|The Grimm Details|
|"My Confidence to Workout Has Returned"|
|Thu, 02 Jan 2020 16:54:00 +0000|
|Before starting with Grimm, I was having weakness in my left arm with pain coming and going due to neck injury. Through just a few visits my symptoms have resolved, my range of motion is significantly better, and my confidence to workout has returned. Most importantly Grimm PT has helped me maintain these results on my own, by allowing me to identify warning signals before pain returns.|
- Allison P. 1/2/2020
|Alpaca Bag for Peru!|
|Sun, 01 Oct 2017 21:26:00 +0000|
There are too many memories of my time on the inaugural Mechanical Care Everywhere mission trip to Peru. As each day passes I am amazed at how small the world is becoming to me and how many similarities we all share. Cusco and New Orleans are both Roman Catholic cities and share many similar customs. Masks, celebrations, Catholic school uniforms, and even a second line parade following a funeral reminded me of home. However, never have I found it so important to assist the patient in becoming self-reliant and independent of the therapist as I did in my short time there. In the small mountain village of Ccorca, there are no therapists to treat the people. What better system is there besides MDT which is based on the assessment and following education of the patient in self-care to assist these people in their musculoskeletal problems. Frequency of flexion and poor sitting posture are not unique to the technological world as we know it but is an issue in underdeveloped areas as well. Women, men and children in this area work very hard farming and raising livestock without the assistance of machinery that we are accustomed to using here in the United States. This means hours of flexion planting and harvesting potatoes, heaving lifting and carrying, miles and miles of walking in mountainous terrain and you guessed it: very little extension.
Having traveled hours to get to our makeshift clinic, patients were lined up waiting to see us. Many people were expecting pain medication as they do here but were so grateful to find non pharmaceutical methods to manage their symptoms. Many patients had tears in their eyes as they thanked us for the time that we spent assessing them and giving them tools to manage their symptoms on their own. Many women could not wait patiently in line and would do their best to interrupt my evaluation of another to insist that I see them by tapping on my shoulder or thrusting their intake forms into my view. They were desperate for help!
This was a common job of the people I evaluated. I had assessed an 85 year old woman who carried a pack such as this and had walked two hours to seek care and had to rush back to take care of her animals before it turned dark. Extension in standing over a table abolished her painful symptoms in minutes. There were tears in both of our eyes as we hugged each other after the assessment. Was this something she could do? Yes. Was this something she could do on her own? Yes. No need for endless visits to the clinic which is something that would not be possible in this culture.
I remember reading many years ago that Robin McKenzie wanted to reach as many people as possible to allow them the tools to treat their own pain. Colin Davies reminded us that this was indeed part of his mission and that he would be proud of our efforts in Peru. I am proud to have served and hope to do more in the future. Yes, "Alpaca bag for Peru" and beyond with Mechanical Care Everywhere!😏
For more information on Mechanical Care Everywhere you can visit the website: http://www.mechanicalcareforum.com/mce/ and please consider a small donation for future endeavors.
|Should I Work Out if I Have Lower Back Pain? Part 1|
|Tue, 23 May 2017 23:42:00 +0000|
This is a question I hear all the time...actually it is generally phrased "When can I work out?" I wish there was an easy answer for this, but it depends. There are absolute contraindications or Red Flags, meaning you shouldn't exercise until medically cleared to do so. These include:
You may be thinking, I wouldn't even think of asking that, but I have had a few patients in the past that I recommended they go to the Emergency Room. If you are experiencing any of the above, I recommend the same for you. You may need need some imaging to rule out something serious like a broken bone, infection, or cancer. Of course, you wouldn't want to make any of these problems worse.
Stay tuned for Part 2 next week when we will discuss return to exercise in the absence of Red Flags.
|The Season of "Mardi Gras Float Riders" Shoulders|
|Wed, 15 Feb 2017 21:11:00 +0000|
Throw Me Something Mister!
A little self –care goes a long way
While throwing beads, practice stopping the activity as soon as you feel discomfort in your shoulder and rest for about 30 seconds. This will allow your shoulder to recover. A good habit to get in is actually stretching your shoulder blades together with your hands clasped behind you – 3-5 reps with 3 second holds.
If you have rested about 5 days and are still suffering with a painful shoulder you can actually try a commonly prescribed McKenzie exercise for shoulder mechanical pain. This exercise is called shoulder extension in standing. Place your affected arm behind you with the palm facing up by internally rotating your shoulder. Stretch in this position to the end range. You can hold this stretch for 30 seconds or perform sets of 10 – 15 repetitions. As with any exercise if it makes your pain worse or obstructs motion – don’t do it and see a McKenzie practitioner.
A great friend of mine, Joel Laing, Dip. MDT a physiotherapist from Melbourne Australia, a great mate, has a you tube video with some more helpful tips.
McKenzie, Robin, Grant Watson, and Robert Lindsay. Treat Your Own Shoulder. Raumati Beach, N.Z.: Spinal Publications New Zealand, 2009. Print.
|Your Back Pain May Be Rapidly Reversible|
|Thu, 22 Dec 2016 20:31:00 +0000|
|Do you have back pain that is lingering? Did you know that along with the pain, mobility and strength are also affected? The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is an reliable assessment that may determine that your pain may be rapidly reversed with one exercise. This exercise can then be used to abolish your pain as well as prevent it from returning. Check out this video of a young man with central low back pain and his rapid recovery.|
|Be the Best You Can Be|
|Thu, 05 Mar 2015 22:50:00 +0000|
|I haven't been blogging lately, because I am working on becoming an expert in my craft. No excuses I know, but really I have been busy!|
Many years ago and today I read a quote from Brian Tracy, a motivational speaker, who said;
"If you read an hour a day, one book per week, you will be an expert in your field within three years. " Brian Tracy's Blog, (2012).
I must say, that I am currently doing this by taking part in the online portion of the McKenzie MDT diploma program. Talk about stepping out of your element! Online classes were completely foreign to me when I started. My heart rate was a little racy the first week because I didn't know how to navigate the website, the first module was very foreign to me and I doubted my decision to do this. I must say there is quite a bit of reading, tons of early mornings, and questions to be answered and discussed. I am 6 weeks into the online portion with about 6 weeks to go. Hopefully on the downside of the mountain! Actually, I am really enjoying the process.
