What I know from listening to these personal stories is that musculo/skeletal problems are not getting serious attention from the medical community. Physicians are trained to deal mostly with life threatening conditions. And, indeed, it is a good thing that we have experts who can recognize serious illness, save our health, and often our lives.

But for many who suffer from pain and discomfort in their musculo/skeletal systems, the early stages of their problems are difficult to diagnose. Conventional tests are better for diagnosing a problem when it is advanced and needs surgical intervention. Many physicians are trained to see the worst case scenarios, but not to deal with the small, uncomfortable conditions about which the patient is complaining. If the patient complains of a muscle ache…the doctor may think of a torn muscle, or if the patient has a nerve inflammation the doctor may think of something more serious requiring an MRI or CT Scan to diagnose correctly.

This is why I recommend to my clients that they start with simpler interventions by Physiatrists (MDs), Chiropractors (DCs), Osteopaths (DOs) and Physical Therapists (PTs). They are equipped to take care of the aches and pains, the small things that bother most of us humans. And, they are required to refer the patient to a more invasive health practitioner if they see that the problem is beyond their ability to improve. Most people come to see me after they have seen other health practitioners. Sometimes I must also refer them back to invasive practitioners if I see that the problem is more than physical therapy is capable of solving.

Some clients tell me that no physical therapist has ever spent so much time with them just working on their bodies, teaching them how to carry themselves, how to walk, sit, what exercises they need to be doing when they are on their own. Many clients worry about having to leave New York City because they won’t be able to find anyone ‘out there’ who will look after them and their needs as we do in our Body Tuning Studio. I tell them that most certainly there are good practitioners elsewhere who can do what I do or better and I even post a list of the ones recommended to me and some I know personally (see The Nature of Physical Therapy).

But, every once in a while, after receiving a body tuning, a client will tell me that they have had a similar hands on experience from a physical therapist in another State or even in New York. To me this is wonderful to hear and confirms my awareness that others are doing good work for their clients, even though they may not be able to call it ‘body tuning.’  And so, in an effort to help my own clients who move away, and others around the country who need the kind of treatment we offer, I propose the following:

If those of you who are reading this, know personally of practitioners who work as I do, who spend at least 30 minutes with each patient doing hands on therapy and another 30 with various modalities; those who use a variety of techniques, methods, modalities and exercises to ease pain and discomfort in the body, please email me their names. I will then offer them a weekend working with me and my clients, demonstrating their skill, after which, if I and my clients are confident of their abilities, they will receive certification as a Body Tuner. My desire is, eventually, to have many practitioners in every State who are working as I do to alleviate the pain and suffering of musculo/skeletal problems and who can call themselves ‘body tuners.’

There is no cost for this certification weekend, other than what the practitioner must pay to fly or drive here, and hotel expenses in NYC. But, this offer is only for those who are doing the kind of work that I do. Once they receive the certification they will go on my referral list of body tuning practitioners posted on my website.

Please contact our office if you have a practitioner to recommend for weekend certification, or if you need any further clarification.

Stay ‘tuned.’

Shmuel Tatz

Dear Ms Glaser,

I am the Shmuel Tatz mentioned in William Broad’s excellent article: How Yoga Can Wreck Your Body. Glenn Black studied with me for 5 years in my ‘body tuning’ studio, and is an example to others of how a yoga teacher with knowledge of body mechanics can minimize the damage yoga can do.

Mr. Broad states that I “devised a method of massage and alignment for actors and dancers” which is not correct. What I have done is to create what I call ‘body tuning’ which is designed to tune every part of the body, just as a musician tunes his instrument. I have worked with actors and dancers, musicians and politicians, but my practice is devoted to anyone and everyone who has pain and discomfort in the body and seeks relief.

What I wish for yoga professionals to understand is that they must know the biomechanics of the human body. Also, they need to work with someone, as Glen Black did with me, for at least 5 years to learn about body pathology, mechanics, disease and injuries. Yoga teachers should be aware of all facets of the human body so that they do not themselves nor recommend to their students other than what is health giving and safe.  I studied yoga after I learned physical therapy. If yoga teachers have a basic education in physical therapy they will never do hyper-extensions of the spine because they will know the great damage it can cause the discs.

