Episode 100

 

  • In this episode: Thank you to everyone who has listened, subscribed or in some other why helped us reach 14,000 downloads. We also talk about how Christiaan and Djimmer ended up as physical therapists. 

  • Chip Review @ (26:15): Whole Foods 365 – Pastrami on Rye (Thank You Matt Schneider)

  • Trivia question of the week @ (29:29): What were Mickey Mouse’s first words?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

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Brief overview of the episode:

            Thank you to everyone who has helped us reach episode 100. We can’t thank you all enough for listening, providing input and feedback bringing in chips and generally just supporting the two of us as we discuss physical therapy, chips and throw out some random trivia.

 

Other episodes you might enjoy:  

Intro to Rebound Therapy and Wellness Clinic: Episode 1

Dr. Mike Pascoe Interview: Episode 12

Chip of the Year: Episode 52

 

Shingles: Episode 50

  • In this episode: Shingles, not the most typical physical therapy topic but somehow it keeps showing up at the clinic. (00:20)

  • Chip Review: Doritos – Nacho Cheese (09:10)

  • Trivia question of the week: If you head south from Detroit which foreign country do you hit first?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

*** At certain points the sound quality of this episode is below our standard (Djimmer had to call in and the internet connection was poor).

Shingles, Herpes-Zoster, Varicella-Zoster Virus. This is the reactivation of chicken pox. Now a day everyone gets vaccinated for chickenpox but when Djimmer and Christiaan were kids the vaccine had not yet been developed. The version of “vaccination” that we received was to be placed in a room with a child who had chickenpox so that we would get it. Since shingles is the reactivation of chickenpox hopefully its presents will continue to decline as chickenpox becomes a thing of the past.
I’m sure you are asking why a couple of physical therapists are discussion shingles. Well, prior to the hallmark rash forming there can be 2-3 days of burning along a dermatome. Dermatomal pain may be present in the cervical, thoracic and lumbar spine. In these cases it may feel a lot like sciatica, cervicalgia, a muscle pull any other radicular pain. Some one who has experienced this before may set up an appointment for physical therapy and when they come in the rash is now presents.
When shingles is seen in a patient it is something that needs to be treated medially. This will include an anti-viral medication as well as potentially some pain medication. Once the rash clears if the patient continues to experience thoracic, lumbar or cervical pain now physical therapy can be initiated and a clear picture of what is causing those symptoms can be found.
Increased age and compromised immune system are common factors in developing shingles. Interestingly enough, and this may contribute to why we are seeing shingles more often, is that prolonged corticosteroid use has also be associated with increase prevalence of shingles.

Other episodes you might be interested in:

 

Pain: Episode 29

Pain: Episode 29

Radicular Pain: Episode 22

 

Morton’s Neuroma: Episode 49

  • In this episode: Morton’s Neuroma. Pain in the forefoot and between the toes, sometimes numbness and/0r tingling. Usually related to tight footwear. (01:06)

  • Chip Review: Pop Chips Potato – Crazy Hot, Thank you to Skylar and his Mom (12:45)

  • Trivia question of the week: What names were given to the three tunnels in the movie The Great Escape? (11:10)

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

Morton’s neuroma symptoms, typically pain in the foot, worse with shoe wear or boot wear or stake wear, any kind of compression of the foot. It is most common in middle age. More common in women, but that could just be footwear related. Most commonly seen a the 3rd digital nerve. However, any of the digital nerves are possible. More or less the middle of the foot.
A neuroma is typically caused by an enlargement of the nerve ending, almost like a benign tumor of the nerve ending. This enlargement then causes compression, which results in pain, numbness, and/or tingling. Historically surgery, minimally invasive, to remove the growth was an early treatment option.
Much more recently physical therapy treatment and other non-surgical options have been found to be as if not more effective. Intrinsic foot strengthening, getting the muscle of the foot stronger as well as doing a shoe assessment and looking at the daily activities that are causing pressure on the forefoot are the places to start working to correct.
Generally speaking unloading the forefoot will help. Djimmer has been using a very simple taping technique where you pinch the bottom of the foot together. This causes the top of the foot to open up and reduce the pressure on the neuroma. 99/100 times this will relieve the neuroma. This is a temporary solution but it allows for patients to be comfortable and then work on strengthening, balance and the other aspects of treatment.
If taping is helpful often times an off the rack orthotic will be appropriate. You don’t always need a $3-400 orthotic custom made for it to be affective. This is something you can cut to length and move from one shoe to the other.
Shoes and getting shoes that fit properly is one of the easiest and quickest ways to help yourself. Reducing pressure on the forefoot is going to be the primary cause of a Morton’s neuroma so reducing that pressure is part of the long term solution.

