(00:00:00) Tom Coughlin is with us. He is the owner of Copeland physical therapy and our topic for the rest of the hour today will be how to prepare for winter activities how to avoid injury in winter activities. And if unfortunately you do get hurt what some of the treatments might be Tom is a an expert in sports medicine is a certified athletic trainer as well as a physical therapist and got some attention this past summer for treating Twins baseball player Kent Hrbek, who was he had a shoulder injury some and some other problems? What do you do differently for an athlete who's in a real hurry to get back on the field then for, you know on average person who just comes in and you can take their time with them. We get that question all the time Bob and I think the main difference is the amount of time we spend in the intensity of the work that we ultimately reach in their rehabilitation program as far as any special treatments or any special types of adaptations of modalities or whatever. The really aren't much different than what we do with everyone. But what we're looking at in Rehabilitation of someone such as Kent is the time Factor he needs to be back hitting those home runs as quickly as they possibly can and in order to do that. We know that if we provide a physical therapy rehabilitation program on a daily basis as opposed to every other day, they will return much more quickly. The reason that we don't see, you know, the average person off the street or someone who doesn't have those demands such as Kent does every day is a cost factor. It's just cost prohibitive for someone to come every day but in the case of a professional athlete who's making millions of dollars Money that is spent on their Rehabilitation on a daily basis is very small in comparison to what they could be making or what they could be generating for their team. So I suppose that the fact of the matter is if somebody wanted to spend the money and the time they could get rehabilitated very quickly. Yes. That's very true. In fact with Kent Kent. I got a little sick of each other over six weeks period of time because for the majority of those six weeks we were we met every day. I think he we had maybe one or two days off in that six week period and the most of the time I was seeing him twice a day, I'd see him in the morning for an hour and a half to two hours and again in the afternoon for an hour and a half to two hours and we spent a considerable amount of time together working on his problem starting with one type of therapy. That was very gentle and very much oriented towards helping with the healing process. And then as he progressed and got better why we changed the program and had him work harder and do more strengthening things so that he could protect his shoulder better and Only when he when he did get back into a plane he had virtually no problems with it and we were very pleased with that. We were quite concerned about where he would be after six weeks. I don't want you to talk about his specific case certainly, but what are some of the kinds of things that are done in physical therapy how unpleasant is it for the patient? How painful is it? Well, normally we like to have a provider of therapy in a in a pain-free atmosphere and that doesn't always happen but essentially one of the misconceptions about receiving physical therapy is that it's painful and it's I hate to put Dennis in a bad light but it's I think compared to go into the dentist sometimes and it really is not that painful and it shouldn't be that painful typically we like to in our in our practice operate under the philosophy that pain means no gain and that what we're doing with our patients is first of all making them as comfortable as possible helping them relieve the pain and then as the pain is diminished and their motion returns, then we start getting more aggressive with the exercises so that they can strengthen the area that's been injured and then use it as normally as possible given the nature of the injury that they have. How do you what do you do to ease pain hot packs? That kind of thing. Well hot packs is one modality. They were use unfortunately. Although heat feels good ice is more effective in relieving pain. Then heat is in most cases ice is a topical anesthetic and if you leave it on long enough for the area that you're treating to become numb then it has penetrated to the level of the injury and caused the mechanism of the injury and the pain to become anesthetized and and the pain goes away and using heat quite often heat causes swelling and swelling is one of the sources of pain swelling causing pressure on nerve endings. And this will this will increase the pain which then increases the reactive muscle spasm to pain which then increases more pain and it becomes a sort of a vicious cycle we call it but in some cases where swelling is not a consideration where it's chronic long-term tightness that stiffness and conditions of that nature then heat is a very good adjunct to use Tom Cole. Is with us, our topic is getting in shape for winter activities and avoiding injuries in winter sports activities. If you have a question for him, our phone lines are open now in the Twin Cities area 2276 thousand is the number two two seven six thousand elsewhere within the state of Minnesota 1-800-662-2386 five two nine seven 004 those outside Minneapolis st. Paul in the surrounding states call us directly at area code 612 2276 thousand tell Dorothy are calling long distance and she put you on pretty quickly. Let's talk a little bit about the special precautions that Ordinary People should take when exercising in cold weather certainly like we were having today. Well, I think one of the primary precautions to take when exercising any time, whether it's cold weather or warm weather or normal weather is to make sure that that