As for yoga students, in my opinion it is best to learn yoga first in private lessons just as a piano student begins with private lessons. In group classes teachers do not have the time to pay attention to each student’s specific problems. After you become adept at learning the basics of yoga practice you can take group lessons. Unfortunately whether you take private lessons or group lessons, most teachers have no training in biomechanics and there is, then, always the danger of injury to themselves and to their students.

Again, I think Mr. Broad’s article was an important one in alerting the many yoga practitioners that along with the good that yoga can do, there is also a downside which can bring pain and limit mobility.

Sincerely,

Shmuel Tatz

Body Tuning is the yogi’s best friend. It is like holding on to a hand of someone who can see you better than you can see your self. This is the gift of any relationship. In yoga you can make a shape with your body but you might not be able to address the habitual patterns that are held in the body with it alone.

Body Tuning is based on pain free range of motion for the joint and the surrounding myofacial structure.  It’s first objective is to make the body feel safe again and establishes the feeling of health alignment and support. This is done before any intervention is applied. It seems to remind the body of what feeling good is like. Then as small pressure and slowly increasing the demand of movement on the body occurs through the technique the body feels safe enough to let go because of setting up this prior pattern of pain free rang of motion being established. It remembers and let go even more deeply.

This tuning is like a mantra that the body can hold on to and come back to it original state of freedom and health. It moves out of its compensation and reactiveness into ease and grace.

- Lisa Matkin
Stepping Stones Yoga Studio

Many yoga teachers come to me to help them with the body discomfort and pain they experience as they advance their practices. As one of them said to me: “Yoga is supposed to be good for the body but I’m finding that yoga injuries are far more frequent than I think they should be…both for myself and my students.”

To this I say: Yes, yoga can be very good for the body, and to derive satisfaction from our yoga practice we need to do some things for the body to make it ready. First of all, we need to watch how our bodies react to what we are doing. But this is not always easy for us to do by ourselves. That is why we need to have a private lesson with a good yoga practitioner who will see if we are moving correctly. And then, even more importantly, we need to have a body tuner who can check our bodies at a deeper level, that is, someone who can go deeper in the body to see what kinds of changes are taking place. And if the body tuner finds something wrong, it may be necessary to slow down the yoga practice.

Another yoga practitioner came to see me with an injured hamstring and psoas muscle pain which caused her right leg to rotate externally in a painful manner that disturbed her yoga practice and teaching. She also had old injuries from dancing that were exacerbated rather then helped by her yoga practice. She was frustrated that she couldn’t figure out how to heal herself. She told me that she was aware that challenging the body with advanced asanas (postures) can be beneficial to the body and mind, but occasionally, moving the body past its expected limits to more extreme positions can strain the body and even cause injury.

In yoga practice we are trying to go to the maximum of mobility. As a body tuner, I have to look at the attachment of the psoas muscle and the hamstring. In many cases the tendon attached to the bone is inflamed and I need to work manually and use some modalities to cure the inflammation. It is also very important to check how the spine is moving, mechanically. I often discover that some segment of the spine does not have enough flexibility and also that the tendon of the hamstring is being overworked which causes inflammation. First I teach how not to irritate the tendon, and second, I use a specific treatment for this problem.

In her yoga practice the teacher needs to avoid any pain and discomfort. Sometimes this means doing only half of the maximum.

For every hour of yoga practice one needs ten minutes of Body Tuning. If you practice weekly, say 6-8 hours per week, you need to have weekly Body Tuning sessions. If you drive your car to the Hamptons once a week, you take your car to a mechanic once a year. If you drive it every day you will need to see the mechanic more often for a tune-up. 

A yoga teacher who has benefited greatly from Body Tuning in our studio addressed the idea that Body Tuning is like a ‘set of tools’ that can be used to help yoga students learn more about their own bodies, to help them understand their restrictions and to heal the pains that their yoga practices don’t heal. She expressed it very well when she said that she thought of Body Tuning as ‘a supplemental practice that helps clarify movement, range of motion and mobility so the asana practice can better serve us.’

