Physical Therapy and The Magic Loogie

The Hipster Doofus

Magic Bullets and Magic Loogies

SUBJECTIVE
I’m on the second leg of a trip home from Indianapolis. Should land in about 30-45 minutes. I’ll be glad to be home. I went to a very good and informative course on the ASTYM system. I sat and completed it’s certification. It’s a different type of manual therapy designed to introduce irritation to an area to allow for healing of the tissues. Much like the way a vaccination helps prevent the flu, or chicken pox, or polio. The idea behind the system is very neat. In my opinion, there are very few new ideas in physical therapy. It’s all renewed interest in old ideas and a change of presentation. But this….this was new. The potential, in theory, is very neat. The ASTYM people were quick to point out that this treatment philosophy was not a stand along procedure. It was meant to be performed alongside other treatments, especially exercise. Orthopedically speaking: one thing is not going to get any one person better. Healing does not occur in isolation.

OBJECTIVE
One of my favorite episodes of Seinfeld is the Keith Hernandez episode. Before he sold Just For Men, he did a bit role in the early 90s on Seinfeld as a new friend of Jerry. They did a few things together: movies, dinner, and such. But Keith asked Jerry to help him move. That’s a big thing between guys. The only friend I’ve ever asked to help me move was my best friend and we’d known each other 20 years before I was comfortable enough to ask him to do that. Anyway, Kramer and Newman didn’t like Keith Hernendez because of an incident after a Mets game. They were under the impression that Keith hocked a loogie at them after harassing him because of his performance in a baseball game. Jerry maintained –and demonstrated– playing from the Oliver Stone JFK movie, that there was no way Hernendez spit a loogie that hit both of them, as the loogie would have had to made a 90 degree turn in mid-air. Jerry’s final statement, “That’s one magic loogie.”

Many therapists out there purport to have a magic loogie. It doesn’t exist. Each condition that is appropriate for physical therapy, requires, at the very least, some form of exercise (whether it be strengthening or stretching) and some type of hand’s-on therapy.

ASSESSMENT:
Evidenced based practice shows that these are the only two things (manual therapy and exercise) cause lasting effect. I’ve got lots of things that make you feel better. I’ve got a bag of tricks that will work on virtually every condition that walks in the door. Heat, electrical stimulation, and other modalities are like the spice rack in your kitchen: a soup is soup but the addition of salt and pepper makes it all go down nicer. The modalities aid in helping make the treatment more effective but they don’t cause lasting change.

PLAN
The appropriate amount of exercise and manual therapy will get you there. But that exercise program….you have to keep doing it. For the rest of your life? I don’t know. You need to keep doing it for a while. The ASTYM system that I learned about this weekend, I’ll work it into my practice, but it won’t be the sole thing on which I base anyone’s treatment. Remember there’s no magic loogie.

My Own Laser Gun.

The Man.

SUBJECTIVE
When I was little, Star Wars ushered in this whole science fiction thing for me. Star Wars was it! I couldn’t get enough. Yeah, I had little diversions here and there: I dabbled in Buck Rogers, I had a few Micronaunts, a friend of mine had some neat Star Trek toys, but I always stayed true to my Star Wars toys. I had (and still do –they’re in my office at the clinic) almost all of the figures. As best I remember there are about 3-4 that I don’t have. I’ve made a contact in the last year of someone who inherited a collection of Star Wars figures through a divorce. She’s wanting me to help her unload them and told me I had first dibs on the figures I wanted. Anyway, I loved the “little men” as my mother called them, and I also loved the role-play toys as well. I had a light saber, I had a copy of Han Solo’s gun.

Well, 30 years later, I have a real laser gun at the clinic.