It is very exciting because the course is limited to 20 participants from around the world. It is just amazing that I am taking part in discussions with other experts in MDT from Brazil, Scotland, India, Greece, Chile, Canada, Africa, Poland, New Zealand, Australia, and a few interesting states like Pennsylvania, Florida, New Jersey, Virginia, and of course Louisiana. Just downright amazing! The internet has made the world a much smaller place and I am grateful. You see, I have been practicing MDT McKenzie Method for almost 30 years by myself! To have conversations with others who are so knowledgeable and enthusiastic is invigorating.
My goal in this endeavor is to simply be the best MDT practitioner I can be and hopefully teach others someday. MDT is not offered in the physical therapy programs around here in any great detail. I think it is a shame, because in my opinion, it is the most effective assessment and treatment plan around. I would have saved myself some grief in the early years of my practicing if this were taught in school. This is probably why your favorite doctor or clinician isn't aware of the power of MDT. He/she just hasn't been exposed to it in any great detail. I want to change all that around here. I want people to have access to rapid results with emphasis on self-treatment for their musculoskeletal problems.
What is your goal? Are you setting goals? Are you taking steps to achieve your goals? I invite you to join me in stepping out of your comfort zone. Who knows we could all be experts in our fields if we just devoted one hour a day. Wow! Think of the possibilities.
In the meantime if you are having any aches, pains or movement problems interfering with setting and achieving your goals, you know what I am going to say, "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!" Schedule yours today by visiting grimmpt.com or by calling 504-228-0524. I hope to see you soon.
5 Ways to Gain a Competitive Advantage: The Importance of.... [online] Available at: http://www.briantracy.com/blog/personal-success/5-ways-to-gain-a-competitive-advantage-the-importance-of-continuous-learning-and-personal-development/ [Accessed 3 Mar. 2015].
|Things People Say in the Gym that Make Me Think Cervical|
|Sun, 08 Feb 2015 22:46:00 +0000|
When athletes get frustrated and complain about any of the following:
I always think, hmmm, I wonder if this is a cervical problem? It is not unusual in my practice to see any of these complaints resolve with end range movements of the neck. It doesn't mean it is a serious problem, and generally it is a condition that is rapidly reversible. The MDT McKenzie evaluation will help me to decide which direction that patient should move in to abolish their symptoms. I am sure you are saying, yeah right! No way can this shoulder pain be coming from my neck! Well, you might be right, it could be a shoulder problem but it could be coming from your neck. A MDT McKenzie evaluation will help to determine that. Don't worry, if it is a shoulder problem we've got that covered too.
Check out my previous blogs on neck problems at the gym: Hurting my Neck at the Gym and Hurting my Neck at the Gym - part 2. The best way to find out where your nagging upper extremity problems are coming from is to get a great comprehensive evaluation. The MDT McKenzie evaluation is a reliable assessment process designed for all musculoskeletal problems, including pain in the back, neck and extremities. Once your clinician knows the source of your pain, they will then instruct you on how to take care of the problem yourself in as little as 3 - 5 visits. If you don't let it linger too long, this could easily be remedied in a few visits with noticeable increase in strength, decrease in pain and improved mechanics and maybe even a few PR's.
You know what I am going to say. "Everyone deserves a good mechanical assessment and treatment plan!" Call 504-228-0524 or visit grimmpt.com to schedule your evaluation today.
McKenzie, R. and May, S., (2000) . Raumati Beach: Spinal Publications.
McKenzie, R. and May, S., (2006) . 2nd ed. Raumati Beach: Spinal Publications.
McKenzie, R.,(2011) Treat Your Own Neck, 5th ed. Raumati Beach: Spinal Publications.
|Patriotism,CrossFit and I|
|Sat, 31 Jan 2015 23:54:00 +0000|
|When I began CrossFit a little over 3 years ago, I was a little dismayed over the hero workouts. I am pretty sure that I am the most patriotic person I know to put it in perspective. Here we are doing a silly workout named after someone who paid the ultimate sacrifice for me and my country. Really? It felt like a "dis" to me at the time.|
My emotions are running a little raw this week so forgive me, please. You see, I just watched American Sniper.
First, I just want to say that I am eternally grateful for all of our first responders out there, including EMS, the fire department and the police force and to our military. You will always see me at every game tearing up or outright crying during the national anthem because I just can't help it. I even get emotional when I watch them sing the national anthem on TV. Why is it that the only time we really honor our heros is with a CrossFit workout? My attitude about these workouts has changed over the years because it really is the only time on my radar, so to speak, that we seem to take the time to honor our heroes.
If you are suffering from pain or movement loss, you may have a rapidly reducible condition. If you want to find out check out grimmpt.com where "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!" Call 504-228-0524 or visit grimmpt.com to set up your evaluation today.
|Have You Fallen and Can't Get Up?|
|Sun, 18 Jan 2015 22:47:00 +0000|
|http://breakingmuscle.com/strength-conditioning/take-the-stand-up-challenge-52-ways-to-get-up-off-the-floor. Awesome! Can't do many of these variations though.|
I walked into my "box" this morning and guess what was part of the workout? You guessed it. Getting up off the floor! Our coach had us lying on our backs, rolling up to a squat and then standing on both legs. Then he added a little variation and we attempted it with standing on one leg. I couldn't do it. Close, but still didn't quite come up to standing. I wasn't alone. There were several others who couldn't do it as well. These are people who actually exercise. Try it yourself and see if you can do it.
One of my physical therapy instructors said that one of the most important things you could do for yourself is to lie down on the floor and get up every day. I would say I have to agree with her. I have far too many patients who cannot do this.
If you want to challenge yourself I suggest working on the Turkish Get Up which is shown is this video. Try to perfect the technique on both sides before you add weight to your hands. This is an excellent exercise for posture and coordination no matter what your level of (or lack of) fitness is. It should be a baseline of all of your exercises. Once you master this you can progress to adding weight as in this video:
This video is done by Gray Cook is a well-respected physical therapist who is known for founding the Functional Movement Screen, the Selective Functional Movement Assessment which are used in physical therapy clinics, professional athletic settings and gyms all over the world. He really explains this movement well. He explains in his book Movement that the Turkish Get Up is a self-limiting exercise used to "improve poor movements and maintain functional movement quality."1
So get your get up on and get up and off the floor everyday so that whenever you fall, you know you can get up! If you have any pain or limitations in movement, 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 assessment today.