Indeed, Body Tuning can and should be a supplemental practice in a yoga teacher’s studio. It is very important for a yoga teacher, after studying yoga for few hundred hours, and practicing it for several years, to add a second step: To study Body Tuning and add it to their practice. The reason is that not every yoga student has the time and the financial means to see a body tuner. But, once trained, yoga teachers can do Body Tuning either before or after their yoga sessions to help their students understand more about their bodies and how not to overdo. Spending 5-10 minutes or more, depending on the condition of their students, would be extremely beneficial.

A fourth yoga teacher, trying to define Body Tuning and its value to her, said the following: ‘Body Tuning is not massage, although there is massage involved in it; it is not physical therapy, although it is therapeutic; it’s not chiropractic, although there are elements of chiropractic in it. It is of specific benefit to yoga teachers as it makes us think differently about alignment in the body. Body Tuning is not standardized. There is no formula to it. It is personal and intuitive and it heals.’

Massage Therapy: Every body tuner needs to be highly skilled in different techniques including Swedish, deep tissue, soft tissue, trigger point, and so on. A body tuner needs to know how to manipulate soft tissue with different massage techniques, both Eastern and Western. Yoga teachers often go for massage therapy. This is good. Massage is relaxing and relieves stress, but ultimately the yoga teacher needs more and deeper therapy, such as Body Tuning, to discover what is happening in the skeletal system.

Physical Therapy: In terms of the physical therapy component of Body Tuning, each body tuner is supposed to know conventional physical therapy techniques, to have the ability to evaluate the musculo/skeletal system, and to know different movement techniques from Alexander, Tai Chi, Fendenkrais, Kung Fu  and Trager. Practitioners of Body Tuning need to know how to use different modalities, including ice, laser, electro-stimulation, magnets, ultrasound and more. And they must have the ability to apply the proper modality for each condition. Some patients react badly to electro-vibration but do well with lasers. Some patients feel discomfort from magnets but respond well to ultrasound. Some like heat, some cold…some more intense modalities. The knowledge of the therapist in understanding the patient is important in deciding on the correct modalities in each situation.

Chiropractic: Chiropractors talk about ‘adjustment.’ In physical therapy we talk of ‘manipulation.’ They mean the same thing. Experienced body tuners need to know when to adjust and when NOT to adjust the skeletal system. It is more important to know when not to manipulate. Manipulation is strong medicine, and like every strong medicine it can help or hurt. This is why the body tuner needs to be experienced. But the patient has a responsibility as well. And that is to be aware of what they are feeling while the body tuner is working. The pain that one feels is supposed to feel like good pain, therapeutic pain. It is like being able to tell if a soup is too salty or a drink is too sweet. The patient experiences what is happening and decides if what they are feeling is good or not good. If the patient feels better when the Body Tuning session is over, that is good. But the real question is: how much better and for how long will the patient feel better? That will determine how good the body tuner is.

In terms of Body Tuning being ‘intuition.’ My ‘intuition’ about the body and its problems is the result of many, many years of experience. No one body worker can develop ‘intuition’ after only a few years of working on the body. Just like a musician who must practice many years before he is ready for a recital, a body tuner needs to have a minimum of 10-15 years of experience in order to become a good body listener and helper. I worked many hours learning how to do preventive physical therapy; I read much literature about the body and I visited and observed experienced therapists. I also had other physical therapists work on my body. There again, like a musician who learns a great deal from his own practice, taking lessons and listening to other performers, I learned from studying, working on my own, and getting experience from others working on me.

Some people have had good results from Body Tuning in only a few sessions. But, I don’t do miracles. And, as far as fast, quick fixes go, usually people who feel better after one or two sessions will return in a few months, with a bigger problem. The human body has memories. When I change the physical mechanics, the body responds well, but we have a brain and to change our habits in the brain takes much longer.

So, to sum up the value of Body Tuning in conjunction with the practice of yoga, I’d like to express it this way, using again the analogy of an automobile. If I have a car and only drive it on weekends, I can take it to my local mechanic. But if I have a race car, I will need perhaps four or five mechanics with special expertise. If, as a yoga practitioner I do gentle yoga twice a week, Body Tuning will only be needed once a month. If I take or teach intense, advanced yoga, and do it every day for an hour or more, I will need one day every week for rehabilitation with a body tuner. Saunas and hot tubs are excellent therapy for body aches and pains. However, the serious yoga teacher and practitioner will need more. They will need deeper Body Tuning to discover what is going on in the skeletal system so they can be more effective in their practice and remain pain free.

