HOW to STRETCH and not HURT yourself

Tip #1:  Don't try to do this

1.  Stretch HOT!
Ideal inner body temperature should be 103.5 degrees.  That means you should warm up BEFORE stretching, or stretch in a warm room.  That doesn't mean it needs to be hot yoga: that seriously raises your core temperature, and you need to drink some MAJOR water to make sure you don't faint like a distressed damsel.


Note:  If you are pregnant, you should not be raising your core body temperature above 101 degrees.  This is because the baby has a body temp of 1 degree celcius higher than you!
AND fetus's can't sweat the way you can.  So if you wanna work out hard, get thyself a rectal thermometer.  Sexy. 

2.  Stretch SLOW.
A good stretch is warm, and doesn't seem like its straining you to the max.  You feel some burn, but not so much that your sarcomere's and muscle fibers are liable to tear.  No super stretch or major burn is happening.  You're not shaking.  You've got it under control. 

3.  Stretch LONG.
Hold your hot, slow stretch for a long time.  Ballet students hold each stretch for about 2 minutes; longer is not a problem.  Bouncing, however, will not increase your viscous flexibility.  Hold it loooong.  Use the 2-minute setting on your electric toothbrush at the same time, perhaps, and kill two birds with one stone.

4.  Stretch Often:
If you get into a daily stretching routine, you will begin to feel how tight you become after sitting, sleeping, or just *not stretching* for a length of time.

5. Build some MUSCLE:
Being hyperflexible without muscle mass can cause injury!  Those muscles stabilize your joints so they don't just move every which way.  So don't neglect the iron pumping just because you're stretching well.

FEET SERIES: Plantar Fasciitis

Oooh, we were born with beautiful cute feet.  Don't you love cuddling up and kissing infant toes?  But after years of improper use, we sometimes neglect and don't care for our feet.  Bursitis, bone spurs, fallen arches, etc.  can create pain that radiates throughout our whole body, negatively affecting our beloved Q of L.

Don't understand how to protect your feet? Here's the FIRST of a series of Common Foot Injuries to prevent and...heel. 

a) Plantar Fasciitis:
Where: The tissue at the sole, bottom of your foot is called Plantar Fascia.  The arch, the connection between the heel and the toes. 

What:  Overuse and overstretched tissue can become inflammed and painful. 
Why:  Overuse and overstretch occurs when people gain weight, putting additional pressure on their foot tissue.  Long distance running, especially downhill, or on uneven terrain, can cause high pressure and overuse.  Tight achilles tendons (back of the ankle)  can pull the tissue, causing an overstretch.  Poor Shoes! (Hey New Yorkers!)  with little support can unevenly distribute pressure, causing plantar fasciitis. 

How to Heal:  Stretching the calf and achilles tendons.  Ice and use over the counter medication to reduce inflammation. 

Practicing in Different Settings...

I've shadowed in a few different settings, looking for role models and my true vision of myself as a PT.  Listening to different therapists handle caseloads helps me understand exactly what I'm looking to accomplish as a PT.  

OHSU physical therapy rehab is pretty low-key.  Mostly Caucasian clients, several sports and work injuries, a number of mental health cases with pre-existing conditions.  Average american dress and weight distributions.  We listened to folk music and soft rock, and PTs are respectfully polite to their patients. 

Several PT private practices in Portland are peaceful and positive, with PT combined with reiki, massage, and acupuncture.  PTs listen to the sounds of the earth, and wear organic cotton.  They care about the emotionally cathartic experience you may be having as soft tissues in the body are released. 

Shadowing at the Sports Clinic in Soho felt more like home.  Clients came from all over the world, and were frequently extremely well-known in their fields.  They were on vacation, headed back to Africa, or working on their latest television script.  We listened to hip-hop while PTs ran around in sparkly ballet flats and teased firemen about whether they "really" are most likely to cheat on their wives.  Clients has sports injuries, or post-operative pains: they frequently were returning to PT for a third or fourth time, after heading back from their pain-inducing, favorite sports. 

Did you Know...

Your accessory ligaments on your joints are so strong, that your bone will generally break before a ligament will tear?


The reason why:
Ligaments support, strengthen and reinforce movable joints, in places like your elbow and knees.

Ligaments are avascular (have no direct blood supply), so they take forever to heal.  And no one can stomach that much daytime tv.

Sensitivity and Severity

Sensitivity:  How easily an inflammation or negative reaction is triggered.

Severity:  The degree of pain that is caused when triggered. 

High Sensitivity and High Severity:  Must be treated very cautiously.  Many movements will trigger pain reactions, and they will be strong. 

Low Sensitivity and High Severity:  Most movements will not cause problems, but the few that do will cause extreme pain.

High Sensitivity and Low Severity:  Many movements cause a reaction, but its just a dull pain. 

Low Sensitivity and Low Severity: If you're going to have pain, this is the best kind to have.  Rarely triggered, and when it is, it doesn't hurt *that* much. 

Blackberry Thumb and Cellphone Elbow

I had a massage this weekend, and the masseuse noted that I had developed Blackberry Thumb, a term that refers to an overly developed (and tight) muscle between my thumb and forefinger on my texting hand, specifically from the repetitive motion of texting from particular types of mobile devices...time to get a new cell phone, ay?  perhaps an iPhone?

Had started to get concerned about becoming a physical therapist with pained fingers.  Now, as it turns out, its good I'm getting out of marketing and PR.  Recommended cure?  Thumb stretches, ice, and, um, less texting....Lots of hand yoga in the days ahead (and more headset, less cellphone elbow....)