OBJECTIVE
I’d resisted buying the laser for almost 6 years. The local rep who sold us most of our equipment had been harping on this thing for a long time. At the time I had other equipment that I wanted. The business was just taking off. Another investment just wasn’t what I was wanting at the time. Well last month, Patrick (the rep) finally convinced me to try this thing out. He brought us lunch, set up the machine, and let us play with it. He “inserviced” us on uses of the laser: shoulder impingement, headaches, plantar fasciitis, muscle spasm, fibromyalgia, and pain from shingles. Shingles? Shingles!

Dynatron Laser

Some of you know this but on occasion I have a minor bout with shingles here and there. That’s a story for another day. But relating to this story, I was currently having an issue in my left forearm.
So I self treated.
During the inservice.
Three 30 second zaps.
Holy cow.
The pain was gone in 30 minutes and hasn’t been back since.

Needless to say, we bought the machine and have used it on just about everything that walks in the door. Right now we may be overusing it because we’re assessing what conditions it’s effective on and which ones it is not. The only thing I’ve seen truly that it is a no-go on is hip bursitis. At least on the 2 clients with which we used it, there was little change.

ASSESSMENT:
Low level laser therapy sends energy through the skin to about 1 ½ to 2 inches deep. This is a deeper heating mechanism than any other physical therapy modality with which I’ve worked. The laser has 4 diodes on it that produce a red light that penetrates truly down into the muscle, ligament, nerve, or bone. In damaged tissue, it brings blood to the area and stimulates the blood’s healing properties in that area. It’s effects on wounds are incredible. We’re using it on surgical incisions –such as total knee incisions– and it speeds them along nicely. I’ve witnessed it reduce a hard as a rock spasm in a woman’s neck into soft, normal muscle. I’ve got another woman who’d been planning and canceled (it was scheduled for this week) a surgical procedure for plantar fasciitis because the Laser had helped her. We’re even using it helping to increase shoulder and knee range of motion after surgery by teaming the treatment with stretching and hand’s on treatment. The main thing that the FDA approved it for was carpal tunnel syndrome. We just haven’t had a carpal tunnel client walk in the door in the last month. But I’m itchin’ to try.

PLAN
All that being said, low level laser therapy is not a cure all. There is no magic bullet. The laser is a tool that, when used along with manual therapy and exercise, helps speed along healing and rehabilitation. I will tell you this: I’ve never been this excited about a modality we use in the clinic. It has virtually no contra-indications. It’s painless. You might feel a little heat with it but that’ all. The effects aren’t immediate (except with that muscle spasm). It usually takes 3-4 treatments for the laser to do what it needs to do (although my Shingles treatment was). This thing works.

And I’ve got my own laser gun.

Becca’s Wedding and the Power Button

Subjective:
Today I’m going to the wedding of one of my oldest friends. Becca Gardner will be –later today– Becca Green. She’s planned this thing down to a “T”. Jenny and I made the trip to Mount Magazine yesterday evening to stay at the Lodge with the Gardner Clan and were able to see and visit with all of the Gardners over wine, cheese, summer sausage, and goldfish crackers. Exactly my kind of evening.

Objective:
I’ve always felt a kinship to this family. Back when Kristi and I double dated with Natalie Gardner and her boyfriend John back in the early 90s, I got to know Nat very well and as a consequence her family. I went to several Gardner family dinners at the Villa and at Outback (with and without Kristi as she and I drifted apart). But Natalie and I remained friends through college and our professional lives.

Becca and I got to be “tight” so to speak when I came home from college to do my internships (there was no need for an apartment in Conway then). Some of Becca’s friends had gone off to college, all of my friends were off at college. We began to run around together some. She was her own person to me at that point. Prior to, she’d always been Nat’s little sister. We went to movies together, we went to dinner some. We went to see “Legends of the Fall” (three hours of my life I’ll never get back) and we saw “Pulp Fiction” together. Hell, after I was “real” –licensed to practice physical therapy– and had an apartment again in Little Rock, Becca had a key to my apartment. She worked around the corner from the Waterford and wanted some place to go at lunch. I told her to make herself at home. 3 years later when I was moving out of the apartment and into the house with Jenny when we got married, I found a box of tampons Becca had hidden in the apartment.

