Welcome to Health News

June 13, 2010 – 11:00 AM

Ed Deboo, PT, along with two other Bellingham Physical Therapists were profiled in the “Northwest Health” magazine.

“Ed Deboo, PT, doesn’t want to fix people. He wants them to fix themselves. ‘I don’t want you to come in and watch you ride my bike,’ he says.‘I help to facilitate the healing process and remove roadblocks, but you own your own health.’

To read the entire article and view the pictures, please click here to download the NW Health PDF

What’s new in the literature?

I will often come across an article that I think my patients would be interested in. I have included a short summary and then cited the source if someone was interested in the entire article. Enjoy!

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Does Pilates help increase abdominal and upper extremity strength and endurance?

August 1, 2010 – 2:28 PM

One of the common questions I get from patients in the clinic  is “will doing Pilates help me” and then I answer their question with another question “well, what are your fitness goals?”.  If you need to increase your core strength, flexibility, and muscular endurance, then the answer is an unequivocal YES!

Pilates can be a very important component of your fitness program since the emphasis is on core strengthening and improving flexibility, both of which most of us lack as we become more “mature”.  I just read a study by June Kloubec from Adolphus College in St. Peter, Minnesota that looked to see if doing a 1 hour session of mat based Pilates exercises 2  times per week could effect abdominal endurance, hamstring flexibility, upper body muscular endurance, posture and balance.

After 12 weeks, the participants were re-tested and the results were very favorable:  the participants in the study demonstrated significant increases in abdominal endurance, hamstring flexibiliy, and upper body strength. 

So how do you know if you have core muscular weakness issues?  One example would be if you injure your back without doing anything dramatic, such as ”I just bent over to pick up a pen” or my favorite, ” I must have hurt myself in my sleep since I  just woke up with this pain” .

For my local Bellingham readers who have been thinking about giving Pilates a try, the Pilates Studio of Bellingham would be an excellent choice.  Maria and Geoffrey Knight do an outstanding  job and they are constantly learning to add new classes to compliment their Pilates classes. 

Remember, movement is life, so get moving!

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Chronic neck and shoulder tightness? Check your breathing

July 4, 2010 – 1:48 AM

When I treat patients with chronic neck and shoulder pain, one of the first things I check is their breathing pattern.  Sounds pretty basic, right?  I mean, who really needs to be taught how to breath?  You would be surprised how many people are using the wrong muscles to breath.

Let’s take stroll down memory lane back to Human Anatomy and Physiology.  We have a large dome shaped muscle, called the diaphragm that goes from the front of our lumbar spine (low back) to the lower six ribs.  When it contracts, the diaphragm flattens down to pull air in, filling our belly. 

 When we use our belly muscles to breath, we are influencing our nervous system as well.  Our autonomic nervous system can divided into two main area, parasympathetic and sympathetic.  When we are relaxed and not in pain, we are usually in parasympathetic tone: muscles are relaxed, blood flow to muscles is maximized, and our chest and neck muscles are relaxed. 

Sympathetic tone is just the opposite, our “fight or flight” system: this is charactarized by chest breathing which increases the tension in our neck and upper shoulder muscles that can lead to pain.  Chest breathing should not be your normal pattern in a relaxed mode. The muscles of the neck and shoulders are known as accessory breathing muscles and should only come into play under high need situations (high impact exercises, ran up a flight of stairs, etc).  Characteristics of chest breathing individuals include frequent breath holding and sighs.

Test time.  How can you tell how you are breathing? First of all, lie down and get comfortable.

  1. Place one hand on your chest, just below your collar bones.  The other hand on your belly.
  2. Now breath normally and check to see which hand is moving.  If you are breathing with your chest muscles, your top hand will move.  If you are using your belly, as you should be, your top hand will be stationary and your your bottom hand will raise and fall with each breath.
  3. If you are already belly breathing, congratulations!  If you realize you have been chest breathing, don’t worry, you can make some changes, it just takes practice.

