There were a number of difficult, beautiful hills on the second day.  My muscles felt like rubber as I was puffing away up a hill yesterday when a rookie rider (shout out to the Power of the Patch team) passed me on the left and turned back to sputter out, “This kinda sucks.”   About a quarter-mile later, there was an even more challenging hill.  I puffed up that one and found “Power of the Patch” at the top resting and yelled out, “No, that kinda sucked.”  As I churned out the next few miles I reflected on the previous night’s speaker, Dan Erschen.

Dan has MS.  There are a few types of MS, his type is characterized by ”attacks.”  One of his attacks took away his ability to walk for a year and a half.  He says, “Believe it or not…I’ve had more good come out of having MS than I’ve had bad even though it hit me as hard as it did.”  Even though he is 50 years old and battling MS, he completed the 2010 WI Ironman in 14 hours and 41 minutes.  And you know what he has to say about it?  “It’s not a big deal.”  He went on to talk about some of the challenges he and others face who are battling MS stating after each one “That’s a big deal.” ….. building up enough endurance to walk to the mailbox for the first time, feeding himself without anyone’s help, buttoning his shirt, lasting 5 minutes on the elliptical machine.  These are usually the goals physical therapists help people with MS achieve.

As I kept puffing up the hills reflecting on his words as well as the courage and spirit of the patients I have worked with who have MS, I decided no matter what, I was doing the 150 miles.  I refused to walk my bike to get up a hill (even if that meant cruising at a mean 3 miles an hour at some points), because you know what REALLY sucks?  There’s no cure for this disease.

Please help Dan achieve his goal by donating to his cause- the MS Society.  If you really want to be inspired visit his page and read his own words.  Visit the Active MSers page for more info on staying active through MS.

Here’s Dan finishing the Ironman.

http://www.youtube.com/watch?v=8jt1JPnUELU

©2012 Geaux to Physical Therapy. All Rights Reserved.

Image by IronHide via Flickr

An article^[i] in the The Journal of Orthopaedic and Sports Physical Therapy (JOSPT) recently discussed a possible new hallmark of carpal tunnel syndrome – a stiff neck.  Carpal Tunnel Syndrome (CTS) is a condition in which a nerve in the wrist is compressed, causing symptoms of numbness, tingling, and weakness in the hand.  It can cause considerable pain and debility in the hand and many patients complain of it waking them at night or causing them to drop objects.  Carpal Tunnel Syndrome is most commonly thought to be caused by compression of the median nerve within the “carpal tunnel” in the wrist.  Or so we think.   In the JOSPT article, neck mobility was assessed in women with CTS and a second healthy group.   The research showed that women with CTS had less neck mobility, essentially a stiff neck, compared to the healthy counterparts.  The research also discussed previous studies that also found the presence of abnormal posture, arthritis, spinal stenosis, and pain in the neck and shoulder in individuals with CTS.   Apparently, CTS and conditions of the neck hang out well together like peas and carrots.  Hmmm.  One of my patients made a relevant comment this week, “You mean one part of the body is connected to another?!”

The carpal tunnel is a space within the wrist.  In this space lies a nerve, the median nerve to be exact, as well as 9 tendons.  If you can correctly comment below the names of the 9 tendons, you get a cookie, or maybe one of those mashed potato cupcakes.   During cadaver dissection, nerves look like little white strings.  The median nerve arrives from the brachial plexus, a bundle of nerves in the neck and shoulder region that look like a complicated braid.  The brachial plexus arrives from nerves that shoot off from the neck.  When you pull one side of a string, does it make the other side of the string move?  I’m simplifying something that is much more complex than that, but can you see how movement of the neck might affect a string or strings that come from it?

