Tag Archive for: physical therapy

Overcoming Discomfort

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Last month, I did 70 push-ups on my 70th birthday. They were not full push-ups; they went about halfway. It took a year to be able to overcome shoulder weakness and discomfort because of torn bicep muscles in both arms. But by doing push-ups every day, I gradually pushed out the number every few weeks, beginning with 10 and culminating with 70. Most importantly, I don’t have any pain nor discomfort when I do them now.

I attempted to do full push-ups this past Sunday. I was able to do four with the shoulder discomfort starting on the fifth one. But I know the process and I know over time, by gaining strength in the other muscles and with a consistent effort, I will do 70 full push-ups before this year is out.

Now, I’m turning attention to my right knee that’s bone on bone. I saw my physical therapist yesterday to get his direction in strengthening my knee. There’s a lot of work ahead of me, but I’m determined to make my knee function better than it currently does—15 minutes at a time.

While all discomfort is not the direct result of soft tissue problems, many are. The only thing you can do is to get the best direction from physical therapists and other health professionals and then get to work. It will take time and you must be consistent. It may get worse before it gets better.

But stop and think: what if you had 50% less discomfort or 30% more range of motion or 60% more strength? Would it be worth the effort? Only you can decide, but from nothing you get nothing. What can you get from 15 minutes per day?

What are you prepared to do today?

        Dr. Chet

Eliminating Pain

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Chronic pain afflicts us all at some time. I’ve talked about my knee enough to write a book, but pain can be in many areas: lower back, shoulders, feet, hips, wrists, and deep muscle pain as might occur from fibromyalgia. Should you give the pain time to work itself out? No—that’s the worst thing you can do, because you may be setting yourself up for years of pain that could have been prevented.

Pain Pathways

Chronic pain may develop when pain pathways become established without intervention. While complicated in nature, what happens is that the series of biochemical reactions and different types of sensory neurons that let your brain know that something is painful get stuck in the “on” position. The original cause, whether from an injury, surgery, or a disease or condition, may have healed, but the nerve fibers are still sending pain signals. In order to affect changes in those pain pathways, you must take action.

Relieve the Pain

This seems obvious, but too many people refuse to do it. What I mean is that whether you’ve been prescribed pain medication or use over-the-counter medications, take them regularly. You don’t get hero badges for avoiding medications and staying in pain. You’re also not limited to medications.

There are many supplements that work for some people, including high-EPA omega-3 fish oil, glucosamine and chondroitin, tart cherry juice, turmeric, and others. If you’re going to take them, be consistent. We also now have CBD oil for internal use and creams and sprays for topical use. Some people find it works well for them, while for others they don’t work at all. How to know? Try each one.

If you can relieve the pain, you can return the area to normal functioning. This is especially true for muscles and joints. When you’re in pain, you compensate by changing the way move. That makes matters worse over the long haul. I’m not suggesting that you will be completely pain free, but if you’re able to move better, that will help you with the second part of pain management.

Rehabilitate

If you’ve had surgery on joints or soft tissue, you had to go through a physical therapy program to restore range of motion and function. The exercises that you were given were supposed to continue until you had a complete return to joint function. Most people get part way there and then stop. My father-in-law had surgery on both shoulders; he completely rehabbed his right shoulder after rotator cuff surgery, but he stopped short with his left. As a result, he could get close to putting his right arm fully extended overhead but got to only about ear level with his left.

Besides stretching to get back range of motion, you can also strengthen the muscles directly involved in the motion as well as those that provide stability to the joint. As just one example, the rotator cuff muscles do just that: they rotate the humerus. But the biceps, triceps, pectoralis major, and deltoid all provide stability to the shoulder. The best thing to do is to check with a physical therapist, most likely using an online video service these days, and get the exercises if you don’t know them. Then get to work.

The Bottom Line

In order to live your life fully, you must deal with chronic pain. The keys to pain management are to

  • Reduce the pain
  • Work on improving your movement of the area involved
  • Work on strengthening the area and surrounding tissues
  • If all else fails, consult a pain specialist.