Listening and Physical Therapy

There are about 30 PTs at the clinic I volunteer at, and I certainly can't shadow them all.  Currently, my favorite PT to shadow is an east coast rock climber, who told me today that I have awful shoulder mechanics.  Like many of the PT's, he's very strong in his craft and intellectually gifted, but the particular skill that allows him to stand out from the group and makes me want to copy his style, is his listening ability.

I was amazed when I began shadowing at how much information some doctors fail to hear.  Often its because their mind is elsewhere:  diagnosing the ligament tear, typing in chart notes..., and their brain is so actively focused that they aren't hearing the patients words.  Othertimes, it looks like they are not checking in on the facial cues and emotional body language of the client.  Sometimes they simply don't ask the right followup questions.

Many of us have had the experience of being in a doctors office and not understanding the high-tech vocabulary they are using, or not having things properly explained or broken down. Or of mentioning a pain or ache, and having the MD brush it off as nothing. 

My favorite PT is amazing!  He hears everything, like God or the Paparazzi.  His jokes refer back to topics the client touched on earlier, and his explanations are clear and match the lowest barometer of client vocabulary.  The complexity of explanations increases as clients become more familiar with their personal anatomy. I'm hoping to learn and absorb his style so I can be one of the doctors with ears...

Street Anatomy

I just discovered the Street Anatomy blog and am completely in love! Also, mildly creeped out.  But I really adore the above work by Maurice Mbikayi on measuring the impact of technology use on our brain chemistry. 

"When I was first interviewed...

T

...They asked me what my favorite equipment was.  I said exercise balls, a wooden dowel, and a mirror.  No expensive machines.  It's part of the reason I was hired."

-Tidbit from a favorite PT at the hospital

AIDET

Were you ever curious to know how hospital staff are trained to (hopefully) give you that warm, fuzzy, organized feeling?

I attended a supplemental volunteer training today where we went over AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You), which basically outlines the positive energy that seems to radiate from well-adapted hospital staff, convincing you to hand over your money and bodies through an instilled sense of trust.  It all starts at the greeting.   A breakdown:

A) Acknowledge:  Good afternoon, Miss Jane.  We've been expecting you, and are glad you're here.
That's such a classic gangsta line.  "We've been expecting you..."  


B) Introduce:  My name is Pumpkin, and I will be conducting your test today.  I'm  a certified ultra sonographer, and I do about 9 of these procedures a day.  What questions can I answer for you?
Don't let anyone be unsure about your role, and why you are there.  As a volunteer, I'm always having patients ask me profound health-related questions that I'm totally not qualified to answer.  Sometimes I get away with answering it by re-iterating the PT, and saying, "What you're physical therapist said was..." or just "Lets ask when s/he gets back". 

C) Duration:  This test will take about 15 minutes. Then you will need to wait about 10 minutes for us to process your results.
No one likes to be kept waiting! Damned if I do. 



D) Explanation:  You will need to drink this solution, than wait ten minutes.  The test will be then be administered, and the results will be sent to the clinic. 
We like to know whats happening.  This is where it stops being gangsta and is just, you know, polite.


E) Thank You:  Thank you for your call.  It was a pleasure to serve you.
I think this is especially important as a volunteer shadow: thank people for letting me watch their personal appointments.

HIPAA Regulations and Blogging

I'm not gonna lie: HIPAA regulations scare the bejeezus out of me.  And I know I'm not alone:  when I tried to get my medical records from my old hospital, the clerk in charge refused to give me basic information that was allowed, simply because he didn't fully understand the rules and didn't want to err on the side of wrong.  (Side note:  once I did convince him that it was perfectly legal to share that specific information over the phone, he offered way more information than was legal, which is kinda really shady).  


So I want to put it out there when I'm blogging: I'd rather be safe than sorry.  As much as I'd like to post about specific cases that I've shadowed,  I absolutely can't.  HIPPA regulations can be somewhat convoluted in regards to blogging, but that's the easiest rule of thumb to follow.  


The following is quoted from the Social Medic on "The Healthcare Blogger Code of Ethics and HIPAA":

"The code has five essential points:

• Perspective – that your readers understand your professional perspective. While we usually argue that this type of classification is usually unnecessary to the public it’s important to identify whether you are you an EMT-Basic, EMT-Intermediate, EMT-Paramedic, Registered Nurse or Medical Doctor for your readers who do understand the differences to know your professional perspective
• Confidentiality – Bloggers must understand and maintain the importance of confidentiality when blogging about patients. All blogging about patients must be done so that their identity cannot be inferred
• Disclosure – Bloggers must disclose any commercial ties that may exist between a company and themselves. You can read more about disclosures here
• Reliability – It is important to cite sources of information accurately and correctly. Additionally it is important to correct inaccuracies where they are discovered
• Courtesy – Attack the idea, not the person. This is a simple directive to maintain a professional demeanor and practice good netiquette. You can read more about the do’s and don’ts of online behaviour here"

In addition, any information that could be used as patient identifiers, such as location of city or hospital, time of incidents, patient descriptions, etc, have the potential to reveal identities, and must therefore be completely avoided.  

Purpose

Why did I start this blog?

Two major reasons:

1. To help keep my friends and family informed on issues related to the human body, self-care, and of course, my progress towards becoming a physical therapist!  
2. To keep me disciplined in learning as much about new research and the field of Physical Therapy as I possibly can!

So please: if you have something you'd like to research, or you'd like me to share, I highly encourage you to clue me in.   And if I seem like my postings are lagging (two many late night dance parties),  I would love a firm slap on the wrist.  

Thank you, and would love your ideas and comments!

Arielle