Seven Tips from a 93 Year-Old Bowler

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The following is a guest post by Susan Ito, a home health physical therapist who resides in the San Francisco Bay Area. She is a writer and teaches writing in the MFA programs at Mills College and Bay Path University. Her work has been widely published in journals and anthologies and her website is www.susanito.com

My mother is on the verge of her 93rd birthday, and she still goes bowling every Friday (with a bunch of her other 90 year-old friends). Her average score is way better than mine.

She and I have shared a home for the past 14 years, so I’ve had a close-up look at her habits. I’m also a home care physical therapist, and I’ve had the chance to compare and contrast her daily routines with many of my much younger, and much less able, patients. For years, I’ve studied this puzzle, I’ve taken continuing ed courses on fall prevention, balance and conditioning for seniors, and I’ve realized that there are many small details that can really add up to physical vitality late into life.

What does my mother do that many other seniors don’t?

She ties her shoes. This might not seem like much, but it’s been documented that people who bend down to tie their shoelaces have significantly better flexibility, balance and fine motor dexterity than people who slide their feet into a pair of backless slippers or (cough) Crocs.

She climbs stairs. Every day. We live in a multi-level home with no elevator. She climbs a minimum of ten flight of steps a day. It’s common for retirees to move into an environment that’s “easier” to navigate—a single level home, or a building with an elevator. But the physical act of climbing stairs, multiple times a day, gives the hip extensors (gluteal muscles) a powerful and necessary workout that doesn’t otherwise happen naturally. When the hip extensors get weak, it destabilizes the entire pelvic girdle, and falls occur much more frequently. There is no other naturally-occurring activity that keeps the hip extensors strong. Bridging, a yoga pose, can work, but most seniors don’t practice that on a regular basis. (It’s not as good as stair climbing, but it’s a decent substitute.) Stair climbing also provides some high-intensity interval training for the cardiovascular system.

She takes care of a dog. In addition to providing a source of loving companionship, our dog helps my mom stay fit in a number of ways. First, there are the necessary short but frequent walks. My mom can be kind of sedentary, but the dog walks give her multiple reasons to bend down to fasten the leash (manual dexterity, balance and having a flexible center of gravity), walk up and down the stairs to the street (see above), walk for half a block and bend down to pick up the dog poo (manual dexterity and balance again). She also picks up a heavy ceramic water dish from the kitchen floor, carries it across to the sink, fills it and sets it down on the floor again. This is an incredible feat of balance, core strength, and stability. If she outlives our old dog, we’re getting another one right away.

She bowls. This is her version of strength training. She uses the same 16 pound ball that she bowled with in her twenties. Hauling that massive orb off the rack, up to chest level, walking a few feet and letting it roll down the alley is quite a feat, and it’s a fantastic upper body, trunk and balance workout.

She takes a bath. My mother is Japanese-American, and for her, bathing in a bathtub is as essential as brushing her teeth. Getting in and out of the tub, even using wall railings, is the same skill as getting up and down from the floor. This is an essential task that is lost as we age. Even if you prefer showers to baths, make sure that you regularly practice getting down on the floor and then getting back up on your feet. It’s a complex choreography of controlled descent and ascent, flexibility and strength. Once, she got tangled in the dog’s leash and fell down in the middle of the street. I have no doubt that it was her bathtub skills (and the luck that she didn’t break any bones) that allowed her to get back on her feet on her own rather than needing help from 911.

She uses a cane. Over the past year, she’s gotten a bit more wobbly. Sometimes she needs an assistive device for safety. But instead of using a four-wheeled walker or a wheelchair, she uses a single-pointed cane. This provides her with just a touch of added balance, like reaching out with one finger and touching a counter or railing for support. If you overdo the support, you’ll lose necessary strength and balance. Don’t get overdependent on a walker unless you really need one.

She enjoys her daily ice cream. I’m not sure if this calcium bonus has really kept her from breaking any bones, but a mini cone after dinner every night has kept her satisfied and happy.