Jenny just asked me my first memory of Becca. I’ve got several but the thing that sticks out is that sometime during her 15th year, Becca asked if she could drive my car on her 16th birthday. Well, on that day she reminded me of that. Without hesitation, I was good to my word. As we were leaving Trace Creak Country Club in Benton, I handed her the keys. I had a Plymouth Laser back then. It was the Plymouth version of the Mitsubishi Eclipse. We walked towards the car and I handed her the keys. Kristi –who wasn’t going to ride with us in the first place– asked where we were going. I told her. I wouldn’t let Kristi drive the car because she liked to press the “Power button” which gave the car more power for hills and such. Really it just ran more gas out of the tank. So I banned Kristi from driving it. Well, Kristi had a fit because I wouldn’t let her drive it, but I’d let a newly licensed 16 year old drive it.

Assessment:
I’m very proud for Becca and John. May they have a wonderful life together. She’s a very deserving young woman. I’m sure the wedding will be beautiful and that the Bride will look stunning. May God bless them and give them many years of happiness together.

Plan:
Today Jenny and I will enjoy the festivities associated with the wedding. There’s a reception immediately following, a hayride, and then a “toddies and s’mores wedding afterparty. The kids are at home with the grandparents. Woohoo! I don’t have to give a bath tonight! One hour to the wedding. Time to put on the tie.

APC

My Instructor Wasn’t Chelsea Hightower.

SUBJECTIVE
I watch Dancing With The Stars, with only a slight bit of guilt. It’s not the most manly show on TV, but I watch it. I can tell you several reasons including seeing the dancers, watching the girls in the skimpy outfits, hearing the judges skewer some D-level celebrity who is tyring to make a comeback and get to C-level. But that’s not it. I have a legitimate interest in the show. A few of you know this: during my “lost”summer, I took ballroom dance at Fred Astaire Dance Studio in Little Rock.

OBJECTIVE
Ashli and I’d broken up in May of ‘97 and I was yet to meet Jenny until November of that same year. I call it the lost summer because I was trying to figure out where my life was going. I’d reconsidered several things in my life back then. Got rid of a car to get memories out of it. Looked into a different career –I thought about going to Osteopathic school. Dated around. Almost bought a condo. And….I took ballroom dance. Some old girl that I dated a couple of times –I can’t remember who– took me to a “bring a guest” night at Fred Astaire. She wasn’t taking dance from Fred Astaire but a friend of hers did and would get free lessons if we went with her. It just so happened that the day before I’d watched “True Lies”.

That night at Fred Astaire, I saw some couple do the Tango. I can do that. Well, I really did think that.

So when they hit me with the sales pitch –by a cute dancer that would be my professional partner– I signed up. I’m sure I was swayed.

Those of you who know me well, know that my rhythm is about as good as the rhythm method of birth control.

They tried me with the Foxtrot, the Tango, The Waltz –on these, I did okay. However, the Latin Dances were bad. Finally I told Tracy Garalde (my instructor) that I wouldn’t do Latin Dance anymore. I couldn’t separate my hips from my shoulders, something I hear the professionals on Dancing With The Stars say to the “Stars”. I decided to cut my losses and focus on the other dances. While I practiced, my rhythm was okay. Going 2x a week, I did okay keeping time with the music. If I missed a session, it showed. As I type this former Senate Majority Leader Tom Delay is dancing on the TV and counting his steps. Huh, that looks familiar. The Tango that I’d wanted to learn never took off, the Foxtrot, was a little better, the waltz was okay. However, my specialty was the Hustle. I can still do this one. Without counting.

ASSESSMENT
I enjoyed it. I liked dancing with the various ladies –believe it or not– I was the youngest enrolled. The money however began to force me out. I’d begun to get board with it after about 6 months. Oh and I’d met Jenny: someone much better to spend my money on.

