 A couple of mornings ago my partner remarked during breakfast “that was the most restful night of non-sleep I’ve had in a while”. Neither of us have been sleeping well for awhile, compounded by the anxieties and fears related to coronavirus. I asked her how that happened and she said
“I just kind of gave in to it I guess”. And it turns out that seemingly effortless act is the key to better quality rest during these strange new days. The persistence of sleeplessness had caused me to try to be funny about it with some friends parodying my end of the day routine starting with the dramatic announcement of “I’m going up” at the end of the evening through the routine of preparing for bed and the part about lying down for the first of many times with pillows just right and my book, beginning the charade of “trying to fall asleep”. In the coronavirus era of being told to ‘get lots of sleep now’ and ‘keep to your usual sleep wake times’ it was pretty funny and it seems everyone is having trouble sleeping right now. Yikes. There are many reasons of course. And during sleeplessness it’s hard not to revisit previous conversations, actions and behaviors, anticipate subsequent events and ruminate on “what ifs” and generally try to fill in the gaps between those thoughts with proactive “to do and to care for” items and people. This is definitely not good. Even in my sleeplessness I feel unworthy because I am not getting up and being productive as we are being urged to be. None of this helps sleep so we all continue in this cycle of wakefulness. But then while mindlessly scrolling through social media I came across a shared post on my niece Julia’s page. It was from a trauma psychologist acquaintance who lives in Beirut, Lebanon, Dr. Alaa Hijazi. Dr. Hijazi was talking about taking care of ourselves during this worldwide time of sheltering, reduced human contact and presumed productivity. “I thought I was spared the horrid "motivational" phrase going around now "If you don't come out of this with a new skill, you never lacked time, you lacked discipline" until I saw it on my local yoga studio page. As a trauma psychologist, I am utterly… horrified, enraged, and bewildered about how people can believe and spread this phrase in good conscience. We are going through a collective trauma, that is bringing up profound grief, loss, panic over livelihoods, panic over loss of lives of loved ones. People's nervous systems are barely coping with the sense of threat and vigilance for safety, or alternating with feeling numb and frozen and shutting down in response to it all. People are trying to survive poverty, fear, retriggering of trauma, retriggering of other mental health difficulties. Yet, someone has the nerve to accuse someone of lack of discipline for not learning a new skill, and by a yoga teacher! This cultural obsession with [capitalistic] "productivity" and always spending time in a "productive" "fruitful" way is absolutely maddening. What we need is more self compassion, more gentle acceptance of all the difficult emotions coming up for us now, more focus on gentle ways to soothe ourselves and our pain and the pain of loved ones around us, not a whipping by some random fucker making us feel worse about ourselves in the name of "motivation".
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 Government mandates, the AAOS and common sense have prevailed to put on hold nearly all scheduled joint replacement and other elective surgeries in Pennsylvania. This likely has been both reassuring for patients and their families as well as anxiety making for those living with end stage joint pain. But, here’s the thing it allows for even more time to get better prepared!
To be redundant, working from home leaves a lot to be desired when it comes to disciplined postures and ideal work stations. Sometimes slipping on to the floor with the cats for what you think is going to be a quick check of email might become a 50 minute exchange. Getting up might suddenly feel like something has been twisted or is stuck and it might be...but before you seek me out on telehealth consider most of these strains happened while you were doing nothing but sitting badly. So let's first try moving the area to see if you can loosen or stretch out the back. To be clear these exercises are NOT designed for people having radiating pain in to the leg(s), numbness or tingling or who have had recent back surgery. For that and for those folks who have a persistent pain you will need something more specific and personal and reach out via my telehealth link instead. The following series starts in supine (lying on your back on the floor) moves to sitting, standing and finally on hands and knees. Thank you for your nice feedback - yes the model, Danielle is TALL...she is also a former Division I Volleyball player who is now a Personal Trainer for Fitness Essentials here at the EngineHouse 16 Collaborative. Great job everyone getting through the week! Working from home is not like having a home office where the ergonomics can be thoughtfully designed. As a result the imperfect new normal might result in head and neck pain, shoulder and arm pain, tingling, or coldness from these faulty postures. Yes, take breaks same as you do at the office, but now you have the option of lying down and actually stretching without being stepped on by a coworker on their way to the break room...unless of course you count your dog, an 11 year old son, or a preoccupied partner. Be gentle with all of these, they are posture changes and do not need to be forced. The neck stretches can be done 3-5 times unless there is no stretch sensation in which case, move on. Hold stretches for 20-60 seconds. The foam roller exercises are designed to extend and stretch your upper back (which might be slouched over a laptop) and 10 easy repetitions should be plenty. Be in touch if you'd like help getting a foam roller...we're using a a 36 x 6inch roller, or see exercise link below. Woodrow Wilson said “If you want to make enemies, try to change something”.
Normally I’d say that is very true, but the interesting case of Telemedicine in Pennsylvania is one thing disproving this axiom. Finally, after years of being one of 9 states in the country without formally addressing the ability of a physical therapist to perform electronic (non face to face) visits via telehealth, Pennsylvania has abruptly changed its stance. And those of us ahead of this curve are thrilled. Prior to this earth shakingly fast policy shift, the total ignorance of the modality was supported by Centers for Medicare and Medicaid (CMS) another snail paced organization not addressing it by refusing to reimburse for the service. As Woodrow Wilson (never) said, if CMS doesn’t pay, no other private insurer will pay, therefore, well, very few physical therapy (providers) businesses offered a service patients would have to pay out of pocket for. Why did this happen inside of 72 hours after years of inattention? The reality of sheltering in place required by the coronavirus has been more effective than any dollars donated to our PA political action committees. First patients drove it with the simple question, "why can't you..." followed by soon to be laid off physical therapists scratching their heads and saying, I don’t understand my Practice Act and ultimately business owners realizing they can make money with it...especially since CMS couldn't explain their 20th century position on the matter and chose to begin reimbursing providers (and somehow having the time to whip together a multi page policy on the matter) immediately. How can telemedicine work for physical therapy patients who may be in need of joint mobilization and manual treatment, or at the very least stretching or tactile cuing? Well it cannot replace hands on care. That is the unique service we supply and patients will always need, but it is not the only intervention we offer. Telehealth encourages renewed focus on education, patient understanding of their issue(s) and the home execution of the patient's portion of their plan of care. This often gets lost in the collaborative environment of the face to face visit. Using Skype, Facetime, Clocktree (my portal) or simply a phone call, electronic visits offer a chance to focus on self-management, exercise technique, environmental set ups and even modifications and home decision making. Ultimately putting the patient back in the driver’s seat managing their health. If you’d like to experience a session with me and you are a current patient of mine you have 2 options: you can reach out directly through Clocktree telehealth a service I have had a relationship with since 2017. If you choose this you must Register first to access the online booking link. Or you can call me directly to set up an appointment. Thank you and hang in there! |
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