I’m not saying that every senior citizen needs to bowl, have a dog or live in a three-storied home. But it’s easy to see how people who never climb stairs, lift anything heavier than a teacup or bend down can quickly lose those abilities.

These are elements that have undoubtedly, in addition to good genes, contributed to her longevity and continued physical vigor. You wouldn’t catch her at a gym or even at an exercise class at the senior center. All of her physical fitness is purely functional. My mother is a living example of “lose it or use it.” She uses it all, every day, in ways that she’s not even aware of, but are keeping her going on through her nineties and maybe even beyond.

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~ Susan Ito, PT

Foothills physical therapist Carol Wong and Susan Ito have been friends and colleagues since the 1980s while working on a committee for health rights in Central America. Their friendship has continued over the years and miles as Carol’s life brought her to New Hampshire.

Many Hats: How Legislative Work Changed My Patient Care Philosophy

_MG_6633We all wear many hats in life. For me, this includes wearing many hats in my professional life.

One of the things that first attracted me to the field of physical therapy was the variety of skills needed in the profession. Everyday, when working with my clients, I had to be a good listener, an investigator, a problem solver and a teacher. As a partner in our practice, I see the details, work with the numbers, work through problems logically and even deal with equipment when it needs fixing. It’s all in a day’s work in a small, independent practice like Foothills.

Outside the office, there’s one hat that I’ve been wearing for many years: the policy hat.
Early in my career, I was asked to help with research on legislative issues in physical therapy. This work started as online searches for examples of law from other states, or studies that supported the need for physical therapy education standards. I liked this work and found it interesting and thought provoking. Then one day, I was asked to testify at a legislative hearing. To say I was nervous was an understatement. I had to hold my hands firmly on the table to keep the legislators from seeing them shake. I did well and, as a result, was encouraged to continue this part of my work.

Several years later, I was asked to become a member of the advisory committee of physical therapy to the board of medicine here in New Hampshire. My application was accepted and I was appointed by the Governor. It took some time to really understand my new role. As a committee member, I was to represent the public, not the profession as a whole. “What is best for the public?” became my mantra. Patients’ needs had to come first.

As a member of this committee, I learned of a national organization of members of physical therapy boards and advisory committees, the Federation of State Boards of Physical Therapy (FSBPT). I began attending meetings, developing a better understanding of my role on the advisory committee, hearing how other states worked and learning better how a licensing board works to protect the public. My interest in the legislative aspect earned me a place on the FSBPT Ethics and Legislative Committee. It was what I learned as a participant of this committee that allowed me, in conjunction with ten others, to craft and have passed legislation in New Hampshire to create an independent Physical Therapy Board.

I went on to chair the Ethics and Legislation Committee, be elected to the FSBPT Board of Directors, and ultimately be elected as President of FSBPT Board of Directors.

I also continued my work locally in the legislative arena, working with many others to change the law to allow the public to directly access physical therapy services, and to choose which physical therapy provider they want to provide those services.

Wearing the policy hat gives me a broader view than I might otherwise have, and helps me to remember all that’s at stake and how far we’ve come.

My work with legislative issues and appreciation for putting first what is best for the public is reflected in my philosophy about client education—helping clients to know that their choices matter and that they are entitled to receive complete information about their condition from me or other providers. The choice of how and with whom to receive their health care is their choice alone, and I will help them with as much information as they need to help them make those decisions.

Wearing the policy hat gives me a broader view than I might otherwise have, and helps me to remember all that’s at stake and how far we’ve come. That broad view deepens my commitment to providing quality care and first-rate information for my patients and it all ends up being pieces of the same whole. In the end, it’s really just one big hat after all. In an ever-evolving regulatory environment, it might be possible to get lost in the details, but my work at Foothills never lets me forget that it really is all about the patients.

~ Maggie Donohue, PT

Metatarsalgia: Yes, I Had Pain Under My Toes!

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It was so painful that I couldn’t walk the Esplanade in Boston with my friends—I had to sit on the bench and wait for them to return. We had to forego our plan of exploring Beacon Hill (up and down hills) due to my foot pain. Not only did this experience stop me in my tracks, but it deepened my understanding of foot pain and its treatment.