Well one night, Jenny and I went to a dance with the Saint James Methodist Singles Group. While dancing, Jenny asked me “why aren’t you leading?” “I told her I thought that I was.” So there you go. 6 months of ballroom dance and I thought I was leading the whole time.

PLAN
So Jenny and I laugh about this still. I can still do the Hustle. I’m pretty good at a few other steps: washing the dog, the sprinkler, the lawn mower and the grocery cart. Don’t worry, I’ll spare you having to see them.

Moving On Up, A Quarter Inch At a Time.

SUBJECTIVE
This past week at the clinic I treated a lady who’d had a hip replacement done back in January, and to quote her, “It’s just never been right.” This lady, we’ll call her Weezy, is active, loves to garden, does lots with her church. She’s a busy septagenerian. In general, she’s in good health. That hip has been her only issue, health-wise. The typical course for a hip replacement is groin pain on the affected side, and functional deficits such as walking, getting in/out of chairs, and trouble with daily function.

OBJECTIVE
Weezy was disappointed with her hip replacement. The hip pain was much better, but as she said, something wasn’t right. She related that she could get up and down better, she could walk better, and was active in the church again. As a matter of fact in 3 weeks she was going on a seniors trip to Branson. She was functional again.

After gathering a history, the investigative process began. The active motion in her new hip was what was expected, but the strength in her hip and knee was a little weaker as compared to the unaffected leg. Gait however was another story, Weezy still walked with a pretty good limp. Her balance was decent. On postural inspection though, the left (surgical) hip was shorter (about a 1/4 inch) than the right. I quizzed her on this and she swears that her left leg wasn’t shorter before surgery.

ASSESSMENT
It’s not atypical for a leg to be shorter after a hip replacement. It’s also not atypical for someone to never know that they have had one leg shorter than the other all of their life. With Weezy, I don’t know which came first, was this leg shorter all of her life? Or was it shorter after the replacement? What I do know it that I put a 1/4 inch heel lift in her left shoe and the limp went away. I also know that she tells me that she immediately felt better while getting around and walking and moving. A quarter inch isn’t much to look at. But as the survivor of a cracked foundation under my home, I can guarantee you a quarter inch means a bunch to everything on top of that quarter inch difference.

PLAN
Physical Therapy promotes simple solutions to complex problems. If something is tight, we stretch it. If something is weak, we strengthen or stabilize it. Not every leg length difference needs to be corrected. The ones that have been present for the majority of someone’s life, I leave alone, but the ones that are somehow new need to be investigated and treated.

Adam

Weezy Jefferson

Kramer and Frodo on the Forefront of Healthcare Overhaul.

Subjective:
Sunday morning at the Carson House. We stayed home from church today. I’m watching Fellowship of the Ring on TNT. Loved the books. Before the movies came out, I’d read the Lord of the Rings series 3 or 4 times at least. 6th grade. Sometime in junior high. College. Then before again before the movies came out. I vaguely remember reading them during my lost Summer before I found Jenny. That’s another story. Anyway, I tuned in this morning just before Gandalf was lost in the Mines of Moria. Frodo comments to Gandalf that he wishes the ring had never come to him. Gandalf’s response was that “So do all that live to see such times. But it’s not for them to decide. All that we have to do is decide what to do with the time that is given to us. There are other forces at work in this world besides evil.” As I remember the movie came out over the Holiday Season in 2001. I also remember “all that live to see such times” getting lots of attention back then because of the events of September 11th. We still live in “such times”.

The such times statement is powerful. But here’s the thing: we always live in such times. There’s always something going on. In the last century –1900– bad things were going on: the rise of the various -isms in Europe, then World War I, polio, the Depression, WWI, Korea, the Atomic Age and the Cold War, Vietnam, Kennedy, Civil Rights, and Segregation, Nixon, Iran, Cold War, Fall of Communism, and then September 11th. It’s not that it’s such times. It time. We all must face our challenges. The current challenge is and event of such times is Health Care Overhaul.

