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. 

The Back Pain Manifesto

If you have back pain, I can make you feel better.  You can walk out my door with less pain than you arrived with.  I can virtually guarantee it.

But that relief is temporary.

I'm more in the business of lasting, effective treatment programs.  And that means that under my care, your program is going to be based on exercise, body mechanics, nutrition, and fitness.

Do those things and you will be better.  And if you continue to do your exercises, use good body mechanics, eat right, and stay fit, you will stay better.

You might be surprised to know that most folks don't choose that route.  They want something passive--something where they lay down, get some kind of treatment, and are cured.  In 2-3 visits.

It doesn't work that way.  It takes effort.  And dedication. 

In a discussion about what it takes to stay healthy, a friend argued that I had a job that gave me the time to exercise and an income level that let me do healthy things.

That has very little to do with it. 

Check in with my alarm clock.  It says 4:30 AM.  That's because I've always exercised early.   Get it done before the day gets started.

Right now, it's 6 AM and I'm looking across the gym at a room full of mostly women who are doing a CrossFit class at Cherokee.  Many of them have young children at home so this is the only time they can exercise. 

Check with my boss.  This time of year, I'm working 60+ hours a week (it is football season after all).  During my slow period, I'm still working about 50 hours a week.  So no, my job doesn't give me the time to exercise.  I make it a priority.  I make that choice.

I don't watch television.  When people talk about their new favorite TV show, I have no idea what they're talking about because I don't have a favorite TV show. 

The way I see that equation is that you can either have back pain or favorite TV shows.  Your choice. 

If you would rather watch one of the dozen or more CSI shows, the nighttime soap operas, or something about drug addicts or zombies than feel good, so be it.  My brain doesn't have room for all that.

Sometimes I don't sleep enough but that too is my choice.  I've got too much going on and am perfectly willing to give up an hour of sleep to paint, play with grandkids, ride my bike, paddle, spend time with my wife, do things around my farm, watch a sunset...get the picture?

Again, it's all about choices.  If a little more sleep in the morning is more important than whether or not your back hurts, that's your choice.

There are plenty of people getting rich off of you because you want a quick fix.  You want to walk in and maybe get "adjusted" and that's all it takes.   Or get a prescription for one of those -codone drugs. 

It is never that simple.

And by the way, saying that your pelvis is "misaligned" or that your hips are "out of alignment" is one of the biggest farces perpetuated on the public that history has ever known. I keep a cartoon of two guys laughing hysterically with the caption "my reaction when someone tells me they got their pelvis realigned."

And pain medication relieves pain.  It doesn't correct the problem. 

You want that magic pill that once you take it everything is fine and you go on with your life.  If only life were really that simple.

Somebody told me this week about her daughter  (a teacher) who was allowing a chiropractor to inject her muscles with sugar-water.  First of all, if that chiropractor is doing that, it is highly illegal.  Second, how can a college educated person allow this to be done to their body?  Is there any part of that which even approaches sanity?

You want your back pain to go away? 

#1  Lose weight.  You're overweight.  Probably.

#2  Get good core strength, admittedly hard until you get #1 under control.  Start by walking.

#3  Exercise daily. Daily.  I've got another cartoon that says "if you don't have time to exercise an hour a day do you have time to be dead 24 hours a day?"

#4  Eat better.  If it contains white flour or white sugar, stay away from it.  Dietary fat is not the culprit--carbohydrates are.

#5  Turn off the TV.  Do you really need to sit around any more than you do already?

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.

The choice is simple.  Either take care of yourself, taking ownership of your health, or keep having back pain. 

One of my frustrations as a physical therapist is that I can work someone through all this, teaching them how to take care of their back and emphasizing a set of exercises that they can do at home.  

Maybe even get them on the road to better fitness and weight control. 

They leave me essentially pain-free with a concrete plan to stay that way. 

And then 2 years later they show up with the same problem. "Are you still doing the exercises I taught you?"  Uh....no.

They had the tools to stay healthy and pain free but for a million different reasons (excuses) they didn't follow through.

So they keep returning with the same problem.  Or get frustrated and start trying things to which there is no scientific basis. 

And about that...before you start some treatment out of the mainstream, check it out.  Get online and look it up.  If there is no scientific basis for it, why would you consider it?

If all it has going for it are testimonials and no research to back it up, smart people would stop right there.  Sure, we don't know everything, but if there is proof positive that it doesn't work or even that it might cause long term negative effects, why go there?

Ask the tough questions.  Expect tough answers. 

It's all on you.  

Football Mom Again!