1 Cook, Gray,et.al. Movement: Functional Movement Systems, On Target Publications, (2010); 232.
|It's All About Priorities|
|Sun, 11 Jan 2015 22:44:00 +0000|
|As you probably know by now, I see many patients that have mechanical, rapidly reversible pain. I do a thorough history of your symptoms, review your past medical history, and then do an examination. Once I am done I have a pretty good idea on how to abolish your symptoms. |
Generally, this requires you to perform ONE exercise several times a day. I could give you dozens of exercises that won't be effective but can keep you busy but I try not to waste your time.
It is not uncommon for me to hear, this is not possible. There is no way I could possibly perform this one movement even though it reduces or eliminates all of my pain, restores my movement and improves my strength. I have heard that this is just plain boring to do several times a day as well.
As I have said before, if you are unwilling to do the work, then what I do does not work. So please make time in your busy schedules for your surgery, the follow up rehabilitation and the possibility of complications. Please make time in your busy schedules to take multiple pharmaceutical medications that always come with major side effects including additional pains and sometimes death.
Isn't it time that we all become a little proactive about our health? Perhaps we should eat right, exercise, get plenty of water and sleep and do the one exercise that can abolish your symptoms?
Why is this so hard? I would love to hear your thoughts on this.
Although I truly believe "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!" If you don't think you can do the required homework, don't waste your time. If you are interested in finding out if one movement performed several times a day can abolish your symptoms then call 504-228-0524 or visit grimmpt.com today.
|I Triple Dog Dare You!|
|Sun, 28 Dec 2014 22:46:00 +0000|
|The Saints aren't going to the Super Bowl, so you don't have to worry about that. |
Mardi Gras is until February 17, so you don't have to worry about that.
Why am I bringing these up? Because these events are pretty major in these parts. These two events demand a certain amount of celebration if you will. They can derail any of the best intentions if you let them.
Forget the going to the gym resolutions this year (unless you want to come to CrossFit with me, of course). Instead, I am challenging you to do a Whole 30 with me and my husband.
A 30 day process of tweaking our diets, lifestyles and environments with major rewards. This will be the third one for us and we would love to help you with yours. We are beginning this January 4, so you have plenty of time to purchase the book, review their website, prepare your kitchen, and to just get your mind ready to commit to it.
First of all, I want to say that we are not affiliated with the Whole9. We do not reap any monetary gains by endorsing them. What we do get is the satisfaction of helping you to feel as good as we do.
I have been fond of saying that the Whole 9 could put both of us out of business! I am fine with that too. I really believe this. I realize that most spinal and joint pains are inflammatory in nature and that much of it can be resolved with a change in your nutrition.
Just imagine what it would be like to:- Significantly reduce your joint aches and pain
- Improve your sleep
- Decrease your stress
- Improve your digestion
- Clear your mind
- Reverse disease
- Reduce or eliminate your prescription medications
- Clear up your skin
- Improve your memory
- Improve performance
- Lose a little weight if needed
- Become the best version of yourself
This could really happen in as little as 30 days if you decide to take on this challenge. Let me know if you want to do this with us. We can make a private Facebook community to help each other through this. It will be life-changing. Promise! It's not easy, just like anything worthwhile, but we can support each other. If you want a testimonial from a previous patient of mine, let me know and I can get you in touch with them.
What is the worst thing that could happen? Why nothing, of course. In that case, you can simply go back to eating the way you used to. Besides it is only 30 days.
I still say "Everyone deserves a Good Mechanical Evaluation and Treatment Plan!" Call 504-228-0524 or visit grimmpt.com to set up your assessment today.
|Want to Improve the Depth of Your Squat? Rapidly?|
|Mon, 15 Dec 2014 14:11:00 +0000|
|Having done several Functional Movement Screens and Selective Functional Movement Assessments, I have come to learn that most squat limitations are due to a lack of dorsiflexion of the ankle. Always looking for ways to come up with a quick fix and accepting my coach, Raul Filpo's challenge to find a way to improve his dorsiflexion and mine, I found a solution.|
Inspired by a treatment technique called Total Motion Release, I chose to exercise the plantar flexors in a round of 3 sets of 15 and then retest. The results were dramatic to say the least. I was able to gain 25% in range of motion in one set. I wish I knew this the last time I did "Karen" ( 150 Wall Ball for time) and was no-repped at least 50 times for insufficient depth in the squat.
Raul Filpo's, owner of FixCi CrossFit, method of dorsiflexion testing was used as well as the squat as a way to gauge improvements. Keeping your heel on the ground, bend your knee touching the box (or a wall) and measure how far from the box your toes are with your heel on the ground. Have a partner place a dollar bill under your heel to make sure your heel remains in contact with the ground...Record the distance because we are using this later for comparison.
Here is a a video taken of 4 individuals who did not have prior knowledge of the stretch. They were instructed to perform a squat with their heels on the ground to the best of their ability. We then measured dorsiflexion as described above, performed the therapeutic exercise as I prescribed, then measure the dorsiflexion afterwards. I had them do the prescribed exercise again for another round of 3 sets of 15 and the results were amazing. Rachel increased her dorsiflexion on her right ankle 2 inches and on her left 1 1/2 inches! All participants increased at least one ankle an inch. It really is remarkable.
Make sure you test your squat for depth before you perform this miraculous and ridiculously simple maneuver as a test/ retest like Kelly Starrett of MobilityWOD likes to do with all his mobility exercises. Pay attention to the depth of your squat as well as to the position of your torso.
Perform 3 sets of 15 unilateral toe raises on the side that had the most dorsiflexion. Retest both dorsiflexion measurements. Did you get more range of motion? Retest your squat. Did you drop lower with a more upright trunk? Then do it again on the other side. Did your range of motion increase even more? Thought so. You are so welcome! I know you are thanking me for this!
This would make an awesome research project for someone who was willing to take the challenge on. I would do it, but I am getting ready to go back to school next month and really don't know what it will all entail.
