165 Lilly Rd NE, Suite B, Olympia • 360.455-8014

Rehabilitation

Right knee pain caused by left hip and pelvis! What???

knee image

knee pain image

This doesn’t really make sense, does it; right knee pain caused from the left hip? Until…you look at this video and see that the right knee tends to fold into a knock kneed position as the patient puts weight onto the right leg.

A concept called “crossover gait” has been around for a long time in running circles (at least since 1994, as noted in a medical article, “Relationship between foot placement and mediolateral ground reaction forces during running–Clinical Biomechanics March 9, 1994”. Here is the definition of crossover gait: The runner places the weight bearing foot under the center of the body or across the center to the opposite side. It happens with same sided hip weakness and opposite abdominal weakness.

The idea of crossover gait also happens with walking as well as running, but the consequences can be different. In the video shown above, the client’s left pelvis is higher than her right when she is, at the same time, putting weight through her left hip and leg as she lifts the right leg to place it onto the step. She SHOULD be contracting her left glut muscles and right abdominals at the same time to assist in lifting the right leg, (whether stepping up onto a step of taking a step forward) but she does not. Instead her left pelvis shifts to the left and the right side of the pelvis drops as she lifts her right leg. This causes her to have to fold her right knee into a knock knee position. THAT will cause knee pain.

If you watch the video, you can see she has been taught to lift her right pelvis and contract her left side glut muscles, which raises her right pelvis allowing the right knee to unfold to a straight position from a knock knee position!

Physical Therapy in Olympia, Tumwater and Lacey, Where should I go?

There are many fine physical therapy clinics in the Olympia, Tumwater and Lacey area. How do you chose where to go?

You can choose based on location. A friend of mine told me today she chose to go to physical therapy at a clinic close to her house. What would prompt a close choice versus reputation? Maybe she needed to go 2 or 3 times per week. If someone needs to go to PT 2 or 3 times a week for a month or so, then going close to your house would be very convenient, HOWEVER, ask yourself the question: does your condition warrant 2 or 3 times per week?

Recently a former patient returned for a new session of physical therapy. She is a fairly frail 80 something year old, and was sent for BOTH headaches AND shoulder pain by her physician. Her prescription from the physician was directed to be 2 to 3 times per week for 4 to 6 weeks. She may have thought she needed to come that often, but…….when I evaluated her headache AND shoulder pain, I determined that both problems were mainly caused by the same anatomical structure.

I gave her an exercise program based on this one problem, and added customized and specific exercises for the shoulders and neck. As of Friday (January 30) 100% better in the headache and 75% better in the shoulders. She came for 6 visits at 1 x per week.

So the bottom line is, unless you actually NEED to have therapy 2 or 3 times per week consider going somewhere that uses less visits more effectively and you may save yourself some time and money.

The therapists at Comstock Physical Therapy, Joyce Mills, Lori Waterman and Linnea Comstock have extensively studied the body to make our exercise programs very effective and efficient. Give us a call if you would rather go to PT once per week instead of three times a week!

Physical Therapy…May I have a private room please!

When you go to a physical therapist have you been offered a private room or are you treated in an open gym, no curtains to provide privacy, with many other people in the gym?

As a patient YOU can choose what you want. When you go to your first PT appointment, make sure to let the scheduler know that you would like a private room, if you wish.

Many clinics have one or two private rooms and a large gym. It is less expensive to have an large open gym with a few private rooms than to have many private rooms and a smaller gym. Why? It is much more expensive to frame in, sheet rock, putty and paint walls then leave spaces open. Unfortunately you, if you are the patient, may be more likely to gently be guided to an open gym space due to the lest costly nature of this arrangement.

Recently my husband went with his buddies to go get coffee. He came home telling me they watched a lady receiving physical therapy in an open gym with lots of windows. They watched her on her hands and knees stretching her buttocks towards the window. Unfortunately they got quite a show.

