We've Come A Long Way Baby

I suppose you know by now that I've been at this stuff for a long time.  As of December, I will have been a physical therapist for 38 years.  I've been an athletic trainer for 32 years.

I have a hard time even fathoming all that.  Heck, it doesn't even seem like I should be 38 years old.  

The reality is that I've been a father for almost that long.

Health care in general and physical therapy, athletic training, and sports medicine in particular bear no resemblance today to what it was then.

A couple of weeks ago, I talked about physical therapy treatment of back pain.  Things like body mechanics, core strength, fitness, and weight control today serve as the basics for evidence-based physical therapy care of back pain.

In 1977, it was hot packs, ultrasound, massage, and Williams Flexion Exercises.   Physical Therapists today don't even know what Williams Flexion Exercises are, since we now know, because of solid research, that they don't work.

In 1977, Athletic Trainers were still limiting fluid intake.  As an athlete in the early 70's, I can remember one small cup of this new thing called Gatorade that we were allowed in the middle of an August football practice.  We now know that to be a big mistake.

As I wrote last week, in 1977, we were telling everyone that there was no evidence that steroids made you bigger and stronger.  I even went on Bob Gilbert's The Sports Page radio show to declare that they really wouldn't do much for you.

Oh how wrong we all were.  What we didn't know much about then was also all those horrible side effects.  All I knew was that a buddy of mine that was into bodybuilding after a UT football career had gotten into steroids quite heavily.

I was an undergrad at UT and headed for physical therapy school so I was everyone's health care person.  So he confided in me that his testicles were the size of pinto beans and wondered if it could be those steroids. 

My family doc at that time had even recommended steroids to me a couple of years before.  He knew I was trying to make it as a college football player and needed to be bigger and stronger.  He shared the product information sheet that came with the steroids and one word jumped out at me:  Impotence.

I knew then that I wanted children one day so that's all it took.  Football, for me, was not worth that.

So my undergrad diagnosis of my buddy's testicular atrophy was "well...YES."  Little did I know how right I would prove to be.  That buddy never fathered children.

So jump forward to 1985.  What do we know now that we didn't know then?

That early intervention is the key.  That proper treatment started early makes all the difference in the world.

That concussions are serious business.

That rushing someone back to competition after an ACL reconstruction is simply wrong.

That ankles don't become "dependent" on ankle braces.  We used to avoid bracing ankles because of that.  We now know that the braces just protect the ankle.

We used to say "ice for 48 hours, then heat after that."  No way.  Ice is almost always better than heat.  And if it's an injury and there is still pain, inflammation, or swelling, you NEVER use heat.

We've come a long way baby.

PED's

One of the things that I hear too often is "the professional athletes use it so why shouldn't I?"

This ranges from multi-colored tape jobs to alternative forms of health care. 

Well, there are many reasons why it really might not be a good idea.  First, keep in mind that professional athletes will do anything (anything) to succeed at their sport. 

My sport, bicycling, has been notoriously drug-enhanced.  I defended Lance Armstrong all the way to his TV confession.  The most drug-tested athlete in the history of sport, who had apparently passed every single one of those drug tests, was guilty as sin.

Proving that drug testing is a farce.  That even the best tests can be beaten.

With millions at stake, the NFL is packed with people who will do anything (anything) to play the game. A first round draft pick that plays for five years will be wealthy beyond our comprehension for the rest of their lives unless they're really stupid.

Even some athletes without huge financial incentives follow the same pattern.  Several years ago, Olympic athletes were asked if they would give up 2 years of their life for a gold medal.   Overwhelmingly, they said yes. 

These are athletes that rarely are able to make a decent living at their sport.  Yet, for one moment of glory, they would give up 2 years of their life.

Most of what we're talking about is Performance Enhancing Drugs (PED's).  You've heard the term.  

It's a problem in sports that just won't go away. 

The first thing most people think about with PED's is steroids.  More specifically, anabolic steroids.  Athletes will take them to get bigger and stronger.

Back in the early 80's, many of us, yours truly included, insisted that there was no evidence that steroids made you bigger and/or stronger.  Those using steroids were laughing at us behind our backs. 

Because they do make you bigger and stronger but at a tremendous cost.  Like impotence.  Yeah...really. 

Like liver disease, kidney disease, heart disease such as heart attack and stroke, high blood pressure.  

Like hair loss and acne.

Females on anabolic steroids can grow hair, get deep voices, and have menstrual irregularities.  

Males on anabolic steroids can grow breasts.

Anabolic steroids can cause increased aggression, irritability, and altered moods. 

There are other things that athletes are using to enhance their performance.  Human Growth Hormone (HGH) is one.  I can't even begin to tell you how dangerous HGH can be.

The one that is probably the biggest problem around here is stimulants.  The bad news is that those can be bought in any convenience market in the country.  Marketed as "energy" products, they come in pill and drink form and under a lot of different names.

But they are all basically just stimulants.  Check the ingredients.

And 16 year old athletes (or any 16 year olds, really) do not need to be taking chemical stimulants.  Ever.