you are indeed capable of exercising without fear of some sort of injury, whether it's musculoskeletal injury or whether it's risks related to your heart or cardiovascular problems. And this means if you've had any history of any type of a disease or injury or problems related to cook your cardiovascular system check with your physician, make sure that you are cleared to begin an exercise program and make sure that you know what your guidelines are going to be whether there's no restrictions and you can go out and start exercising. However, is is appropriate for you or if there's some restrictions on the intensity or the amount of activity you should have or whatever. I think it's very very important that you make sure that if you've had any history at all or if you've never exercised and never had A history of any kind of disease or injury then it's still very important to check with a physician first in cold weather. Like I said, I have Kansas blood and I prefer that the Dome and indoors stationary bicycle and etcetera. But if you insist on getting outside, I think one of the major things particularly on a day like today as you may need to make sure that you've got everything covered all your skin is covered, even though the temperature is not all that high. The windchill is very serious and it could cause some major problems with frostbite or hypothermia. And so you need to be well covered. You need to have a good insulating light insulating underwear and you need to have some sort of a shell over that that's either a wool that allow the skin to breathe and then some kind of protective covering that will cut the wind for you and then you're able to go out and participate whether you want to jog. It's probably not good conditions for cross-country skiing or anything of that, right? But jogging or maybe walking is something people would be thinking about it this time. Hmm. Alright a number of folks on the line with questions for Tom coplin and we'll start with you. Go ahead. Please (00:08:06) number of years ago. I became acquainted with a physiotherapist who had trained at The karolinska Institute in Europe, and I thought that their philosophy of posture and prevention with by good but then experiencing a whiplash injury there seems to be considerable confusion about the comparison of physics physical therapy with for example, Chiropractic and osteopathy it appears in those last two that as long as you keep going back you feel Functional not too bad, but I wish you would compare the differences and also comments about the preventive nature of certain things. You can do (00:09:01) another very good question and I'm asked that question all the time. Obviously you're going to have to realize that my response is going to be somewhat prejudicial when comparing Physical Therapy was Chiropractic simply because I'm a physical therapist physical. The reason there is confusion between physical therapy and Chiropractic is that for the most part physical therapists and chiropractors work on essentially the same types of problems. They approach it basically from a bit of a different philosophy chiropractors typically approach treatment of musculoskeletal injuries more from a manipulation or a mobilization or Just a mobilization type of treatment of what it is that they're trying to treat to free up the joint and particularly dealing with the spine more so than any of the extremities and by these types of manipulations and adjustments. They feel that the patient is then able to go along with their normal activities and and basically be pain-free and be back into activity physical therapists approach it a little bit differently and that they feel that once the mobilization or the motion is been retained that strengthening flexibility and conditioning are important for someone to to keep from having to go back into treatment over and over again and try to teach them self education so that they can do their own exercises so they can take care of themselves and understand what it is that is going on with their problem. I hope this somewhat answers your question. There is there is some differences but basically the confusion revolves around the fact that physical therapists and chiropractors work primarily on the same kinds of problems. Okay. Now any any preventive kinds of things you can suggest well if we're talking about Whiplash which this gentleman referred to once you've had it it makes a little bit more difficult and the postural aspect of making yourself comfortable is very important. We found through research recently that a lot of chronic neck problems are related to several factors. And one of them is posture when you tend to have poor posture with your neck or your back for that matter, it puts extreme pressures on some of the weaker parts of our spine such as the disc or some of the ligaments that are supporting the disc and by keeping good posture you take this pressure off secondly in the along those same lines and in that context, Is the strengthening of the muscles and the ligaments and the tendons that support the spine so that you can help maintain good posture without consciously holding yourself rigid or putting yourself in some sort of a braised. All right. Well, what is good posture and how does one determine if they have it? Well good posture is basically taking a look at you need to know what the structure of the spine is all about. We have several curvatures in our spine that are normal. They have what we call a lordotic posture in our low back and more lordosis type of posture in our cervical spine. And we need to maintain those curves effectively to protect our spine for the average person is very difficult for them to take a look at someone and say this is good posture bad posture. But I think just basically speaking anytime. You're you're in a slump posture with