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scottm

Back to physical therapy

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My new neurologist has sent me back to PT. I met the therapist I will be working with 1 on 1 yesterday, she is refreshingly pleasant compared to the outpatient therapists I've had in the past and has extensive training and experience with stroke survivors. Her evaluation of my right shoulder pain was completely different from any other I've had. She did a lot of range of motion tests but the passive ones which no one bothered with before told the story.

 

It turns out my right shoulder pain is not physical as several doctors and therapists, ortho and otherwise have pronounced but a part of my central pain syndrome. While most of my right side is involved my right shoulder is the worst because of the spasticity compounding the CPS. So next week we start rehab aimed at teaching my brain that not all signals are pain. I'm not sure how it all works but she discussed mirror therapy, some exercises and how we will work to reprogram my brain so it doesn't perceive all arm movement as painful. She described it as being similar to what I had to learn about sensations as an infant which is how I have often described PT myself, relearning all the stuff I was good at by age 2.

 

I like this new neuro and she also spoke highly of him and how involved with his patients he is and she instilled a new sense of optimism that I've not had in a while.

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Good therapists are worth their weight in gold, aren't they? Yesterday, my new therapist taught me to butt-walk. She said that my butt muscles are weak, and that's why I can't move my lt foot backwards (can't butt-walk well either). Butt-muscles are connected to the ham-strings. Makes sense, doesn't it? I gage how good a therapist is by how I feel after therapy. Yesterday, I was exhausted. Means she was making me work muscles that weren't used to having  to work. A good therapist.

 

A GOOD therapist,  and a GOOD doc? You've been twice-blessed, to make up for all of your crappy experiences. And, you deserve it. We all     do. It just doesn't always work out that way.GOOD NEWS.:bouncing-for-joy:   Becky

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Hi Becky and Scott, So good when you get a therapist that explores stuff with you. I so get the weak butt thing. My weak butt and hamstrings are currently causing me grief with left heel strike that I need to get to increase my stride length and walking speed.  I'm going to have to try butt walking. I got my quads going well by knee walking but hadn't thought to try butt walking, will discuss it with the team next visit.

 

Scott fingers etc. crossed that you succeed in the "brain/pain" training. My neurophysio does some of that with me and whenever we do arm work I have to describe any sensations so that he can reinforce the right ones. I think this approach is a large part of why I don't have CPS.  He's been actively working to make sure it doesn't develop.

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Scott, I'm totally wowed by you finally getting great health care.....lots and lots of HOPE!!  :happy:

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Thanks for all the feedback. I think between this neurologist, my PCP and the physical therapist I finally have a winning team. Yesterday I got something from the neurologists office and opened it with some trepidation, it was a prescription for some blood tests for vitamin deficiencies, some rheumatism genetic testing, and a couple tests to rule out lupus as a cause for the pain. It would appear his is eliminating other possibilities to determine the best course forward. And he took the time to actually call my PCP and have a discussion about my case, now that's an example of a doctor that really cares and isn't just going through the motions.:smile:

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Incredible!  Now this is a doctor who should be conducting and writing medical studies; going to suggest it to him, Scott??  :happy-dance:

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Lin he has written a few papers that are out on pubmed but they are mostly about dementia and 1 about nitrous oxide abuse induced neuropathy, of course the collected works of this forum would probably be a study all by itself. :lol:

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My Late Father who was a pediatrician  was old school and would contact Specialists so the parents would be at ease.  It sounds like this Neurologist is from the same old school medicine.  Great that you found a good team to address your issues. 

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Someone please enlighten this ignorant reader about "butt-walking". Do you do it standing up or sitting down?

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Had my first PT session this morning. I'm hurting for sure, but not in a bad way. My therapist is very aggressive while watching for distress and stopping when it starts ramping up too much. We had an interesting conversation when she asked me to rate my pain. I pondered it a moment then asked which pain, I have physical pain and I have neuropathic pain. We settled on a 2 number system with the first being physical. so I walked away with a 5/7 because the room is cold but it faded when I got into the heat outside. I didn't realize how weak my right leg was but that should improve.

