Recent Blog Entries
Posted 11/28/2011
Every day at the Hruska Clinic and across the country, PRI trained Physical Therapists assess and determine whether or not their patient is neutral. Neutral can be used in various contexts. I will provide you with everyday occurrences in which the word “neutral” is used and I will then use these examples of how it relates to the human body. By definition, neutral is:
- The condition of being disengaged in contests between others.
- State of taking no part on either side.
- Indifference.
- Being mutually acceptable to both sides.
All phenomena is defined in relation to its opposite. How do we understand the idea of hot without cold, forward without reverse? Hot and cold are different points on a spectrum of an understanding of what we might call “temperature”. Forward and reverse are different points on a spectrum of an understanding of what we might call “motion”. Thus things always come in pairs. Neutrality, on the other hand, lacks the bias towards one of these opposites. Automobiles have a neutral gear, you are neither moving forward nor backward. Likewise, warm suggests you are neither hot nor cold!! We are constantly seeking a balance between these opposites-they are always moving--there is never a time when they stop. Notice I didn’t say anything about resolving this balance. If there was perfect balance, there would be no motion. When these opposites are managed to obtain the best of both conditions, the conflict between these opposites is converted into symmetry. Let me reit¬erate again how important this is: it’s the constant seeking of balance between opposites that creates our lives as we know it.
We know that we cannot always be neutral in everything we do All too often we end up judging our every thought, emotion, and action as positive or negative. Some individuals have strong opinions or positions on current events or topics; some individuals are liberal where others may be conservative. Other examples that can be related to this include war, euthanasia, taxes, abortion etc. When we look around, there are many examples in which we tend to hold a strong position or bias towards something whether it is right or wrong. That’s a matter of opinion!
So where does “neutral” fit in? Considering the multiple interpretations of the word, I will go out on a limb as a PRC therapist and state “Our patients never obtain complete neutrality!” Wow! What do I mean by this? We as physical therapists are constantly trying to determine whether or not our patient is “neutral”. To truly be “neutral” would mean that the balance point would always meet in the middle; you are neither here nor there kind of thing. How often do you suppose this happens? I will pose another question; do you think our bodies are always in a position of neutrality? There are various movements and positions that we place our body in on a daily basis, we flex and extend, we adduct and abduct, we inhale and exhale. We never just stop in the middle with these movements. To move from one extreme range of motion to the other requires the presence of a mid-point or what I refer to as neutrality. Neutrality is the ability to accept a movement or position in the reflection of the other without conflict. Neutrality is a “range” and/or “zone” of movement; it is a “transitional position”. You can’t get from here to there without crossing the middle! So it comes as no surprise that good attracts bad, and bad attracts good. Likewise flexion attracts extension and adduction attracts abduction. We as humans all hold positions and/or bias whether we like to extend or flex, believe or disbelieve, and whether it is good or bad. And, to complicate matters, what is observed as “good” by some will be observed as “bad” by others. This cycle continues on and on!
In summary, I spoke with my mentor, Ron Hruska, about this topic. As we discussed this topic we both concluded that “neutrality” in its real sense is a “transitional position”. Some patients may be biased towards a particular movement or position. Whether it is right or wrong we all have tendencies towards a matter of opinion, position, or movement pattern. We as PRI therapists must accept the fact that our patients may never be able to achieve “neutrality”! It is our job to allow our patients to experience this “mid-range” and/or “zone of neutrality” and not be biased towards one extreme over the other.
I would appreciate any comments and insight regarding this matter…
Posted 11/22/2011
This past spring my wife, Leslie, and I went to Las Vegas on a little get-away trip and left our kiddos home with Grandma and Grandpa. At that time we were coming out of a long winter in North Dakota and just needed some sunshine and warmth. We spent a LOT of time at the pool soaking up the sun and relaxing. We had been there before so didn’t feel the need to walk the strip too much and it was very relaxing. The highlight of our trip, however, was getting a chance to see ‘The Lion King’ musical before it left Vegas. Yes I know, we took a vacation to Vegas, without kids, and ended up seeing The Lion King. It might sound a little pathetic but it was great. If you have never seen the musical I highly recommend it. The sets were amazing, the costumes…amazing, the singing… amazing. Of course the song we all remember from the movie was Elton John’s “Can you feel the love, tonight?” I know you all can hear it in your heads now… sorry about that.