Other episodes you might find useful:

 

Stress Fractures: Episode 43

Foot & Ankle Health with Dr. Mohammad Rimawi: Episode 40

Plantar Fasciitis: Episode 11

Ankle Sprain_Inversion Type: Episode 3

 

Imaging: Episode 45

  • In this episode: When should you have imaging done, when is there value and when is it just superfluous.

  • Chip Review: Dieter’s Chocolate Covered Potato Chips

  • Trivia question of the week: In which country would one find 8 of the world’s 10 highest mountains?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

Imaging as it value relates to orthopedic injury. Musculoskeletal, the spine, extremities, we won’t be talking about cancers or internal organs. Over the past few years imaging has taken on too much of diagnostic role and less of a confirmation role.
Initial imaging was used to confirm what the diagnostician had found. Now we are seeing more of people using imaging to diagnosis.
When we talk about imaging we are referring to plane films aka X-ray, MRI, CT scan and bone scan. You will see ultrasound a little more these days but it is not nearly as common as the afore mentioned group and so we will not discuss ultra sound in detail today.
Plane film is great at looking at bone and bone relationships. Some really good radiologists can infer more from a plane film then that. You will be able to confirm fractures, dislocations, joint space, bone spurs, osteophytes and in the spine vertebra position. Plane film is relatively inexpensive usually around $100 for a set of images. This is probably the most commonly used and in a good number of cases your insurance company will make you get a plane film before an MRI, CT scan, etc…
MRI is probably the 2nd most common type of imaging. This does a really good job of showing soft tissue as well as bone. This can be done with contrast (T1 or T2) or without depending on what you are trying to find. An MRI is $700 and up so it is a good deal more expensive then a plane film. This type of imaging gives off no radiation and is thus safer then the others.
CT scan is pretty similar to an MRI. It gives off a good deal more radiation so it is not used as often. The image quality is high and depending on what you looking for can in many cases be the best tool to use for the job.
The advantage of MRI and CT over plane film is that there is a good deal more detail and you can almost see the area in almost 3D.
Bone scan is the last type of imaging we are going to discuss today. This is primary used to show where certain bone activity is occurring or not occurring. You see this more often with stress reactions or osteopenia/osteoporosis.

Nutrition for Recovery with Amanda Turner: Episode 44

  • In this episode: We speak with Amanda Turner from Active Fueling on the role nutrition plays with recovery and what we can do to help ourselves out.

  • Chip Review: Private Selection (Kroger) – Sea Salt & Balsamic Vinegar

  • Trivia question of the week: Why are beans the magical fruit that make you toot?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

