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Hope for the future of PT

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Technique < Knowledge

For about a decade, I read all of the research surrounding the McKenzie Method, also known as Mechanical Diagnosis and Therapy.

I felt confident in seeing a patient on the first day and being able to discern, from the details of the history and movement exam, what was happening regarding the person’s pain experience.

This could only be done through an MDT lens. I couldn’t treat post-surgical patients well because protocols weren’t my cup of tea. Protocols required little thought and I believed that a 🐒 could do that type of treatment.

I couldn’t do chronic pain because I didn’t feel comfortable not having an answer to the questions.

All these years later, I’ve become better versed in treating patients with chronic pain, stinkin thinkin, poor health and post-surgical.

The problem was never in the patient, but instead in how I perceived the patient and subsequent treatment.

Having spent hundreds of hours learning about these types of patient presentations, I feel that I can relatively effortlessly slip from MDT classification to a pain based classification, and do all of this within a protocol if it is required.

Spending time in the trenches to learn your craft will allow you to use many different weapons of choice when enacting you’re craft.

Courage to act

Image: Kaufman SF. The Martial artist’s Book of Five Rings: The Definitive Interpretation of Miyamoto Musashi’s Classic Book of Strategy

This holds true in many forms.

I will continue to relate these quotes to those passions that I have such as Physical Therapy.

In the field of physical therapy, it is not uncommon to be asked/told to perform unethical and illegal acts.

As an employee, one has a decision to make:

1. Do said unethical/illegal activity, make my boss happy and possibly lose my professional license

2. Don’t do said unethical activity, go against the corporate line to protect my license and run the risk of losing my job.

You can see how this plays out in a day to day world if you work in healthcare.

I’ve met many that don’t understand the rules of the insurance that they are billing and therefore have no issues doing the company’s bidding because…they don’t know any better.

Once they know better, then it becomes an ethical dilemma. The job keeps food on the table and a roof over the head. Does anyone really want to risk that?

Many don’t and unethical and illegal activities continue to happen.

Every once in a while, someone speaks up and decides that they won’t toe the line.

This decision takes a couple of forms.

1. The employee flat out says no and that he/she won’t compromise integrity

2. The person goes to a higher authority and informs them of what is actually happening in the clinic.

Here is an example of the second example.

If you are a patient, know that these decisions are being made behind closed doors.

As a PT, do you have the “courage” to “act”?

Ankle strength

Some people have lost strength in the ankle due to a litany of issues such as:

Nerve damage

Muscle strain

Shin splints

Ankle fracture

Etc

Getting a stronger ankle joint doesn’t have to be complicated.

Some people have the ability to get stronger, but others may not have that ability.

Check with a licensed professional to see if the nerves are working properly before starting a structured exercise program for the ankle.

This is a basic exercise and is intended for general education.

Guard your ears

Patients want to know why they hurt. 🤷‍♂️🤔🙏

They want to know what we can do to help them get rid of their pain to get back to life. 🌈☀️

They want to know that movement is safe. ❤️👊

They want to know that nothing serious is wrong. 🚩

How many healthcare practitioners are answering the first one with a definitive answer of “xyz” is why your experiencing pain

AND

then goes on to put limitations on the patient

AND

tells the patient that it will take 3X/week for 4-8 weeks in order to get better 💵💸

😂😔🤔❌👎🤯

Patients, YOU NEED TO KNOW THAT IT IS RARE TO BE ABLE TO DETERMINE THE EXACT CAUSE OF YOUR PAIN!

There are many factors that can have a role in pain that for me to give you a single answer may do more harm than good.

I will tell you possibilities and we can have a discussion of how you think these possibilities ply a role in your symptoms, but even then we will not narrow it down to a specific tissue.

What we won’t do is

1. Increase your fear of movement

2. Create a restriction to specific movements without a timeline to reintroduce movements.

3. Overtreat you because we have created a fear of movement, taken away your mobility and then told you that you need to see me for 36 sessions.

If you are spending any money on your health care, don’t you want to see the person that keeps you for fewer visits, listens to your complaints, comes up with solutions to your issues and has a heart of a teacher.

