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Mind Body Physical Therapy http://mindbodyphysicaltherapy.com Rachel Katz, Boulder CO Physical Therapist Tue, 02 Apr 2019 16:43:26 +0000 en-US hourly 1 https://wordpress.org/?v=5.1.1 REHAB RANCH http://mindbodyphysicaltherapy.com/2019/03/rehab-ranch/ Mon, 18 Mar 2019 00:35:13 +0000 http://mindbodyphysicaltherapy.com/?p=934 Rosie is one of our calmest horses

For the first time in many years, I am taking time to reflect on what could be possible for rehabilitation and personal growth here on the ranch. Or as a friend calls it, the “ranchette”. I am interested in working with people who want to improve their confidence and self-regulation skills. My horses are part of what I consider my team and my teachers.

I think it’s time to offer some kind of structured horse encounters that do not involve riding. The whole point is to explore the confidence- insecurity dynamic in a way that feels safe.

If you are interested, reach out.

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NEW Fibromyalgia chronic fatigue self help, regulation http://mindbodyphysicaltherapy.com/2016/05/new-fibromyalgia-chronic-fatigue-self-help-regulation/ Fri, 13 May 2016 01:19:11 +0000 http://mindbodyphysicaltherapy.com/?p=896

I’ve been working on creating a short instructional program on self-help for you if you have fibromyalgia/chronic fatigue.  Tapping into yourself can be very hard, mysterious, and downright intensifying of symptoms. Some mindfulness approaches are too difficult to do when there’s so much pain and de-regulation.  Also, learning can be overloading because your mind is foggy. Here are 3 quick ways to begin on a path to strengthen calming and pain reduction.
And if you are interested in more ways to help yourself, there’s something coming on this soon.

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Research shows you can change a PTSD memory http://mindbodyphysicaltherapy.com/2016/02/research-shows-you-can-change-a-ptsd-memory/ Tue, 16 Feb 2016 16:23:52 +0000 http://mindbodyphysicaltherapy.com/?p=892

PTSD symptoms from an accident or from an overwhelming situation involving fear can continue to surface long after the event(s).  Getting the fear to stop surfacing is a primary goal in healing.  Research is showing that there is a period of time from 10 minutes to 6 hours after a memory resurfaces within a safe setting that is really helpful for settling down and reducing or eliminating the intensity of a persistent fear response.  This is called a reconsolidation window.

The body’s muscular response to a situation like a car accident in which bracing and protective actions occur, should be addressed as part of altering memory for the better in healing PTSD.  The brain stores different kinds of memories in different parts of the brain.  Muscle patterning is best addressed when the muscle pattern linked to a fear memory is carefully brought up in a safe therapy session for reprocessing.

Some of the best therapists for addressing movement patterns linked to fear may be a rare group of Physical Therapists who are also trained in these methods. Having trauma healing training in a body of work called Somatic Experiencing plus a Physical Therapist’s knowledge  of the body can greatly help clients . This combination of training can give powerful, natural healing, long-lasting results with muscle responses to fear, and stress.

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Physical Therapist and client in partnership http://mindbodyphysicaltherapy.com/2016/02/physical-therapist-and-client-in-partnership/ Mon, 15 Feb 2016 16:54:56 +0000 http://mindbodyphysicaltherapy.com/?p=890

Sometimes it’s expected that the PT will know what’s wrong and the PT will direct the process to get you out of pain or guide your healing.

But, it’s also really important for the person seeking help to be an active part of the process.  This may mean you have to spell out for the PT what you know about your condition, how it impacts your life, and what you’ve tried or are currently also trying in addition to PT.

In my clinic, I like to help clients regain an internal sense of what is going on with their body.  It may mean that we work together to bring back a clear sense of what is moving and how it feels to control and guide motion in the back for example.  Having a sense of motion can  also mean learning how the foot and ankle position and support what is happening at the knee. Or, for someone with abdominal pain issues that stem from the gut, this process may involve regaining an ability to literally inhabit a particular space within the body’s interior.

The dynamic of PT and client input back and forth is a guided and exploratory investigation into regaining one’s senses.  This enables strengthening to be in correct movement patterns.

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LOW BACK PAIN DESPITE SURGERY http://mindbodyphysicaltherapy.com/2016/02/low-back-pain-despite-surgery/ Tue, 09 Feb 2016 16:58:56 +0000 http://mindbodyphysicaltherapy.com/?p=886

It is great if you’ve had back surgery that resolves your back pain and you can do what ever you want comfortably.  But, often after one or even multiple back surgeries, back muscle fatigue is chronic, and the ability to move however you want is compromised.