your head or your chin bent forward or if you're in a slump posture where you are slump forward in a chair or sitting watching TV, where you Of a see type of roundness in your back that is poor posture. Good posture is pretty much what your mother always said sit up straight keep your head and Chin back and this will help you restore or maintain the normal curvatures of your spine. It also works as a good exercise to sit up straight and keep your head back by the muscles have to work to do that. And while they're working with other strengthening and that's going to help you keep good posture without being conscious of it. The radio announcer is not slumping over as microphone quite as much as he was a few moments ago. I noticed a little stirring in your chair as we're talking about. Let's take our next question here for Tom coplin. Go ahead. You're on the air. (00:13:20) Good morning. What's the ski season here specifically downhill skiing. I was wondering if you might suggest Some loosening exercises of prior to downhill skiing of specifically for the lower back. I've had some problems after a day of skiing. My lower back begins to feel the some of the fatigue. Is there something you can suggest to keep that area loosen before skiing? (00:13:53) Thanks. Well, that's a good question and it relates a bit to what we were just talking about one of the reasons that you feel that discomfort or taking a low back after a day of skiing is if you'll think about the posture that you're in when you're skiing is typically your bent forward not necessarily slouched or slumped but you're bent forward and this forward bending movement causes excessive pressure on the discs of the lower back and as they receive this pressure, they have a tendency to slightly move and bulge posteriorly which is where the nerve endings are that cause sensation of comfort or pain and as they start getting a little pressure a little pinch, they'll start to feel they'll start to hurt. So one of the things that you can do even before you ski, and and while you're skiing is do a very simple maneuver, Where you stand up straight and just arch your back backwards put your hands on your hip and just move your chest and head back and feel more of a comfortable feeling in your back. I may be a way to another way to describe that is if you've ever been on your knees gardening or doing something in the lawn or shoveling snow and you're bent over and when you stand up your field is stiffness in your back and what feels good about that is just too kind of arch yourself backwards for a minute or two and get that comfortable feeling as you Arch backwards. What you're doing is basically saying to those pushing those discs just slightly forward again and getting them off the nerves and and being comfortable as far as what to do to warm up or to loosen up before skiing. I think a couple of things that are important is that is number one. You may need to make sure that the hamstring muscles are the muscles in the back of your leg or loosened up those need to be stretched. Also your lower back should be stretched by doing a few exercises where you pull your knee. To your chest lying down. I mean it might be kind of hard to do outside. But you want certainly want to do that inside do a few stretching exercises where you twist your shoulders one side and then the other to stretch your lower back and then do some of these back arching Maneuvers where you arch your back backwards, but before I even getting into skiing, I think it's important. If you want to help prevent back problems while you're skiing is spend a few weeks doing some proper conditioning before you go on the slopes. You need to pay it to be careful with your back and do and have your back as healthy as possible. You need to pay attention to several different areas. You need to pay attention first of all your back and the muscles of the back those need to be strong as well as flexible. And there are a number of exercises that can be done for those they need to pay attention to your stomach muscles because good strong stomach muscles work on the other side of the body to counterbalance the problems in the back and cause some strengthening their you also need to make Sure that the hamstring muscles of your lower legs are flexible and loose and also the muscles in the front of your legs on the front of your hip need to be strong along with paying specific attention to your back. You also need to make sure that your leg muscles are strong because if your leg muscles start to fatigue, then you start losing your posture because you're getting tired and you start bending forward more. So you need to do some exercises to build up the lower leg. So it's not just quite simply saying, okay, what do I do for my back? It's what you do for your whole body before you get there and that will help you prevent problems with your back when you're in downhill skiing physical therapist. Tom coplin is with us today certified athletic trainer owner of Copeland Physical Therapy. It's about 28 minutes past the hour, and we'll move on to your question. Thanks for calling. Go ahead, (00:17:29) please good morning. And thank you during the summer. I jog or roughly in the order of about 4 and 3/4 miles a day and during the winter. I resort to cross-country ski machine and I usually do about All six kilometers a day. Occasionally. I get a flare-up of Achilles tendonitis way down in the lower part of the heel, and I was wondering what the best treatment for something like this would be would it be better to apply heat or cold or what usually I just end up with stopping for a few days until the inflammation goes down. I'd rather try and avoid non and Fuller anti-inflammatory drugs. Thank you. (00:18:16) What you're describing is a first of all achilles tendonitis, I think we should talk briefly about