Related:

• FitYoga: The Body Whisperer
• Yoga Journal: Fine-Tuning the Body at Carnegie Hall

Sometimes we get lucky. Sometimes, we don’t. A client of mine once complained to her internist that the specialist he recommended for an area outside his expertise was impatient, bordering on nasty. She said: “I looked up his medical credentials and I’m sure he’s very smart but he was officious and rude. So, do I stay with him?” The doctor replied: “You should have both a kind doctor and one with credentials. I’ll see if I can find you one.”

So, what happens if we find that caring and well credentialed doctor, and as our doctor/patient relationship moves on, we develop a mutual friendship? Perhaps we meet outside the office at parties. Perhaps we invite our doctor to our home and our invitation is reciprocated. With the change in relationship, how can we, both doctor and patient, maintain the proper perspective and distancing required to be objective? The answer is: It is very difficult.

One of my clients told me that her husband, a plastic surgeon, had constant requests for ‘lifts and tucks’ from their personal friends. He would see them in his office only for an evaluation and then refer them on to another plastic surgeon he trusted. She quoted what he had told her: “I would never operate on a friend. Just as I would never operate on my wife. A friend’s comfort in having me as their surgeon would not outweigh my discomfort. What if she didn’t like the outcome? Worse, what if I made a mistake and harmed her in some way? Nothing I’d want to do with any patient, but the friendship would further compromise both her and my objectivity.”  Smart man.

All kinds of problems can result from a doctor taking care of a relative or friend in any but an emergency situation or where there is a minor ailment such as an abrasion or perhaps a child’s sudden earache. In the broadest sense, it compromises the patient’s care. A doctor needs to be circumspect, objective, and that will be much less possible if the patient is a friend or relative. The worst story I’ve heard from a client about what can happen when a doctor and patient have a friendship is the following: The gentleman in question went to his friend, an internist, who would not accept payment for his services,  but in order to be compensated for his time, he billed the insurance company, providing a bogus diagnosis. It was entirely different from what the doctor told his patient/friend that he had, which was really…nothing. The gentleman decided to change insurance companies and when he did, the new company checked his medical records and came upon the internist’s ‘diagnosis’ and refused the insurance on the basis of a ‘pre-existing’ condition. Now, of course the doctor had committed fraud. But if the patient were not also a ‘friend’ to the doctor he might have reported him. However, he felt he could not… so he did not.

Doctors who treat friends and do not charge them, lose money. They are not like retailers or car salespersons who can offer discounts but are still remunerated for a goodly amount of the purchase price, and, therefore, do not lose compensation themselves. And, at this time in medicine where managed care pays doctors much less than they bill for, treating a friend without compensation compromises the doctor further.

To read more about the many reasons why medical societies have created guidelines for doctors treating family members or those with close relationships please see: http://www.acpinternist.org/archives/1999/01/relative.htm

In my body tuning practice I have many clients who have also become friends over the years. This makes it more difficult for both the client and me for the reasons I’ve stated about doctors and patients. I have to be vigilant so that treatment and socializing do not overlap. So I request from my client and demand of myself the discipline to be totally quiet during treatment so that I do not take my attention from the body problems I am trying to remedy. As many of my clients know, if they begin to talk, I will request that they remain silent during the session. When it’s over, clients are usually quite relaxed, in less pain, and not in the mood to talk, anyway, which means that I have done my work well and they are responding to the treatment and not anything else. This said, there are also situations where I will refer the client/friend to another practitioner in my office or elsewhere in order to keep the boundaries between friendship and treatment.

There is yet another issue I have discovered through my clients and from my own experience over the many years I have been in practice, which is that when a client wishes to have a referral from a doctor, whether it is for a physical therapist or another physician, the doctor will often refer the patient to a practitioner with whom he has a business relationship, in other words they refer patients to each other. But, a better approach might be to ask the doctor to whom he would refer his own mother or his wife. It may, of course, be the same person, but chances are it will not be. If your doctor is a real friend, he will refer you to whoever is the best practitioner in his personal experience.