Physical therapists are trained to assess adjoining joints to get a more global picture of what might be contributing to a condition.  In a physical therapy evaluation of a patient with CTS, I screen range of motion and strength in the joints all the way up from the wrist and hand to the neck. I also assess mobility of the median nerve along its entire course from the hand to the neck, in what I like to call “flossing.”  Whatever impairments I find, treatments are incorporated to address them.  If CTS is not managed well with conservative treatments of physical therapy, splinting, and injections, then surgery may be suggested.  If you have or think you have CTS, be sure someone takes a look at your neck.

Although this study points out that a stiff neck may be a common feature in CTS, more research needs to be done to see if this may indicate it contributes to CTS or if CTS contributes to neck pain and associated conditions.  We don’t fully understand our body’s nervous system.  I have a feeling it’s more than just peas and carrots.

Is all this talk of vegetables making you hungry?  Try this out.

©2012 Geaux to Physical Therapy. All Rights Reserved.

1. De-La-Llave-Rincon, et al. (2011). Women With Carpal Tunnel Syndrome Show Restricted Cervical Range of Motion. JOSPT, 41(5): 305-310.

Find a PT.

©2012 Geaux to Physical Therapy. All Rights Reserved.

Most of us think about football players or veterans who have suffered from a concussion or brain injury.  But the types of individuals that I have also seen in physical therapy are those involved in car accidents, a slip on the ice, being hit on the head, or someone who has fallen, many times the elderly.  Many times the reason they were referred to a physical therapist was for neck pain or dizziness.  Sometimes these individuals have not been diagnosed with concussion or post-concussive syndrome and it’s only until I ask them about whether they have the other symptoms of concussion or MTBI that they even realize that these problems are all connected to a brain injury.  Unfortunately there is no cure for brain injury or concussion, only prevention and education and awareness in recognizing a brain injury.  It is important to seek medical attention to be sure the brain injury isn’t more serious or worsening.

Symptoms of concussion or MTBI:^[i]

1. headaches
2. confusion
3. difficulty reading
4. memory deficits
5. neck pain
6. nausea and vomiting
7. dizziness
8. personality or mood changes

Here is a nice link to an article about what concussions and mild traumatic brain injuries are.

Here is a video of someone who has post-concussion syndrome as he describes what it feels like:

httpv://www.youtube.com/watch?v=reMBWnFU60A

Adolescent Concussion: 1 Prep Football Season 1,800 hits to the head

 If you think you might have had a concussion or MTBI, be SURE to seek medical attention from your doctor.

Illinois Study if you would like to participate and have had a concussion before.

Thanks to  kedoink kedondeng on Flickr for the picture.

©2012 Geaux to Physical Therapy. All Rights Reserved.

1. Umphred DA. (2007). Neurological Rehabilitation, 5th ed. Mosby: St. Louis.

At this point in physical therapy we try to strengthen other areas of input including muscles and the inner ear to compensate for bad vision.  I also recommend that if the person relies heavily on their vision that they make sure they have adequate lighting and turn on the lights in the middle of the night in order to help prevent a fall.

I’ve wondered what it’s like for someone who suddenly loses their vision to maintain balance.  I would imagine they go through a period of feeling a little clumsy moving around due to losing one input to the brain on balance, though if anyone has anything to share on going through this, comment at the bottom.

How would you fair?  Try closing your eyes while standing.  What does it feel like?  Are you swaying more?  Don’t notice anything and feel completely stable?  Try to lift one leg up.  Can you do this and hold yourself upright?

©2012 Geaux to Physical Therapy. All Rights Reserved.

1. I’m developing a bad habit of resting my head in my left hand when I’m deep in thought over my paperwork, which is straining my neck.  So, if I’m clicking, I can’t do this.