To have to limp off your foot to avoid sharp pain not only feels terrible, it can affect your knees, hip or back as well. Sometimes you end up walking on the outside of the foot without even knowing it. Many people buy all sorts of gel pads for under the toes, extra cushioning inserts—anything to get the relief they are in search of.

The kicker here is that I have treated this type of foot pain in many of my patients, evaluated their specific situation, discussed footwear options and treated appropriately from my list of approaches for many years. So, now I was the one who needed help. I knew all about it. So, why did this happen to me now?

As for the cause, well, that’s complicated! It could be shoes that have too high a heel, or are too tight in the toes. It could happen from dancing on your toes in Zumba and also running on your toes in same week. It could be that your arch needs more support, causing your foot to overload the toe joints. It could be the toes have become arthritic, and have lost their normal motion, so they get irritated more easily.

Really, what’s most important is that we figure out what could help the situation as it is right now.

That is the most common question from my patients: Why now? I prefer to switch it up to what can we do now? The answer usually involves a full evaluation of the foot position barefoot when standing or walking. In addition, we test muscle tightness in the calves, weakness in the arch support muscles and control or lack of control and strength in the hip muscles. Footwear types, heel heights and correct fit can make a difference. All of these details factor into the issue of foot pain, and specifically metatarsalgia.

Now, for the treatment. One of the most helpful items is a metatarsal pad that does not go under Foot pad 2the toe joints, but instead just behind them, back closer to the heel. I can’t emphasize that placement enough, as it is meant to unload the toe joints, not cushion them! The big issue is where to find these met pads. Around town you can obtain some made by Spenco that are green, somewhat larger, and don’t stick on. Then there are those by Dr. Scholls, but be careful to not confuse them with Dr. Scholls toe cushions! Metatarsal pads are available online; my favorite ones are those made by Pedag (met arch pads) that stick onto the inside of the shoe. We also have them and some made by Hapad here at Foothills.

That’s helpful, but what about shoes, and how do we put them on the inside of the shoe or insert? First of all we may encourage the use of shoes with a removable insert to allow easier placement of the met pads. Luckily, not only do sneakers offer these inserts, but all kinds of men’s and women’s work shoes come with removable inserts as well. You just have to search, and or ask at the shoe stores for this specific requirement, and then choose according to your taste in shoes. In addition to the met pads, some patients need the added support to their foot with specific inserts, either custom made or off the shelf. One that we recommend is the Superfeet insert available at EMS or the Runner’s Alley. (They go by shoe size.) The decision as to the need of orthotics is made with your therapist, depending on the findings of Shoes2your evaluation and your specific reaction to treatments, such as taping of the arch in some cases.

Once you have been put on a program, with or without met pads or orthotics, it still takes time and attention to the stretching and strengthening program. Doing stretches even before getting out of bed can make a big difference for the day. This means pulling the foot up firmly, then firmly in for ten seconds and out for ten seconds. Another idea we use is to step into the shoes with the met pads, etc, that are right by your bed, for the first step in the morning—that alone can prevent abrupt pain that can last quite awhile.

It pays off! I resolved my pain with the use of better footwear, met pads built into orthotics, stretches of my calf muscles and avoidance for awhile of walking barefoot. I can now walk whenever and wherever I want, including activities like hiking and snowshoeing. I still remember the intensity of that original pain, and I realize that unless you’ve experienced it, it’s hard to understand how it changes your life.

That is why I enjoy treating my patients with not only metatarsalgia, but any foot pain issue. Because I know what we can do about it!

~ Martha Torrey, PT

Prepared: Sticky Soles and Hiking Poles (and Tape, Just in Case)

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Marmalada, the highest peak in the Italian Dolomites

I love mountains! The Dolomites of Italy have always had a special place in my heart and soul.

I first traveled to the Italian Dolomites after completing my Masters in Physical Therapy. To prepare, my husband Alan and I met with climbing friends to select the best climbs, studying maps for months before our departure. For three weeks in 1997, we hiked and rock climbed our way around and through the Dolomites. The dizzying heights and vertigo of the Vaiolet towers, Sella Massif, the Sussolungo, Tre Cima and Mt Paterno and the famed “zona de Cinque Torri con le Tofane” near Cortina di Ampezzo were simply indescribable. The rock climbing was challenging and technical, the scenery spectacular.