The easiest position to learn to belly breath is lying down, then standing, and finally in sitting.  If you are having trouble learning to breath in to your belly, you may need to place a book on your stomach and then breath in and “push” the book up and let it fall back down with exhalation.  Social norms tell us to “suck in our gut” so letting our stomach muscles relax is sometime pretty difficult to do, but essential for proper air exchange.

So, why do we need to practice belly breathing anyway?  Because concentrating on breathing correctly with your diaphragm is the quickest way to begin self quieting, leading to a greater sense of relaxation. 

Now that you have mastered the art of belly breathing, here are some tips to help you maximize your state of relaxation:

  1. Make sure you are completely exhaling each breath, slow and steady.
  2. With each breath, visualize yourself  “sinking” further in to your bed or chair as your muscles become more relaxed.
  3. Become aware of areas of your body that you may be holding tension in and let those areas relax with exhalation, becoming “heavier”.

Belly breathing can be  particularly effective with those individuals that have difficulty sleeping secondary to pain or just the inability to “shut things down” for the night.  Daily practicing of belly breathing will make it much easier and more natural feeling.   Be patient with yourself as we have often learned to be stressed for many years and are now just starting to practice how to relax again.  Good luck!

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Careful what you say

June 16, 2010 – 7:16 AM

Words are powerful.  They can healing but also hurtful.  Most people in the health care profession understand this intuitively.  Even if your body is injured, you cannot complain about your body as being “bad” or use phrases such as ”my terrible shoulder” or “my neck is really screwed up”  and then expect to recover in the shortest amount of time.  My patients know that I will redirect them if anything is said negative about their body or condition because I really do believe that effects the healing process in a detrimental way.  I just read an interesting article that now puts some science to my beliefs:  A new study by Maria Richter and colleagues from the Friedrich Schiller University of Medical School in Germany demonstrated how words that describe a painful experience such as “excruciating” and “paralyzing” can turn on areas of the brain where painful input is processed and stored.  “These findings show that words alone are capable of activation our pain matrix” says senior author Thomas Weiss,PhD.  This study has particular implications to those who suffer from long term, chronic pain.  Those who dwell in their pain and discuss it frequently may actually be exacerbating their symptoms by keeping that part of the brain that processes painful input “turned on”.  The researchers also went on to show that when the pain centers of the brain are turned on, the participants had less tolerance to a painful stimulus, thereby making the same pain experience  greater. 

So what do we do with this information?  First of all, stop dwelling on the pain and keep it objective, “muscle strain of my neck” versus “I have really screwed up my neck now and it’s something really major”.  As healthcare practitioners, it is our job to acknowledge our patients levels of pain but then redirect their thoughts and words to begin the healing process rather than continuing to dwell on the painful site.  Remember, if painful words can turn on the “pain sites” in the brain, just think what positive words and thoughts can do to the brain……just a thought!

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Proximal stability before distal mobility

May 21, 2010 – 9:42 PM

If you have ever been a patient of mine, you have probably heard me talk about certain treatment principles that I strongly adhere to.  One such principal is  “Proximal stability before distal mobility” which simply refers to the fact that we must first have good mobility and strength along our core (mid-line structures along our spine) before we can maximize our extremity function (distal mobility).

In developmental terms, babies are born with great mobility, but very little stability (muscle control). Babies first develop head and trunk control and strength. They then start to roll over and eventually start sitting up.  Only after they gain good control of their trunk, do they start to reach with their arms and eventually pull themselves up to start the walking process.

How does this concept apply to the treatment of musculoskeletal pain? This developmental concept supports the rationale for the evaluation, treatment, and strengthening of the mid-line structures first before evaluating and treating the extremity.  For example, the client with shoulder pain will need to have the thoracic spine (middle back and ribs) evaluated and treated before the shoulder is worked on, even though the “pain” may be located in the actual shoulder region.  Remember, we are taking a structural approach to treatment, not pain driven.

The same can be said about chronic hip, knee, or ankle pain where the lumbar spine would need to be addressed first. Can the lumbar spine (lower back) provide first the mobility and then the stability needed for proper lower extremity (leg) function?

Therefore, any unresolved upper or lower extremity pain may need to have mid-line structures treated first to maximize functional gains.