what that is. The Achilles tendon is the extension of your calf muscle as your calf muscle attaches to the to the posterior of the back part of your heel on your foot. So if you would put your hand if you're thinking about this on your calf muscle and run your hand down along your leg down towards your heel. You'll notice that the the tendon becomes very small and almost a real taut band and then it stops right at the heel or what we call the calcaneus and then where this tendon inserts on the heel on the heel bone is generally where these achilles tendonitis comes from and where it happens and I think is what he's talking about in this situation achilles. Tendonitis is is caused by most tendonitis. It's an overused type of thing. There are a number of factors that can cause be the underlying cause of the - I would suspect at this point. It may be something that is that has been going on for a period of time and is it needs to be just a monitored or maintained so that he can continue his exercise program simply putting heat on it or ice on it or an anti-inflammatory drug to get rid of the inflammation in the tendinitis. I think is treating a symptom rather than a cause and it's important to find out what's causing the tendinitis and try to strike correct that structural problem. Maybe your calf muscles and your Achilles tendon are too tight. Maybe they need to be stretched and and be good and mobile before you start doing the exercises. This will help prevent some of the era tation possibly you have a problem with the alignment of the bones in your foot and by the constant running or pounding on your lower leg will cause the Achilles tendon to overwork and and have some tendonitis. So these things need to be approached and taking a look at so I would suggest that You do two things a self remedy and if that doesn't work, then maybe seek some professional help to take a look at specifically what's happening. Number one is stretching the Achilles tendon and that basically is a good way to do that is to stand facing a wall with your with the affected foot flat on the floor with your knees straight and your hips straight and with your feet approximately two feet from the wall. Put your hands against the wall and lower your body to the wall keeping your knees straight putting a stretch on the back part of your calf muscle make sure that you keep your heel flat against the floor occasionally. If you don't feel much of a stretch in that maneuver then put something like a book or a telephone book under your for foot under the ball of your foot. So you raise your front of your foot up slightly and that will help give you a stretch now as opposed to are asked as to answer the question about whether you should put heat on it or whatever. I still feel that ice packs are the treatment of choice. In this kind of condition ice will decrease the inflammatory effect and iced must be put on and kept on until numbness is occurred or won't have perpetrated to the level of the problem. It won't do any good there. If you put heat on it, you will increase the inflammatory effect. You will increase the tendinitis you'll have longer problems with it then if you use ice packs, so I still it gets numb may take 15 20 minutes and do it three to four times a day and I think that will help decrease the inflammatory response fairly quickly without using any drugs. Is there anything to be gained by leaving the ice pack on for longer than that say like to a half hour 40 minutes something like that. One of the conditions one of the concerns leave me an ice pack on too long is localized frostbite may occur. So typically what we recommend is you leave it on until it gets numb then take it off and then reapply it if you want to do it more often than every four hours then maybe put it on half an hour take it off half an hour so that you don't have any of these kinds of problems facing you Tom coplin is with us as we talk about To various Physical Therapy problems and we've got a couple of lines open again in the Twin Cities. Now, the number is 2276 thousand if you got a busy signal earlier try now, you might get into two seven six thousand those toll-free numbers are available to those of you outside Minneapolis st. Paul one 865 to 9700 now, thanks for waiting. You're on the air with Tom coplin. Hello? (00:22:38) Hello Tom. Hi. I play baseball in the summer and lots of tennis in the winter. And I've had this problem for the past two years to the point where I'm thinking about just just giving it up. I've when I make a snap throw in baseball also really hard in tennis I get this extremely shopping and my right shoulder and I've been to several doctors and I run up a horrific medical bill. They first thought they gave me with I was tendonitis of the tree before that then they did a soundscan X-rays and also Graham and they can't find anything wrong with me. But yet it's it's almost impossible for me to do either should I should I try Physical therapy and if so, what would you suggest? (00:23:19) Well, first of all, the shoulder is a very complex mechanism and is quite an enigma to try to help understand some of the things go along that go wrong with it particularly in throwing Sports. However, the shoulder is also be as interesting as is it's also something that I think is very treatable if you were aware of exactly what the problem is. It sounds is the as if you have something that we call rotator cuff either tendinitis and impingement. There may be some small tearing in the cuff muscle that doesn't always show up on an ultrasound or in arthrogram and that will produce problems what we find that is once you've developed problems with the rotator cuff and less you had some sort of specific Rehabilitation work done on a rotator cuff. It will continue to cause you problems and doesn't just heal by itself. It doesn't