The Guys
Subjective:
My girls both watched the Wiggles when they were little. Well, Noelle still does but she’s not quite 4 yet. Olivia doesn’t watch them, purposely; however, if Noelle has them on, she won’t get up and leave the room. The Wiggles can be annoying –I’ll be the first to say that. I got sick of them when Olivia watched them all the time, but I still like them better than Dora. Jeff was my favorite Wiggle. He’s the one in the purple shirt who likes to sleep a lot. Kind of like me. Maybe he’s narcoleptic. As I remember, Jenny liked Anthony. Mainly, I think, because he has rhythm. Olivia liked Anthony when she would watch them on TV, but when we went to see the Wiggles in Little Rock, the only one she cared about was Murray. She screamed, “Look at me, Murray! Look at me!” throughout the show. Some of the Wiggles’ songs are catchy, some are annoying as can be and beg to be made fun of. They used several songs I knew from when I was little, but they have original stuff too. Their version of the song “Taba Naba” will stay with me all day long if I hear it (I’ve jinxed myself by typing that). Something about that song and it’s tropical vibe reminds me of Jimmy Buffett. While doing the bath the other night, I was trying to teach Noelle to bathe herself by singing “Head, Shoulders, Knees, and Toes”, one of the Wiggles “greatest hits”. As we sang that, something clicked to me: this is what I do professionally all day long. Not bathe people, but work with their head, shoulders, knees, and toes.
Objective:
Physical therapists are the musculoskeletal specialists. Our field is based on the treatment of the body’s dysfunctions via use of the muscles, bones, and joints. One of the new emerging fields of our practice is the prevention of these same dysfunctions. The chorus of “Head, Shoulders, Knees, and Toes” precisely names the parts of the body that we treat.
“Head, shoulders, knees, and toes (knees and toes); Eyes and ears, mouth and nose…”
Nose? Yes, the nose. No, it’s not common and we don’t ever get anyone specifically for this issue but it’s not uncommon for me to treat someone with sinus problems. Sinus issues often cause headaches. For years I’ve done some hands-on treatments for opening up sinuses. There are some pressure points on the face near the eyes and to the side of the nose that will open up your sinuses and allow you to breath for a while after pressure is applied. That’s what we did for years. The cold laser that we got last fall will open up nasal passages pretty quickly. It wasn’t uncommon to see the therapists in Carson Physical Therapy self-medicating with the laser during the “cold and flu” season back in the fall. The laser allowed about 4 hours –by my reckoning– of relief and breathing.
Eyes. Okay, this is an indirect treatment, but, I have to give this speech to about one person per week. Last week I actually got to give it to an eye doctor! Computer monitors and bifocals don’t mix. Wearing bifocals while sitting at a computer causes you to hold the head cocked back so to speak, so that the eyes can focus through the bifocal portion of the lens. This backward bent position of the neck pinches nerves and compresses discs in the neck. I see lots of neck pain clients with this as a contributing factor in their problems. Solution: when doing computer work, wear reading glasses, not bifocals! You will get neck related issues from this.
Mouth. TMJ issues abound. Clicking jaws, mouths that open too much or not enough. Physical therapy has it covered. It’s a joint like any other in the body with muscles, bone, and ligaments and responds therapy just like the rest of the body.
Head, shoulders, knees, and toes. I’ll get to toes in a minute. The first 3, that’s what people think about when they hear “physical therapy”. Headaches. Neck problems. Shoulders that hurt and don’t work right. Knees that creak and are worn-out and hurt every single step. I’m not minimizing this portion, this is 95% of what I do.
"What the..? A surprise party! Who planned this?"
But toes….. In Stripes, Bill Murray says that an “Army without leaders is like a foot without a big toe.” The Big Toe is essential to so many things that we do.Without a big toe, your balance is messed up. If the big toe doesn’t work right, you don’t walk correctly. If the big toe doesn’t dorsiflex (bend up away from the ground) you will end up with back pain because of how it affects your gait, your walking pattern. So, I stretch out Big Toes.
Assessment
Physical therapy treats the whole body. When I say that I mean that we treat this part and that part. But we also treat the body as a whole. Look back at that last section on the Big Toe: if it doesn’t work right, you end up with back problems. An elbow issue can become a neck issue. A neck issue can become a knee issue. It’s like picking verses out of the Bible to study. Yes that verse says something particular that God wants us to know, but taken out of context from the verses around it, the intended message can be missed.