I am an unabashed, unapologetic fan of football.  Especially high school football. 

I played for many years.  My son played and was quite good (if I do say so myself).  Even though his college career was ended with a rather catastrophic injury, I believe he would do it again (without that last injury).

But the game I love is under attack.  Parents are keeping their kids away from the game for fear of the injuries.  It is seen in some quarters as being too violent.

I happen to believe it is the best sport that we have for teaching life lessons. 

Lessons like teamwork and dedication and commitment. Like leadership and work ethic. Things that inarguably benefit our growth and development. 

You may recall an article that I wrote a couple of years ago based on a letter I received from "Football Mom."  

Football Mom had never wanted her boys to play football.  She wanted to shield them from a sport that she had lots of history with but that had lost her love.

This week, I got another letter from Football Mom.  I'm copying it her pretty much verbatim but changing a few things simply to make it generic to the sport rather than to any one school.

So here it is.

Dear Joe:

"I (Football Mom) had lost my way since the last article.  I became frustrated about the lack of 'success' they (my sons) were having on the football field. 

Let me say that the systemic discipline that Coach and his staff impart on 7th and 8th grade young men is something that I can't repay him with bars of gold.  My son has drank the golden kool aid of the cornerstone of football programming.  Discipline on and off the field.   

My son talked to me two nights ago about career paths he was considering including medicine and constitutional law and my rumblings about the requirements with my son replying 'discipline always wins mom.'

Then Thursday night happened.  My oldest son went into the Junior High Game for an extended amount of time. The first play his hands were clenched with nervous anxiousness, his feet moved as tentatively as he cruised taking his first baby  steps. 

I was frustrated,  I had taken him to the Junior High all summer at an insane early hour day after day, done load after load of teenage boy football laundry, drove circles dropping, picking up, repeat.

Then I watched as every play transpired the nervousness that only a mother can spot from the stands dissipated.  

He continued to contribute to his team even making an unassisted fumble recovery. 

So if you think this is where the story would end because of success you and I are both wrong.  As he gets in the car he is overflowing with pride excitement and happiness. 

An analogy that I immediate thought of was a friend years ago took me to see a waterfall and as we approached he made me close my eyes and I laughed and asked him why?  He said I want to see your eyes when you see it for the first time. 

So here I was on a normal nondescript Thursday night looking directly into my sons eyes and seeing the feelings of pure accomplishment and joy that HE felt of being an athlete.   What a gift I was given."

Dear Football Mom:

Nuff said.

Take Care of Your Eyes

It's not so much that I run out of ideas for this space (although some might think so, seeing as how I really get off on some odd topics from time to time) but more like what things can I write about that are relevant, that are important to you.

For you see at the heart of my column is education.  I guess I'm a teacher at heart.

So I looked back at the list of the columns that I've written through the years and one topic that seems ignored is eye care.  Only one column in 30 years about eye protection.

And it's a pretty big problem.  Something we just don't think about often enough. 

Lots of pro basketball players are wearing protective eyewear these days.  It goes back to Kareem Abdul-Jabbar, who started wearing eye protection after too many scratches to the eye.  He sort of made it cool to do so.  Now lots of athletes do the same. 

It was really apparent last week when I was riding bicycles with a friend who didn't have any eye protection.  I started to say something but then figured that this was a responsible adult and he didn't need me preaching at him.

I should have said something.

Think about it....traveling at maybe 30 miles an hour and a bug hits you in the eye.  Ouch!

Or, worse yet, a piece of gravel gets flipped up out of the road and strikes you in the eye.  Serious damage can happen, not to mention that you will probably wreck.

Most of the time, people on personal watercraft don't think about it either.  Back when we owned a couple of those things, a near-injury was what it took to finally convince us to always wear eye protection. 

I guess the one I worry most about is the motorcycle rider.  Sixty miles-an-hour and no eye protection seems insane to me.

An insect propelled into your eye at sixty is going to do some damage.

What kind of damage?

Everything from mild irritation to blindness.  Corneal abrasions or lacerations are very painful and are probably the most common eye injury of any consequence.  If you suspect anything more than just a little irritation, see you ophthalmologist.  Lots can be done.

Even if the injury to the eye isn't substantial, if you're riding a two wheeled vehicle, something hitting you in the eye can easily cause you to wreck.

Industrial workers have long since adopted protective eyewear in the workplace.  In most jobs where there is the risk of a projectile  ending up in the eye, protective eyewear is required.  The military has discovered the necessity of protection.

But then I'll see one of my buddies on a bicycle or somebody on a motorcycle without proper eye protection and I just cringe.