One of the frequent issues I see in clients after  back surgery is a subtle, but important to correct. loss of muscle length in the hip flexors.  This puts a person in a slight (or sometimes more pronounced) tip forward at the hips.  This then makes the low back muscles work constantly when upright instead of sharing the effort or being up more evenly through core muscles and structures.

When you are standing up you need to relearn how to get all the way up onto the top part of the ball of the hip socket.  You will need to re-learn how to fire the gluteal muscles and use their action to inhibit the tension in the hip flexors.  Often a person needs some hands on help to learn this, and or get help stretching out chronically tight hip flexors.

Then, you can make use of this good positioning in normal actions like walking.  It really takes a load off your low back muscles and makes them part of a team of support.

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Tackling the Evidence Elephant in Chronic Pain Research http://mindbodyphysicaltherapy.com/2015/10/tackling-the-evidence-elephant-in-chronic-pain-research/ Thu, 29 Oct 2015 04:25:05 +0000 http://mindbodyphysicaltherapy.com/?p=873

Good morning.  Coffee is in hand, and I’m wanting to quickly make a few comments about the complex topic of addressing treatment evidence in treating chronic pain.  First of all I want to point out that the very nature of this topic starts my mind glazing over even with the presence of delicious coffee in hand.

I’m not a statistician.  Even reading articles that delve into evidence and measures is tough for me. I am much more inclined to think about effectiveness in terms of what I experience in my clinic, directly.

So, I want to point out that there is a good article in the August 2015 APTA ( American Physical Therapy Association) Journal on this very topic titled Interpreting Effectiveness Evidence in Pain: Short Tour of Contemporary Issues.

Here are a few ideas from this article which you may find valuable in your practice.  There are 2 terms to be aware of.  One is efficacy which addresses clinical trials in optimum conditions.  The second one is effectiveness which is about seeing if something works in the real world which is your clinic.

The body of the article delves into the specifics of the complexities and reasons why clinical trials rarely give us any concrete clarity in treating chronic pain. I can’t clearly summarize that discussion well enough to try. If you want that level of mental engagement read the article.

What I love is the acknowledgement that the holy grail of clear evidence of efficacy and effectiveness is not going to show up anytime soon in the field of chronic pain treatment.  And I’m not going to wait around for it either.  That’s just the nature of it and it is reasonable to accept that you can’t wait for the evidence to show up to engage in efforts to improve treatment outcomes.

One measure that is useful is what’s called a minimally clinically important difference (MCID)1. Another is smallest worthwhile effect (SWE)2 that a patient is happy with. Your clients who have been through many other significantly underachieving treatments serve as their own control.  Their symptoms have endured as largely unchangeable. You are the provider who will guide them over the significance threshold.

These measures are individualized and reflect real perceived improvement in a clients quality of life in dealing with their pain.  A general range of relevance is at a minimum 30%.  This is acknowledged to be an arbitrary cut off.  If a client is in a severe situation, perhaps for them even a 20% noticeable reduction is an important milestone.

When you work with chronic pain conditions, you may be seeing clients who have been through other interventions and seen by many other providers. Some of those providers may also have been Physical Therapists.  You can get some idea of what else a client has previously tried in your history and their narrative.

This enables you to make a clinical decision that might take you into new territory.  You would be justified in not taking your client back through previously  presented therapies. Try something else.   The suggestion of the authors of this article, is to at least have a solidly based “biological plausibility” for what you do. Secondly they suggest limiting possible interventions to those with “rigorous evidence of effectiveness”.

Now unfortunately, you are right back where you started from with the failures of research to be able to provide  the “rigorous evidence of effectiveness”. You can keep learning and observing working towards MCID and SWE.

I believe that what you observe and create for healing in your clinic can be identified in the terms of MCID and SWE concepts.  Clients who invest their time and money to be treated don’t stick around if they aren’t getting a measurable improvement.

The article ends with comments that we need to maintain a level of dispassionate observation, acceptance of our own biases, and an eye to evidence.

I will end this note sharing a quote from the article. Epidemiologist Archie Cochrane says ” …be delightfully surprised when any treatment at all is effective, and always assume that a treatment is ineffective unless there is evidence to the contrary.”3

Your clinic is your vital stage for creating significant healing in your toughest cases.  At the end of the day what provides your deep satisfaction is feeling inside yourself that you have made a difference in a profound way for someone who is suffering.

If I can help you do this better, then my goal of sharing forward what I’ve learned is being achieved.

Thanks for taking your time to read this.

Rachel

1) Jaeschke R, Singer J, Guyatt GH. Measurement of health status: ascertaining the minimally clinically important difference. Control Clin Trials. 1989;10:407-415.