Timeline

00:00 – Intro
            – Amanda Turner from Activefueling Nutrition
            – Private Selection (Kroger) – Sea Salt & Balsamic Vinegar
00:37 – Probiotics vs Anti-probiotics
01:16 – Amanda Turner Resume
02:20 – 2x Boston Marathon Qualifier
02:50 – Active Fueling
            – Right in the heart of DTC
03:14 – Do we still call it a diet?
04:40 – Let’s start with Dixie State
05:28 – Is there something nutritional that everyone can benefit from during their
recovery?
06:12 – Food you love or hate from recovery?
07:05 – High sugar and high carb, the same thing?
07:29 – General guidelines to reduce the barrier to entry on proper nutrition?
08:16 – Food is not just a fuel source
10:07 – Weight is not a measure of health
11:14 – BMI (body mass index)
12:27 – Which is why I drink Coffee and are Eggs good for you or bad?
13:01 – Choline is great for the brain –
13:26 – Red wine
13:55 – How important is hydration to recovery?
            – 60% of our body weight is water
15:08 – Hydration options outside of H2O
15:42 – How about chocolate milk as a recovery aide?
17:05 – There is an upper limit on calcium
17:37 – Kids do the funniest stuff with their diets
18:46 – Protens, Carbs, Fats and sugars are needed for functions of the body
21:10 – That’s a big red flag
22:29 – Are there better times to eat? Is carb loading a real thing?
24:05 – Timing on eating for sports performance and recovery
25:06 – Consistent timing and context based
25:43 – Recovery is not just 1 meal
26:21 – What foods should people be eating during prolonged activity?
            – Sugar? Whole foods?
27:28 – When I’m hiking I eat Snickers
28:16 – One food everyone should avoid and one food people would eat more of?
30:30 – How about that kale train?
30:50 – I love how Brussels sprouts….
31:16 – I just finished watching Salt Fat Acid Heat
31:47 – Pizza Hut and Kale
32:40 – How much chocolate should I eat?
34:31 – On a side note – Buckler Beer
35:42 – Trivia Time!!
            – Last week: In what sport would you perform the Fosbury flop? High Jump
            – This weeks: Why are beans the magical fruit that make you toot?
37:01 – Chip Time!!
            – Private Selection (Kroger) Sea Salt & Balsamic Vinegar
39:25 – I could use a little more acid – I’d be interested to hear what you learned
40:25 – The first attempt at the Outro
40:32 – How to contact Amanda
            – ActiveFueling.com
            – Phone: 720-598-0018
            – Facebook – Active Fueling Nutrition
            – Twitter – @activefueling
            – Instagram – @activefuelingnurtrition
41:55 – Should we refrigerate chocolate? How about Butter? Eggs?
43:31 – E. coli
43:50 – Outro for real this time
Other Episodes you might be interested in:

Intro to Rebound Therapy and Wellness Clinic: Episode 1

Dr. Mike Pascoe Interview: Episode 12

FAI/Hip Labrum: Episode 21

  • FAI (Femoral Acetabular Impingement) is becoming a common diagnosis. This is a bony change that causes the hip labrum to tear and fray. Both cause pain and loss of sport ability.
  • We review Kettle Brand Spicy Queso Potato Chips, compliments of Judy Kay.
  • Trivia question of the week: The Bullfinch Pub in Boston is better known by what name?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
  • Thanks for listening!!

 

Today we are going to be covering hip labrum pain, hip labrum tears, hip labrum reconstruction, femoral acetabular impingement (FAI), which all full under the same heading. Then we are going to be reviewing Kettle Brand Spicy Queso Chips, compliments of Ms. Judy Kay.  Thank you Mrs. Kay.

 

So we are going to start with labrum tears. So the labrum sits around the outside of your hip joint. It helps to deepen the joint; it helps improve stability around there. It is also chock full of pain fibers. It is kind of like a gasket. I learned that from Dr. Parker. You learned gaskets from Dr. Parker?

 

When you have irritation to that you will feel pinching, you will feel pain.  Most of the time pain with either be in the front of your hip or into your groin.

Very common with people who are super flexible or single limb athletes as we call them if you do a lot of j ump, pushing off or landing on one leg. This is a pretty common injury. Although I think it is often, and this is speculation on my part, miss diagnosed. I has become one of those fade diagnosis. Everyone with anterior hip pain, now all of a sudden has FAI.

 

A lot of that has to do with the fact that there is now a surgery for it. The surgery is relatively routine. That has only been in the last 10 years. I remember treating a your lady 20 years ago. For hip impingement and there was not really any surgery at the time that could be done for it other then a complicated open procedure or a potential joint replacement. Neither one of those was a valiant option at the time. So we treated it conservatively and low and behold it got better.

 

We definitely see that a fair amount where you have a small tear and not need surgery. Even if you get diagnosed with a labrum tear, see it on imaging. If it is small enough you can treat it by stabilizing the joint. Treating it with physical therapy working on strength, balance, stability and range of motion.

Holland vs The Netherlands: Episode 20

  • The difference between Holland and the Netherlands? Plus we go over the holiday of Sinterklaas.
  • We review Burt’s Guinness Rich Chili which was brought to us by Steve Kovisto. Thank you Steve!
  • Trivia question of the week: What is the new name for the country formerly known as Swaziland?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional physical therapy information throughout the week.
  • Thanks for listening!!