Here's to endless below parallel wall balls, air squats, squat cleans, and overhead squats! Maybe we all be doing these unilateral toe raises before we do any workout involving squats...What do you think? Give it a try.
Please let me know how this this works for you. You can leave a comment below or video yourself doing this. I would sure appreciate it if you would. If you want to learn more about Total Motion Release, the FMS or the SFMA and how they can work for your individual issues give me a call.
You know what I am going to say, "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!" Call 504-228-0524 or visit grimmpt.com to set up your evaluation today.
|MRI's 4 back pain is like picking your nose...|
|Sun, 07 Dec 2014 22:41:00 +0000|
From a friend/MD: "getting MRI 4 back pain is like picking ur nose in public. You'll find something interesting but what do u do with it?
This is a twitter post from a fellow Credentialed MDT physical therapist name Alison Helmetsie from New York/Pennsylvania way. You know I LOVE when people say things better than I can and this is definitely one of those times.
A MRI is just that a finding. Are you prepared to deal with the consequences of that finding? What is your doctor supposed to do when there is an "interesting" finding on your MRI. What is normal anyway? What if that finding isn't the pain producer at all. Aren't they just a little obligated to do something once they see something "interesting" on your MRI?
If we are talking about bulging discs I just want to say maybe they are normal. I mean really. If we all begin aging around 12 years old and develop ruptures and tears in the annulus that surrounds the nucleus, in which with repeated movements or sustained postures, the nuclear material can seep into those cracks and cause a bulge. Wouldn't this be "normal?" What about all of us who have bulging discs that have no symptoms at all? Are we abnormal? Why would our creator design us this way? It sure seems like we are designed to bulge...
What if your finding on Xray or MRI is scoliosis. You know where your spine deviates to the right or left of center. What if you have obvious scoliosis? Where you can actually see this curvature of the spine. What if you have image findings like this and you have mechanical pain. Is the pain really coming from your scoliosis or bulging disc or something else? Do you really care? If one or two movements repeated throughout the day at regular intervals abolishes your pain, restores your motion and gives you return of strength? Do you really care what the MRI says?
I know that I don't...I don't really care what the image says, I just want normal pain free function. In fact, I have seen some pretty horrendous MRI's out there over the years. If I treated the MRI those people may not be pain free and enjoying their lives today.
So are you really prepared to get a MRI and sit down with your doctor to discuss the findings? Aren't they supposed to tell you no heavy lifting? No running? No exercise? NO FUN EVER AGAIN? Are you ready for this? If not, then quit asking for MRI's.
Now you know I am not saying this is all or none. You may have cancer, or your disc may be extruded giving you major neurological symptoms, or your scoliosis may be so bad it may progress to impede your breathing. In that case, maybe you will need to curtail your activities. If you play professional football and have these findings, where any kind of contact will make your condition worse as in stenosis, then football is not the right sport for you. However, in all of these instances there are activities and exercise that are actually good for you. As long as you know what to do, how much force, how many repetitions, and what to avoid, exercise is GOOD for you! But again, you know this already. Your body is telling you this.
If you want to die a slow painful death, then just don't do any exercise...lie around in bed all day and eat horrible food. Your poor heart muscle will then do the job for you.
Want to know if you have a rapidly reversible condition? You know what I am going to say..."Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!" Visit grimmpt.com or call 504-228-0524 to see up your assessment today.
|Why Am I So Much Stiffer in the Mornings?|
|Sun, 30 Nov 2014 23:15:00 +0000|
| We all know what imbibing is and the swelling and increased tension we feel the next morning, when we have been partying all night long. Well, your discs in your spine do this every night! I like to say they have been "partying all night long" without you!|
If you need a more scientific explanation then check out this article on the Nutrition of the disc
Essentially your discs get their nutrition by a process called imbibation. They absorb fluid from surrounding tissues and then extract the nutrients out of it. This is due to the osmotic pressure of proteoglycans. We normally don't feel this increased pressure and stiffness in the disc, but if you have degenerative changes or an injury in the disc you generally feel stiffer and may experience more pain in the morning.
It takes about 4 hours of normal life (i.e. moving around) for the discs to return to normal height. You can test this on yourself by bending forward as far as you can, as in touching your toes, first thing in the morning and then again 4 hours later. You should see a considerable increase in flexibility because your discs aren't under so much tension.
This also explains why we are all taller in the mornings. In fact, you can be up to 2% shorter at the end of the day. Hope this helps explain some of that morning stiffness and increased pain a little.
However, if you are under the age of 40 and you have stiffness in the morning that doesn't ease after 30 minutes, or isn't eased by resting, seek additional medical advice. This might be indicative of an inflammatory spinal condition.
You know what I am going to say. "Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!" Visit grimmpt.com or call 504-228-0524 to schedule your assessment today.
|Your Back MAY Be Out, BUT...|
|Mon, 24 Nov 2014 01:01:00 +0000|
|...Your sacro-iliac isn't out of whack, you are not too fat, your hips aren't misaligned, your SI is fine, your hamstrings aren't too tight, your arches haven't fallen, your core isn't weak, and your back isn't swollen...your piriformis doesn't have a syndrome, Your IT band isn't out of tune and your overly pronated feet are just fine like they are. You might have Scoliosis and Spondylolisthesis and your leg lengths might be different too, your stenosis and facets might be showing up abnormal as well. Your structure may not be normal at all, but what is normal?|
I always like to say if you took a MRI of my spine or pointed out my asymmetries and imbalances I probably couldn't get out of bed! Maybe these are simply what make me different than you. These type of findings are what I like to term "noise" in my evaluations. I am always thinking are these the pain producers or not?
"Once you start mentally leaning towards the idea of asymmetries as a major cause of pain, you start noticing and emphasizing only the cases that seem to confirm that expectation … and ignoring the ones that contradict it. "- Paul Ingraham
I was reading Paul Ingraham's article a few days ago and found it to be excellent! I agree with pretty much everything he has to say. Especially when he says
"It is every health care professionals highest ethical responsibility not to mistake profitable recommendations for good health care. They are rarely the same thing."
Does this sound like me or what? If you have time I recommend that you read this. It is great food for thought!