Route-finding and rappelling a technical climb in a country where English is not the primary language was at times scary and confusing. I remember one quite heated exchange with a non-English speaking couple who attempted to climb over us on steep rock—we did not want to be beneath a climbing party, risking falling rocks from above. Walking by the light of a single match as we made our way through the dark World War I tunnels in the bowels of Mount Paterno was hair-raising.

The respite of the mountain refugios (huts), plentiful along the trails, offered a place to eat, drink and rest for the night. As much as I wanted to taste the food and wine in this very Austrian-German region of Italy, I found myself feeling too nauseated to enjoy it. Olivia was born seven months later.

For many years, I had longed to return to this beautiful, craggy limestone mountain range. While I love New Hampshire’s White Mountains, and the Sierras, Tetons and Wind River ranges of the west, there is something magical about this very beautiful mountain region in northern Italy. Ten years later, we planned a return to the Dolomites for another hiking adventure.

A week before we left, we were descending the Falling Waters trail in Franconia when I slipped and fell while wearing my favorite cross-trainer shoe, injuring my ankle. After three days of pain and swelling, I was diagnosed with a grade II strain of my anteriotalofibular ligament. I was leaving for Italy in just a few days and could walk with pain, but hiking looked impossible. As a physical therapist, I knew taping and bracing would help a joint in need of stabilization, so I taped my ankle with strapping tape and donned a brace, both providing enough support to walk pain-free. I also used the same advice I give patients on a regular basis and brought along my hiking poles to help unload my ankle. These interventions allowed me to hike pain-free through the Alpe di Siusi in Compaccio and up to Alpe di Tires hut for the night. I was back in the beautiful Dolomites, now enjoying the trails with my family. Once back home, I began my rehab program of ankle proprioceptive exercises.

Slipping is a common mechanism leading to a fall, especially on the New Hampshire steep rocky trails, adorned with lichen and almost always damp. I invested in a pair of sticky rubber-soled hiking sneakers. I now have amazing traction on the rocks and I have not sustained another ankle injury since using these sneakers (5-10’s are the brand name). In the winter I use Microspikes, a traction device that attaches easily to hiking boots. They very effectively keep me upright on low-sloping ice and snow.

The only thing between your feet and the ground is your footwear, so choose wisely.

I am looking through my guide books mapping out my next mountain adventure. Equipped with poles, sticky rubber-soled sneakers, and strapping tape just in case, I will be able to comfortably negotiate any mountain terrain!

~ Donna Lannan, PT

Picking Up Gait Speed for Health and Longevity

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Happy Birthday to me! I had the pleasure of celebrating my 50th birthday on a cruise with eight other women in the western Caribbean. While I was on that cruise, I was totally surprised with how slowly some people walk. I am not talking about the lovely gray-haired seniors in their designer flip-flops, I am talking about 30, 40 and 50 somethings in designer sneakers! I found myself trying to bob and weave around people in the corridors on the ship and on the pier going to and from the ship. Now, I know it’s important to relax and enjoy the scenery while on vacation but it was almost painful to walk as slowly as most of the guests on the ship!

So, that brings me to my thoughts about gait speed. Gait speed is simply how fast you walk and it can be considered the fifth vital sign after blood pressure, heart rate, temperature and respiration.

A 50 year-old female, walking at a preferred pace, should walk about 3.59 feet per second. A 70 year-old person should walk about 2.79 feet per second.

Gait speed does decrease as we age but we can influence that decline with a few simple things! The best advice is to walk, and walk fast, now! Walking is one form of physical exercise that builds muscle, improves cardiovascular health and decreases depression.