Today is our 20th episode. Would should have live streamed it. No we should not live stream. Maybe at a later date. We want to have the option of taking certain things out. That’s a good point.

 

In today’s episode we are going to cover the difference between Holland and the Netherlands. It’s very relevant to PT, if you come to Rebound Therapy & Wellness clinic (http://reboundclinic.com/2ptsna-bag-chips-podcast/). This question get’s asked twice a week? Daily! I would say Daily. We figured it would be a little more fun.

 

There is a great YouTube video that we always show patients, (https://www.youtube.com/watch?v=eE_IUPInEuc), called The difference between Holland and the Netherlands. It does a much better job than we ever could. It’s good watching material on worldly affairs and geography.

 

So today’s show is really dedicated to the Netherlands and all its quirks and intricacies. Since both Christiaan and I are … not really from there but kind of. I’m kind of from there. More or less. I’m not really from anywhere in particular. How does that feel? It has the largest claim to me. You are born of Dutch parents, which by default makes you more Dutch than anything. Yes it does. Which is good because you know what they say.

 

Hank likes this, our friend Hank who is also Dutch. “If you ain’t Dutch, you ain’t much.” There you have it. It’s a world renowned saying. It’s a famous quote. There are a lot of those. “Wooden shoe rather be Dutch”. Which is also really good or, “God created the world, but the Dutch created the Netherlands.” Just chock full of inspiration.

 

Which is because, as everybody knows half of the Netherlands is below sea-level. If we weren’t good at making land we would have 17 million people crammed into half the space we have now. It’s crowed already in the Netherlands, let me tell you. For reference it is about the size of New Jersey. 17

 

Fall Prevention & Balance: Episode 19

  • Falls are a big concern especially as the weather becomes cold, snowy and icy. When you can up-train your balance system that will help reduce your fall risk.
  • We tried to review SunChips Harvest Cheddar. It did not go as planned.
  • Trivia question of the week: What holiday is currently under a United Nations investigation?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional information related to Fall prevention & Balance injury throughout the week.
  • Thanks for listening!!

Today we are going to be going over fall prevention and balance at the request of one of our all times favorites, Maryann. Thank you Misses Shepard. And we are going to review SunChips Harvest Cheddar. Potentially. Schuuuuuu. Aw this is going to be good. So fall prevention and balance kinda comes down to balance as a starter. Balance has 3 main components; there is the visual component, there is the proprioceptive component, which is your bodies awareness of itself, and then there is the is your vestibular system. We also tend to talk a little about muscle strength. If you don’t have the strength to hold yourself up you are going to fall over.

 

It’s maybe not as much pure muscle strength as it is dynamic stability, right. The ability for your muscles to work together in order to keep you up right. I think that is something we run into maybe with post operative patients. Lower extremity post-op patients where there is maybe some muscle imbalances that can affect your balance.

 

Big time. I mean post-op there is a huge proprioceptive loss. You no longer have the same tissues in the same places as you did before. You have to reprogram that entire situation. Especially if you are talking about joint replacements or ligamentous surgeries like Achilles and ACL. There are struggling with that.

 

I’d say that with most all our patients at some point in time we work on balance, be that either core stability, sitting balance, standing balance.

 

There is huge need for balance to be addressed because really one else talks about it. No. Your PCP, your surgeon, your physician will tell you “ work on your balance”. That right, that’s classic. Especially when you get past 60-65. That’s the first thing your primary care Doc tells you “make sure that you work on your balance”. OK how? And what kind of balance. Stand just on one leg. What am I supposed to do? Walk on a tight rope?

Rotator Cuff Injury: Episode 18

  • Rotator Cuff Injury is common and becomes more likely as we age. The good news is most are non-surgical.
  • In honor of Thanksgiving we are reviewing Trader Joe’s Turkey Stuffing and Seasoned Kettle Chips
  • Trivia question of the week: What is the only sea without any coasts?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional information related to Rotator Cuff injury throughout the week.
  • Thanks for listening!!

We are going over rotator cuff injury and we are also going to be reviewing Trader Joe’s Turkey Stuffing and Seasoned Kettle Chips. All the flavors of Thanksgiving in each potato chip, I gotta’ tell ya’ they tried cause it looks like a feast. It does you can smell it from here, we have the bag open already. If I had smellification I would be able to smell it.

