Sunday, June 29, 2014

"The Back Whisperer" -- A Guest Blog from a Recent Patient

I am going to dedicate this week's blog post to a testimonial.  I am honored that this patient came to me for assistance with her problem.  Realize that her story may or may not resonate with you, but if it is does, I am recommending that you get a good mechanical assessment before you begin any exercise/treatment program.  Some of these exercises may make you worse.  You won't know until you get a good evaluation.  So without getting too preachy I am going to let you enjoy her experience...(I did add some pictures  and did not change her text or correct any typographical errors).

Get Your Cobra On!  


"

L5/S1 Herniations - My Story

June 24, 2014 at 8:37pm
For a decade or more, my back was usually achy after I spent a gloriously long day in my beloved garden. The hurt always went away the next morning, after a long soak in an Epsom salt bath and a good night’s sleep.

I started CrossFit in June 2013 and the achiness lasted aday or two more than normal. As the results showed, I excitedly stepped up the weights and ran a few more meters. It was painful the next day, but I pushed thru it - the CrossFit mantra.
WOD = Workout of the Day
One night the WOD called for what seemed like endless laps in theyard of “Junk Yard Dog”. This was the first night I felt the burning sensation.
Junkyard Dog Exercise Part 1

Junkyard Dog Exercise Part 2
Soon after that night, the WOD called for a 2 mile run, and that burned too. Then I was punished for being 20 seconds late one day (late because I rounded up the box owner’s dog who had run down the street) and the 20 burpee penalty pushed theburning over the edge to no relief zone. I put CrossFit on the shelf.

That afternoon of the burpee punishment, I took xrays at my husband’s chiropractic clinic, and he saw an L5/S1 bulge. We began therapy and ice packs, but the pain couldn’t be relieved. It disrupted my sleep, it hurt when I sat for too long,it hurt when I drove the car over 30 minutes, it made rising from chairs anawful task, and, most alarmingly, I had a spike of pain when I sneezed while watching the NFL playoffs on tv with my husband.

It was at this time that Nola Paleo Club had a lunch meeting, and my husband and I sat with Lynn Grimm and her husband. I told them the short version of my story and explained my confusion of what professional to see for what. It’s quite a quandary even for someone with the medical and spine contacts like me.

In late January 2014, an MRI indicated two slight herniations. My husband modified the therapy in his clinic accordingly to include multi-time per week decompression, ultrasound, medical massages, and electric stimulation. He was confident the herniation/lesions could heal. Within 2 months, the pain had subsided, but an aggravating, constant cramping on the opposite side of the herniations presented itself. I suffered with this lingering cramping for 6 weeks.

In May 2014, I began yoga for the stretching component in anattempt for relief with limited results. Three other incidences coincidentally occurred in May: 1) my husband took a yoga class with me and when we were incobra pose I told him this was the first time I was in total relief since January; 2) I ran into someone who said he had pulled back from CrossFit due to a cervical herniation and that Lynn Grimm had turned his injury around 180 degrees; and 3) I read and told my husband about Lynn’s blog entry speaking about her specialty of McKenzie Therapy.

Cobra Pose
My husband attempted to explain flexion versus extension tome, and said that Cobra fell into the extension category which is the essence of McKenzie Therapy. He encouraged me to visit with Lynn to see if her method could help my lingering pain.

My first office visit with Lynn was on a Friday at 11am and it lasted about 80 minutes. I was apprx 6-7 VAS at the onset. She put me thru a variety of moves - left, right, forward, backward - and in the end said my homework for the next week was lying flat on my back every 2 hours and hugging my knees. I did my first few sets of knee hugs in her office.

VAS Scale
I left her office feeling good, felt progressively better asthe afternoon progressed, and for the next 36 hours felt exponentially better –almost as if I had never injured my back!!! I instantly labeled her The Back Whisperer. I was speechless. I honestly thought a sore back was my future ands he would only be able to provide some relief; I never dreamed I would be pain-free. Because I felt so good, I exerted myself a little too much so by the time I hit send on my status update note to her the pain reappeared. I again over-exerted on Sunday even tho I was feeling some pain so by Monday morning I was sadly back to square one. Monday thru Friday of that week I slowed my roll and continued my bi-hourly knee hugs.

By the time I saw Lynn for the second time the following Friday I was 5 VAS. She swiftly lectured me for doing my knee hugs too early in the day, in the middle of the night if I woke up (“but they feel so good”), she tried to explain spinal cord imbibition to me and the importance of no rigorous spine activity within 4 hours of awaken, put me thru a series of moves again, and this time assigned my homework of bicep curls, shoulder lifts, toe lifts,and squats assisted with a medicine ball against the wall, and my stretching homework was sitting in a chair, holding my ankles, and slowly reaching thru my legs toward the back of the chair.