Plan
Soon Noelle will outgrow the Wiggles. She’ll be able to bathe herself. But the “Head, Shoulders, Knees, and Toes” song will probably stay in my mind for several years. My recommendation to you: Remember physical therapy with any type of movement dysfunction. Many times there is a simple solution to what’s going on in your life. Just like a simple children’s song. Tonight, I might watch Stripes. Or maybe I’ll watch Raising Arizona. Who knows?
APC
May 16th, 2010
Subjective:
I grew up in the shadow of a billboard reading Warning: Prepare to Meet God. Well not really. The billboard was about 2 blocks from my parents house. It was/is on the access road next to I-30 and we turned by that billboard every day. It was one of the first things I read. To be honest, at 5 or 6 years old that was a pretty scary sign. I was old enough at the time to be scared of the word WARNING. I knew that meant I could get hurt. Hell, this is Saline County! There’s always a freakin’ tornado warning or a thunderstorm warning. A local church has sponsored that billboard for decades. Sharon Missionary Baptist Church to be exact.
Objective:
The Sign is a beacon in Benton. It’s a landmark. People only vaguely familiar with Benton know that sign.
“Do I turn before or after the Prepare to Meet God sign?”
“They’re building a new movie theater? Where? Oh down behind the Prepare to Meet God sign. That’ll be a good spot.”
“Take the exit just past Prepare to Meet God”
I have no idea how old the Sign is. It’s at least 38 years old. It is very ominous. The intent was, I’m sure, get right with Jesus and have a better life. What I saw and understood in my little mind was that the world was about to end and God was coming. To this day anytime I see a movie or TV show with a guy wearing sandwich board or carrying a sign that says “The End Is Near” , I think about that Billboard. When I was 9, it was the height of the Cold War and the Russians were coming! We were going to be nuked! As I said, I’m not too sure of the history of the sign but I’d be surprised if it wasn’t erected soon after the interstate was constructed in the 60s, just a few years after the Cuban Missle Crisis. Back then I-30 was called the “New Benton Highway” and had lights on all the exit and entrance ramps. The lights on the interstate said “stop at Benton, we’re welcoming, we’ve got great dining, clean restrooms, and good schools. But we gotta warn ya: Prepare to Meet God!”
Assessment:
The sign doesn’t scare me anymore. Not sure about my daughters. Sometimes Olivia, my oldest, can be pretty oblivious so I’m not sure she’s noticed it. Like I said, it’s a Benton landmark like the Courthouse, or Ed and Kays, or Redgate. Yes, I realize Redgate Liquor Store is across the county line, but as Saline County is Dry, Redgate has always felt like it was part of Benton as it was the first place across the Line to buy liquor. Ironically, the Applebees next to the Sign now has a private club permit for liquor sales. The Sign has a message to it, but I see it so much I don’t think about it or consider it. That’s kind of sad. The biggest, most thought provoking message in town gets lost in the background of the world around it. The Sign does get its point across if I dwell on it, like today.
Plan:
Warning! Prepare To Meet God! I hope that sign stays there for the next 38 years. Although the land underneath the sign had a For Sale sign on it. I’m not sure if Sharron Missionary Baptist still maintains the sign or if it’s a private party taking care of it. If they ever take it down, I won’t know how to tell people to get to my parents house.
May 1st, 2010
This piggy went to market.
Subjective:
This has been a good weekend. I haven’t accomplished a whole lot but it was good. Got some laundry done. Jenny and I went out on the town Friday night to hear some local live music with friends. Yesterday, I grilled steaks for dinner. Today we hit church and McAllister’s Deli. Grabbed a Sunday nap. Cooked ribs for dinner. Called it a weekend. I brought home a box of stuff to do for work. It’s still in the trunk of the car and it’s 6:38. Maybe I’ll get it out later. Procrastination is one of my finer attributes. For instance, Santa brought us Mac laptops for Christmas and today (April 18) I finally hooked up my video camera to it and learned to “make a movie” on this thing which I type. My plan is to do little video short movies on various physical therapy topics. I’ve had that idea for a while but just haven’t done it for various reasons. I can talk to people but have problems talking to a camera. I’ve been on TV and do fine talking to an interviewer but have a little problem talking to a lens. I’m working on it. I’d like to make shorts on various topics, sciatica, rotator cuff tears, and why flat feet are troublesome.