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5 strengthening exercises to avoid at the gym

May 11, 2010 – 7:16 AM

I will often get asked about weight training and which exercises should be done and others that need to be avoided.  Let’s first start with the 5 to avoid so we don’t reinforce incorrect or faulty movement patterns.  I’ve compiled my “top 5 list to avoid” based on my experience as a Physical Therapist.  Let me give you a quick overview of how I look at strengthening exercises: Whenever we “load” a movement pattern (that is to use weight) we are reinforcing that movement pattern in the central nervous system, telling our body “yeah, that’s how I want you to move!”.  Therefore, it is critical that our form is perfect, symmetrical, and it ultimately reinforces a posture or position that we would want the body to get stronger in.  That being said, here goes:

1. Dips:  These are used to help strengthen the triceps, chest, and shoulders. The problem with dips are the levels of stress that the movement places on the anterior shoulder capsule in the completely lowered position.  You also notice that when you are at the lowest position, there is a significant amount of forward rounding of the shoulders.  I spend most of my day trying to improve postures and eliminate the forward shoulder (or rounded shoulder) posture that so many of us have.  An alternate exercise to strengthen the tricep would be a standing tricep push down with cables with the shoulder blades ”set” back and down first.

2. Back Squat: Let me first say that I love the squat, but  I’ve got a couple of issues with this one.  If done correctly, the back squat can be a very useful addition to your strengthening program.  The problem is that most people do it wrong!  They often rest the bar at the base of the neck instead of farther down and are unable to keep their lower back in a neutral position throughout the range of movement.  Placing the bar just at the base of the neck  further “locks up” an area that is historically tight on many individuals since this is where the cervical spine (neck) meets the thoracic spine (rib cage) and we aren’t meant to weight bear in this area.  Since most people end up using too much weight, we come to the next issue:  Incorrect return to neutral from the down position that places too much stress on the lower back region.  What tends to happen is that the legs start to extend first, and then the lower back lags behind since the strength of the lumbar extensors tend to be the weak link in this chain.  Therefore, in your quest to maximize the strengthening response in your legs, you may be placing your back in a vulnerable position.    In defense of the squat, all my back patients are taught how to properly squat since this a very functional activity that is done multiple times per day. Most of my more “mature” clients have trouble even getting out of a chair without using their hands, so I will have them start working on “chair squats” with perfect form.  As they become stronger, we then can load the movement pattern with either weight in the front (front squat) or with dumbbells in their hands ( a variation of the dead lift, another exercise I love if done correctly).  Remember to watch the knees, not letting them come together as this could be a sign of weak gluteals.

3.  Hip adduction machine.  This is the one where you sit down with your legs spread apart and the weight is in between your legs.  You try to pull your knees together, working the inside of your thigh.  First of all, most of us do not have weakness of the adductors (muscles of the inside of the thigh) and actually develop a much greater weakness of the hip extensors (gluteals) and abductors, the muscles that move our legs out to the side.  A very common movement dysfunction that I see often is the inability of the gluteals to control hip movement in a simple standing squat.  The knees often will come together with those individuals with weak gluteals as they seek greater stability as they squat down.  This is a movement flaw that I work hard to correct so….why would I want you to further strengthen your adductors that further promotes this “knee in” movement pattern?  The focus should be on strengthening your hip extensors (gluteals) and hip abductors (lateral thigh muscles) and leave the adductors alone!

4. Upright Rows:  This exercise is used to strengthen the shoulders and upper trapezius.   The problem lies in the up postition when the elbows are out to the side and your hands are turned palms down to the floor.  This has the potential to place your shoulder joint in a compromised position that could lead to a very common movement dysfunction called an “impingement” that can lead to the dreaded rotator cuff strain.  That position is very similar to a test that Physical Therapists will use when evaluating a shoulder to see if that reproduces any pain.  Also, notice how your shoulders round forward  when you have the weight in your hands in the down position?  Rounded shoulders are not a position that we want to reinforce by strengthening in this manner.