Objective
So what do we do with the time that is given to us? It is time to overhaul healthcare. I’m not that crazy about a Public Option. I don’t like the thought of the government doing much more with healthcare than they already do. But you know what? As a therapist in private practice, I worry less about my payments from Medicare than I do some of the other insurance companies I deal with. That’s government owned. Medicaid however has too many rules. There was talk a few weeks ago about a Insurance Co-op that everyone could get in. Although I haven’t heard much about it in a few days. Either way, as our associate minister pointed out during a healthcare sermon in August, the Good Samaritan story needs to be thought about before a public option or the Co-op is ruled out.

On Seinfeld, Kramer –pardon me, but I did try to find the specific episode for quotes and I couldn’t, although I’m pretty sure it’s the one where he goes to a Veterinarian for his own healthcare– makes the comment that the medical field is in the business to keep you sick. His argument is that it’s a business and if you’re healthy you’re not making the doctor any money. It got laughs on the show but always stuck with me. Consider that when you read the following. This morning I read something on MSNBC Health, 75% of the 2.1 trillion spent on healthcare was to preventable and reversible conditions. As I said on a previous blog post: The Current state of healthcare is after-the-fact. Causes of conditions must be addressed, not just surgery and drugs. 1.5 trillion dollars is preventable and treatable. The EPIC study they cited listed these facts about the 23,000 people in the study:
4 Behaviors were encouraged and changed:
• not smoking
• exercising 3.5 hours a week
• eating a healthy diet including fruits, vegetables, beans, whole grains, nuts, seeds, and low meat consumption
• keeping a healthy weight

The Results:
• 93 percent of diabetes
• 81 percent of heart attacks
• 50 percent of strokes
• 36 percent of all cancers could be prevented.

Assessment
Wow. Those numbers are incredible. Now I don’t have an EPIC study for that I’m about to spout out but I’ve got some experience to back a few things up. Losing weight will help your knees and back. Stopping smoking will help your back (in a roundabout way, smoking dries out the lungs, the lungs pull moisture from the vertebral disc, drying out the disc, causing thinning, and degenerative disc disease). Wearing orthotics and good shoes will make your knees last longer. Bifocals and computer monitors don’t mix –it leads to neck problems. Enrolling at a gym –and going to it regularly– will help with stress, blood pressure, cardiovascular fitness, muscle strength, flexibility, and balance. Oh, it also burns calories. Back off of the salt at dinner. Finally, wearing a helmet on a motor cycle is a personal choice, I realize that, but not wearing one and having an motorcycle accident drives up the cost of healthcare. The motorcycle helmet is the closest thing to a seatbelt motorcycles and bikes have.

Plan
Prevent something bad your life. Remember these are “such times” and we have to decide what to do with the time that is given us.

The Medically Oriented Gym

The current state of healthcare in our nation –and the world– is not wellness. It’s all after the fact. Wellness and prevention are the wave of the future in healthcare. Cars are the second biggest purchase most people commonly make (the largest being a house). What do we do with our cars? We drive them around, give them baths, feed them gas, and maintain them. Many of us take care of our cars better than we take care of our own bodies. Semi-routinely, you peek at the tires to see if they look flat, change the oil and filters, check the fluids, and align the tires. We keep our cars “well” by preventing problems. If you don’t maintain your car, change the oil, or check the fluids and belts, it’s going to cost a lot more than your standard trip to Fought Tire or Pep Boys.

We go to the doctor because something is wrong: “My knee’s been hurting. My fingers ache. It hurts when I look to the left.” Whatever becomes of it, new healthcare legislation is in play at Washington, D.C.: Healthcare is going to change. Wellness and prevention will be a bigger part of it. Two years ago Carson Physical Therapy began offering wellness and prevention services, specifically: massage. Carson Physical Therapy is now embarking on a new project, a new service: The Medically Oriented Gym. Physical therapists are the medical experts in the area of musculoskeletal conditions as well as the instruction and administration of exercise as it relates to disease and dysfunction.