Being physically active can be simple and free, or fairly low cost. Take a walk outside or, if the weather is not good walk in the mall or join a gym. Start with five minutes if that is all you can tolerate and slowly build your endurance over time. If you are hesitant because of arthritic knees or a bad back, try stationary biking or water walking. Local hotels often offer swim memberships to the general public. Climb stairs when given the opportunity; there are studies that show seniors who live in houses with stairs live longer. Going up and down stairs daily keeps us strong! There is always a way to be more physically active.

So get out there and walk, walk quickly and build up a sweat! Keep your gait speed up, park further from the store entrance and live a longer healthier life.

~ Brigitte Cook, PT

Being Versus Fixing

 

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We are part of the healthcare system. We help our patients “fix” the problem in their body. We aim for measurable goals: strength, range-of-motion, distance, speed, repetitions, 0-10 pain scale. Quantifiable goals.

And we also recognize that sometimes we can’t push, that the patient’s having a bad day, that they need to talk, that progress is not on the agenda for the day. One of the beauties of working at Foothills is that we spend one-on-one time with patients and, for many patients, we see them at intervals over the course of many years. We get to know them and lives are shared—some things that maybe wouldn’t be shared in another setting. We also have the beauty of being in close contact with them, of literally touching them. Sometimes it’s “being” that is what’s more important. Listening to them, hearing their story, is what they really need. That can be healing in itself.

I recently had a life situation that called upon me to just be. It’s a situation many of us can relate to and that’s being in the care or the presence of an elderly and aging parent. My father is 89. He’s generally looked 10 years younger than his years. My sisters and I have affectionately called him Timex (…keeps on ticking…). He has rebounded from ailments in the past with predictable strategies: navigating meds, getting back to walking, driving, running errands, and even seeing a personal trainer. He has slowed down, but always gotten back up.

This last month was different. My father was bed bound, progressed to a wheelchair and is now, after a month, just starting to stand and take steps. We have done some “fixing.” Even though progress is still being made, the goals seem lower now. There has been more “being” this time around. He recognizes he’s in another stage of life, of accepting the loss of independence as well as more reliance on others. He reflects on the good life he’s had and we take extra notice of and document his life stories. He is of sound mind, and yet ready to say “enough.” We talk about the governor’s recent signing of assisted suicide (in California) and he wishes it was that easy. He talks about the blessing of going to sleep and not waking up. It’s hard and new territory in our conversation, but I’m grateful to have these talks. I appreciate this preciousness of just being.

Time is precious. No matter what the age of the person. In this day in age of tech devices and “phubbing” (phone snubbing), time and our presence is what we can give to people.

So, in that 30 minutes or one hour I’m with a patient my aim is to to listen and give my attention to the moment. Often to fix and help, and sometimes to just be.

Carol Wong, PT

Fifteen Years! Wow!

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We’re celebrating 15 great years together as an independent physical therapy practice. Thank you all for your support every step of the way, and for the community spirit you’ve built with us through the years. Read more about our story, here.

We’re proud to have been voted the “Best Physical Therapists” in the Concord area five years in a row, from 2011 to 2015, for the Capital Area People’s Preference Awards. And we did that with your support! Thank you for being an important part of the Foothills Physical Therapy community. We look forward to partnering with you toward achieving your health goals.

How Running Less and Smarter Made Me Faster

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A few years ago, sometime around an “important” birthday, I became more serious about running. It coincided with our move to Webster, when I discovered that my neighbor and I had common goals around wanting to get fit and healthy, so that began a friendship and a commitment that we both needed. I’d always been active. I’d hiked all but one of the 4,000 footers and generally kept moving all the time, but wouldn’t have described myself as an athlete. The urge to really push myself to be faster was something new. So, my dear friend and I laced up our running shoes and set out to be the best we could be. We started training together—running almost every day as well as walking and biking. We found ourselves running races, getting stronger, improving our speed, and feeling really proud of ourselves. It always helped to have our furry four legged friends with us as well!

I accepted the injuries as part of the deal. In the beginning, I’d run through pain, run just because I thought I had to push through everything and keep going going going. I remember someone asking me what I was running from, and why I was doing this to myself. At the same time, I was almost always running with something wrong with me—running through pain. That question stuck with me; I still think of those words.