The Back Whisperer struck again!!! I was more diligent about the stretching homework so I know they are the root of my total and complete relief. I have been totally pain free for 10 days even with painting a deck including the stairs, risers and posts on the deck, vacuuming and buffing 800 sf of hardwood floors, and even one CrossFit WOD – my first since January.

The stars were aligned for me with my husband recognizing the cobra pose as a McKenzie stretch and me running into that friend who Lynn had recently helped recover. I wish everyone’s recovery could be like mine but, alas, everyone’s back history, injury(s), and treatments vary. I just feel so very, very lucky to have talked everyone’s ear off that I came into contact with, googled my fingers raw, and kept persisting until I found the solution that was right for my situation.

I cannot highly recommend The Back Whisperer enough. Lynn Grimm is my hero!


You know what I am going to say!  "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!"  Schedule your appointment today at www.grimmpt.com or call 504-228-0524.  

Sunday, June 22, 2014

Why I Have a Cash-Based Practice


The Times, they are a Changin'!   Having practiced Physical Therapy for 29 years I have experienced a rapidly changing climate in healthcare.  With attorneys trying to direct my practice and insurance companies dictating what is and isn't appropriate for my patients, I was getting just a little fed up with the system.  Although I have been paid an hourly rate over the years when I worked for someone else, their reimbursements for my services, for which I have studied extensively over the years, have been declining.

If you haven't been paying attention, insurance companies are essentially taking over the practice of medicine.  They are telling P.T.'s, Doctors and Surgeons what procedures they can do, what they can or can't bill for,  and who they can treat.  I don't know about you but I don't want a insurance company representative deciding my healthcare needs.  Actually, I have been paying out of pocket for my health and dental care for years!  Why?  Because I want the best care I can get to stay healthy, prevent illness or hospitalizations.

I have always wanted to have my own practice.  I feel I am good at what I do, am conscientious to do it in a timely and efficient manner.    I feel this  is best for my patients.  However, if I opened a private practice in the traditional sense, connected to insurance companies,  I would need a large staff just to navigate all of the paperwork.  This would result in a huge overhead that I feel is unnecessary.

In my small cash based practice I average less than 5 visits for patients with low back, neck, or extremity pain.  I pride myself on teaching my patients how to take care of themselves and don't expect them to come back visit after visit for gradually changing programs.  I don't generally see patients who require physical therapy after surgeries and leave this up to practices that accept insurance because that can mean 30 or more visits to physical therapy in some cases.

In this business model, I am able to spend as much time as I need to with a patient to provide proper care and instruction in self-treatment.  It feels really good to practice this way, too!  Really good!

Essentially, I really wanted to spend more time with my patients, doing what I felt best for them and less time on paperwork and needless documentation.  After all, documentation and billing isn't about patient care...One on one time spent with your therapist is!


I Gave Up!

 (the Paperwork that is...)




Sunday, June 15, 2014

You Need to Know About the McKenzie Method!

If you have ever hurt your back or had joint pain in your hips, knees and ankles, you know how hard it is to find relief.  There is a rapidly growing school of thought that we have the ability to heal ourselves once we know what specific exercises we need to do.  This is the McKenzie Method.  This is practiced by orthopedists, physical therapists and chiropractors all over the world.  Good thing you have access to this type of treatment right here in the New Orleans area!

With healthcare changing as rapidly as it is, we need to learn how to take care of ourselves, with proper coaching, and prevent further episodes.

Check out this CBS video from one of my mentors, Dr. Yoav Suprun, physical therapist at Canyon Ranch in Miami.  If this sounds familiar, you know what I am going to say!  "Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Call Grimm Physiotherapy today at 504-228-0524 or visit grimmpt.com to set up your assessment today.  







Sunday, June 8, 2014

PT in a Box


logoI am currently practicing Physical Therapy in a CrossFit box here in the New Orleans area.  I actually rent a  room inside CrossFit Roux. I am there because I believe that fitness is one of the answers to a healthy painfree life.  I also believe the CrossFit is an excellent way to get fit.



I was reading this article by a fellow physical therapist/crossfitter/strongman  and thought I should share it here:  How partnering with a therapist or chiropractor can benefit your box.  I feel that if you belong to or own a gym, you need to work with a good Physical Therapist, Chiropractor, Orthopedist or good Massage Therapist.  If not, you are leaving some great gains on the table, and some easily correctable "injuries" left  unattended will result in attrition.

I have been asked by an acquaintance on how to know who to choose when you need healthcare services between and PT, Chiropractor, and Orthopedic Surgeon.  It seems like a simple question, however it really is pretty complex.  The answer is it depends.