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On 25/6/2017 at 11:56 AM, numnah said:

Someone please enlighten this ignorant reader about "butt-walking". Do you do it standing up or sitting down?

you do it on the floor or a very firm physio bed if you can't get on/off the floor.  sit up straight legs crossed or straight out front. I find legs crossed is easiest. make sure you are sitting on your "sit bones" with your back straight now lift one butt cheek up and move it forwards then do the same with the other one so you are even again. It's a small movement an inch or 2 at a time, and needs good core strength. it's a variant of a babies bump crawling, which is also a useful exercise for us, especially if you use the weak leg as the pulling leg.  If you get the chance watch babies and toddlers learning their basics it's a good tutorial for those of us who have to start again.

 

Scott, That sounds like a great session. I love my running group sessions as they are also like that especially when Gavin is working. He has that skill to push people past what they think they can do without wrecking them. I know I push harder when he is in the room, even if he isn't directly working with me. As the head physio he tends to butt in with whatever else is going on. And make small changes to technique or exercises. He made me push the difficulty level on the stepper up way past what I thought I could do, but he also explained that at that level he only expects me to do 10-20 secs at a time, I need to get fast twitch muscles working and this is the way to do it.  So I'm now up to 5-15 secs on and about 30 secs off for about 8 sets at level 10 and it's made a huge difference.

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Numnah, I went to PT today, and worked some on butt-walking, so let me tell you while it's fresh in my mind- I was taught to butt walk pretty much as Heather described except that I was taught to keep both feet flat on the floor. ONCE BOTH FEET ARE PLANTED, PUSH WITH YOUR LEFT FOOT, AND LIFT YOUR RIGHT BUTT CHEEK. Both feet planted, push downwards with your right foot, and bring left cheek off the mat, until it is even with your rt butt cheek. You've done this dozens of times, without attaching a name to it. Think of how you scoot yourself back in a chair, for instance. I think that part of the reason my instructions were a little different than Heather's is because my left leg needs to learn to bear weight, so I have to use it to push with my feet. Hope this doesn't confuse you.   Becky

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That makes sense Becky. By planting the feet and using them to push down they are turning on the hamstring as well as the glute, which is much closer to the walking muscle pattern than what I described, that planting the feet with bent knees thing still defeats me, although I'm getting better at bridges so that would be why my butt walking differs to yours.  My lt hamstring is very stubborn still and has trouble fighting my over strong quads. So your PTs way of doing it would be better for me and I'll have to see if I can progress to it.

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On 6/24/2017 at 10:56 PM, numnah said:

Someone please enlighten this ignorant reader about "butt-walking". Do you do it standing up or sitting down?

 

Hi Gina, I'm glad you got the answer to your question....when I read it last week, all I could think about was called "butt scooting"; used to get up and down stairways if difficulty walking....Very dangerous!   Hope you stay with the butt-walking on the floor as described....:smile:

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Thanks everyone for your replies. I could do it with both legs straight. Now I guess I'll have to try it with feet planted. Might be difficult, with left knee being bionic. Doesn't bend in as far. 

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After 14 years of a very successful recovery a ftractured hip last February resulted in a setback requiring  a second journey of recovery. After 7 months relying on a wheelchair and two wheel walker I discovered something called The Alter G antigravity treadmill and am now once again fully ambulatory

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Oh yes, I love the Alter G! The hospital where I do my running training has one and I used it for 3 months earlier this year. They only use it in very specific circumstances but it did wonders for my confidence and patterning, now that my calf muscles are stronger I don't use it.

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I'm so happy for you. It is such a great feeling when you find that 'perfect' person. aaaaaaaaahhhhhhhhhh  Image result for relieved  Breath Of satifction

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On 5/9/2017 at 10:21 PM, becky1 said:

What is unique about it?

The Alter G treadmill has an air cushion/bubble fitted over the treadmill area that lets them adjust how much gravity you are working with. You put on these tight fitting "shorts" and they zip you into the bubble which then fills up with air and supports you so that you can't fall and they can control the gravity. When I started I was working at about 30% gravity and at that level I could hop on my bad foot, and do running patterning.  Over 6-8 weeks we were able to increase me to 45% gravity. They gradually increase the gravity as you get stronger.  It's a great way to improve gait and strength.

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