul!

Fast-forward 16 years! We now have seven therapists, 2 front office people, four PT technicians, and an athletic trainer. Wow. We are responsible for 12 other people and their families. This can be scary, and also exciting at the same time. We never actually advertised to fill these positions, but somehow the right people kept showing up at the exact time that we needed them. I like to think this is something that Karen and I caused to happen, but we truly feel there was a higher power involved in putting together this team! We are therapists and support staff who come from a variety of settings, from different backgrounds, and with different strengths and gifts, but have the common goal of working with patients to achieve their maximal potential and mobility to resume life as they envision!

People often ask what is the worst part of this job, and for me that answer is definitely the paperwork. I did not go to school to write notes 50% of my day, but I went to learn evaluation and treatment techniques to assist patients along their journey to wellness. People also ask what I like most about my job. I get to spend each day helping empower people to be the best they can be, and return them to their activities of daily living. I help promote a culture of positivity and happiness which seems to be infectious. We use hands on techniques, education, and plain old kind words to motivate and inspire people.

I am sure that we have made many mistakes along this journey, but we have made decisions from our heart, and I think that keeps us along the right path. We want to make each day better for our patients, our staff, and our community. We promise to persevere and keep evolving to meet the needs of you, our “neighbors.”