A client came to see me after seeing three orthopedists who were her friends. Two recommended surgery for her knee problem. The third recommended physical therapy, and said she would need to devote at least 4-5 months to getting better. This was a great deal of time for her to consider as she is a professional woman and her time is limited. The doctor gave her a list of physical therapists from which to choose. I was not on the list as I had no business relationship with the doctor. She went to several physical therapists, and not being satisfied, asked a good friend to recommend her own physical therapist. The friend recommended me and the woman came to see me. She told me that having seen several other therapists, she now had the experience and could determine that I was the one to finally help the painful problem in her knee. Clients need to be willing to take the time to find out by personal experience, who is best suited to take care of them, just as this woman did.

It is important as you search for the best physician for whatever ails you to keep in mind that it is in your own interest to consider whether the practitioner can be objective about you and your problems. If you keep friendship out of the equation you won’t have to worry that your treatment may have been compromised by the blurred lines between medicine and friendship.

Most people who hear the word ‘cane’ picture an elderly person using it as a ‘walking stick’ for balance or as an adjunct to injury or surgical repair of hip or knee. If we are lucky, that is if we get to live a long life, most of us will need to use a cane for one reason or another. Sometimes when our joints are damaged we take pain medication to try to avoid surgery but the damage to our joints continues. Using a cane can take the stress from the inflamed joint, thereby avoiding the side effects of medication and perhaps delaying the need for surgery.

What is most important is that we know how to use the cane properly. We need instruction before we venture out with our new helper because constant walking with a cane, if used incorrectly, can injure rather than heal. Repetitive stress injuries can occur in the wrist and shoulders. Improper posture can heighten problems with the core of the body. To avoid this:

• Use a cane that is the right height for your body size
• Hold the cane with a straight wrist, as if it is an extension of your arm
• Place the cane parallel to the heel opposite to the injured leg. If there is no injury the same thing applies. This will help the cane wobble less and provide more support.
• Slowly move back and forth from one leg to the other to feel the support of the cane.
• Take slow rhythmical steps and feel how the cane acts as a cooperative third leg.

Outside its use for support for balance or injury, few of us know that a cane can be so much more. For instance, many martial arts studios give instruction in the use of canes for defense or attack. And, too, senior citizen workshops make use of canes to teach self-defense.

But beyond the use of a cane for aggression or defense lies another reason to buy a cane: It is a useful tool to benefit the health of your entire body. The following paragraphs detail some of the ways you can help improve  your body by using a cane.

Upper body, wrists and fingers

• Grab the cane with both hands and hold it horizontally in front of you, arms extended. Swing it from side to side; this movement helps your elbows and shoulders to remain loose.
• Rotate your wrists towards the ground (as if you are knocking in a downward direction). This encourages their strength and flexibility.
• While you’re at it, try letting go of the cane with one hand. Then crawl with your fingers horizontally across the cane. Rotate the cane so that it is parallel to your body and repeat the finger exercise, this time crawling vertically up and down the cane. Repeat with both hands.

Better posture

• Balance the cane’s tip in the center of your palm. The taller you stand, the easier it is to balance the cane. Once you’ve mastered balancing the cane on the palm, try balancing it on one finger. If you get tired from such tricks, simply place the cane behind your back under your armpits; this position automatically forces your spine into straighter alignment.

After standing for so long trying to improve your posture, you may want to stretch your body.

Stretching

• Sit down on a chair and cross your legs so that the ankle of one leg lies on the knee of the other. Put the handle of the cane around the raised knee and pull it towards your body, stretching the hip muscle.
• Then put both feet on the floor and grab one foot with the handle of the cane. Gently pull your foot up with the cane, keeping your knees straight and your body upright. This provides a nice stretch to the calf muscles without the rest of your body having to compensate.
• To stretch your back, place the cane vertically in front of you with both hands on top. This is the way elegant gentlemen of the 18^th and 19^th centuries sat with their canes which were a symbol of their station in life. Move the cane forward, your body stretching toward your hands. This relieves tension in your back. The cane acts as a point of balance allowing for a good stretch.

Reflexology

• With the tip of your cane you can massage the bottom of the foot. Then, with its handle, tap your heel and shins—gently.