just heal by doing normal types of Nautilus or Eagle exercises for the shoulders. It has to have some specific attention to it. And I would suggest that that if you if you do want to continue with these throwing types of activities that you maybe take a look at a good sports physical therapist and see if they can help you with some of their specialized equipment because it is if it is the rotator cuff which it sounds like it could be a number of other things but it typically is the rotator cuff it is a treatable entity. It will take some time but it is treatable do the throwing activities and the tennis cause the injury in the first place or is it just aggravated by them. Usually, they're caused by it. It's a it's another overuse type of injury that we were talking about where you repetitively use that particular muscle group over and over again. And what happens is as you throw or use the play tennis and use your racket with your arm over your head as those muscles begin to fatigue, then they start functioning improperly and as they function in properly you lose the coordination of the shoulder movement and this will cause irritations and in Emotions and tendonitis particularly in the rotator cuff. Okay moving on to our next question Sports Medicine form you go ahead, please where you calling from (00:25:28) today. I'm calling from st. John's. All right, go ahead. Um, I have a question and the fact is I ran cross-country like my five years ago and I got a bursitis or tendonitis in in my hip and I was wondering shouldn't like overtime shouldn't Scar Tissue build up and get get stronger than like the original tissue that was there because I know like I know if I run a lot even now it'll still come up again. I'm just wondering if I don't know what the deal is. (00:25:58) Well, it sounds like you have a condition called trochanteric bursitis. If you put your hand on the side of your hip and run it down. There's a there's a bone that's just on that on just on the lateral side or the outside of your thigh. And that's the trochanter and people who run a lot sometimes have problems with that in. You condition the one who becomes chronic. It's very difficult to treat your thought about well, maybe the scar tissue has formed over the years and strengthen. The area is somewhat misleading thinking because of the fact that scar tissue also is a as a problem in and healing and Leslie healing has been guided properly with the right kinds of stretching sometimes a scar tissue will bind down tissues. It will bind down tendons and muscles and cause continued aggravation. And at any time you try to use the area when it's bound down by the stick Scar Tissue, it will just produce further irritation and problems treatment indication for that is stretching the scar tissue and I think you know before I recommend any type of stretching or exercise as you about that, I need to know more specifically what it is because at this point, I'm just guessing that it's a trochanteric bursitis, but the answer the Jan the general nature of your question the scar tissue itself as it forms moreover years does help strengthen. We can't issue but it also is a double-edged sword and that as it strengthens the we can't issue at also sometimes binds these tissues down and doesn't allow them to move like they normally would. Next question from you. You're on the air. Where you calling (00:27:32) from calling from Bemidji? Yes, please. Yes, I was interested in two-fold question. I guess one relating to you're referring to overuse of muscles and then also about posturing with regard to the overuse. I enjoy doing weight training and yet I'm more interested in tone and definition that I am in any kind of bulk or developing over strength. And so I tend to do a lot of reps with lightweight and I am interested in that I'm aware of the overuse idea and I'm wondering if there are ways to in are there certain number of reps past which you would have advised not doing and or are there ways to protect yourself or or know when you're when you're entering an overuse typefaces, you know, especially if you're experiencing some pain in the shoulder or whatever and then I guess my second question briefly would just be wondering if you're familiar with the Alexander technique with regard to posture and if you are if you could comment on that (00:28:28) Well the answer your first question before I forget the name, I'm not familiar with the Alexander technique for posture. So I you know, I can't comment on that as far as the weight training aspect of try to prevent overuse injuries when you're trying to weight train for for tone as opposed to bulk and weight you have to realize that different individuals have different body types and the number of repetitions that different individuals do I think depend primarily on what their body type is in the number of in sets of reps typically, however 2 to 3 sets of 15 to 25 reps again, depending on your body type is I think a pretty fair number. I know a number of bodybuilders will get into types of exercise programs and weight training where they pump for hours and hours and hours and which points to the fact that correct technique is probably as important as number of repetitions. Preventing overuse problems because a lot of times when these overuse problems begin to happen is either because of incorrect or is because of incorrect technique and incorrect technique, I guess can happen because of two reasons one. You don't know the proper way of doing the lift or secondly you may know the right way and start the proper technique but as you fatigue you begin using improper technique and this will cause the overuse syndrome or the tendinitis problem. So I think a good rule of thumb is that if you're doing a number of repetitions and you begin to develop some soreness or some pain that is different from