Any 🐒 can take your money, but not every professional can provide you the help you’re paying for.

Reflections on “The Alchemist” Part VII

“My heart is a traitor… It doesn’t want me to go on.

Naturally it’s afraid that in pursuing your dream, you might lose everything you’ve won.

Well then, why should I listen to my heart?

Because you will never again be able to keep it quiet.”

I have a couple of big picture drivers in my life.

1. Have no regrets

2. Don’t do anything that would bring shame to my dad.

In 2008, my brother died. He died from an overdose of Benedryl…(I hear it all the time, I didn’t know it was possible…me neither).

He had his demons…we all do. He was a great guy, but again, he had his problems. He had been imprisoned for DUI and just got out. He started joining me at the gym and he was making great progress in the gym. He couldn’t squat more than me, but that bastard deadlifted 405 on his first attempt. (I say that out of love because it took me years to lift 405).

Anyway, we would have conversations about serious things every once in a while (we shared a room growing up. I worked overnights and was going to school and at the time he wasn’t working, so the bed was his at night and mine during the day).

Aside: those that know me, know that I am like a tornado. Wherever I go, I organize things so that they make sense to me. This usually means a bunch of separate piles with very clear distinctions between the piles. (It works for me!) Mike, on the other hand, was just a slob! He loved candy. It wasn’t uncommon for me to come home after working overnights and going to school in the morning, only to find a ton of wrappers in the bed and a full cup of coke on the floor. It was like living with a big kid at times (usually that’s one of the ways I get described, but Mike took it to an extreme). I used to think that if I just pushed it all on the floor that he would clean it up…Nope. Just a new pile of wrappers the next day! I miss my brother. He was a good person and was very good to me growing up. I’m going to keep reminiscing a little because…why not?

I used to love to sing Karaoke and was actually a DJ for a while. It paid good money, but I’m glad I stayed in school because: who goes out to sing Karaoke anymore? Mike had a problem with alcohol. I’m not saying anything bad about him, it was just true. It didn’t make him a bad person, but like I said, he had demons. We went out to the bar (mind you, I didn’t drink at the time), after working out (the bar was right next door to the gym). I sang some songs, bought him a Long Island iced tea (I had no clue what this drink was prior to that night) and he listened to me sing a couple of songs. The car ride home (I’m the little brother, obviously not by size). He said, bro I’m proud of you. You grew up in the same house we all did. You can go out to the bar and drink orange juice and have a good time. You work full time and go to school. You’re going to be great at anything you do. (This memory always brings tears).

I was a new grad physical therapist. Not even practicing for a year when my mom called me in the middle of the night to scream through the phone that “I lost my baby!” Those words and that conversation is burned in my brain. That whole night at the hospital was like a haze. Hard to believe.

What’s harder to deal with is that 10+ plus years have passed and how much he’s missed out on. He was great with kids. He would’ve loved my kids. I think of all that he could’ve done and seen. He always wanted to go to Alaska. I made a copy of one of his pictures and carried it with me while we honeymooned in Alaska. I miss my brother.

I learned one thing…life is very short and don’t have any regrets.

The second big picture ideology that I try to live by is to not bring shame to my dad.

You’ll hear me say it frequently that my dad is my Superman. He knows that, which was very important for me to make sure that he knows I’m proud of him and the life he lived and continues to live.

He served as a medic for the 101st Airborne, the Screaming Eagles, in Vietnam. He stated in Vietnam longer than he had to in order to ensure that his younger brother didn’t have to go to Nam. He came home and worked in the family business (construction) for 30+ years. He divorced my birth mom (whom I have no contact with, which is why I say birth mom) and took care of all the kids as best he could. He and Aida worked hard to move us to a quieter area with less shootings. They made the decision to send me to Providence. Essentially, all of the good things I have came from that man.

I disappointed my dad one time. I was 13 and was a shoplifter. I would steal anything just to see if I could.

I got caught at the old Cub Foods on Larkin Ave. I was stealing magazines and baseball cards. I was with my cousin at the time (and I still believe that he got caught, but water under a bridge). I was fined $2,000 and was out in handcuffs, but wasn’t arrested.