The Medically Oriented Gym (MOG) is a new concept in fitness, bridging physical therapy and the fitness center environment. The MOG encompasses wellness, exercise, and personal responsibility while integrating it with your healthcare. People exercise to stay healthy. Some do it on their own. Some need a push. Some need a gym. Some have medical issues that they feel keep them from exercise. Some aren’t comfortable in a typical fitness center. Some folks need a different type of gym. They need a different experience.

The MOG bridges that gap. I first read about the MOG about 3 years ago in a trade publication. Some clinics in the northeast were doing it. I loved the idea and wanted to explore the concept with Carson Physical Therapy, but at the time we simply didn’t have the room. We recently moved our clinic to a larger facility and part of the reason being the ability to offer the MOG.

If you go to a fitness center now, there will be some employees there. You might even see a personal trainer helping someone. At the MOG we will have a licensed physical therapist, physical therapist assistant, or certified athletic trainer present every day to help and guide you through the workout. Yes, the vast majority of the time your workout will be self directed, but the therapist or trainer will be there to supervise and advance your program, give you a new challenge, make sure you’re exercising correctly, and answer questions.

Who benefits? Who is a candidate for the medically oriented gym?
• Clients with cardiovascular issues, diabetics, those with balance issues, or arthritis. In short, those with a medical condition.
• Clients wishing to lose weight.
• Clients who have had weight-loss surgery such as a Lap-Band or Gastric-Bypass procedure.
• Clients who need to gain strength after battling cancer.
• Clients with osteoporosis or general deconditioning. Any age, any fitness level.
• Clients who need “prehab” for an upcoming joint replacement surgery or other orthopedic surgery in the next 2-4 months.
• Clients who have finished their rehab but wish to continue their exercise program at a facility already familiar to them.
• Finally, anyone who wants to get healthier.

The process is this: You join the MOG. A physical therapist performs an evaluation that assesses several items including (in no particular order) weight, strength, flexibility, balance, blood pressure, cardiovascular fitness. In short, we assess your general fitness level. When working with the therapist, your personal goals will be discussed, (“I don’t want to take so much medicine”, “I want to lose weight”, “I want to get ready for an Alaskan Cruise”, “I need to get ready for a knee replacement”). Based on that information, goals are established and an individualized exercise program is created. Information is shared with client’s family or referring physician. This program includes cardiovascular fitness, strengthening, flexibility, and balance. Periodic re-evaluations will be performed each month to measure against your baseline numbers.

In the current state of healthcare, prevention is a non-covered service (for the most part). That sounds unfair to me too, but let me point out that your oil change and tire rotation isn’t included in your car insurance either. Our MOG will have a basic membership but we will also have some different tiers that will include massage packages and personal training sessions built in.

The MOG will be housed within Carson Physical Therapy, but as the gym grows, we hope to move it into its own facility, separate from the PT clinic. We’ve got to start somewhere. Until then, come check us out. Ask questions. Ask your doctor, is right for you? Ask yourself, are you ready to get healthy? Are you ready for a change? Remember, your healthcare is your responsibility. Isn’t it time to change the oil? Rotate the tires? Whether it’s with us at the MOG or somewhere else, isn’t it time to exercise?

**************************
Adam P. Carson, DPT is an orthopedic physical therapy specialist practicing in Bryant. He has 13 years of experience in physical therapy with a special interest in manual therapy and foot injuries. He can be contacted at adam@carsonphysicaltherapy.com.

Bagger Vance.

Subjective:
I haven’t blogged in a week. Wow, that sounds geeky. I used to say I hadn’t written in a week. Some of you know this, some of you don’t, but I used to write a newsletter. The Afterthought, I called it. It was quirky. It was snide. It was sarcastic. It was about me. I did it about every 2 months for about 4-5 years. For the most part, I included nothing of value. It was just my observations. I’d gotten a laptop (grayscale screen, 80MG hard-drive. I was the coolest kid I knew). I’d have movie reviews, things I’d done, places I’d seen. I wrote about my experiences in PT school –gross anatomy. Finally at some point it went away.