2. I wanted to see what it would feel like to go through constraint-induced movement therapy

No, this is not an oxymoron.  Constraint-induced movement therapy (CIMT), also called “forced use” is a technique that can be utilized in the rehabilitation of disorders of the brain to facilitate improved function of an affected limb.  Following a stroke, many people suffer from hemiparesis or weakness on one side of the body.  This in turn leaves the person with a hand with limited function and a lasting disability.  With CIMT, the unaffected arm is constrained in some way via strapping or a sling for several hours per day, thus forcing the patient to use the weaker arm and hand for most activities during the day. Because of neuroplasticity, the brain’s ability to form neural connections to accommodate an injury or an environment, the hand is able to get stronger and more functional.  One example of neuroplasticity in people without brain injury is the representation of the sensation in the brain in musicians who are string instrumentalists- with them having more than normal neural connections for the fingers and hand.  For neuroplastic changes to occur, the nervous system must be stimulated frequently, so CIMT might be continuous for several hours per day or even for days on end.  The theory is the more you attempt, think about, and actually use the affected hand and arm, the more neural connections will be made to restore control to a hand or arm that was weakened through a brain injury.

Here’s a video out of California showing what this therapy might look like.

http://www.youtube.com/watch?v=MMTh2hWvB2g

I have to say that switching my mouse is just a small percentage of what someone who actually has to go through CIMT has to experience.  It was incredibly frustrating at times and I can only imagine what this is like with all daily activities, for hours on end for several weeks at a time.  Interestingly, by the end of the day I felt my left hand getting just a little more dexterous with less errors using the mouse than for the first hour.  I wonder if patients feel a tangible improvement even after one day?  Well, at least my “forced use,” however frustrating, did accomplish one therapeutic goal– no lazy headresting.

“Why are more people right-handed?” from Scientific American

©2012 Geaux to Physical Therapy. All Rights Reserved.

What is the cause of this disease?

• This disease presents most often in the early adult, 20-30 years old and more often in women
• Most of the people who are affected by MS live in the northern latitudes
• The disease is autoimmune, meaning the body attacks itself, however, we’re not sure exactly why.

What are the symptoms of this disease?

• Vertigo, double vision, changes in sensation, weakness, fatigue, forgetfulness, pain, sexual dysfunction, personality changes, loss of balance, incoordination, anxiety, muscle spasms, speech changes, tremors, numbness and tingling, urinary incontinence, problems swallowing or breathing
• … this is not even an exhaustive list of the symptoms of this disease
• Symptoms can be infrequent and vague in the beginning, and can be any combination of the above symptoms

What happens over the course of the disease?

• Two types of MS are characterized by periods of relapses and remissions.  For some, symptoms emerge during a relapse period but once in remission, symptoms disappear completely.  For others, symptoms emerge during a relapse period but once in remission, residual symptoms remain that do not get better or go away.
• Another form of MS is a steady, progressive decline in brain and spinal cord function without cycles of relapses and remissions

How is it diagnosed?

• There is no definitive test for MS.  It often takes years to reach a diagnosis, during which time the patient is left to wonder why he/she is experiencing such strange symptoms.  Neurologists primarily make a diagnosis by exclusion, history of symptoms, and MRI of the brain.  Many times, patients are relieved to have some semblance of an explanation as to what is causing their symptoms.

We do not know how to stop MS.

• Although treatments have gotten better, there remains no cure for this disease.

I’m riding this weekend to help someone answer these questions and in gratitude that I nor any of my family have been afflicted by this disease.  If you would like to help answer these questions too, you can go here to donate.  To read stories about those who have this disease, you can go here.

Thanks to D Sharon Pruitt of Pink Sherbet Photography on Flickr for the picture.

References

National Multiple Sclerosis Society  http://www.nationalmssociety.org/index.aspx

“Multiple Sclerosis” http://www.mayoclinic.com/health/multiple-sclerosis/DS00188

©2012 Geaux to Physical Therapy. All Rights Reserved.