Working in a hubbub of physical therapy activity every day, of course I sought out the advice of my peers. They’d send me home with exercises and advice; I was to “listen to my body.” I’d promise to do it all, but I’d head home scheming about how to get back to my training. I’d lace those running shoes right up, and out the door I’d go—pain and all. I was listening, all right! But, I sure didn’t change my ways. Running races and training with my friends gave me something so wonderful that I was still willing to put up with the pain.

Last November, I was training for a half marathon and ran late one dark evening to squeeze in a training run. Stepping into a pothole, I sprained my ankle pretty badly, and I never ran that race. This injury got my attention, and held onto it for months. And, this time, I took my physical therapy more seriously. If I ever wanted to run again, I realized that I needed those exercises and that sage advice. For once, I did everything Carol Wong (my Foothills physical therapist) told me to do, home exercises and all. I realized I had no other choice—if I wanted to run again.

Yes, I needed to learn to listen to my body. I needed to learn patience. I needed a rest.

When I picked up my training again later last winter and in the early spring, I took a different approach. I now ran just two times a week, and it felt good to allow my body time to recover in between runs. I continue now at two runs per week, and both are usually 5K races, so the “pushing” aspect is always there. I walk every day, but stick to that running routine. If I run longer than 5K or more than twice a week, my body tells me about it.

The big surprise in all of this? My times are faster! Really—if I’d done this from the beginning, I wonder where I’d be now. I wish I’d known how listening to my body would have such an impact on my race times. I still have issues with that ankle and with my back, but my recovery time is a lot better and it feels good to be running at a faster pace than I ever have before.

Last week, for the first time, I came in as first female over all in a 5K trail race. I was really excited! I really didn’t see myself ever getting to this point and I’m still thinking, how did I do that? If that’s what listening to my body can give me, I intend to keep listening. It certainly is challenging to be patient but it’s worth it.

I still think about that question, what am I running from? I do know why I’m doing this. I run because I can. It’s important to me to feel my body pushing to be stronger and faster. Sure, I run because I don’t want to get old. But, really, what I do want is to grow old in a body that can do lots of the things I’m doing now, and still be resilient and strong and continue to realize the importance of resting. Running, walking, eating well and, yes, listening to my body are all part of my plan.

~ Melissa John, Office Manager

Whiplash and Neck Pain: How Can Wearing A Scarf Hurt?

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A young resident at the University of Michigan Hospitals, where I worked many years ago, came to me after suffering a whiplash injury in a car accident. He was in considerable pain—to the point that even wearing a scarf around his neck hurt, a conundrum which neither of us fully understood. Nonetheless, I really wanted to help him, as well as show him what physical therapists had to offer.

First Priority: Addressing Range of Motion and Strengthening

First, we needed to improve his limited neck range of motion. At the time, I was studying at Michigan State, and had learned an osteopathic approach with Muscle Energy Technique for the entire neck and upper thoracic spine. The big learning point for me was that the joints of the first two cervical vertebrae were key in gaining rotation of the neck! I was able to use manual therapy to enable the joints to glide again freely, following up with home exercises to maintain the gains.

Neck Mobilization

Neck Mobilization

As he continued in treatment, he described the weight of his head as so great that it felt it would almost fall off as the day went on. Not only was he working with patients, but he also spent a lot of time stooped over, reading up on diagnoses. The idea of taking posture breaks was just as rare, unfortunately, as washing hands in the health care industry at that time. We added neck strengthening work to the picture, not yet understanding the importance of also strengthening the upper back and scapular stabilizers.

Moving on to More Puzzling Symptoms

Being an MD, my patient had x-rays done in an effort to further understand the ongoing pain. (X-rays were not always done back then for whiplash injuries.) This brought up the reality that a lot of neck pain does not result in visible signs on x-rays, especially for someone so young. Luckily, I was continuing my studies with the osteopaths, and started using myofascial release on the muscles coming up into the neck, front and back. This started to reduce his level of his pain.

The answer to the question of the painful scarf is that whiplash affects all of the tissues: nerve, joint, muscles ligaments, tendons, fascia, and skin.