2.)Ferreira ML, Herbert RD, Ferreira PH, et al. A critical review of methods used to determine the smallest worthwhile effect of interventions for low back pain. J Clin Epidemiol. 2012;65:253-261.

3.) Cochrane AL. Effectiveness and efficiency: random reflections on health services. Published June 1, 1972. Reprinted 1999. Available at http://www.nuffieldtrust.orguk/publications/effectiveness-and-efficiency-random-reflections-health-services. Accessed March 29, 2015.

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Comments on Theoretical Considerations for Chronic Pain Rehabilitation in APTA Journal http://mindbodyphysicaltherapy.com/2015/10/comments-on-theoretical-considerations-for-chronic-pain-rehabilitation-in-apta-journal/ Sat, 03 Oct 2015 23:22:43 +0000 http://mindbodyphysicaltherapy.com/?p=868
The APTA Journal’s September 2015 issue had a great article on Theoretical Considerations for Chronic Pain Rehabilitation by authors Martin Lotze, and G. Lorimer Moseley.
How very timely for the above article to come across my desk.
I will briefly summarize the points in it for you.
There is a new paradigm developing in the field of chronic pain relevant to Physical Therapy treatment.  The explanation is changing from a model based on structural-pathology to altered perceptual processing.
In the altered perceptual processing model, pain signals are associated with the perception of a need to protect in some manner. There is a shift towards understanding the pain issues in danger versus safety constructs.  This model certainly has validity for some kinds of chronic pain.
The article discusses the need for clinicians to be much more attuned to:
1.)  Clinician observations and recognition that behaviors and dialogue reflect neural representation. ( i.e. What you see and observe can add to a cohesive sense of what the client’s brain is processing in relationship to their pain.)
2.)  Clinical inquiry into the patient’s framing of their pain in a biopsychosocial manner. This ties into a need for improving the client narrative aspect therapy.
3.) Then, as clinicians we are to attend to the importance of our relationship with the client. We help redirect and create measures of safety.  We are to help reduce the client’s need to protect which is associated with their pain. We need to include education about their pain, “Explaining Pain”.
The “Explaining Pain” model seems to me to be a very concious process of mental reframing to quell pain signals. This is a top-down approach.
I recommend also including my methods of bottom-up processing involving restoration of the perception of safety in a manner uniquely relevant to each patient.
The authors note that there may be maladaptive neuroplasticity involved “…whereby body-related neural representation become less precise, an abnormality thought to be important in some of the multiple system dysfunctions that are seen in people with chronic pain”.
This article supports in a clear way the need for new ways to interface with our clients for treatment.  It does not talk in specific ways how to accomplish the above. And, if you’re like I was as I began to delve into these concepts, I really didn’t know how to get started doing something different in my clinic.
The manual therapy methods I will be sharing directly relate to rehabilitation of maladaptive- neuroplasticity which I usually term negative neuroplasticity.  There is more info on negative neuroplasticity coming up in later segments of the lecture you will shortly have access to.
Are you interested in addressing concretely how to do a better patient narrative, how to work with issues of safety on multiple levels, how to evaluate and therefore “see”  what’s in front of you better, and how to sort out what is a right course of rehab for chronic pain?

Please feel free to send me clinical questions. I work so much better when I have something specific to address.

Warm regards,
Rachel

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Pairing calm emotion with face muscle movements http://mindbodyphysicaltherapy.com/2015/08/pairing-calm-emotion-with-face-muscle-movements/ Wed, 19 Aug 2015 15:11:36 +0000 http://mindbodyphysicaltherapy.com/?p=854

I don’t know if this will help you but it may be worth a try at times. The research is that you have emotions that will affect your body’s muscles and the muscles can effect the emotions. It’s a 2 way street. Sometimes you can’t stop being stuck in what’s negative. There isn’t a simple switch. But, this is a way to explore something positive and link positive-helpful emotions with muscle activity to improve muscle length, elasticity, and reduce excess muscle tension.
When you’re really stuck with painful muscles or tight muscles and you are aware that you also struggle with stress or challenging emotions, it is often a tough situation to change. Positive changes may be so small as to be almost un-noticable. Still, if you are trying to resolve a tough pain situation, you need to include exploration and curiosity as part of the process of healing. If your situation is really difficult I don’t want to imply that holding a pencil in your mouth to simulate a smile or this silly video is going to radically and permanently change a thing. But, let me know if this is at all helpful to you.