Can you feel it? If you have come to therapy here or with a PRI trained therapist this is one question that I am sure your therapist has asked many, many times. Probably to the point that you hear your therapist ask it every time you do your exercises at home. When we are doing an activity with our patients we are trying to turn specific muscles on and turn other specific muscles off to improve the way in which we move. If you cannot feel the specific muscles we want you to feel when doing your activities, or are feeling other muscles too much, you are not going to have the success with the activities that we would like you to have. So we ask: Can you feel this?… Can you feel that?… Are you feeling this?… Can you feel the love, tonight? (Just kidding). To underscore this importance of “can you feel it,“ over the next few blogs I want to highlight a few of the major muscles we want you to feel, and probably more importantly if you are not feeling them what we may need to work on to be able to feel the correct muscle work.
Usually one of the first muscles we want our patients to feel is the left inner thigh muscle, or adductor. In our normal pattern of asymmetry our body has a tendency to center our weight, or base of support, over our right leg. This weight shift is usually accomplished with activity of the right inner thigh muscle to pull the body to the right. In order to do this our brain, primarily with reflex activity, turns off the left inner thigh muscle to make this shift easier. This in and of itself is not a bad thing as long as we have the ability to turn on our left inner thigh, turn off our right inner thigh and shift our weight to the left side as easily as we can to the right. Think about slow dancing (I’m thinking of a certain Elton John song…) and you can picture how the inner thigh muscles can pull or sway you from side to side. In order to get this side to side (frontal plane) activity to occur equally we want our patients to feel their left inner thigh work more than their right inner thigh to overcome our normal asymmetrical tendencies.
So, can you feel it? If you can, Great! Keep feeling it because we want you to use that muscle to stabilize your pelvis and not let it sneak back to the right. If you can’t then we need to address some other issues so that you can feel it. The things that might keep someone from feeling their left inner thigh work are primarily things that prevent them from being able to get in a proper position that allows them to fully shift their center of gravity to their left side and shift their pelvis over the top of their left hip bone (known as AFIR to PRI trained PTs). There may be some restrictions in the hip joint itself (posterior capsule) that need to be stretched out to allow the normal joint mechanics to occur, and allow the pelvis to shift over the thigh bone. If someone cannot fully get their hip socket into that position it will be challenging at best to feel that inner thigh muscle work. This will probably be the first thing we will address with some stretching activities for your left hip. If the right inner thigh muscle is too strong, hyper active, or tight, it may be preventing the pelvis from shifting correctly to the left or the left inner thigh muscle from turning on. If this is the case we may need to do some activities to inhibit or shut off that hyperactive right inner thigh (right adductor inhibition). Sometimes our patients can feel their inner thigh great lying down, but then when we transition to standing activity all of a sudden it is impossible to feel it. We then usually cue those people to find and feel their right shoe arch. This is done for a few reasons. If the center of gravity is too far to the right (which is part of our normal asymmetrical pattern) the tendency is to roll onto the outer aspect of the right foot which will cause you to use your right inner thigh (as opposed to the left leg) more for stability. Again if the right inner thigh is working too much it will be difficult to find and feel the left inner thigh. If we cue a push into that right arch that will allow the center of gravity to shift back to the left, shut off the right inner thigh muscle and allow better feel of the left inner thigh. Sometimes we may need even to look into footwear or orthotics to assist this to happen. One last thing that may be affecting someone’s ability to shift their weight to the left appropriately is the inability to fill up the right lateral chest wall with air. Once again our normal asymmetrical bodies and patterns create difficulties for our left diaphragm to work efficiently and for our right lateral chest wall to open up or expand the way it should (right apical expansion). If this is significantly restricted it can limit the ability to shift to the left and to feel the left inner thigh. So we may need to even look into activities that stretch the right lateral (and sometimes posterior) chest wall to get the body in a position to allow the left inner thigh to work as well as we need it.
