Falling Off the Wagon Isn’t the End: Learning from Lapses in Exercise & Recovery
During a routine follow-up, my patient “Larry Lapes,” who has chronic ankle and back pain, asked me a question that stopped me in my tracks: “Do you have any strategies that help your patients stick to their exercise routines?” His question prompted me to reflect more deeply on lapses and relapses in behavior change. Behavioral…
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Hip-Spine vs Spine-Hip vs Both – 3 Case Examples Lessons Learned
An 80-year-young woman visited her primary care physician with “pain going down my leg”. She had difficulty grocery shopping, picking up her small dog. X-rays showed osteoarthritis in her lumbar spine, and she was diagnosed with “sciatica.” The doctor referred her to a spine surgeon, who ordered an MRI and gave her an x-ray-guided spinal…
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“Take my wife, please” – patient centered care consider significant others
After completing an initial Physical Therapy consult with a 62-year-old gentleman with osteoarthritis of the knee, I asked, “Do you have any questions, confusion, or concerns that we should go back over?” Before he could respond, a voice chimed in from the next room. “Tell him that you look like an old man when walking,…
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Understanding Delayed-Onset Exercise-Induced Pain in Individuals with Chronic Pain Syndromes
Introduction Two patients with chronic musculoskeletal pain and Ehlers-Danlos Syndrome (EDS) recently demonstrated similar but unexpected responses to routine exercise interventions. Their experiences prompted me to reexamine my understanding of exercise-induced pain in individuals with chronic musculoskeletal conditions. Patient Case Studies Patient A: During a physical therapy session, a patient with EDS performed a spinal…
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Balancing joint capacity and exercise load using synergistic muscle action
A key concept in managing and preventing hip pain is understanding the balance between the capacity of the joint to handle load and using exercise training load to increase the capacity of the joint. To modify movement, one can “load” it by adding external resistance. Or “unload” it by decreasing or eliminating external resistance. Or…
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Physical Therapy telehealth lessons learned mistakes made
My perception of my abilities in providing telehealth video conferencing Physical Therapy or Physical Therapy service online follows the Dunning-Kruger effect. The Dunning-Krueger effect is a process of overestimating and underestimating our abilities and competence. When I began offering telehealth Physical Therapy in 2017, I initially overestimated my abilities. Over the past seven years, I…
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Musculoskeletal pain which are important steps which are less important?
Thesis: Choosing a diagnosis is an early step in solving non-traumatic muscle and bone pain problems. A diagnosis helps guide treatment, predict how problems will progress, and improve communication. A diagnosis has many functions, including direction for intervention to solve problems, predicting how problems will progress, and assisting in communication. Antithesis: Medical terminology is notoriously…
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How to fact-check health medical information from Chatbot AI, & internet sources
The growth of Chatbot artificial intelligence (AI) improves access and efficiency of obtaining information about health and medical issues that individuals are facing. Internet websites, blog postings, social media platforms, and Chatbot AI searches are convenient starting points for quick health and medical information. However, how do we know what you read and hear online…
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What is the alternative to I have fallen, & I can’t get up? – improve strengthen flexibility “just do it”
A patient with Parkinson’s syndrome, living alone expressed to me his frustration. He had fallen and was unable to get back up. He pissed on himself. He used his fall alert system via the internet to notify the rescue squad. In addition to the embarrassment, he felt about not being able to get back up…
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