5. Empty can exercises:  This is an exercise that has historically been used to strengthen the rotator cuff.  However, in the exercise your thumb is pointed down towards the floor as you raise a dumbell about to shoulder height.  The problem lies in the position of you hand.  When you have your thumb pointed down, this again places your shoulder in a compromised postition that negatively effects blood flow to the the rotator cuff.  So, as you are strengthening the rotator cuff, the muscle demands greater blood flow, but the thumbs down position prevents maximum flow.  Solution?  Do the exercise about to shoulder height with your thumbs up.  Still works the rotator cuff without the compromised blood flow. 

As always, I welcome your thoughts, questions, concerns, and gripes.  Have a good workout!

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Is physical therapy needed after lumbar fusion? Well, it depends….

April 26, 2010 – 1:01 AM

I was just asked again over the weekend from a friend of mine who had a one level lumbar spine fusion if PT is needed after surgery to help with recovery.  I asked him what his doctor had advised him and his reply from his surgeon was  ”well, I don’t think you need PT, just don’t bend, twist, lift, or do anything beyond walking and you should be fine in time”.

The problem with this advise is that what happens when you want to resume a normal life that involves all sorts of lifting, bending, and maybe even a return to sports?  Ever try to get through your day without lifting, bending, carrying, etc?  Not too easy.

In my opinion, yes, he very definitely needs the services of a physical therapist to help him maximize his recovery.  Now, let me say a few things in defense of the surgeon:  the reason he advised his post surgical patient to not seek PT is probably because of the feedback he has received from other patients that have had PT treatment after surgery “well, they massaged the tissue and scar for awhile, then ultrasounded it ,then put some electrodes on there with ice for 20 minutes and gave me a few exercises to do.  It wasn’t all that helpful and so I stopped going”. Passive modalities and generic “back” exercises are worthless in the long run and do not lead to lasting changes. PTs who provide this type of therapy are doing their patients a disservice.

Here’s what I told my friend:  The first question you need to ask yourself is why did I rupture a disc in the first place?  When we lose mobility in an area due to stiffness, we will “re-gain” that movement somewhere else, usually in the least desirable area.  Most manual therapists will tell you that the thoracic spine and rib cage becomes very stiff and hypo-mobile in many patients with chronic lower back pain.  Different parts of our spine have different affinities for movement:  the lumbar spine can rotate, but really likes to flex forward and extend backwards.  The thoracic spine can flex and extend, but mainly likes to rotate.  This relationship works great since everyone is doing what they really like to do, until the thoracic spine becomes tight and stops rotating as well………

Now, many things contribute to the thoracic spine becoming tight and that’s a discussion for another time (probably how your sitting reading this is a big contributor).  However, now you have a situation where the thoracic spine isn’t rotating all that well, but the body still requires rotation to occur for almost all basic functions, including walking.  Guess what? Now we call up the lumbar spine and ask it to not only flex and extend, but “can you rotate as well too?”  For awhile, things are good until your hip becomes tight and stops moving as well as it once did (notice how it seems a bit harder to get those socks on as we age).  Now, the only place you have to get any motion is the lumbar spine.  After time, the lumbar spine develops an instability due to the constant movement and becomes an area of pain.  The surgical solution is fusion, but now you’ve fused the only place the body had left to get some  movement…are you beginning to see the long term problems with this?  It is common knowledge that the disc area above and below the fusion site is more susceptible to herniation and rupture in the future.  Now you know why.

The role of Physical Therapy in the management of post lumbar fusion rehab is NOT to ultrasound and e-stim the area, but to perform a movement analysis of the entire spine to determine areas of restriction and to then restore “normal” movement in the area.  In my experience, this usually involves treatment of the thoracic spine and ribs to improve overall mobility regardless of the painful area.  Then the patient needs to be taught  how to move smarter and create new movement patterns in order to avoid movements and postures that will  increase loads on the lumbar spine. Finally, we need to strengthen our entire body.  Notice I said our entire body not just our “back” since the body moves as one functional unit.

The lumbar spine is under a tremendous amount of load and getting the rest of the body to share the load is the best thing you can do for a healthy back.

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The “plastic” brain: How our thoughts, environment, and exercise can change our brain.