Stimulation of the circulatory system

• Eastern medicine practices often include slapping the body to stimulate the blood. You can do the same thing with your cane by thumping the body gently with the handle of the cane.

Muscle strengthening

• Place the cane across the rear of your neck with one hand on each end. Press your head against the cane. Repeat several times. Then move your head from side to side for mobility.
• For traction: In the same position, gently use the cane to pull your neck up. This relieves tension and stress on your spine.
• If you want to work out your quadriceps. Sit down in a chair and holding the handle of the cane under your knee, lift your leg slightly. With your leg up, raise and lower your ankle several times. Repeat with the other leg.

Acupressure and the cane

• Just as acupuncture or acupressure would do, you can learn to find the proper points on the body and tap them with your cane to stimulate them for various body conditions.

The cane can be used for so many positive things. Fred Astaire knew it. And who can imagine Charlie Chaplin without his cane? If you are so inclined, you can even use it to gently poke the person in front of you in the movie theater who is talking too much.

If you think of the cane, or walking stick, as a positive instrument that can provide you with increased good health, perhaps you will be stimulated to buy one. If you do, keep it in your sight so it will remind you that you have some fun ‘stick-cersises’ to do before the day ends. See if you can discover more of them and how much better your body feels after using your cane. And then, spread the word.

Picture Socrates in a pair of Nikes. With every step, the unnatural support of the shoes, while seemingly comfortable, prevents certain muscles in his lower legs from working as they should. Unable to roll through the foot as he walks, his calf, ankle and toe muscles  become weak, resulting in foot conditions like flat-footedness and hammertoe. Instead of naturally landing on the ball of his foot as he walks, he lands on his heel. This unnatural gait leads to knee, hip and back problems. In addition, the thick-soles of his Nikes distort this great philosopher’s perspective of the distance of his foot relative to the ground, leading to a greatly increased chance of sprains and other injuries caused by missteps. In addition, the shoes keep his feet in a constant, unchanging temperature and the high concentration of nerve endings on the bottom of his foot are stimulated less, making him more prone to viruses. In the end we see an unhappy, physically compromised, pained philosopher, perhaps eager to drink the hemlock.

Until his unjust trial and subsequent demise, Socrates lived a healthy life.  With every shoeless step he activated the many muscles in his foot, free to function naturally without the constraint of shoes. That strength in his legs improved his agility and flexibility. His back did not have to compensate for an improper gait, allowing for correct posture. Barefoot, he could sense the various textures under his feet, allowing the nerves of his feet to be stimulated and increasing his blood flow.  In a sense, Socrates was grounded in how the world felt, literally, and not only what it looked like or appeared to be. Who knows what philosophical insights might have come from that?

In today’s world our female celebrities walk in stiletto heels. Our politicians would deign to appear at a rally… barefoot. We have been taught that exposed feet are considered uncivilized and unsanitary. But, why not be rebels? Why not walk barefoot at home instead of shielding our feet in slippers? Why not throw off our sandals in the park and treat our feet to the delights of the grass? Or why not invest in a pair of so-called “minimalist” shoes (sneakers which resemble gloves for the feet) for running? The benefits of doing so override any reservation.

And on the subject of minimalist running shoes, Daniel Lieberman, an evolutionary biology professor at Harvard, and subject of a NY Times article by Claudia Dreifus (Aug.23, 2011) has studied running and runners. His contention is that runners in shoes most often land hard on their heels. This causes a shockwave that travels up the leg and eventually to the head. When he first observed a barefoot runner, he saw that he landed on the ball of his foot, causing no shock wave to hit his head. Going to Africa to observe people who never wear shoes, he noticed that when they run they run in a ‘lighter, gentler way because it would hurt to run the way people do in their shoes.’ Dr. Lieberman, himself, runs either barefoot when the weather allows, or in a ‘minimal shoe.’

The reality for most of us is that we can’t be barefoot all the time. We have to go to work, in subways, buses, automobiles. We have to walk on dirty street pavement. We are not allowed in supermarkets without shoes, much less restaurants:  “No shoes, no shirt, no service!”  So here are some exercises to do, in your shoes, and also once you are free to take them off.