In most people, the spine is made up of 24 bones, called vertebrae, which are categorized by region.  The cervical spine (your neck) has 7 vertebrae.  The thoracic spine (upper back) has 12 vertebrae.  The lumbar spine (lower back) has 5 vertebrae, which are the thickest and widest, because they have to handle the most load.  The lumbar spine connects to the sacrum (your tailbone), which sits in the middle of your pelvis.  Your pelvis then connects to your femur (thigh) which connects to your tibia and fibula (shin), which connects to your talus (crux of ankle)…. ok I’ll stop here.  The point is bones are sequentially connected up from the foot to the spine.  Yes!  The position of your foot can affect the posture and position of your spine.  That’s crazy!  But true, and the reason why there are so many ads for shoe inserts that claim to reduce back pain.

The spine’s number one job is to protect the spinal cord, which transmits messages back and forth from the body to the brain via nerves.  Nerves transmit messages about pain, sensation, and your position in space back to the brain.  They also transmit information from the brain to the muscles in your body to move and react.  Certain spinal conditions can irritate and damage nerves as they exit the spinal column.  When nerves are damaged they can get very cranky, causing altered sensation (numbness, tingling), loss of agility and reactivity (clumsiness), or weakness (cramping with everyday activities).  This equals pain, sometimes in the butt.

The spine is a stable anchor from which your arms and legs can move.  It is the core of your body and thus the active support system is often called the “core muscles.”  The spine is also supported by ligaments and the intervertebral discs (referred to only as “discs” if you are in the know).  Discs are cartilaginous structures that separate vertebrae, acting as spinal shock absorbers.  They are largest in the morning and lose height over the course of the day, which is why we are taller in the morning (hope this fact helps you on Jeopardy).  Just as shocks can blow out in a car, so can the discs in your back, leading to very cranky nerves.  As we age our discs lose the ability to stay as hydrated, thus they lose height and the spaces between the vertebrae diminish, placing us at increased risk for developing arthritis or nerve irritation.  Luckily, you know a good therapist ::wink wink:: who can help you prevent blown shocks and cranky nerves by providing you information about risk factors and tips for maintaining spine health.

Risk Factors for Back Pain

• Poor posture
• Improper body mechanics
• Repetitive movements and stationary positioning
• Age
• Lack of exercise and weakness
• Being overweight
• Tension and stress
• Smoking
• Previous back injuries
• Physical anomalies from birth

Lucky for him, he's an invertebrate.

Top Ten Tips for Maintaining your Spinal Health

1. Stay active!  30 minutes of moderate intensity activity is recommended on most days of the week.  If you use the “talk test” moderate intensity is hard enough so you feel like you’re working, but not so hard that you can’t talk to someone next to you.
2. Exercise, especially core muscles.  Stay flexible and strong, particularly in your legs, hips, and shoulders.
3. Keep a healthy weight to minimize load on the spine.
4. Use proper lifting techniques, avoiding twisting motions.
5. Sleep in a position that places the least strain on the spine by keeping a neutral posture.  Don’t sleep on your stomach.  This position causes your spine to stay extended or bent backwards for a prolonged period of time, placing increased strain on the tiny joints between vertebrae.
6. Move frequently and don’t stay in one position for too long.  Don’t perform too many repetitive motions, especially twisting and bending.
7. Make sure your workspace is ergonomic. Fun ergonomics video
8. Stay in good posture.  The better your posture, the less stress and strain on the spine.
9. Refrain from smoking.  Smoking alters bloodflow and limits the body’s ability to heal.
10. Just Relax.  Stress can increase muscle tone and cause us to fall into faulty postures.

In physical therapy you will learn how to reduce your risk of developing spinal dysfunction or manage the symptoms if you are already experiencing its effects.  If you would like more information about the spine and spinal dysfunction you can visit some of the websites below.  I am a visual learner and find the pictures of anatomy on these websites to be particularly helpful.

http://www.nlm.nih.gov/medlineplus/ency/article/003025.htm
http://www.nlm.nih.gov/medlineplus/backpain.html
http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp#5
http://www.cdc.gov/niosh/topics/ergonomics/

©2012 Geaux to Physical Therapy. All Rights Reserved.