Back Pain

One of the most difficult things to deal with in health care is back pain.  Statistics tell us that 80% of Americans will have a significant episode of back pain at some point in their life but that other 20% probably has had an episode of back pain that was not bad enough to seek health care but still a problem.

More U.S. dollars are spent on back and neck care than any other medical condition yet we seem to be making little headway in fighting the pain and disability they bring.

The gamut of things that are used to treat back pain boggles the mind.  In physical therapy, it's a big part of what we do. 

My clinical practice for most of the last 25 years has focused on extremity orthopedics (Prior to that, it was pretty much everything orthopedic).  

Knees, shoulders, feet, ankles.  Sports injuries.  But because of the demand, I'm seeing a lot of patients with back pain these days. 

So what do we do with those patients?

Dealing with back pain is a complex, complicated affair.  Lots of treatments give you temporary relief.  I can help most patients feel better.  But what we are trying to do in physical therapy is to provide you with effective, lasting treatment.

Sometimes we help the patient to manage their back pain.  Back pain that has been severe and constant that becomes mild and infrequent--well that is often a successful outcome. 

Sometimes the back problem is structural to the extent that we can't help you.  A lot of times, surgery can.  Effective surgical interventions save a lot of people from lifetime back problems.

It is my opinion that there are several key ingredients to treating back pain.  Most of them are on you.

#1  Exercise daily.  As in every day.  Walking is usually great for back pain.  Consult a professional.

#2  Lose weight (if you need to).  Back pain is not strictly the curse of the obese but it doesn't help.

#3  Build core strength.  What is core strength?  Basically your trunk.  Pretty much everything from your armpit to your kneecaps.

#4  Eat better.  In sports, we have a saying "garbage in, garbage out."  Good health demands good eating.  Fewer carbs, fewer desserts.  Abandon sodas.  Read ingredients.

#5  Sleep!  Most of us don't get enough (I don't).  But proper rest is essential to dealing with the physical demands of the day.

#6  Watch less TV.  Do you really need to sit more?

That's it.

It really isn't that hard but it takes persistence.  You must diligently do all those things.  You must consistently do that which will make you healthy.  It is the only thing that really works.

In a lot of ways, your physical therapist becomes your partner in health care.  It's our job to recognize the many challenges (not everyone can afford to eat well, not everyone has time to exercise every day) and strategize with you about how to overcome those challenges.

October is National Physical Therapy month.  Sure, this has been a little self-serving but my profession has done a good job of leading the research on what truly works with back pain.   

Don't Hide Your Scars

When you see Graysen McConnell, you automatically think, "what a beautiful, got-it-together young lady."

I remember Graysen as a cheerleader at MHS.  Her dad has been a friend for years but I never knew much about Graysen other than what I saw on the football sidelines.

But Graysen has a story.  She has scoliosis.

Scoliosis usually begins developing in puberty and affects girls more often than boys.  In some cases, it is self-arresting, stopping on its own with minimal consequences.  In others, it progresses to a severe degree, causing all kinds of complications, sometimes the least of which is really bad back pain.

Scoliosis is something I know well.  As a physical therapist, I've seen my share professionally.

But on a more personal note, my wife had a favorite uncle with a very severe case of scoliosis that eventually led to complications that caused his death. 

Let me let Graysen's mom Shawna describe her daughter's scoliosis:

"When most people look at Graysen they don't automatically notice her crooked back.  They think she has one hip cocked.  You know, one leg bent at the knee, causing one hip to hang lower.  She puts her hand on her hip.  It just looks intentional.  The hand is intentional.  The bent knee is intentional.  It makes it all look more natural and it has become a habit.  The 'ole hand-on-the-hip, one-knee-bent trick.  You will see it most of her pictures.

But, Graysen's back is crooked.  45 degrees when last measured in October."

That was from early last year.  Her problems were immense.  Her back pain was severe and unrelenting.  So she and her family starting seeking solutions. 

That search took them to Austin, Texas and Dr. Matthew Geck, an orthopedic surgeon that specializes in scoliosis surgery.

Graysen had the surgery on May 29, 2014 in Austin.  Although they had hoped for a minimally invasive surgery, that wasn't possible.  So Graysen ended up with a 10 inch scar along her low back.

Leap ahead to a year and a half later.  Graysen is a sophomore at Lipscomb University in Nashville, majoring in biochemistry and looking to a career in dentistry.    Her surgery was a huge success.  She is essentially pain free now.  Life for this wonderful young lady is SO much better.  Her back is straight and her health is good.

And she wears her scars proudly.  She is not ashamed of them, does not let them affect who she is.

And once more in her mom's words:

"Don't hide your scars. They create questions and interest, they start conversations and a way to know each other better.  They can open doors, if we let them. Share them and your story. I know that it has power and beauty, and I now know THAT is the purpose of our scars."

If you are interested in more, you can follow the McConnell family saga through mom's blog called "Graysen's Backstory."  It can be found at graysenmcconnell.blogspot.com.