As you know, I want to get to the root of your problem and teach you how to care for it yourself. I love Graston and have advanced training in it. I hardly ever use this because it doesn't get to the root of the problem, neither does electrical stimulation, foot orthoses, dry needling, or ART. These seem to be all the rage in physical therapy and chiropractic care these days. They are all targeted to treating soft tissue as if that is all that could possibly causing your symptoms. If your symptoms are disc related, these modalities don't even come close to treating the cause.
I also have advanced training in spinal and joint manipulations but rarely do I need to use them when I practice MDT or the McKenzie Method. This method is based on a progression of forces beginning with self generated forces. In the majority of cases, this is all that is required in rapidly reducible conditions. If I ever need to do a spinal manipulation I am assured that the force progressions have been thoroughly explored before this treatment option is reached. You know I will think twice or three times before I every manipulate someone's spine. I am really freaked out right now with spinal manipulation right now because of the recent death of a 30 year old father of two. You can read more about that here. I wonder what he was having his neck manipulated for.
So if you tell me you have your spine manipulated several times a year over the last umpteen years and it helped, then I always wonder if this really worked why are you still going after all of these years?
I guess what I am trying to say is, don't get hoodwinked into believing everything you hear from anybody in the healthcare business, including me. Don't buy into it unless you have results. Unless of course, you just want a massage, a spinal manipulation, dry needling, Graston or ART. They all feel good to me too, just temporarily. If you want to get to the root of your problem, to see if you have a rapidly reversible condition, and you want to learn how to take care of it yourself you know what I am going to say. "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!" Visit grimmpt.com or call 504-228-0524 to set up your evaluation today.
|One "Slick" Exercise for her Hip...A MDT Testimonial|
|Mon, 17 Nov 2014 00:37:00 +0000|
The following is a testimonial from a friend of mine that I did not actually treat. I invited her to be a demonstration patient for a McKenzie course here in New Orleans. The course was entitled "The McKenzie Institute: Part E: Advanced Extremities. The McKenzie Institute is the only one that I know of that actually brings up actual patients for demonstrations. This is a huge component of why I found this method so fascinating. They are actually willing to demonstrate their technique on patient's who have not been coached or have any idea of the method. My husband also attended this course with me and we were both impressed with rapidly reversible joint conditions that we saw during the course. So without further adieu, here is her unedited testimonial. (I did add a few pictures for interest.)
My pain was annoying. It wasn’t life threatening or the result of a traumatic accident or degenerative disease; I hadn’t dealt with it for decades. But it was pain, and it lingered, and it had a negative impact on basic daily activities, like sleeping on my side and moving from standing to sitting or vice versa.
Then, in 2012, Mark Miller (PT, Dip. MDT), for a solid hour or more, told me all the ways in which I was “deranged.” My reaction? If I ever see that man on the street, I’ll tackle him with an affectionate but borderline-illegal bear hug. (That inappropriate impulse might actually support the “deranged” diagnosis in more than one context, now that I think about it. But consider yourself on notice, Mr. Miller: forewarned is forearmed.)
If you, too, are in pain, find someone trained in the McKenzie Method to tell you you’re deranged. Because I’ve learned hard lessons, and you should learn from my mistakes.
Lesson #1: Stupid Human Gym Tricks Are Stupid
So a Stupid Human Gym Trick wrenched the hell out of my hip and quad. Don’t ask; I won’t tell. What I will tell is that for 15 months or more, every time I moved my hips or took steps or did anything with lower-body impact, I re-learned the lesson to eschew Stupid Human Gym Tricks (instead, and I can’t emphasize this enough, develop practical training goals, and follow a coherent training plan developed by someone who knows something about those goals and how to safely get you there). And (spoiler alert) I’ll also tell how I developed my undying affection for Mr. Miller and how the McKenzie Method brought me relief I didn’t think I’d get without surgery.
Lesson #2: The Googlez is Not a Trained Health-Care Professional
Immediately after my Stupid Human Gym Trick fail, I was simply happy I hadn’t broken my ankle. But a few days later, I realized my thigh was sore, really really sore. I hoped it would go away, so I backed off my workouts, Googled, talked to friends, took anti-inflammatories, stretched, foam rolled. These were, at best, temporary Band-Aids. Months went by (I let things linger longer than is probably advisable, which might be Lesson #2.A: When Standing Up, Sitting Down, and Lying On Your Side All Hurt, Take Action), and finally I sought out a health care professional trained in Active Release Therapy (ART). I didn’t have much guidance or experience with injury, and ART seemed like a reasonable next step.
Yes, it was confirmed: big nasty adhesions in my thigh were making my life hell. Under the direction of a professional, there were x-rays, adjustments, massage therapy, heat, ice. Also, ultrasound and Graston. I was assigned do-at-home stretches, more foam rolling, directions for icing. For months, my thigh was so deeply and thoroughly bruised from my therapeutic efforts that people would gape and demand, “What HAPPENED?” Someone once said, “It’s painful to look at.”
My quad pain improved but was still not gone. More troubling was that as I got some relief in my thigh, I discovered hip mobility issues—I couldn’t squat below parallel. When I asked about mobility, I got more aggressive versions of the stretches I was already doing. When I asked if the pain would ever go completely away, I got vague answers: “You might always feel a tweak,” “There’s no way to know for sure,” “It may be worse if you’re fatigued.” None of those answers seemed right to me (do people without major trauma, from things like car accidents and Action Movie Balcony Dives, actually walk around every day in pain?), but I showed up for every appointment, followed every instruction to the letter.
Eventually, my courses of treatment expired and my insurance (yay! I have insurance!) refused to authorize more visits. I tried more sessions paying out of pocket, but after months when I still had pain and mobility issues, when the relief seemed mostly temporary, and when the answers were still more non-committal than I preferred, I abandoned that ship.
Lesson #3: If at First You Don’t Succeed. . . .
I had recently discovered powerlifting (yeah, I’m a gym rat in my 40s, but I was a slacker and an obese couch potato through my early 30s, so I’ve only begun to discover strength sports), and you can’t be a powerlifter unless you can squat, to depth, and with weights as heavy as you can manage. I couldn’t get my hip crease even with the top of my leg, much less below the top of my leg for a legal squat. It wasn’t that it hurt too bad to do it (although it did hurt, and it hurt even more without a weekly dose of massage); it was that I just . . . couldn’t. And I wasn’t ready to go back to a life spent entirely on the couch.