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Concussion and Eye function Recovery http://mindbodyphysicaltherapy.com/2015/03/concussion-and-eye-function-recovery/ Tue, 03 Mar 2015 00:26:38 +0000 http://mindbodyphysicaltherapy.com/?p=837

I recently had a concussion. Of course I want to get better as fast as possible. I am using the skills I know to help others, to help myself. My route to rapid recovery may help you to understand ways to either help yourself or someone else.

One problem area for me was difficulty focusing my eyes. Normally both eyes work together. It’s as if a person has a flashlight beam coming from each eye and they meet up together, either close in front of your face, or outwards at a distance. My “beams” weren’t coming to the same point in space. It was as it they could come near each other but never met. The effort in my eye muscles was considerably higher than normal just to get my eyes to work somewhere close to optimal….but not making it. There are several technical names for this problem. One is convergence insufficiency.

This failure of the eyes to be able to aim to the same place can come about from a brain injury. It can also come about from a response to a dangerous or traumatic situation.

In my particular situation, I was standing on the grass by the country road by my front gate. I’d just gotten off my horse because he was acting spooky from the wind. After settling him down somewhat, I became distracted by a conversation struck up by a passing neighbor. I was looking at Bob. Something spooked my horse and he jumped right into me. I caught the motion of his rapidly oncoming black shape from the periphery of my vision.

A person’s brain has a mode of operation that is all about monitoring the world for danger. When this mode is intensively and instinctively switched on, it can cause each eye to work independently of the other eye. The eyes separate into very wide, divergent gaze. This kind of eye function enables a bigger field of view. The widening of the eyes to the sides broadens the ability to perceive and react to danger approaching. Good response for the danger situation but a bad state to be stuck in for normal eye functioning which requires focus and convergence.

In my situation, it helped me to notice trouble coming my way, fast. My hands flew up in front of me in enough time to keep a little space between my horse, Sharouf, and myself. But, his thousand pounds was too much for my balance ability. I went over backwards slamming my head into the ground. It felt like I was a quarterback getting sacked in the NFL. And I have no business being out there in a NFL game.

It is possible that my subsequent eye fatigue and trouble focusing was due to the concussion I got. I also thought it was possible to be from the danger-alert-function of my brain. Correction of the danger-alert system is the “low hanging fruit” in the recovery process. It is not about resting and waiting for the brain to recover although that is certainly a component of concussion recovery.

Correcting the stuck danger-alert mode involved processing the danger in small chunks, and re-establishing a felt sense of movement in the upper neck joints, the eye tracking ability, the balance ability, and a re-write of my memory of the event to create more protection then I actually had.

There are many ways to therapeutically modulate a frightening memory into one that is less overwhelming. One way to increase a sense of safety and protection is to be larger. While doing a therapy session processing the loss of my control by being struck, I imagined I was that huge blue horse statue that “greets” arrivals at Denver International Airport. I don’t particularly like the sculpture, but it sure worked to help me imagine being so big that my horse bounced off me instead of the other way around.

Feeling myself able to stand my ground increased my feeling of safety and protection. This helped my instincts to finish up the behavior saving me. I paid attention to the feeling of my eyes re-organizing back into normal paired and focused vision. Creating and supporting a sense of safety helps the body complete movement patterns. That was important for my eyes and head. More of the lingering muscle spasm, tension, and strain resolved, leaving me that much closer to fully recovered.

I had help to do the above therapy work from several sources, and from my own understanding of the process. And, it really helped get my eyes back on track.

In a nutshell, here’s what I did.
Chiropractic 2 times to help reduce muscle spasm in upper neck/head muscles that clenched my head onto my neck in a position off to the side.
Practice of protective reactions multiple days either by myself or with gentle support to my head and neck. Actions like feeling my hands come up, feeling my eyes separate, adding in better defenses then I really had, feeling the fear and freeze up reaction cycle through several times all were part of speeding up my recovery.

Hope that helps you understand some ideas about recovery from concussion.
Rachel

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Central Nervous System Regulation and Bad News http://mindbodyphysicaltherapy.com/2015/02/central-nervous-system-regulation-and-bad-news/ Tue, 03 Feb 2015 16:46:22 +0000 http://mindbodyphysicaltherapy.com/?p=830

If you are someone who receives very bad news about someone you are very close to like a family member, you may experience feelings of distress or even panic. If you are someone who already has a challenged ability to cope under duress, it can become very difficult to get yourself settled down so you can think with some clarity. In this short clip, Rachel helps show ways to help settle back down out of a panic feeling. If you are someone who has a brain injury, or PTSD, or lives with a moderate amount of pain daily your nervous system may already be vulnerable to easily becoming more upset. This can show up as high agitation or the opposite state, overly shut down or depressed. Either way, helping re-establish better self regulation is key.

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