My Chilifest 2020 injury & how staying present helped avoid long term pain

The Colella family at ChiliFest 2020

I absolutely love all of the festivities Oconomowoc has to offer, and pre-pandemic, I went to ALL of them.

At the time of ChiliFest 2020, the little one was 5 months old, and I had him in the Ergo carrier. As we were walking of the ice, I fell. Normally, I have great body control, and know how to fall well, people who practice martial arts know what I’m talking about. However, we, as mothers, have this pesky instinct to not let our children get injured, so I leaned back a smidge, but landed right on my knee. It. Frickin’. Hurt!

I often say that I’m so grateful I do what I do and know what I know because it has gotten me out of a ton of jams. Here’s an example that has less to do with the nuts & bolts mechanics of the body, but more about mindset & framing the situation.

Lets break the events down in 2 different ways:

What Actually Happened

-I fell on me knee. It hurt a lot.

-My supportive husband calmly asked if I was okay. I told him to just give me a minute.

-An onlooker from the boardwalk asked if I was okay. I waved her off.

-I assessed the situation: baby The baby was not crying. The way my leg looked was not contorted or bloody- yay.

-I took a “graded exposure” approach. Can I squeeze my thigh muscle? With some pain, but yes, intact. Can I bend my knee? A little.

-I ask for help getting up (though I pretty much did a full pistol squat on the opposite side, because I rock).

-I put 10% weight on my right side, shift away, gradually shift more and more until I can put full weight on it. Okay, ready to walk.

-I continue to apply that graded exposure technique and I create benchmarks (ok, this part is a little more mechanical PT), and don’t go back to workouts, until I can do some light hopping & partial range single leg squat without pain, which too about a week.

What could have happened

-I fell on my knee. It hurt a lot.

-The baby starts crying.

-My husband, whom I was fighting with a little earlier, just comes over & tries to pull me up.

-I’m not ready yet. I fall back down.

-The onlooker asks if she can call an ambulance. I don’t know what to make of the situation, so I agree.

-I get x-rays, muscle relaxors and am placed in a long leg brace that prevents movement. The x-rays come back negative for fracture, but state I have some mild arthritis.

-The whole process takes a lot of time, money, and mental energy.

-It’s hard to work, and get around the house. My husband starts to do the laundry, and is generally nicer to me…I could milk this out a little more than maybe I need to.

-Time for my PT appointment, I’m just scared to move it & don’t trust it yet…must be that pesky arthritis.

Let’s take another example. My daughter falls off the monkey bars. Dad, who does not have as much of the keeping-children-alive instinct, is of course, less concerned.

Being in the present: I rush over to comfort her & assess the situation.

Catastrophizing: I immediately know she broke her arm. In the 10 steps to get there, I’m already visualizing her in a cast.

There’s a lot of talk about “being in the present,” but I rarely see it applied to injury. I hope this helps you apply mindfulness to real life situations. I also hope you realize that the specific exercises, or other treatment you get in physical therapy, is a small part of the equation, and the person, the physical therapist has the potential to help you feel at ease and back into a healing mindset. At OPT, you’re always treated as a whole person.

What to look for in a dry needler & the 13% rule

Have you heard of dry needling? It is a minimally invasive technique performed by a physical therapist (an in some states chiropractors & osteopaths) that can be quite effective for headaches, radicular pain/ sciatica, chronic hip “weakness,” rotator cuff dysfunction, persistent “knots” & trigger points, as well as a myriad of other orthopedic conditions.

As regulating boards were deciding how much training physical therapists needed to be able to do dry needling, it was determined that 87% of what is needed to safely & effectively perform functional dry needling, it already known by physical therapists. The structure palpation (knowing what anatomical piece can be felt by touch) is a big part of it, but also the clinical decision making. There’s a lot more that goes into it than just hurt here, poke here- which I refer to as the caveman approach.

The 13% is the actual handling of the needle, & education of all of the precautions and contraindications (reasons it shouldn’t be done). Yes, we practice everything on real people & have it done to us.

Just in case you don’t believe that I (or any physical therapist that does dry needling) can, in fact, palpate the correct structure, the process of functional dry needling through Evidence in Motion (formerly Kineticore) was validated through fluoroscopy, which is like a video under x-ray.

Why does all of this matter?

Some people will have success with me, after they did not have success elsewhere with dry needling; this is because my process at Oconomowoc Physical Therapy may be up to 87% different than another physical therapist’s process. Some people price shop & often run into that “Caveman approach” of hurt here, poke here, vs OPT’s 87% approach of finding root sources. I will also say that sometimes there are direct muscle injuries, in which case there is quick, near full resolution of symptoms, but often times, muscles are just splinting the pain area & needling just reveals other deeper tissue issues.

I hope this helps you make a more informed decision about who to trust with the care of your whole body.