That’s my goal for the next 60 days: to take a weakness and make it as strong as possible without causing any damage. Progress slowly and be methodical in the approach, and if that doesn’t work, get a referral to a pain clinic. Your life is too important to let pain rule you.

What are you prepared to do today?

        Dr. Chet

How Flexible Are You?

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Living every day you’re alive requires flexibility. Range of motion in your joints is important to your ability to move, but it can be difficult. As the years add up, touching your toes with your knees locked, whether sitting on the floor or standing, lifting your arms over your head, or even lifting your arms to shoulder level can be a challenge.

Connective tissue tends to tighten as we age; it’s another case of use it or lose it. And when I say age, I mean from teen years on. Later, after we’ve torn ligaments, sprained ankles, been in accidents, and on and on, if we haven’t worked on our range of motion, we can end up restricted in our ability to move. The less we move, the more restricted we can get.

The obvious way to increase flexibility is to stretch. There are dozens if not hundreds of programs online, but I would recommend that you get an examination by a physical therapist who can identify your strengths and weaknesses and prepare a program just for you, taking into account your current level of flexibility and previous injuries. The older you are, the more strongly I recommend physical therapy, because if you stretch too far and damage connective tissue, you’ve just made your situation worse. Another option, especially if you’re younger or more fit, is to try yoga, which is an overall muscle-strengthening and stretching program. Take a class with an experienced instructor so you can get feedback on whether you’re doing the movements correctly.

Stretching is something you should do every day. There’s one area that needs special attention and that’s your core. I’ll cover that on Thursday.

What are you prepared to do today?

        Dr. Chet

Preventing Muscle Loss

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This final installment on muscle focuses on keeping the muscle mass you’ve got. That’s one of the keys to living every day you’re alive: the ability to move at every age. There are three things that are important to hanging onto muscle.

  • Use it or lose it. Actually, you’re going to lose it not matter what, but the degree to which you will is partially dependent on using it. Whenever you can take the stairs, take them. Whenever you can lift something, lift it. While I would hate it personally, it was better when we had to get up and actually walk to the television to change the channel. More today than ever, we don’t take the opportunity to build muscle or increase stamina.
  • Exercise regularly. No matter your age, there’s always something you can do. Orthopedic issues happen as we get older—arthritis in hands, shoulders, hips, and knees, or torn ligaments and cartilages. They can all put limitations on what we can do. We have to work within those restrictions and do as much as we can to maintain and even increase what we have. A session with an excellent physical therapist (ask your doctor if you qualify for some free sessions) or certified personal trainer could be worth the money. It’s never too late to begin. Research has shown that even people over 100 years old can increase strength and stamina.
  • Consider taking essential amino acids every day. While the focus has been on what EAAs can do for people who train hard, the bulk of the research has been done on people 50 and older. It’s clear you can slow down muscle loss and increase muscle strength by exercising regularly and taking EAAs every day. I’ve been taking them the days I lift, but I’m considering taking them every day. In continuing to research the benefits, there doesn’t seem to be a downside to taking EAAs. There’s some preliminary research that indicates that taking EAAs may even be beneficial for pre-diabetics to reduce insulin levels and triglycerides if they exercise regularly as well.

The purpose for the month’s Memos is showing you how to learn to live every day you’re alive. Muscle is critical to that goal. We’ll move on to another important physical component of living next week.

What are you prepared to do today?

        Dr. Chet

Common-Sense Health: Where Is Your Wallet?

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Keeping things balanced is important, and I try to do that in the Memos I write. Usually I tackle issues that are serious with significant health implications, but life is to be enjoyed so this week, we’ll lighten up before a holiday by talking about a guy’s wallet. And this is also about balance.

When Paula and I had dinner with friends this weekend, the husband talked about the physical therapy for back pain he’s been doing. The exercises have worked, but he chided me: “You didn’t tell me my wallet could affect my back.” Oops. He’s correct.