Objective:
I quit writing in ‘97. I’d been in a relationship with someone I thought I’d marry. I had just graduated from school. I’d gotten my license to practice. I was ready to marry because that was the next logical step in my life, and that was whom I was dating at the time. Doesn’t sound like the right reasons to get married does it? Regardless, we broke up. Socially, I was embarrassed, and I missed her friendship. It was a total cutoff when we broke-up. That was what needed to be done. But when we broke up, I quit writing.

All that I can think of is –to quote Bagger Vance– I’d lost my swing. The will to write had gone. I felt like I had nothing to say. I really don’t think I was depressed, I just didn’t have the want to write. I had nothing to say –at least in print. In the time after that I met the true love of my life: Jenny. She’s so good to me. I overmarried. I honestly believe that. But here and there, I’d sit down to write something and sporadically I would do something but nothing really came out.

Assessment:
My best friend thinks that The Legend of Bagger Vance was a horrible movie. He says it was horribly racial, “how did Hollywood let them put that movie out with all of the sterotypes”. My answer was that Will Smith was in it. At the time, Will Smith did no wrong in Hollywood. The main focus of the movie was that Matt Damon was a golfer who couldn’t play anymore. He’d lost his “swing” fighting the Germans in WWI –what amounted to post-traumatic stress syndrome. He just couldn’t play anymore. Bagger showed him his swing again – in this case, his swing was a hot blonde South African: Charleze Theron.

I first became aware of the web-log (blog) during the 2004 Presidential Race. I kept hearing about guys on the “floor” at the political conventions writing their blogs. These personal websites that you could write your ideas, thoughts, memories, opinions. That sounded like something right up my alley. I made one, wrote next to nothing on it. Lost the password. No swing.

Plan:
In late May, Olivia –the product of my love with Jenny– graduated from kindergarten. She looked so sweet on that stage. Little cap and gown. Man, I was proud that morning. That same day, some 12 years before, the young lady I’d mentioned back in the Subjective section of this essay broke up with me. I realized that anniversary during our family breakfast at the IHOP (that’s where Olivia wanted to go after her graduation). Not sure why it popped into my head but it did. Regardless, sitting there at breakfast that morning, I found my swing.

APC

This Week In Old Jewish Gangsters With Back Pain

Cuba 1959. Hyman Roth (left), Michael Corleone (Right)

Subjective:
I’m treating Hyman Roth from Godfather II right now. Not the Hyman Roth (Rocco Lampone killed him in the movie) but someone who looked like a whole lot like him. No hair on top. Graying sides. Tufts of gray hair sticking over the buttons of his short sleeved pink oxford shirt. Mr. Roth has back issues currently. Hyman Roth has been “dying of the same heart attack for 20 years” according to Michael Corleone, which to me meant that Mr. Roth was always complaining of his poor health. The old Jewish Gangster was involved in casinos and gambling more than extortion, drugs, prostitution, and racketeering. He was in business with Michael’s father, Vito. My understanding was that it was an investment group building casinos specifically in Vegas and Cuba. He had partners in Vegas (Moe Greene –who Michael had killed in part I) and Johnny Ola in Cuba. Michael ended up needing to bump off Hyman Roth for business reasons.

Objective
My Hyman Roth had a back surgery last fall to alleviate back and leg pain. The leg pain improved but the back pain did not. That’s not that uncommon for spinal stenosis ( a condition where the canal the spinal cord runs through narrows, it’s akin to arthritis and degenerative disc disease issues). His legs are better but “my back feels like Hell.” Crazy, how often I hear that expression. He also has exophthalmos, a thyroid condition that gives you bug-eyes. On examination, Mr. Roth had a flattened back (no hollow in the low back), tightened hamstrings and tightened quadratus muscles (the flank muscles on either side of the back), generalized stiffness through the spine, and a weak core. So how do you treat that? Soft tissue mobilization to start with limbering up all of the low back muscles, specifically getting at the paraspinals, and those flank muscles. Following that some joint mobilization (stretching the stiff vertebrae) for the stiff spine. Then stretching and strengthening exercises.