the muscle soreness that you normally feel then it's a good time to quit sports medicine and physical therapy. Our topic today with Tom coplin who is a physical therapist and certified athletic trainer as well about 19 minutes now before 12 o'clock and thanks for waiting. You're on the air now with Tom. Go ahead. (00:30:22) Thank you. My husband has a shoulder injury from throwing ball this summer. X-rays show that he has calcium deposit in an area of in his shoulder the doctors given him a cortisone shot and I'd like to know what you think of cortisone as treatment and the doctor said if it doesn't respond in in or that it should respond in four days or else it hasn't worked and then he will require physical therapy. I wonder what you think of cortisone and also what kind of exercise such as swimming and so for that he should do as it's healing. (00:31:02) It's a very good question because we hear a lot about the magical cures of cortisone and cortisone injections. There's nothing wrong with one or two injections of cortisone locally to help with a problem. We see that all the time and Athletics professional college sports with individuals who are not active athletes a professional athletes and it works quite well. The problem with cortisone becomes is in the Repeated injections doing it two or three more than two or three times getting 567 injections in an area. That's when cortisone becomes a real problem because the the action of cortisone quite simply is to work on the inflamed damaged tissue and to get rid of it and let your body build healthy tissue and one or two injections will do that. Doing more than that the cortisone will then begin to work on the healthy tissue and start to weaken that and there are reported cases of people having tendon snap after a repeated injections of cortisone and it's primarily because of this so there's nothing wrong with one or two injections. The calcification makes it a little difficult as far as long-term prognosis for rehabilitation because calcification means that there is a piece of bone that's in a place. It's not supposed to be someplace in the muscle or tendon it and is going to cause a it could cause a continuing aggravation or irritant not necessarily so a lot of us have calcifications and calcium deposits in places that don't bothers but in the shoulder it tends to be a bit more of a problem but it's but again it's based on that observation is based primarily on where the calcification is located as far as the kind of exercises to expect if this doesn't clear up in four or five days as suggested and the Therapy might be something to look forward to the type of exercises that you should experience in. The beginning are specific exercises that are designed to work on the muscle that has the problem and not General swimming or overhead flyers or exercises where you're doing a lot of gross movements of the shoulder those will cause problems until the specific injury itself is well dealt with and taken care of again. We're probably talking about the rotator cuff. It's the basis of the mechanism of shoulder function. And that's the exercise program that you probably will be looking at is Rehabilitation of that rotator cuff Tom in response to an earlier question. You talked about some of the things people should think about in preparation for downhill skiing. How about for cross-country skiing? Cross country skiing I think is somewhat similar to downhill skiing in some of the preparation because my orientation towards safety in any type of sport, but again in cross-country and downhill is protection of the back there is probably a much greater danger of knee injury and downhill skiing than there is in cross-country skiing just because of I think the more violent nature of downhill skiing cross-country skiing the biggest things that you need to be aware of is number one the back again because of that constant forward posture of being bent forward it puts its significant strain on the back and I think anyone who's gone out for the first time or two and cross-country skiing will experience the making and soreness in their back and that's and that's very the very reason why so some of the things I said earlier about preparing for the back I think still hold true as far as cross-country skiing is concerned obviously. Need to have good strong legs. Probably not the power type of strength that you would look for downhill skiing across countries gain, but I think the third thing that maybe is a little more important in cross-country skiing to prepare for is the upper extremities the shoulders and the arms. There's a lot more activity and work done with the upper body in cross-country skiing generally speaking then downhill skiing and you need to pay attention to some conditioning exercises for the shoulders and the arms right back to the telephones and more questions now for Tom coplin, thanks for waiting. You're on the air with him. (00:35:16) Good morning Tom. Good morning from time to time. I have trouble with my neck be not a place maybe two or three times a year. I'll go to a chiropractor to have it adjusted and typically if my back or my necks out of place. I'll try some Hatha Yoga postures first and I've had good results from that. I'm curious regarding my neck a posture. I use is laying flat on the floor on my Can bringing my legs up over so that my toes are above my head and that forces my chin up into my chest and pause for maybe 10 or 15 seconds in that posture and I was curious and it's uncomfortable and I'm curious if you have an alternative to that. (00:36:08) I personally would not advise that exercise for someone with neck problems particularly chronic neck problems. If you will think about and picture in your mind the exercise that you just described to me that is that causes extreme flexion and slouching of the neck that