If you have a wallet in your back pocket and you sit most of the day, the force of the chair on the wallet can compress the sciatic nerve, and voila, you may have pain shooting down your lower back and the back of your leg. A recent paper talked about three men with lower back pain that was due to their wallet.

The simplest solution is to reduce the size of your wallet or just carry what you actually need on a clip in your front pocket or in your jacket: a picture ID, a credit card, your Costco card, and some cash. What more do you need? Membership cards? I have an app on my phone that shows my gym membership so I don’t need to carry that card.

If you have lower back pain, I would recommend you get a referral to a physical therapist to find out how you should deal with it; there may be different muscle groups involved depending on your specific anatomy. But if you’re sitting on a fat wallet that throws off your balance, changing that could make a difference.

How could your pillow affect your hip? I’ll let you know on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Curr Rheumatol Rev. 2017 Mar 9. doi: 10.2174/1573397113666170310100851.

 

Excuses for Avoiding the Gym

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The New Year is upon us and with that, a commitment by many to exercise regularly. No matter where you live, that may involve joining a gym, but all gyms are not created equal. What you need, besides a convenient location and reasonable price, is a facility that provides you with the equipment you need to accomplish your goals and short-circuits your excuses.

“I don’t know what to do.”
I’m going to challenge conventional thinking in how you solve that problem: once you have clearance from your physician to exercise, ask for a referral to a physical therapist. He or she will work with you to determine the best exercises for your body and your history, especially the more years you have in your body. Broken bones, sprains, strains, injuries, gaining weight, losing weight—we all have a physical history. If you have a problem with the mechanics of your body or reinjure yourself, that will impact your ability to exercise, so begin with a physical therapist if possible.

Paula and I both have done that. Once we worked with our physical therapist to find what exercises to do on which machines or weights or tubes, we selected a gym which had the resistance and aerobic equipment most suited to our needs. I still do the exercises I was shown and I’ve been running for close to a year with no time off for injuries. That’s the longest I haven’t been forced to take time off.

You may even find out you don’t need a gym; walking or running plus exercises you can do at home may be all you need. Your physical therapist will get you headed in the right direction. The downside: if you’re exercising at home you can do it anytime, and that may lead to eternal procrastination. If you’re letting exercise slide day after day, maybe you need a more formal workout setting.

“I just don’t feel comfortable there.”
Think about how your social needs may affect your adherence to your workout plan as well. Paula reads while she bikes and I listen to podcasts on the treadmill so a big gym works for us, but you may need a more social environment with friends to keep you honest and engaged.

“It’s too far.”
Another factor is location. When Paula worked out on the way home from her job, she found that the farther the gym was from work, the less likely she was to get there; it was too easy to run errands on the way and never quite make it to the gym.

“I got hurt and I’m too sore, so I can’t exercise.”
Besides getting input from your physical therapist, here’s the most important advice I can give you: start slow. If you begin by doing too much, you’ll be sore or injured and you’ll be out. Your objective is to keep going—it’s a marathon, not a sprint—so an easy start is your best plan.

It turned out that Planet Fitness works for Paula and me: plenty of resistance equipment and all the aerobic machines we could want at a very reasonable price. I also must add that there are more really overweight people working out at the Planet than anywhere I’ve ever been, which I love to see.

For you, it may be someplace different; maybe you’ll do better with swimming and workout classes at the Y. The important point is to select your gym by what you need and you might find it becomes a lifetime habit.

What are you prepared to do today?

Dr. Chet

 

Start with Physical Therapy

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I talked with hundreds of people in Cincinnati this past weekend, and many had issues with pain and discomfort. I can relate—I’ve got a shoulder that’s killing me. While everyone wants to know which supplements can help, it all begins with physical therapy.

The most-asked question was about lower back pain, which afflicts more people than any other joint or joints. Many people claim to have bulging discs. You know something? That’s nothing special; it’s the results of walking upright combined with carrying too much weight on the front side. If you can get . . .

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