We were finally getting closer to the issue of the scarf hurting the neck, but we had other issues first. He also had puzzling periods of dizziness and lightheadedness. It was much later in my career when I learned about cervical joints causing such symptoms; it’s widely understood now that cervical joints and their nerve relationships can cause those issues.

Neck Strengthening Using Resistance

Neck Strengthening Using Resistance

The Painful Scarf Question

This is where I have to admit that I learn from my patients as well as ongoing advanced studies. Some patients following whiplash have a high irritability of the muscles and tissues around their neck. This is always found in every patient, and has nothing to do with whether they experienced a high speed versus a low speed impact.

The answer to the question of the painful scarf is that whiplash affects all of the tissues: nerve, joint, muscles ligaments, tendons, fascia and skin. In order to progress in treatment, we often use manual therapy, stretching, strengthening, posture correction, fascial release, craniosacral therapy, evaluation of jaw biomechanics, TENS (aka, Transcutaneous Electrical Nerve Stimulation).

Last but not least, some simple patient education helped him to understand the entirety of the tissues involved. It turns out the scarf weight on the neck can be a tracking device as to how well treatment is progressing.

For the resident patient, success came. But I sure do wish I had a chance to work on him now that I know so much more!

With ever increasing awareness,
Martha S. Torrey PT

Is Spinning Good or Bad? It Depends!

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Brigitte, getting ready to put a healthy spin on the tennis ball. She won the match!

I can remember being a kid and spinning in a tight circle my front yard ’til I fell to the ground and watched as the sky would spin violently above me. At that age, I thought that I was some how getting in sync with the spin of earth. YouTube videos are full of people trying to walk or run after spinning in a circle with their forehead on a bat only to then fall dramatically to the ground or veer off into a bush. Did you ever wonder why that happens?

In the most simple terms, the spinning and falling happen because of an imbalance between the nerve signals to the brain from the inner ear. In the case of my childhood spinning, I was “super charging” the inner ear on the side of my body toward which I was continually turning, creating the imbalance. This imbalance makes our eyes move in a type of beat called a nystagmus. A nystagmus is a normal movement of the eyes that helps us track objects as they move by us, for example cars on a road or a train moving on a track. But a nystagmus that is caused by an inner ear problem can give people vertigo and dizziness.

A couple years ago, I woke up in the middle of the night to turn over and felt the whole room shift. It was dark, so I did not see the room spin, but I felt like my brain had moved inside my head. I mostly ignored it and was able to easily fall back to sleep. But when I got up the next morning and tried to wash my hair in the shower, my world began to spin. As a physical therapist, I specialize in vertigo, so I knew that I was probably suffering from BPPV (benign paroxysmal positional vertigo), or “rocks in my head.” I was sure I was not suffering a stroke because I could bring on the spinning by changing my head position and I could talk clearly, walk on my own and had no numbness or feeling of weakness. Just room spinning dizziness when I moved my head. I felt a little off balance when I walked, but a simple finger on the wall was all I needed to steady myself. So, I tried to treat myself and proceeded to get sick and could not go to work. Fortunately, a colleague was able to “put my rocks back in place,” and I was much better within a week. I had about three more episodes that year, none as bad as the first, and have been dizzy-free since.

In my case, the imbalance in signal was from a rock or crystal floating around in my inner ear on the right. These rocks or crystals are in the inner ear to detect the pull of gravity and they are supposed to stay in one place. But, in the case of BPPV, they break loose and float freely. Therefore, every time I moved my head, they would move and create an imbalance in the signal to my brain.

The good news is that physical therapy treatment for vertigo and dizziness can be very successful. Depending on the cause of the imbalance, patients usually improve with simple exercises or even a one-time treatment. Dizziness is something you should not have to live with, so talk to your doctor about treatment options. For more information, visit the Vestibular Disorders Association website.

My vertigo occurred four years ago and I have continued to hike mountains, play badminton and competitive tennis without any dizziness or balance problems. Now, the only spin I have is with my forehand and backhand shots on the tennis court!

Brigitte Cook, PT