I got home that night (understand that my dad typically would wake up at 3 AM to prepare for work) and it was about 11 PM. My mom told him what happened. I was never really punished (aside from paying back $2000, which at the age of 13 wasn’t easy to make…thanks to Norm Fanning for getting me a job shoveling manure). He said that “I’m disappointed in you son”.

I worked my tail off to pay back the fine by the end of summer.

It’s been 25 years and I’d like to believe that I haven’t done anything since that day to bring shame to my dad.

The moral of this story is twofold.

1. Have no regrets.

2. Have a role model in which to look up to and live up to.

Thanks for reading.

I got to go see a man about a horse.

Don’t live inside you’re own head

The Mask

Why does my world Keep on tumbling down

I love my life with a smile because I’m afraid to frown

People see my smile and think everything’s okay

I live the way they want me to, never my own way.

Why do I let their words change my life

They only bring me pain and unwanted strife.

Is my life worth living is a question that I ask

Taking my own life is a complicated task.

I don’t want to die, I just want to kill the man you see

Because under all this happiness lies the real me.

Hey all,

I’m okay. This is the start to my next blog, which was inspired by today’s Gary Vaynerchuk episode with Kevin Love.

I was diagnosed as bipolar when I was 20ish.

it was on/off, run/sleep. I once put a car on a credit card. It’s just the way that I lived. Go hard and then shut down.

In 2015ish. I had a panic attack and seriously thought I was going to die. The worst part of it for me was that it happened at work. Work had always been my safe place. I was always a rock at work.

Thinking you’re going to die causes you to quickly establish priorities. The only people that I thought about at the time was Ania and Lenna. I thought about how they would make it without me.

This event caused me to make some changes in life because I realized my priorities.

Since that time, I have made decisions to most positively affect my family. I stopped putting as much stress on myself and I started having fun again.

No different than playing 3 on 3 as a kid. No different than Kairos.

I just Let Go and Let God.

Since that time, I’ve talked to a therapist and am having more fun in life almost 40 than I have in a long period of time.

If you are having issues that seem overwhelming and you are having trouble shaking…talk to someone.

Reflections on “The Alchemist”

“But I’m afraid that it would all be a disappointment, so I prefer to just dream about it.”

How many people never live their dream?

Golden handcuffs, fear of failure, fear of success, letting others dictate your actions, lack of self confidence, lack of self awareness are all possible reasons why a person may avoid chasing a dream.

When I started at Palos Health, I asked as many people as possible if they loved their job.

Everyone loved aspects of the job, like the pay (which was slightly better than average), the retirement plan (which was slightly better than average), health insurance (which was much better than average), and vacation time (which was slightly better than average).

There were a lot of reasons to stay in that position, but no one said they loved the job itself.

I never wanted to be in a position because I couldn’t afford to leave. This was the case for many people that continued to work there.

This is the definition of golden handcuffs.

I think we all have fear of failure or rejection. Me included. Can we overcome that fear of action, also known as paralysis of analysis?

The answer is yes. Just jump!

Failure is a possibility. It’s always a possibility.

Sears was around forever…until it wasn’t.

Toys R Us was around forever…until it wasn’t.

Montgomery Wards, Woolworths, Cub Foods, arcades, etc.

Even the largest companies can fail.

Failure is something to plan for, because it’s a possibility. I am not saying it’s something to hope for. There always has to be an exit plan.

One way to create a constant exit plan is to always work with integrity, try to make everyone around you better, work more productively than everyone else on the team, and to be nice.

You’d be surprised how much integrity, teamwork, hard work and good spirits can lead to opportunities.

I say it to all my students and many of those that I interact with as a mentor. I am not special.

It’s unfortunate that in the modern times, just exhibiting those above traits makes one appear special.

It’s not hard to stand out from the crowd, you just have to put a little more in than the next guy or gal. Fortunately for me, the bar has always been set a little lower than my work ethic, which makes me seem like I stand out.

It’s that scene from any armed forces comedy. When the leader asks for one person to step forward and everyone else steps back, that leaves one person out in front.

That’s how I feel sometimes.