Objective:
We had foundation issues with our house about 2 years after it was built. Actually, we have an underground spring in the backyard and had to have Nolan Ryan and the Olshan boys come out and shore up the house. We’d dropped ¼ inch on one side of the house and 1/3 on the other. Now, heaven forbid a tornado come through here and take the house away the foundation would still be solid. If the foundation of a house isn’t solid and level, you will begin to see cracks in the sheetrock, at windows and your doors won’t close correctly. The doors were where we noticed it. Things hadn’t gotten too bad at the house when we caught what was happening, we only had one door that wouldn’t close correctly. But at a couple of doorways and at a couple of windows there were little cracks coming out of the surrounding sheetrock at the corners. Had things gone on longer, other doors would have been affected, windows potentially could have cracked, sheetrock cracks would have gotten severe, brick would have cracked, all because of a unstable foundation. Feet aren’t that different. If you’re feet sit too flat on the ground during the stance phase (the time when you are walking with the one foot on the ground) and push-off (when you propel yourself forward) it can affect many different things in the body.
Assessment:
The effect of flat feet –or even high arches– translates up the body. Problems with the feet show up where your week spot is. I’ve got flat feet. When I don’t wear my arch supports, the pain shows up in my low back. But that’s me. Let’s say you have foot issues: that’s where the pain will show up. Knee issues: pain there. And so on and so forth all the way up to the neck. Here’s the scope: if the foot sits too flat on the ground, it causes the lower leg to rotate in, putting stress at the knee, in turn this can cause the hip to turn in, stress there; this can make the hip rotate anteriorly, stressing the back; further up the chain this can lead to stress at the base of the skull –causing headaches. Now I’m not saying that everyone with flat feet is going to end up with headaches; I’m saying it can cause headaches. I don’t look at the feet on everysingle person with headaches, but if I’ve tried everything else with someone and haven’t made headway I’m gonna look at the feet. Where I see the flat-foot problem on 95% of the people that walk into the clinic is the feet and knees.
Plan:
So, how do you fix this stuff? Stretching, strengthening, and arch supports; custom or semi-custom. Current research shoes that there’s not that much difference between off the shelf orthotics and customs. I’ve been doing a fair number of each of them and having good luck with each. Tomorrow is back to work; we’re seeing lots of knees and feet right know. Feet are really my favorite thing to treat; there’s something neat to me about shoring up a person’s personal “foundation”.
APC
April 18th, 2010
KneeHab: The Total Knee Arthroplasty
Adam P. Carson, DPT, OCS
So, you’ve been told you need a knee replacement. It doesn’t sound appealing. You’ve had that knee a long time and aren’t that crazy about parting with it. It helped you through all those football games. It helped you run that 5k. It’s been with you kneeling at church for all these years. You proposed on that knee. Heck, that knee and you shared some good times with the kids “ridin’ that horsie!”. Somehow you’ve worn that knee out. Every step hurts. Getting off of the couch is murder. Your doctor took some x-rays and said something about “bone on bone” –whatever that means. Then the fateful words “knee replacement” came out of the doctor’s mouth. That sounds about as much fun as a root canal. Well, with the right preparation and and a little hard work, a knee replacement
50 Years From Now, Billy finds this picture of Johnny riding his back from when they were little. Billy again blaims Johnny for all the ills that have befallen him in life.
can make your life easier and get you back on the right (and left) track.
On occasion, a total knee arthroplasty (the total knee replacement) can come as the result of trauma, but on the whole it comes from a knee wearing out over time due to the arthritic changes of life. A professor of mine in college told me that “if you live long enough, you’ll need a new set of knees”. This isn’t that inaccurate. The far end of the thigh bone (femur) has a tissue on it called cartilage that allows some shock absorption, assists with knee motion and structure, and works similarly to ball bearings at the knee joint. The leg bone (tibia) meets the femur at the knee joint and the upper-end has it’s own set of cartilage. The kneecap (patella) makes up the last bone in the joint and works as a pulley-of-sorts helping the muscle on the front of the thigh (quadriceps) straighten the leg, climb stairs, get up from the couch, walk, etc. This cartilage wears out over time because of the pressure on top of it, not unlike a pillow or mattress. You lay on a pillow for enough years, it’s not going to be as fluffy as it used to be. Factors that make the cartilage wear out include being overweight, prior knee injuries, being knock-kneed, working on your feet on hard floors for years, and having flat feet.