April 6, 2010 – 10:25 PM

There has been a long standing belief that after childhood, our brains are static, unable to change, or grow.  However, researchers and scientists are now discovering that the brain itself is capable of amazing changes through its unique properties of “neuroplasticity”.    I recently read a book by Norman Doidge, MD, titled “The Brain that Changes Itself”.  In this book, Dr. Doidge, MD, describes how neurons in the brain and nervous system are plastic and can change and become modifiable with the right sensory input and environments.  The book describes many examples of the brains incredible ability to change and grow even into the last years of our lives.  There were a few areas of the book I found particularly interesting from a Physical Therapy perspective:  stroke rehab, the role of mental imagery, the effects of physical exercise on the brain, and the need to challenge ourselves by changing our environments. 

In PT school, I was taught that the most recovery a patient will make after a stroke will be in the first 6-12 months after the initial injury.  After about a year, whatever function that a stroke patient had, they had to learn to live with. I now know that to be false, as stroke patients can continue to make small but important gains with the right type of therapy,  primarily Contraint-induced movement therapy that was first introduced by Dr. Edward Taub.  This type of therapy involves restricting movement in the unaffected arm or leg and making the involved limb work at very specific tasks that become increasingly complex. This sensory input helps to “rebuild” lost neural pathways and strengthen the existing ones.

Mental imagery is a tool that has been long utilized by  many individuals, from athletes to musicians, as a way to help them prepare for their performance.  What brain researchers are now discovering is that just by thinking about performing a specific task, the same neuronal activity occurs in the brain as when the individual actually physically performs the task.  Think of the disuse atrophy that occurs in muscles with post surgical immobilization or the casting of a bone fracture and how we  may be able to accelerate the rehab process by  just thinking about moving and strengthening the effected limb long before we could actually physically move it.  If we never allow the nervous system to “disconnect” from the effected area as we heal, we may not need to perform as many “muscle re-education” exercises during rehab.

As if we needed another reason to exercise, it has been shown that physical activity helps to create new neurons, brings more oxygen to the brain helping people feel more alert,  and helps with the release of a neuronal growth factor that is crucial to the brains plastic properties.

And finally, nothing will contribute more to brain atrophy as we age than being in a stale, non-changing environment.  Learning a new activity or language, travelling to new locations, or even learning to dance can have a profound effect on the brains ability to keep functioning at an optimal level.

So, turn off the TV, go for a walk on a trail you’ve never been on, rent a movie with subtitles, and for dinner, pick out a recipe from that old Indian cook book you have sitting on your self and help jump start your brain!

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Attention baseball coaches: Hold the Donuts!

March 31, 2010 – 2:32 PM

Spring is finally here and baseball is in the air.  Both my boys (ages 11 and 8) are playing baseball and, like of lot kids their age, batting can be challenging especially as they face live pitching.  Traditionally, baseball players in the on deck circle have a small weight on the end of their bats to help them “warm up”.  This round weight is often called a “donut”.  However, I recently read an article that calls in to question this age old tradition.  Researchers in the Human Performance Laboratory at California State University, in Fullerton, California studied the effects of bat swing velocity on a group of 19 college aged recreational baseball players.  After analyzing the data, they concluded that using a weighted bat for 5 warm up swings just prior to using a normal weighted bat actually slowed down their velocity.   This makes you wonder if the on deck player should be warming up with just a normal bat and should pass on the donuts! 

Journal of Strength and Conditioning Research 2009 23(5)/1566-1569

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Total Knee Replacement Patients: Don’t stop doing your exercises!

December 15, 2009 – 10:00 AM

A study followed 48 men and women for 10 months after they had a unilateral knee replacement.  The researchers found that overall pain levels were significantly lower, but that the effected leg still demonstrated 14% weakness in muscle strength as compared to the non-surgical leg.  What this means is that those individuals still had trouble with activities that required higher levels of strength, including walking up and down stairs and walking up hill.  Bottom line:  keep up with your strengthening exercises long after your range of motion has increased and your pain levels have improved.

A.Valtonen, T. Poyhonen, A. Heinonen, S. Sipila
Physical Therapy Oct 2009;89:10:1072-1079

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