I guess the bottom line is that if you cannot feel your left inner thigh and we keep asking and asking “Can you feel the love tonight?” let us know so we can address all of the issues that may be holding you back from progressing the way we want you to. Oh, and if you get the chance to see The Lion King I highly recommend it, and maybe, just maybe, you’ll hear your therapist’s voice saying “Can you feel it?”
Questions or comments for Torin? to send him an email.
Posted 11/16/2011
I’m sure most people have heard the phrase: No pain no gain. As a physical therapist I have noticed for several years the meaning of that phrase has been lost. Occasionally when I teach patients activities for their physical therapy program it is clear that they are experiencing a reproduction of the pain we are working to overcome. On numerous occasions I’ve heard a patient say, “No pain no gain, right?”. The answer to that question is “wrong”. A better phrase in my opinion would be “No effort no reward”. Pain should not be a part of the equation. Don’t get me wrong, when you use some muscles more effectively because of a new exercise program or even occasionally from your physical therapy program, your muscles may become sore, sometimes to the point of feeling like a cramp. Sometimes that soreness/stiffness can last for days.
When we guide our patients through a program there are specific muscles you should feel working (and some you should not), but when the word pain is associated with those activities we have a problem. If you’re actually experiencing pain beyond what I’ve just described from an activity, I would argue that you’re doing the activity wrong…and it is your therapist’s job to help you learn to do the activity correctly. Once we understand that, we can now start making changes in your life that can help take away your pain.
Train smart and train hard.
~Dave
Questions or Comments?
Posted 11/03/2011
Happy Running!
Lori
To email Lori, !
Posted 11/01/2011
For those who know me, I have pictures of my nieces all over my office desk and home. I have several pictures of them in a full squat position playing with something on the floor….A full deep squat. Now imagine yourself sitting in a full squat position playing your favorite board game or card game with your family or friends. Many of us would fall backwards on our bottom instantly. As we grow up (in our country at least), we spend a lot of time sitting on chairs, benches, toilets, couches, and many of us lose our ability to fully squat. Other countries do spend a lot of time squatting, and their health is benefiting from it I am sure.
Squatting is a very important, and something that we as therapists at the Hruska Clinic are often evaluating (and trying to improve the ability to squat) with our patients. A full, deep squat (when done correctly) assists with: decreasing muscle tone in the back, improving normal hip and knee mechanics, and placing the pelvic floor muscles in position to allow for easier bowel and bladder elimination….just to name a few. When done incorrectly, it may cause the patient pain in the knees, back, hips, pelvic floor, etc.
So, can you squat? A full, deep squat keeping your heels down and knees in, without falling backwards or experiencing pain? If not, you may be a good candidate for Postural Restoration physical therapy.
Questions or comments for Jen? to send her an email!
Posted 10/31/2011
JASON MASEK! Congrats to Jason and his artistic ability....I anticipate these pumpkins will get more and more creative every year! We will be donating our entry fee money and the food donations that we received this week to the Lincoln Food Pantry.
Posted 10/27/2011
On Wednesday, the 19th of October, Dave went to Omaha and did an informative talk to a group of about 100 physical and occupational therapists. The event was sponsored by Gentiva, a home health organization, but was open to therapists in and around the Omaha area whether they work in home health or not. Gentiva holds the event annually, but this is the first year that a talk was done about Postural Restoration. Dave provided an introduction to the group about Postural Restoration, and he felt the information was well received. Dave says he felt honored to represent the Hruska Clinic and the Postural Restoration Institute and looks forward to similar opportunities in the future.
Interested in having Dave as a speaker? Send him an email !
Posted 10/26/2011
And, don’t forget we’re collecting food for the Lincoln Food Pantry! So, check out our Facebook page here, AND stop in and see the real things in person! You can donate your food and vote again…
HAPPY HALLOWEEN from the Hruska Clinic!!!
Posted 10/24/2011
Click here to read about Ron’s dream of the Priori Pool becoming a reality...
Posted 10/21/2011
The Postural Restoration Institute just posted this story, and it was so great we had to share it! CLICK HERE to read about a patient struggling to find answers and prevent surgery, and her path to PRI…
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More blog entries can be found in the archives…
Posted November 28, 2011 at 1:24pm by Jason Masek.