My Gym Wife had seen a therapist about knee pain and had gotten great results. I knew, and liked, the therapist personally. I signed up. This therapist gave me clear answers: yes, my pain should go away entirely. Yes, I should be able to squat to below parallel. More manipulation followed, repetitive strength-building exercises for my quad (“I think she’s a really capable therapist,” I told her assistant on my bajillionth rep of a cable exercise, “but her choreography is SUPER boring.”), more ultrasound, and valuable therapy for building a legal squat. I still had hip and thigh pain, but at least I could get below parallel.
After a few more months of regular treatment and dutiful compliance, I saw improvement in both hip mobility and relief in quad pain that didn’t feel temporary. And I could squat. But I still had pain. My therapist sent me to an orthopedist.
Lesson #4: Needles Don’t Always Work
I could tell my therapist was frustrated. I could also tell that she was working hard to figure out how to fix me. She spent lots of hands-on time diagnosing and treating. She listened. She watched me move. She gave me exercises that addressed my weaknesses. When I did the math about how much time she spent with me compared to what my insurance company was paying. . . . (Lesson #4.A: Insurance Is a Racket, But Just Try to Get By Without It). Nevertheless, I appreciated her honesty and dutifully went to the orthopedist.
I had x-rays in the office before I saw him. He walked into the exam room, listened to me say that I had hip pain that didn’t allow me to move beyond a certain point without pain (he didn’t watch me move; he didn’t ask for much of a history), told me my x-rays were fine, told me my Chuck Taylors were the “worst possible kind of shoes” I could wear, told me to wear orthotic inserts inside heavily padded running shoes, gave me a cortisone injection in my hip, and told me to come back in two weeks if I still had pain. Ten minutes later, he moved on to the next patient.
Meanwhile, I left to buy orthotic inserts. The pain never went away. The cortisone shot made no difference.
Two weeks later, he told me to go back to the therapist. And just to plan on not squatting. Ever.
Lesson #5: Sometimes Needles Do Work
Don’t get me wrong: I don’t love squatting. I’m not one of those weirdos who brags about my squat (how much, how often, how deep, how many nights I dream about squatting) and wears t-shirts emblazoned with sayings about how squatting will salve all wounds, change your life, achieve world peace, and cure ebola.
Because any right-minded thinker knows bench press is the only lift that matters.
But you have to have at least one legal (at or below parallel) squat in a powerlifting meet before you can move on to bench press and deadlift. And beyond a powerlifting meet, you kind of have to be able to bend at the hips to do other things, like standing up and sitting down and . . . well, other activities that aren’t optional and that can’t be hygienically accomplished from a standing or lying position. So not squatting wasn’t an acceptable answer. I went back to the therapist.
This was now a full year after the failed Stupid Human Gym Trick (don’t ask; I’m still not telling), months of various forms of treatment, and lots and lots of office visits and co-pays.
My therapist was still puzzled and frustrated by my pain. “Wanna try something really weird?” she asked. How could I say no to an offer like that?
Her colleague did dry needling. You can Google it. But the short version is that I let her colleague stick needles into my leg until my muscles twitched involuntarily, violently, and painfully. Very painfully. After some treatments, I could barely walk from my car to my front door. If my pride had allowed it, I would’ve crawled up the three steps to my front door. But after three or four weekly treatments, my quad pain was gone. Absolutely gone.
The hip pain, however, remained. My therapist called in another colleague, they watched me move. They asked me questions. She repeated my history and treatment to her colleague. “Bursitis” was their answer. Which (and I’m not a professional here, so don’t take my word for it) I’m pretty sure boils down to “pain because of something.” I had a vague sense she might have thought it was a labral tear (which Google had told me months before was “bad”—again, not a professional here, and see Lesson #2). She reluctantly told me there was nothing more she could do for me through therapy.
I was stuck.
Lesson #6: Sometimes Whining to the Right Person Works
So I whined. A lot. Everywhere. At work, where MDs told me to just not squat. To my friends, who love me despite my whining. At the gym, where people told me to foam roll and stretch in even more aggressive ways. I whined my way through 15-pound squats, and then 20-pound squats, and then 33-pound squats, which were to depth (and it took me months to get to 33), but were so painful that I couldn’t imagine ever putting actual weight on the barbell. I stretched and whined. Whined and rolled and stretched and whined.
Enter Lynn Grimm, who is nice and patient and funny, but either got tired of hearing me whine, or really likes a challenge.
She called me one Saturday out of the blue. “What are you doing today? Wanna come be a guinea pig for an MDT training session?” I’m taking some revisionist liberties here, because I’m sure she didn’t use the phrase “guinea pig,” and I wasn’t informed enough to have remembered “MDT.”
“I think it would be really good for you,” she said. And that isverbatim.
Why not? I had allowed (nay, paid) people to crack my joints, scrape my muscles, bruise my leg, douse me with ultrasound goo, and stick hollow needles into my leg and cortisone into my hip, so how bad could it be to be a teaching Exhibit A? And what did I have to lose? Plus, I’m pretty boring and asocial, so my Saturday was wide open.
Thirty minutes later, I was standing in front of a room full of physical therapists and orthopedists at a training seminar for the McKenzie Method led by Mark Miller.
“So you have hip pain,” he said. And he asked me to move and describe the pain. He asked me a bunch of questions about when the pain started, what I had done, when I noticed it. He asked me what I had tried to do to alleviate it. I ticked off the months and attempts. By this time, it was about 15 months since the Stupid Human Gym Trick (I’m still not telling; it wasn’t that entertaining—just stupid), weeks at a time away from the gym, multiple different courses of treatment with several different kinds of health care professionals, unsatisfactory trips to an orthopedist, x-rays, adjustments, manipulations, exercises, stretches, needling, changes in shoes. Pain, co-pays, frustration, disappointment.
“Did you have a cortisone shot?” he asked.
I was so caught up in the litany of failed efforts that by this point, I had even forgotten the cortisone shot.
“So what is it that you ultimately want?” he asked.
“To be out of pain, and to be able to squat,” it seemed so simple, but I felt stuck. And I was probably close to tears.
“We’ve got to help her,” he said. “She’s tried everything, and she’s been all around town,” [and NOW I felt so very . . . promiscuous] “trying to get help.”