If you are willing to look into the admission requirements for Physical Therapy, Chiropractic care and Medical school you will see that there is very little difference between the 3.  Therefore most of the people are smart.   The Orthopedic Surgeon has an additional 5 years post graduate study in general orthopedics and then can go on to specialize even further with fellowships that last another 1 - 2 years.    It is what you study, practice and enjoy when you get out of your initial training that make the difference between these practitioners.   It is the years following basic studies through continuing education and influences by their mentors that make all the difference.

On somewhat of a side note, generally most post-operative care is the same from therapist to therapist. 
Physical Therapy

Traditionally there has been tension between Chiropractors and Physical Therapists, between Chiropractors and Orthopedic Surgeons as well as Physical Therapy with Orthopedics.  However in my experience we have training in similar or sometimes the same techniques and have similar practices.  There are many practices that actually have Orthopedists, Chiropractors and Physical Therapists working together.   Taping, ART, Graston, FMS, etc. traditionally are techniques used by both Physical Therapists and Chiropractors.  Now they are even used by athletic trainers and massage therapists.  Thrust techniques or manipulations are used by both PT and Chiropractors who have the training to do so.  I have great respect for some Chiropractors, Orthopedists, and Massage Therapists.  I have also been a patient of all of these healthcare professionals in the past.  Just as I have helped others in the Physical Therapy, Massage, Athletic Trainer, Chiropractic and Orthopedic communities.

Chiropractic Care
I have been trained in manipulations, adjustments, or thrust techniques as chiropractors call them, but generally don't use them in my practice.  I have found that I can get better results without them and don't want to mess with the risks.  If you are looking for thrusts or manipulations you may want to schedule an appointment with a Chiropractor or a PT who does so.  You can private message me if you want referrals to some good ones.

Orthopedic Surgery
If you are looking for some excellent soft tissue work I can also recommend some great Massage Therapists and Physical Therapists depending on the type of work you are seeking.

If you feel that your problem may be a surgical one or you want to treat it with medication then I recommend an Orthopedist.  I happen to know some really good ones, including one I know very well.  Let me know what your problem is and I can refer you to someone who can help you.

If you are currently going to Physical Therapy, an Orthopedist or a Chiropractor and it isn't working, you need to go someplace else!  No one likes to waste money or time.  If your problem isn't a surgical one, or you don't want surgery, and your current therapist hasn't helped you, the answer is to try another.  Everyone knows different stuff.  Everyone is different!  Some people will respond to me in two visits when they couldn't with a Chiropractor in 6 months, and unfortunately vice versa.  It just depends on the person and the problem.  As you know I specialize in self-care...it will only work if you do your homework.  So there you have it...a long winded non answer on who to select.  It is really up to you.  My advice is to ask around and use the services of those who are also interested in what you do.

By the way, I know Chiropractors, Orthopedic Surgeons and other Physical Therapists who also practice MDT or the McKenzie Method all over the world.  Next week I will discuss how you know if this method is for you. In the meantime you know what I am going to say "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!"  Check out Grimmpt.com or call 504-228-0524 to set up your evaluation today!

Sunday, June 1, 2014

How to Release a Trigger Point

We are forever grinding away on our trigger points in the gym using a lacrosse ball.  Somehow they still persist.  Today I thought I would try to teach you what works for me when I am teaching my patients how to reduce muscle spasms and painful
trigger points.
 Trigger points are commonly referred to as "knots" in muscles.  They are formed when muscles are injured, overused or referred from other areas.  They are painful to touch and may also refer pain themselves.
If you get a massage you know when they have found a trigger point.  They will concentrate on that area and "dig" around the area.  It is one of those hurts so good kind of feelings.  If your massage is too aggressive, it may feel good at the time, but the trigger point will persist and may even hurt more later on.

In my practice, which is all about self-care, I recommend a gentle approach.  In my experience, trigger points cannot survive gentle pressure.  When you begin to feel these knots, gently press on the center of the trigger point nodule.  It should be very gentle just like laying your finger on a stick of butter. When you put your finger on a stick of butter without pressure, the heat from your finger will actually melt an indentation in the butter that look something like this picture on the right.    Once the trigger point begins to "melt" you can use your finger to melt along with it.  It generally takes 10 - 15 seconds for a trigger point to release and some can take up to an entire minute.  Some trigger points actually begin to pulsate before they are ready to resolve.
Thera Cane
In areas that are difficult to reach you can use a thera cane  that I have linked to Amazon here, a regular cane or umbrella.  I also like to use racquetballs to lie on.  You can tie two racquetballs  together in a tube sock and place under the base of your skull for a general relaxation or use a single ball on a trigger point.  These balls are much gentler and I feel more effective on reducing trigger points than lacrosse balls.

Let me know how this works for you!
Please understand that this self-technique will help you manage your trigger points but will not resolve the reason why you are getting them in the first place.  If you want to get to the root of your problems, you know what I am going to say!  "Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Call 504-228-0524 or visit grimmpt.com to set up your appointment today!