Assessment
Even when treating old Jewish Gangsters, the principles are the same: most back pain comes from muscle spasm and muscle tightness. On loosening up the muscles, loosen up the vertebrae the back feels better. Then strengthen the weak stuff. This is the troublesome part. Strengthening can cause / irritate a back that had been on the mend. It’s easy to do too much, too quick. Let the main pains settle down and start with light core stuff. The appropriate flexibility exercises will immediately cause a reduction in symptoms –usually the hurts-so-good pain.

Plan
The current treatments I’m doing with Hyman Roth are helping. Your back is the product of how you’ve lived your life. As he said in Godfather, part II: “This is the business we’ve chosen.”. His business was gambling and casinos and graft. My business is physical therapy. As I mentioned earlier, Hyman Roth invested in casinos. I’ve invested in physical therapy. We all need to invest in our backs.

APC

This Week In Old Jewish Gangsters With Back Pain

Subjective:
I’m treating Hyman Roth from Godfather II right now. Not the Hyman Roth (Al Neeri killed him in the movie) but someone who looked like a whole lot like him. No hair on top. Graying sides. Tufts of gray hair sticking over the buttons of his short sleeved pink oxford shirt. Mr. Roth has back issues currently. Hyman Roth has been “dying of the same heart attack for 20 years” according to Michael Corleone, which to me meant that Mr. Roth was always complaining of his poor health. The old Jewish Gangster was involved in casinos and gambling more than extortion, drugs, prostitution, and racketeering. He was in business with Michael’s father, Vito. My understanding was that it was an investment group building casinos specifically in Vegas and Cuba. He had partners in Vegas (Moe Greene –who Michael had killed in part I) and Johnny Ola in Cuba. Michael ended up needing to bump off Hyman Roth for business reasons.

Objective
My Hyman Roth had a back surgery last fall to alleviate back and leg pain. The leg pain improved but the back pain did not. That’s not that uncommon for spinal stenosis ( a condition where the canal the spinal cord runs through narrows, it’s akin to arthritis and degenerative disc disease issues). His legs are better but “my back feels like Hell.” Crazy, how often I hear that expression. He also has exophthalmos, a thyroid condition that gives you bug-eyes. On examination, Mr. Roth had a flattened back (no hollow in the low back), tightened hamstrings and tightened quadratus muscles (the flank muscles on either side of the back), generalized stiffness through the spine, and a weak core. So how do you treat that? Soft tissue mobilization to start with limbering up all of the low back muscles, specifically getting at the paraspinals, and those flank muscles. Following that some joint mobilization (stretching the stiff vertebrae) for the stiff spine. Then stretching and strengthening exercises.

Assessment
Even when treating old Jewish Gangsters, the principles are the same: most back pain comes from muscle spasm and muscle tightness. On loosening up the muscles, loosen up the vertebrae the back feels better. Then strengthen the weak stuff. This is the troublesome part. Strengthening can cause / irritate a back that had been on the mend. It’s easy to do too much, too quick. Let the main pains settle down and start with light core stuff. The appropriate flexibility exercises will immediately cause a reduction in symptoms –usually the hurts-so-good pain.

Plan
The current treatments I’m doing with Hyman Roth are helping. Your back is the product of how you’ve lived your life. As he said in Godfather, part II: “This is the business we’ve chosen.”. His business was gambling and casinos and graft. My business is physical therapy. As I mentioned earlier, Hyman Roth invested in casinos. I’ve invested in physical therapy. We all need to invest in our backs.

APC