• When you are sitting, try to move your toes inside your shoes.
• Try lifting your heel and putting it down. And then do the same with your toes. (Classical musicians often keep time with their toes; jazz musicians with their heels…good for the musicians but not aesthetically pleasing to the audience.)
• Make circles with your feet.
• Try writing numbers with your big toe. (best if your shoe is off)
• Stretch your leg and point your toes toward your knee.
• When you have to stand for long periods, try to feel as if the soles of your feet are grounded to the floor. After 20 seconds slowly shift your weight to your toes and back. Repeat five or six times. Then try to shift the weight to your heels without lifting your toes. Finally, try to rise up on your toes, slowly and carefully, ankles staying straight. Repeat five or six times. Then rock back on your heels, slowly, watching your balance.
• Once at home, and able to remove your shoes, lie down on the floor and move close to a wall. Bend your knees so your feet are against the wall and your body and knees are at a 90 degree angle. Slowly slide your feet up and down the wall. Then try to scratch the wall with your toes. Toes are supposed to have the ability to move. Being in shoes inhibits toe movement so we must give them that option when we are barefoot. You can also give your toes this little workout if you are on the grass, at the beach or even walking on small stones. But be careful not to damage your foot. Always go gently and slowly
• Finally we need to always remember to walk barefoot as horses and other animals do. Relax your ankles. Don’t try to put your heel first and then the rest of your foot. The foot is supposed to be flat, which avoids tension.

We need to be without our shoes as much as possible to strengthen our feet and to keep them relaxed and flexible. They support us in everything we do. So, let’s treat them with respect and kindness. We can use Socrates words as our guide: “It is not living that matters, but living rightly.” And living ‘rightly’ means going barefoot as often as we can!

It is of great importance to do our homework when we are trying to find the best person to care for our needs. It takes time and effort. Sometimes we listen to others’ suggestions more than we take the time to investigate for ourselves. If we are considering a surgical procedure, then it is in our best interest to seek other possibilities of solving our problem before we decide that surgery is our best option. Our bodies are fine instruments and need proper care to stay strong and vital. But there are many routes we can take, before the most serious of all: surgery. We can do the best thing for ourselves by going slowly and discovering what paths are open to us.

Considering the options

Whatever our specific condition, whether it be arthritis, a physical injury, or a chronic problem, there are no short cuts to solving the problem. The possibilities open to us are first, seeing our primary care physician, who may recommend medication. The medication may alleviate the pain while we take it but it can often have side effects and cause stomach upsets. Sometimes, just reading the information we are given by our pharmacies, makes us decide to try another way.  We may then be referred to a specialist, an orthopedist, who may say that we need surgery.

If surgery is recommended, we should consider getting another opinion, even more than one. Not from an orthopedic surgeon but from non-surgical practitioners: a physiatrist, an M.D. who can provide us with alternatives to surgery; an osteopathic physician, who uses manipulative treatments; or a physical therapist, who can identify the problem and help to create better movement and quality of life. Each person requires individual techniques and methods. And there is no one answer for any problem. But it is best to try to avoid an invasive procedure, which may or may not correct the problem and from which we will have to spend weeks and sometimes months in rehabilitation.

There are orthopedic studies on arthritis that reveal that people who had arthroscopic surgery and those who did physical therapy had the same result a year later. We know that if we take 100 people off the street who are not complaining of back problems and give them MRIs, some of the MRIs will show bulging discs. And that after back surgery many people find that they still have pain and that the problem was not disc related after all. It is a sad fact that were it not for insurance payouts, many of us would not choose to do surgery too quickly and would investigate other means. But we should do that anyway.

Preparing by asking

So, if you have decided that surgery is the best way for you to solve your physical problem, here are some things I believe would be in your best interest.

• Talk to people who have had the kind of surgery you are contemplating and listen to their journey through it.

• Find out how long the operative procedure will be and how long the recovery period that will return you to the ‘normal’ state you were in before you had the problem.

• Find out what needs you will have post surgery: simple things like bathing, walking, eating can be major problems depending on the type of surgery and when you are in pain and discomfort it is hard to learn new habits.

• Find out how much discomfort you will be in and what kind of medication you will be taking post operatively. Also how long the pain is likely to last.

• Make certain that you will have help. Perhaps your insurance plan will provide nursing care. Perhaps you will have to hire someone yourself.