puts not only the forces of the weight of the head on the disk pushing the poster it practically puts the force of your whole body on the discs of your neck and has a tendency to push those posteriorly. I would I would without evaluating your neck and seeing a specifically what your problem is. I would I would not recommend that kind of exercise for what you're describing to me exercises actually for a neck and for any of the spine particularly, but in particularly, the neck should be more in but extension next year where you move your head backwards rather than forwards and also, Strengthening exercises to help maintain the strength of your neck so that it does stay in good posture. What you're describing is a specific problem and one that's a little bit more difficult to answer without really having an opportunity to evaluate it but generally speaking I would say stay away from that flexion activity stay more into the extension types of movements and do strengthening exercises. I would suggest a very simple strengthening movement exercise for the neck would be isometrics isometrics. Don't necessarily mean working as hard as you can but isometrics mean strengthening the muscle without moving it and for the neck quite simply it would be attempting to do all the movements that your head will do but putting your hand in a way so they can't move the specifically one would be in trying to take you right ear down to your right shoulder. Don't let your head move just put your hand over the side of your head and push against your hand and then do that side to side would be right and left. Then also forward while you try to nod your head put your hand over your forehead and don't let it not down but push against your hand and then also try to tip your head all the way back but put your hand behind your head on the back of your head and hold that 326 seconds per push five or six pushes each Direction. And then the last exercise I would suggest is one where you turn your head from side to side. If you were in a normal sitting erect posture and you try to turn your head all the way to the right or turn your head all the way to the left put your when you try to turn your head to the right side put your right hand on the right side of your face and resist letting your head turn your head to the right same to the left. That's six different motions. Do them six seconds each and do them six times. We called our six by six by six exercise for cervical exercise for cervical neck see what great pictures you get on the radio here just to reiterate much absolutely ten minutes before twelve o'clock. And another question for Tom coplin. Thanks for calling. You're on the air. (00:39:04) Hello, Tom. I'd like Opinion on the cause and treatment and effects of vertebrae's twisting on themselves and how it affects the rib cage and the lungs and how it the during the menstrual cycle how it affects your ligaments and muscles. Thank you. (00:39:23) A lot of questions in that question. I'm not certain to what extent your you're asking about how vertebrae's Twist on themselves. You may be talking about scoliosis, which is a congenital condition of the spine where the spine begins to twist and rotate and each individual vertebrae rotates us a certain amount the degree. They rotate depends on how much scoliosis there is and what kind of condition you have that will cause that as the rotate as a vertebrae rotate in scoliosis then because the ribs posteriorly have an attachment at the at the vertebrae they will correspondingly rotate. As the vertebrae rotates and you will see some chest cavities as we call them appear to be a little bit asymmetrical or not quite in a normal posture. I forgot the question about the lower bag. Well just kind of how how they Holly move I guess. I don't know. I don't understand it. I couldn't pick up all that to well. Okay, I'm sorry. I don't remember the second part of your question. All right, let's move on then. Shall we on to your question? Thank you for waiting. And Tom coplin is (00:40:37) listening. Good morning, Tom morning. I had a question about what has been recommended by a physician. He recommends an exercise cycle. We're dealing with a 50 year old female mild osteoarthritis and growth overweight which precludes impact loading. We have looked at many many cycles. I'm have three specific questions. Is there some place where we can find one where the geometry of the cycle can be matched to the patient. Once she tries. Every position is strained secondly are the ones that involve use The arms as well as the legs which he's find uncomfortable recommended and third is there someplace we can get detailed information on alternate or supplementary exercises to maintain flexibility. It seems like a boring strength position yet. It's primarily for obesity and CV conditioning. Thank you very much. (00:41:23) See if I can remember all those first of all matching the bike to the patient. Well, I think one of the ways that you can match the bike to the patient is you're going to need a good quality bike to start with there's a there's a number of stationary bicycles on the market and I would wholly endorse using stationary bicycles for someone who doesn't want a lot of weight bearing or loading of their spine because they are still Osteo arthritis needs good CV cardiovascular conditioning and needs to have some weight control and stationary bike is excellent for that. But I think at the same time you want to make sure that you buy a good quality bike because some of the more or less expensive bike Because won't give you the features you want you want to be able to adjust the seat height so that you don't have too much pressure on the knees. You want a good comfortable seat a place to go where you can get some comparison that I think is Milt Sunday has a trend remember the name of his