 

Smellification, that would be a cool tool. I’ve been low on the smellification lately. Smellification that is like the Richie Rich thing, you ever see that with Macaulay Culkin, back in the day. Sure haven’t. Well the smellinator 5000 saved them, because it smelled TNT which they then threw out the window. So the parents didn’t die. Gotcha. He was the dude from Home Alone. Yes. Yeah. Anyway we digress. I was going to say the same thing, we digress. Weeeird. That is so weird, isn’t that weird.

 

So rotator cuff incidence, fairly high, 17% of the population has a full thickness tear. The good news. It’s kinda like the disks, the slipped disk. Your disks can’t slip, but that is a whole other story. You can have a rotator cuff tear, and it’s completely asymptomatic. And this grossly affects the population as it ages. So individuals over 60 years of age make up 30%. 30% of 60 year olds or older have a rotator cuff tear, under 60 only about 6%. Ok. If I said that correctly. Yeah, that sounds about right.

 

This is defiantly something that we see more in the aging population. Some of that may have to do with the fact that there could be some postural incidences. As we tend to slouch a little more and we have a type I or II acromion that creates impingement and that can dig into the rotator cuff and just gradually fray away at it. Which will eventually lead to a partial thickness tear and then full thickness tear.

That acromion type is basically a little hook or a slightly bigger hook so it almost acts to kind of carve into it. It’s almost like a nail carving into a rope. Eventually, with that kind of friction over time it’s going to tear. It will.

Shin Splint: Episode 17

    • Shin Splint also known as tibial stress reaction comes in two types, muscle; which will affect the tibialis anterior or tibialis posterior and bone; which is the pre-cursor to a stress fracture
    • This week we are reviewing 3 different chips from Ireland. The Irish trio consists of O’Donnells of Tipperary Irish Cider Vinegar and Sea Salt, KP Mega Meanies Pickled Onion and Tayto Smokey Bacon. Hand delivered by Mr. and Mrs. Schneider
    • Trivia question of the week: What is special about the 37th parallel in the USA?
    • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional information related to Shin Splints throughout the week.
    • Thanks for listening!!

Three bags of chips! This is going to be a crazy episode. This is very highly specialized episode. We can’t thank Matt and his wife enough for bringing in three specific flavors. Schlepping them all the way back from Ireland. They are all in surprisingly good shape considering the state of transported chips we’ve had in the past. I’m thinking these have been in the carry on. Yeah definitely.

Today we are going to be covering shin splints, also known as tibial stress reaction and we are are going to be cover, what we are calling the Irish trio. Which is the Tayto Smokey Bacon, KP Mega Meanies, which is pickled onion flavored, and the O’Donnells of Tipperary Irish Cider Vinager and Sea Salt. Yeah, the Taytos are also known as breige pratai blaistithe, which is gaelic I am assuming for smoky bacon. That would be my guess. Maybe they are just messing with us.

Tibial stress reaction, is the more formal name for shin splint. So we kinda see a little bit of two sorta shin splints. One will be the muscle, which is tibialis anterior, which is the muscle that sits right along the front of your shin. That can get irritated, strained or bothered just like any other muscle in your body. When that is the case treatment is a little quicker then if you have a true tibial stress reaction. Which is basically the precursor to a stress fracture.

This is a very common problem with runners. It’s a very common problem with sprinters. This is something that is usually an overload or an overuse problem or a mechanical weakness is involved.

I remember a case about two years ago when Newton’s came out. Which was a running shoe in Boulder. That was more like six years ago. Yes, like I said two years ago, because I’m not that old. This was a forefoot running shoe, everybody had to go away from heal striking. So we all went to forefoot running, forefoot toe running, toe landing. The Newton shoe came out and before you knew it half of Rocky Mountain Tri Club (RMTC) came in with shin splints. So a lot of times if you have shin splints there is a mechanical component that needs to be addressed. Just fixing the inflammation, is usually not enough. We have to do a mechanical assessment a running assessment and what have you. To figure out why is my shin all of a sudden getting irritated, why is my muscle being overused so much.

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