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Wednesday, May 8, 2019

Typical Athletic Rehabilitation Course

     This graph, which could mean anything, reminds me of the typical rehabilitation course I help guide my patients on. Initially we try some things, some work and some don't, but we get smarter during this time. There could even be a slight increase in pain. Yet, as the rehabilitation goes, with typical components in place the patient starts getting better. These components include:
  • activity modification
  • anti-inflammatory
  • immobilization (boots, braces, taping)
  • orthotic devices
  • stretching
  • strengthening
  • shoe gear changes
  • technique changes
  • cross training
Then, as the patient and I feel they are ready to run, or starting back dancing barefoot, etc, the pain can reflare and we have a slight setback. All and all, at the end of the 3-5 months for a typical injury, the full return to activity is accomplished. I think the dips in the graph above, when the pain increases, is important to know that is it normal part of the rehabilitation process. Rich


Tuesday, May 7, 2019

Balanced Healthy Program for Life


     This image reminds me how poorly I exercise. Being in sports medicine my whole life, you would think I was better. But, I have my weaknesses, and one is spending too much time on activities which will strengthen my legs, and not enough on other parts needed to be healthy. We can all create even better lists, but here is my stab at the perfect health program checklist. The components are:
  • Healthy Diet
  • Good Hydration
  • Proper Sleep
  • General Health (including checkups, dental hygiene, scheduled tests)
  • Leg Strength
  • Balancing (called Proprioceptive)
  • Abdominal or Core Work
  • Upper Body Strength
  • Flexibility Work
  • Standing Strength Poses (Yoga, Tai Chi, Chi Gong)
  • Cardio
  • Proper Recovery Time
  • Great Mental Attitude towards Injury Free Activities
I am quite sure I have left out a few areas on the tip of my tongue (sort of speak).

Stem Cells, PRP, Amniotic Membrane: Good Website Discussion

     I just saw a young gal with a bad arthritic ankle. She has had stem cells injected with long more pain, but it may be the arthritis itself. I found this website for real patients to discuss their concerns or results. After reading all of this, you want the doctor who performs these procedures, to be something they do all the time, like I am a rehabilitation specialist, they should be regenerative specialists.


https://ipscell.com/2016/04/if-youve-had-a-stem-cell-treatment-how-was-your-experience/

Sunday, May 5, 2019

Decision Making in Medicine


     In Medicine there are many decisions to make. The orange arrow above represents the most straight forward direct treatment that you will normally have recommended and that will normally greatly improve your situation. But there are normally other decision avenues that make sense to explore, especially if the typical course is surgical or invasive some way. 

     One typical example concerns bunions. Those are those big bumps on your big toes that can exclude your entire shoe closet.  The typical course is surgical correction (orange arrow). The purple course starts with all the conservative treatments and can go on for years: toe separators, wide shoes, Yoga Toes, Correct Toes, icing, padding, etc. The purple course is standard, and not really thinking outside of the box. The green and red courses are clearly deviations from normal. The green, left brain, is logical, and just means you avoid all shoes that irritate the bunions. The red, right brained, is artistic, definitely thinking outside the box, so may involve acupuncture, laser therapy, homeopathy, special massages, special solutions for soaking, etc. Are any of these 4 directions wrong? Any doctor will have their opinion. I think in general we must do no harm. The goal is the easiest solution to the problem which minimizes or eliminates the disability present. 

Saturday, May 4, 2019

Supinators: Adidas NMD R1 Shoes to the rescue


I love this shoe for my supinators. I comes in various colors also. The image above shows the support along the lateral side of the foot which is very special and unique in the shoe industry. 

The Health Care Provider's Emotional Health


Jack Ma, the former CEO of Alibaba, recently made the press over his support of work days from 9 am to 9 pm and 6 days a week. This is so strongly criticized in the press calling this 996 mentality terrible for the workers. I had to sit down with myself and realize I am normally 776+ (7 am to 7 pm 6 days a week) to get my work done, the plus being some work that can remain to do on Sundays. Medical school in most instances selects very hard workers in college that can obtain good grades in a pre-med environment. That work ethic or obsession or drive gets you through the next decade of medical school, internship, residency and starting a practice. It is the doctor's basic personality which greatly rewards the doctor financially and emotionally. But, over the years, that work ethic can beat you down. The burn out rate of doctors is extremely high today. The demands in my mind seem less related to patient care and more related to paperwork and other expectations. Before the business takeover of medicine which started over 30 years ago, and has only gotten worse, my practice of medicine was 80% patient care, 10% research, and 10% paperwork (865+). Now my practice of medicine is 50% patient care, 50% paperwork (or computer work), and research or blogging is left the time I really should be relaxing. I have no solution, but the next time you see your doctor, give them a little hug if you are inclined (we hug in San Francisco). 

Friday, May 3, 2019

Putting the Pieces of the Injury Puzzle Together


My practice of medicine has much to do with trying to put pieces together of a puzzle. The puzzle being why an injury or pain syndrome occurred, or how to fashion a successful rehabilitation program for a patient. The image below can also stand for all the members of a team gathered to help a patient.


When a patient presents with pain, the Rule of 3 holds reign in establishing why something happened. The Rule of 3, and commonly 4 or 5, stand for the factors that had to exist for a problem to develop, a sort of perfect storm. One simple example is from a patient I saw yesterday. The patient has a tibial stress fracture from running. The injury occurred in clear overuse fashion (Cause #1). The injury, which is to a bone, occurred during a time of low Vitamin D (Cause #2). The runner is a overpronator who had recently prior to the injury switched from Stability shoes to barefoot technology shoes which proper transitioning period or running style changes (probably Causes #3, #4, and #5). By putting these pieces of the puzzle together, the patient was be successfully rehabbed, and the injury will not reoccur. 

Spider Veins from Dr. Jodi Schoenhaus

I thought this was an appropriate presentation to address these cosmetic issues. One of the biggest points Dr. Schoenhaus makes is to make sure these lesions are not the sign of a more serious problem in the veins first and foremost. Rich

https://podiatry.com/news/129/news-title


Thursday, May 2, 2019

Sesamoid Pain and Cleats for grass sports

There have been quite a few times when an athletic whose sport requires cleats that the sore sesamoid under the ball of the foot is right over one cleat. It is great if you can shave down the cleat in that spot as long as stability is protected by another cleat. 


Wednesday, May 1, 2019

Music and Athletic Performance

I have found listening to upbeat music over a book on tape greatly helps my athletic performance. I am glad that there is some proof to it’s effects. Rich


https://youtu.be/ofbnpVbtqTc

Single Leg Balancing vs Dancer's Pose

Hi Rich .... I took a pole-hiking class - loved it! But the teacher said two-minute balances were bad for the hips.  It throws them off or out.  She says instead to do "Dancer" pose in yoga - it's more dynamic and engages the glutes. (I don't remember all she said) But she was adamant about it.
Since my hips have been hurting --- have you heard this before? Do you recommend it?
Thanks!

Hey, thanks for the email. I love single leg balancing as you strengthens the foot to core. Yes, it you are doing it at a time that something hurts, you may have to reduce the time. But, single leg balancing is so natural for the body as it simulates actually what is happening in the middle of each step with our body perfectly stacked up or aligned. Below is the video I did on balancing and one I found on you tube on the Dancer's Pose. The stress to your hips doing the Dancer's Pose seems so much greater than a Single Leg Balance exercise. And, for my non yoga patients, the time to build up to be good at a dancer's pose seems so much longer than single leg balancing. But, please get me more feedback. Thanks Rich

https://youtu.be/3hT2H0mMHNQ



https://youtu.be/mri8YyPHegc