“Sounds like she’s had some really bad advice,” someone said. And I cringed. Because the truth was that I had gotten some bad advice and had made some stupid decisions. But I’d also gotten some really good care. I interjected: “My last therapist was actually awesome: she and her colleagues got rid of all of my thigh pain and increased my mobility. And she was honest enough to tell me that my hip pain should be completely gone, but that she couldn’t help me any more. I’m more frustrated with the orthopedist because I feel like a hot potato, getting bounced around.”
“So what’s your next step?” Mark asked.
“I guess to be able to go back to the orthopedist and tell him that I’ve tried everything, and that it’s time for an MRI.”
Lesson #7: Knives Should Be the Last Resort (and You’re Probably Not There Yet)
Remember that it was a teaching seminar, so I got to hear this awful little detail: “As frustrated as you are with the orthopedist,” he turned to the seminar participants, “why doesn’t the orthopedist want to give her an MRI?”
“Because,” he continued, “he knows that [insert a shockingly high percentage here] of people in her demographic will have some kind of tear that will show up on an MRI. And then he has no choice but surgery. And then,” he turned to me, “you’ll have the expense and pain and recovery time of surgery. But surgery might still not fix the pain.”
“Her demographic” might not have been his exact words, but I remember thinking that he had diplomatically called me “old” and maybe even “the worse for wear and tear.” And the percentage probably wasn’t, like, 300% (again, I’m neither health-care professional nor biostatistician) but I seem to remember that it was upwards of 60%. I am smart enough (and unlucky enough) to know that those odds weren’t in my favor. None of this was looking good for me.
And for the record, viewing surgery as a last resort wasn’t a new lesson I learned, but more like a shocking reinforcement of something I already embraced: I try to stay as far away from medical interventions as possible. Like, for example, the time I told my husband as I was almost passing out on the kitchen floor that we could probably just superglue my finger instead of going to the emergency room for the gaping wound that the jagged black bean can lid had gashed into my finger. Six stitches later, I realized the superglue idea was on stupid par with the Stupid Human Gym Trick that landed me in this hip pain mess to begin with. And I’m still not telling. But you get the point: if I was willing to superglue my blood-gushing finger but was now considering requesting hip surgery, I was at my wits’ end.
Lesson #8: I Owe Mark Miller an Apology in My Head
“So what would you say,” Mark asked me, “if I could give you one exercise to do for 48 hours that would reduce your pain by 80%?”
In my head, I said this: It sounds too good to be true. It sounds almost slick. Because I’ve been dealing with this for more than a year and now you expect me to believe you can fix this in 48 hours? Because in college one summer, I got hoodwinked into selling $1000 waterless cookware door-to-door simply because the guy at the top of that pyramid scheme was pretty slick, so I know slick when I hear it. And “one exercise, 48 hours” sounds pretty darned slick to me.
But I didn’t actually sayany of that because I’m more polite than that on the outside. Plus, I’d showered and driven to the seminar, and I have no social life so I really had nothing better to do with my time. I’d also tried everything else I could think of to try. What the hell? “I’d say, ‘Let’s give it a try.’”
So he watched me move some more. Asked me some more questions. Talked about derangement. Gave me an exercise. Asked me if it helped with the pain. It didn’t. He asked me some more questions. He gave me another exercise. Asked me if it helped with the pain. This one didn’t either.
I couldn’t tell whether this was amusing me that he had slickly promised one exercise but none of his exercises were working, or whether this was one more demoralizing, failed effort at trying to get rid of hip pain that was my own stupid fault.
Then he gave me another exercise. It was simple—not pleasant, but not impossible, and it was less painful than climbing stairs and sitting down had become. It required me to kneel on one knee and lean in a particular way as far as I could. And it worked. Immediately. The pain was better by at least 50%. I had at least another 3 or 4 inches of range in my pain-free movement.
Mark had me stop and talked to me (and the seminar participants) about derangement. He talked about how ball-and-socket joints work, and how they react to injuries. And he talked about derangement a little bit more.
He had me repeat the exercise. A little bit less pain. A little bigger pain-free range. For the first time in more than a year, I was genuinely, but cautiously, optimistic.
I went home with instructions to repeat the exercise every few hours for the rest of the day, and to come back for the rest of the seminar the next morning.
On my drive back to the seminar, I apologized in my head for having dismissed “one exercise, 48 hours” as slick.
Lesson #9: Try It and See
I and my substantially less painful hip got to the seminar early and sat in the back of the room. Someone else was at the front of the room. Mark reminded the seminar participants of the person’s history and the prescribed exercise.
“How do you feel now?” he asked.
“60% better,” responded the person.
I watched at least three or four other people in front of me—people with elbow pain, heel pain, back pain. All of them had been assigned one exercise. All of them felt better. OVERNIGHT.
I knew they weren’t shills or exaggerating, because I wasn’t a shill, and I wasn’t exaggerating.
So when it was my turn, he watched me move, watched me do the exercise, talked a little bit more about derangement (I was beginning to think that now he was simply being gratuitous with the term, but as long as the hip pain was abating, he was welcome to shower me with whatever thinly veiled insults he chose. And I’d thank him for it).
“What about squatting with weight?” I ventured, hesitantly, because so far every doctor and therapist I’d seen had said, simply, not to squat.
“Try it and see,” and just like that, I had a reasonable answer to a reasonable question. “If it still hurts, you may need more help,” and he told me to see Lynn, who also told me how to find other McKenzie-trained therapists. No surgery, no shots, no invasive procedures, no lifestyle or shoe wardrobe changes (although, seriously, I could use some fashion advice, but that’s another topic).
It’s odd to say that I can’t remember when, exactly, the pain stopped entirely, but it was very shortly after the seminar. Entirely gone. One exercise that I did for a week, maybe two at the most. It’s stayed gone for two years. I’m still wearing Chuck Taylors.
But if this shoulder keeps bothering me, I’m going to go have Lynn tell me I’m deranged and work some McKenzie Method magic, because bench press is the only lift that matters.
And Mark Miller PT, Dip. MDT, better watch out the next time he’s in New Orleans, because I’m gonna bear hug him out of gratitude. I’d squat him just for fun, but that would violate Lesson #1, and I’ve learned that lesson the hard way.