Drawing Parallels- 002 The PT & the Sommelier

While patients at OPT are generally happy with their results, one thing many of them can’t wrap their head around in 2021 is how I can know so much without imaging. While this can be a spinoff to other posts on overutilization of medical imaging, limitations of medial imaging, or our general reliance on technology & inability to embrace the physical world around us…I’ll stay on topic & leave those for another day.

Sommeliers are wine experts. They spend a lot of time training their senses (visual, smell, and taste) to identify what type and even year and vintage of a particular wine. I don’t think there exists a machine that can do that.

Similarly, I have spent years with courses and practice with some of the most brilliant and intuitive people I’ve ever known to hone my occupational senses, which are largely tactile through my hands. I put that information & feedback together with the visual and the listening of your story, your symptoms, and my questions. Sommeliers have what they call “mouth feel” and when I get to the end of a range in your body, I don’t just see objectively how far it goes, but what is the “end feel”? hard like a brick wall? springy? viscous?

In every hands-on assessment, I’m essentially taking hundreds of tests. Can I show them to you? Not necessarily. Can you feel them? Most of the time, but sometimes no. If this seems wishy-washy to you, maybe you are not a good fit for this particular brand of physical therapy. However, if you’re one of the many that is in pain despite relatively clean imaging, we may go together like brie & pinot noir.

My goal is that some of the lessons learned at OPT carry over into other aspects of life, and encourage deeper thought as to why we do what we do.

As I evolve as one who treats the body, I believe in learning from my patients, and the world around us.

Please enjoy these stories from the inner workings of my PT brain & my years of experience.

Drawing Parallels-001- Nothing in Nature is Straight

My goal is that some of the lessons learned at OPT carry over into some aspect of life, and encourage deeper thought as to why we do what we do.

As I evolve as one who treats the body, I believe in learning from my patients as much as I teach them.

Please enjoy these tales/lessons from my years of experience.

Back when I was in undergrad, I worked as a “rehabilitation specialist” (which is a fancy way to say minimally trained staff) at a PT clinic. There was a patient who had a business in ocean salvage. I should mention, this was in Maryland. Other companies looked for metal, which I guess can be problematic because there are ions in water, some object can occlude the metal, etc. His tech however, just looked for straight lines.

I’ve thought of this simple idea for years.

I think we as humans like the ease of straight lines. We build straight buildings, we even represent ourselves as stick figures when unaccustomed to human form. There is another architectural option: tensegrity, which we also have examples of in the body. The way we move is not in cardinal planes like robots, but around a 3-axis system of beautifully integrated spirals & diagonals.

There is a principle in rehab called “part to whole.” Break a composite motion into its parts, practice/train the deficient part, then integrate it back together to make it whole. The integration part has many theoretical constructs. At OPT we consider accessory joint motions: did you know the shin rotates out as it locks in extension? We consider PNF (proprioceptive neuromuscular facilitation) patterns where a whole series of body patterns can enhance efficiency. We consider the effect the opposite quadrant has (L hip on R shoulder) because those two body parts have reciprocal motion in walking, and so much more.

So, ocean salvage guy, you are right: nothing in nature in straight.

If your “rehabilitation specialist” or anyone else you are working with, never progressed you out of robotic, straight plane motion, we’d love to see you.

Drawing Parallels: 003- OPT and the 90’s Bulls

Have you been reflecting on trying to find some good that came out of 2020?

I’d like to remind you of a little documentary that aired way back in Q2, The Last Dance a.k.a the Michael Jordan story, and because I’m me, I’ll relate it to Oconomowoc Physical Therapy.

  1. While Jordan is the star of the show, I learned a lot about Phil Jackson. You are the star of your own physical therapy process, I’m just here to guide you.
  2. When Phil Jackson was a player in the 70’s NBA, he was a bit of a weird, hippy outsider, but he could still bring it inside the paint. Remember him in those overalls & cruiser bicycle? If you’ve been to my office, you may see where I’m going with this. I’m in socks a lot of the time. I hum when I’m in my groove. I don’t fit the khaki and polo shirt stereotype. From a assessment and treatment perspective- I bring it.

He was an outside the box kind of guy. Who brought in different philosophies, melded them together to meet the best needs of the players (or in my case, patients).

4. After his playing career, he had a coaching gig in Puerto Rico before the Bulls. The organization (Grrr, Jerry) didn’t hire a coach with previous championships under his belt. I worked all over the country before settling in lovely Oconomowoc. People who come see me aren’t coming for the name of the big organizations. The choice is mainly on potential. Thank you, I see the potential in you too, whether you’re a Jordan…or a Wennington.

I’d love to know your take away from the series or this post.

My goal is that some of the lessons learned at OPT carry over into other aspects of life, and encourage deeper thought as to why we do what we do.

As I evolve as one who treats the body, I believe in learning from my patients, and the world around us.

Please enjoy these stories from the inner workings of my PT brain & my years of experience.