The surgery itself, as wild as this sounds, is carpentry. Medical-grade saws, chisels, and files sculpt the knee joint in preparation for the endoprosthesis (the knee replacement hardware) to be inserted to the knee joint. The leg is closed up. The doctor makes sure everything bends and straightens correctly. And lots of my clients think, at this point, the hard part is over. Well, the hard part has just begun.
Physical Therapy begins the next morning. The therapist gets you out of bed, you walk with the assistance of a walker, and begin work on bending the knee. The whole goal at this point is getting the client to the point that they can safely go home. Preliminary exercises are instructed including being able to tighten the muscle on the front of the thigh (the quadriceps), lifting the whole leg, and actively bending the knee. Most people are in the hospital for 3-4 days before going home. The hospital therapy staff makes sure you have a walker, and teaches you to get around safely at the house.
At home, the second phase begins. Before you get home, make sure someone has looked (or you look before you go to the hospital) over the house to make sure pathways are clear for getting to the bed, getting to the couch, getting to the toilet, make sure there are plenty of pillows at home, and that anything you might trip over is out of the way (lamp cords, area rugs, dog toys, etc.). Depending on your doctor, you will either have home health physical therapy or you’ll be referred directly to outpatient physical therapy. It’s not uncommon for us to receive a client the day after they were discharged from the hospital. The goal at this point of rehab: get the knee straight, make sure that it can bend, and gradually strengthen the knee. Depending on the surgeon, clients usually come to physical therapy 3 times weekly initially, and then tapering down to twice a week as therapy progresses.
How much range of motion should the knee have? It varies from person to person, but a good rule of thumb is that the knee should be able to get totally straight (0 degrees) and be able to bend at least 115 degrees. At 115 degrees, a client can walk foot-over-foot going up the stairs. At our office, we push for 120 degrees mainly because once therapy stops, the clients tend to lose a few degrees of bend. This way if you lose 5 degrees, the minimum 115 degrees is still present. The clients focus on how much bend they have. Yes, that is important, however, but getting the knee to 0 degrees and maintaining that is of utmost importance. If the knee does not get straight, the client ends up with a limp, and the life expectancy of the knee replacement is shortened.
The muscles around the knee do one of two things: they get weak or they get tight. The quadriceps weakens because of swelling and trauma. This is that particular muscle’s response to injury. The hamstring, the muscle on the back of the thigh, and the calf muscle each tighten in response to trauma and surgery. The physical therapy program that you undertake after surgery will be designed to strengthen the quadriceps, and stretch the hamstring and calf musculature.
Many of the exercises you perform will have three functions: strengthening the knee, increasing the knee’s range of motion, and balance. Your exercises will be open-chain (non-weight bearing) and closed-chain (weight bearing). The therapist will have you use a leg press, use a stationary bike, step up and down on a short-step, they might have you “drive” an office chair around backwards, stretch your muscles, lay on your stomach and stretch out the leg, lay on your back with your foot on wall and slide that foot up and down the wall causing that knee to bend. The exercises sometimes seem crazy but they all have a purpose: get that knee working and get you moving again! Another form of exercise you will probably do is practice standing on one leg: your balance will be messed up after surgery. Recovery of balance is essential to your knee replacement recovery.
Once most of your therapy goals have been met, usually 6-8 weeks, physical therapy will release you to a home exercise program. Keeping up with the home program is essential. The knee continues to heal over the course of a year. Swelling will continue, albeit lessening so, over that year.
How long does a knee replacement last? That varies from person to person. It should last you 15-20 years. How do you maintain it? How do you make it last longer?
Lose weight. The less weight pushing down on it, the less wear-and-tear on the new knee.
Wear good shoes and arch supports. The more shock-absorption that occurs in the feet, the less force that is translated to the knee.
Avoid kneeling on that knee.