You know what I am going to say..."Everyone Deserves A Good Mechanical Assessment and Treatment Plan!" Visit grimmpt.com or call 504-228-0524 to set up you evaluation today.
|My Bad! I thought you wanted to get better quickly...|
|Sun, 09 Nov 2014 00:03:00 +0000|
It is difficult sometimes when you are able to diagnose a painful problem and teach someone how to abolish their symptoms in an incredibly short amount of time. In fact, it is probably going to take some kind of major shift in our thinking to truly accept this.
|MDT and CrossFit go together like Rama Lama Ding Dong|
|Sun, 02 Nov 2014 13:10:00 +0000|
Click here if the video does not load.
The McKenzie Method® — Mechanical Diagnosis and Therapy® is a philosophy of active patient involvement and education that is trusted and used by practitioners and patients all over the world for back, neck and extremity problems. This type of evaluation can uncover rapidly reversible conditions. Once the syndrome is uncovered by the practitioner, the directional movement preference is found, then you are taught how to actually treat yourself!
CrossFit is an inclusive fitness program utilizing "constantly varied, high-intensity, functional movement." This leads to health and fitness. If performed correctly this occurs in a relatively short amount of time.
If we all knew how to treat ourselves, and how to stay physically and mentally fit, we would instantly solve the healthcare crisis that is occurring today!
That is why my office is located inside a CrossFit gym. Since both methodologies produce rapid results, I think they go together like Rama Lama Ding Dong!
You know what I am going to say: "Everyone deserves a good mechanical evaluation and treatment plan!" Come learn how to treat yourself by scheduling an appointment today and check out the CrossFit box. Visit grimmpt.com or call 504-228-0524.
|Wake Up and Smell the Cafe Au Lait! A Story of Co-Pays and a Cash Based Service|
|Sun, 26 Oct 2014 21:27:00 +0000|
I work in two settings. Two days a week I work in a busy orthopedic setting where I see a patient every 1/2 hour. I have a waiting list of people to see me there for a few weeks. Why? Because I get results quickly. However, this isn't about me per se. This is about billing, co pays and the McKenzie Method® Mechanical Diagnosis andTherapy® (MDT): evidence based assessment, diagnosis and treatment for the spine and extremities. Two days a week I work in my solo practice at Grimm Physiotherapy. I really love working in both settings.
Here is the rub. In the busy orthopedic setting we accept and bill insurance (a team of people are responsible for billing and collections). We don't accept every insurance but just a few plans. If you have a co-pay of $75.00, $85.00, $95.00 or more ( I have seen the spectrum), you are expected to pay this for every visit. Sometimes we spend part of your 1/2 hour debating the co-pay, but it really isn't up to us. This just cuts into the allotted time we have to spend on your healthcare. You may or may not get the opportunity to see me, a credentialed MDT physical therapist, but you may see one of our Physical Therapy Assistants, or have our Physical Therapy Technician help you with a few exercises, just like other traditional PT clinics.
Now at Grimm Physiotherapy the first visit runs $120.00 for evaluation, and $60.00 for one-half hour follow up care. You get me, a credentialed MDT physical therapist, one on one for your entire visit. There are 30 - 60 minute appointments available depending on your needs but generally follow up visits run about 1/2 hour. I do not use aides, technicians, or assistants to manage your care. I don't double book or dove tail treatment sessions. You get to see me every appointment to improve the continuity of your care.
Back to the dollars or numbers...If you see me at Grimm Physiotherapy 5 visits you would pay $360.00 (+ or -) out of pocket and you possibly could get reimbursed by your insurance company or apply it to your deductible. If you elect to see me in the orthopedic clinic and you have a high co-pay, you may have to pay $ 475.00 (+ or -) out of pocket and you may or may not get to see me for your treatments. Are you getting the drift now? This doesn't even include all of those appointments you paid cash for including massage therapists, chiropractors, and wasted time with other non-MDT clinicians. Imagine the cost of going to other non-MDT chiropractic and physical therapy clinics who book you 3 times a week for at least a month. Imagine how much money that would be out of pocket.
Do you want effective inexpensive healthcare? Do you want to see your healthcare practitioner one on one for an hour? This is what you get at Grimm Physiotherapy. I know, it is the way healthcare used to be, but with all the regulations, paperwork, and red tape you have to go through in a traditional settings this is getting to be rarer and rarer these days.
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 yours today.
|Low Tech vs. High Tech Treatment Options for Pain|
|Sun, 19 Oct 2014 22:58:00 +0000|
Let's just say that my practice is as low tech as it gets... So when you are done with the High and Low Tech treatments that don't fix the problem, then check out the McKenzie Method® Mechanical Diagnosis and Therapy® (MDT). MDT is evidence based assessment, diagnosis and treatment for the spine and extremities which is the preferred practice here at Grimm Physiotherapy. MDT equally well in rural communities that don't have the high tech treatments listed below.
Just for fun, let's look at just a few high tech ways to diagnose and treat low back, neck and extremity pain in the greater New Orleans area...
High TechPlatelet Rich Plasma Injections
Lumbar Transforaminal Epidural Steroid Injections
Cervical Facet Medial Branch Blocks
Lumbar Facet Radio-Frequency Denervation
Cervical Facet Radio-Frequency Denervation
Cervical Interlaminarl Epidural Steroid Injections
Cervical Transforaminal Epidural Steroid Injections
Caudal Epidural Steroid Injections
Ultrasound Guided Injections
Transcutaneous Nerve Electrical Stimulation
Sacroiliac Joint Arthrogram
Magnetic Resonance Imaging
Tramadol (brand names Rybix, Ryzolt or Ultram)
Medrol dose packs (methylprednisolone)
Tylenol with codeine
Yikes! Do I need to go into the side effects and complications from these procedures and medications? Probably not, since most of them are discussed at length in TV commercials for medications and lawyers.
No wonder our healthcare system is bankrupt!
Now for a few examples of:
IceYou know what I am going to say..."Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!" Visit grimmpt.com or call 504-228-0524 to schedule your assessment today.
You know these all feel good. I enjoy them all on occasion, but they just don't get to to the root of the problem like the McKenzie Method® Mechanical Diagnosis and Therapy® (MDT) does.