What are the positives to private rooms?
1) you can have a candid conversation with your therapist about YOUR needs and wants.
2) You can move in physically awkward positions in privacy with your therapist. This is an advantage to you as you have more privacy; also your therapist may be more comfortable asking you to get into awkward positions (which may be helpful for your therapist to understand your problem) to assess your problem knowing she/he is not putting you in potentially embarrassing positions.

At Comstock Physical Therapy we have 3 private rooms and 2 other rooms in our gym which have full curtain coverage. Here is a video of our clinic on the inside. Take a look, you’ll see our private rooms.

Inside of Comstock Physical Therapy

Please feel free to request a private room as we are ready and able to accommodate your request and keep your needs in mind.

How PRECISE should my rehabilitation exercise program be?

If I go to a physical therapist, chiropractor, massage therapist or physician, and he or she hands me a sheet of exercises will I get better?  Will corrective exercises from a personal trainer do the trick?  Or does my health care provider need to provide very specific exercises for my problem to help me improve? 

It matters HOW you exercise, WHICH muscles you strengthen and stretch, and IN WHAT ORDER! The evidence is coming out more and more that muscles actually unplug when you have an injury and pain.  How does that information get to you?  Training is available to physical therapists that provide us this information.  We, in turn, provide that to you in the right order and amount to progress you from your injury to wellness. 

Here is an example:   If you have neck pain and headaches it can be from an actual injury to the neck muscles but it can ALSO be due to shoulder blade muscle problems.  If you go look in the mirror now you can see the way your shoulder blade and shoulder hangs from your neck.  If you shoulder looks like a ski slope, chances are the muscles which hold your shoulder blades up are too long and stretched (such as the serratus anterior, trapezius and levator scapulae) and the muscles which pull it down are too tight (such as the latissimus dorsi and pectoralis muscles).    (Here is one article which emphasizes the importance of this idea:  “A Specific Exercise Program and Modification of Postural Alignment for Treatment of Cervicogenic Headache”  A Case Report”  JOSPT 2005, authors:  McDonnell, Sahrmann and Van Dillon). 

Our  three physical therapists at Comstock Physical Therapy have all attended many courses on precise and corrective exercise programs to help you feel better.  Give us a call today at 455-8014. 

(Here is one article which emphasizes the importance of this idea:  “A Specific Exercise Program and Modification of Postural Alignment for Treatment of Cervicogenic Headache”  A Case Report”  JOSPT 2005, authors:  McDonnell, Sahrmann and Van Dillon). 

Depressed shoulder blades

Depressed shoulder blades

What can Physical Therapy do for me that I can’t do for myself? Part 2

Why go to physical therapy? Can’t I just buck up and do exercises myself and get better? Won’t going to a gym and lifting weights fix the problem?

Let’s take a look:

photo

The lady above is coming for elbow pain on the left and thumb pain on each hand. You may be wondering why I took a picture of her shoulder blades and middle back? The answer: her shoulder blade muscles are the “core” of her arms and their position and movement pattern, if bad, will strain the arms. She may not know how to make sure the “core” shoulder blade muscles are strong and how to stretch the tight muscles that pull the shoulder blade down and out.

Let’s look at her elbows (the pictures below are of someone different who looks like her due to Comstock PT not wanting to expose her face):

bent elbow

bent elbow

bent elbow posture

bent elbow posture

The elbows are bent and forearms twisted in, which is straining her outer forearm muscles and rotating her wrists and thumbs in. (see below) abductor pollicis

The thumb muscle that is causing pain for her comes from the forearm, up by the elbow and twists down by the thumb. When the forearm is turned in and elbow bent, it strains the thumb and forearm muscles causing both forearm and thumb pain.

To fix the thumb and forearm pain and keep it gone, a holistic approach to the whole arm and shoulder blade system is needed to reduce the strain and help the arm improve. Why go to physical therapy to have this treated? To get the holistic treatment and get fixed!