place. Now, it's I won't attempt to to tell you I forgot the name right off hand, but they have a number of different exercise devices that you can go and try out and see which one works best for you. How about a bike in which you were you have to use the arms as well as the legs one of the bicycles that I've seen. In fact, I have this this on this very model in my home myself is this win airdyne? It gives you the opportunity to do the different things that I've talked about. It has opportunity to use your upper arms or not use them and you can use them to whatever degree of effort that you require or would like and I think it's a very good bicycle the thing I like about it is that it it has a big fan wheel on it. Cools you off while you write some people don't like that one interface, but I like the cooling part of it and I think the third part of your question is where can you go to find something to do to augment these or offset to boredom of a stationary bicycling take number one? I think you have to be a little creative to offset some of the boredom of stationary bicycling video tapes on a television set different kinds of tapes not necessarily movies, but educational tapes. I've done some reading while I'm been on my stationary bike listening to tapes, you know, listen to a lot of tapes of Bob Potter's former shows. I think would be very interesting a number of those different things as far as opposed to additional exercises somebody with osteoarthritis. I think probably need some Professional Management in terms of maybe some flexibility or specially exercises like that would go along with the bicycle without me attempting to describe something to you over the radio and again a good Orthopedic or sports physical therapist would be someone that could get help you with that problem. How frequently do you need to use the exercise bicycle stationary bicycle in order to achieve the cardiovascular conditioning that this person wants? Well the research that we've that we're that were familiar with says that it has to be a minimum of three to three to four times a week for approximately 12 to 15 minutes per session. That's the minimum it what we call your target heart rate target heart rate is something that's determined by a formula for your age and but more often by your sex as to how fast your heart should be beating for a period of time in order to get a good cardiovascular effect more than that of course is beneficial and even more beneficial and if you're trying to lose weight you have to also realize that the amount of effort put into exercise is is probably directly related to how much weight you're going to lose and 12 minutes 3. Four times a week probably won't cause much weight reduction and to be able to burn enough calories to get enough caloric expenditure to begin to lose weight. You probably need to be on that bicycle every day for 30 to 45 minutes per session gradually working up to that time not trying to jump on the bike and go 45 minutes the first day particularly someone with the condition that we've heard about today with osteoarthritis. They're going to have to have a breaking-in period I getting used to period where they spend a few minutes a day on the bike every day just to start getting their joints in their legs and their hips used to that new activity and that stress and then everyday adding a little bit of time and adding a little bit of time so they progressively work up to being able to ride the bike. They're not don't expect to lose a lot of weight the first few weeks, but just get your body used to riding the bike first. We're almost down to the end of the hour, but I think we can sleep in one more question here. Maybe two let's go to you next. (00:45:58) Hello. Hello. Yeah. I've got a question its kind of regarding the NordicTrack. But anyway my workout consists of Warming up on the are dying for five minutes and I run three miles and I do not allow us for 30 minutes and thinking of cutting the Nautilus to get ready for cross-country cutting the Nautilus in half and going on the NordicTrack for 20 minutes. But what is your opinion of the NordicTrack? Thank you. I'll hang (00:46:24) up. I think the NordicTrack equipment is is excellent. It's one of the it's one of the best pieces one of the best devices on the market for cardiovascular conditioning NordicTrack. For those of you who are maybe not familiar with it or is pretty much what the with the word seems to imply it's a stationary cross-country skiing machine and it tries to simulate cross-country skiing but much as stationary bike simulates bicycling and you can get on the on the device and get a good upper body and lower body workout at the same time and it's because you're working the upper extremities along with the lower extremities you get a very good Euler effect and it's also a good way to start conditioning yourself for cross-country skiing. I think from what it sounds to me like that. You're on the right track reducing some of your Nautilus extracting and do a little bit more of the NordicTrack type of work for a few weeks before you go out and you sounds to me like you should be in really good shape for your cross country skiing outside. Mmm-hmm Tom. We have just a few seconds left. What do you think about the practice of taking a hot sauna and jumping into the snow? That's that's something I think is is more of a what they call a Reciprocal contrast effect which causes the pores to close down and open up and close down and open up is a good for you or not. Yeah, it's if you don't have a heart condition, I don't see anything wrong with it. But if you've got a cardiac condition then don't do that. Okay, Tom coplin Physical Therapy expert owner of Copeland Physical Therapy. Thanks a lot. Midday made possible by Ecolab Incorporated and it's Chemlawn subsidiary. This is Bob Potter.