Finally, how can all of this go easier? Can you get ready for the surgery? YES! If you know that a knee replacement is in your future, talk to your doctor about “prehab”. Go see a physical therapist to get an exercise program in place that will assist in getting the knee ready for the surgery. The stronger the knee is before surgery, and the better the knee bends and straightens before surgery, the easier the recovery afterward (not necessarily quicker). Start wearing arch supports in your shoes (off the shelf arch supports are fine). Start losing weight.
Recovery from knee replacement isn’t easy. The harder you work on it, the more reward you’ll get from it. It will teach you patience. Truthfully, knee replacements are a growing experience. There is a brotherhood and sisterhood among those that have the procedure. It’s not uncommon for clients at the clinic to pull up their pant leg and compare scars and tell war stories. Don’t be discouraged! You’ll get back on the right path and get back to your life. Who knows, you might want to get the other one done someday.
April 17th, 2010
Subjective
I’m moving the Blog onto this site. There’s several reasons but mainly it’s marketing, driving people to the clinic website, and a few others. Mainly business though.
Objective
This will be a little bit of a pain b/e the old stuff is on the other website. Making this look like there’s nothing but one other post. Oh well.
Assessment
THis will be a positive move. I’ve just got to put up with it.
Plan
We’ll see how it goes.
APC
April 7th, 2010
Today at the clinic, we worked on some neat stuff. I’ve treated lots of various sports injuries but just a few dancers. Let me clarify.
I’ve worked with cheerleaders, drill teamers, dance teamers, and pep steppers. Today though, I worked with a ballet instructor who’s had an ACL repair. This was our 3rd visit and she’d already made good progress since starting with us at the clinic. The dancer’s surgery was earlier in the spring and she’d done therapy at another clinic up until the summer. However, she felt as though her therapy was too conservative. “I’ve got to be able to teach and do all of this in the fall.”
Before she got to us, she could walk without a limp and had wonderful ROM and strength, but she couldn’t do her dance moves. That statement shows my ignorance on ballet. These moves aren’t “mad skills” like Napoleon Dynamite, these are ballet positions.
We started out with 2 visits that first week and then the dancer went out of town for a vacation and then to a convention. That first week, we acually started with football agilities. Slow speed running, high knee exercises, skipping, defensive slides, back peddling, and dipsy-doodles. She’d seen most of these at one point, her daddy was a football coach. The dancer had a hard time with these at first but they got easier.
She’s back in town and she’s a new woman. The first thing she did in the clinic was skip to me. The last time I saw her skip, the dancer looked kind of like a gimpy kangaroo. THe skip today looked perfect. Like the skip of an 6 year old girl on the playground.
Today we worked on ballet moves. One of her initial concerns was not straightening the right leg quite as much as the left. She’s only off a degree and I explained to her that degree will either come or it won’t. Overall I think that final degree will come with continued activity.
What I did explain to her was the importance of balance. Not balancing work and family or a balanced meal but standing on one foot balance. Specifically standing on the surgical leg while doing the ballet moves with the other leg.
The neat thing about all this: the dancer’s getting better. I can tell she’s proud of what she’s accomplished. 3 weeks ago the dancer had been very depressed that she wouldn’t get back to her craft. The neater thing: she did all the work. It was all in her. All I did was coach. Like her daddy used to do. I showed her what to do and how to do it.
July 22nd, 2008
I set this up several months ago but didn’t really know what to say. That doesn’t mean that I do right now but I’m going to post something anyway.
For several years I’ve noticed that things run in cycles. People always hear others say “things happen in threes”. Usually it’s someone dying that I’ve heard that about. Hate to be a bummer bringing up death, oh well.
Hips, and elbows and knees don’d come to physical therapy that often. I’m not sure why. It’s kind of like the nickle. You just don’t get as many of them in change at the store. Hips and elbows are injured less frequently than knees, shoulders, backs, and necks.
Anyway, things come cycles. Carson Physical Therapy saw 4 new elbows in one week! There was a fracture, a dislocation, tennis elbow, and a surgery. That was pretty wild.
What does that mean to you the casual reader? Elbows get hurt too. Take care of them! One small thing you can do to help them: move that mouse to a more comfortable position. Don’t reach so far for it. The closer you keep you elbow to your side and do this the better. Those keyboard trays with the little perch for the mouse on the side help pretty good.
How’s that for a first post?
July 19th, 2008