• Find out how long it will be before you can be independent without help from outsiders and back to work or doing normal activities again.

• Find out if the operation is likely to take care of the problem permanently or the likelihood that there will be a recurrence.

• And consider this: Studies show that people who did physical therapy before surgery recover two to three times faster than those who did nothing.

Summary

We need to take great care of ourselves and invest our time in finding the best practitioners for what is ailing us. I am happy when my patients come and tell me, as one did only recently: “I know that I need physical therapy for 3 months and you’re third physical therapist I’ve seen. I just want to find the person who is best for me.”

It’s best to try alternative ways to heal before you decide on surgery, because there is no way back. Look for respected practitioners who will spend time, energy and use their experience to take care of you. If nothing works to your satisfaction, surgery may be your option. But it would be in your best interest to make that your last option and not your first.

A Creative And Artistic Profession

To become a better physical therapist, just like becoming a better pianist, you have to practice. Physical therapy is a creative and artistic profession. In medicine there are perhaps ten different drugs for a particular condition, and several surgical techniques that could aid the patient. In physical therapy, there are therapeutic modalities and active and passive movements the physical therapist can use. In the use of manual therapy, learning to touch and move a patient’s body, there are a hundred different possibilities for each condition. This means that physical therapists need to have more experience and knowledge of movement.

Studying Physical Activities

In the area of movement, which is a large part of the practice of physical therapy, the study of physical activity is necessary. You need to learn to study Western sports activities and Eastern physical education, like Tai Chi, Kung Fu and Yoga, plus modalities, like cupping and shiatsu. In sports like tennis, for example, it is better to study the movements of table tennis where you have slow and then quick movements. Racquet sports require control of both racquet and ball which teaches coordination. But the physical therapist needs to have a feeling for all sports in order to be able to do better manual therapy.

Modalities

In the use of various modalities, we learn that different patients react differently to the same modality…electricity, light, mechanical vibrations. There are no explanations for why different people have different reactions to them, but they do. Every human sensation is different. Some patients dislike grade five manipulation but have a good response to grade one. So the physical therapist needs to be attuned to the patient’s comfort and to find alternate modalities for increased healing. When you are in training to become a physical therapist, you can only practice modalities on yourself and friends. But this is the best time to experiment with them. It is not necessary to have tendonitis to understand how the tendon works and to experiment with what you can do with a healthy tendon and how various modalities feel.

My Personal Experience

Ten years ago I woke up and my knee was swollen. I was in a lot of pain. I tried to do different modalities but the inflammation did not disappear. After two weeks there was no improvement, so I visited an orthopedist. He had me take an MRI which showed that I had a torn cartilage and arthritis. He offered me surgery. Like many other patients, I wanted another opinion. I ended up seeing several other knee specialists. Three suggested surgery, but I declined. Instead, I asked for anti-inflammatory medication. I took it and four days later the swelling went down. I then saw two chiropractors to find out what they recommended for my condition. One said I had a pinched nerve in my back. I didn’t believe it. I then saw an acupuncturist who talked about my kidneys. I was not in sympathy. After that, I saw four or 5 physical therapists. One said he had the same problem I had and had surgery. I asked why and he said because the orthopedist had referred a lot of patients to him and he was afraid that if he didn’t have the surgery done he would lose his business.

After half a year of physical therapy, I was fine. Now, 10 years later, I hardly remember what happened to my knee. I have had no symptoms since. I’ve seen patients who had arthroscopic surgery for the same problem and the price they paid years later. They were in discomfort, and finally needed a total knee replacement. My recommendation to patients stems from my own experience: Find a good physical therapist. Work for a minimum of 2 or 3 months to get results, and remember that in some cases, full recovery can take 6-8 months. My personal insight, following not only my own experience but what I have seen and heard from patients who have gone to orthopedists, chiropractors and physicians, is that we in physical therapy have the best possibilities, the best modalities to make it possible for patients to avoid unnecessary procedures.

Physicians, Chiropractors, Occupational Therapists, Massage Therpists, Athletic Trainers

Once upon a time, before physicians became pain management specialists, they referred their patients to physical therapists. Now they are likely to give injections and medications rather than refer to other health practitioners. Chiropractors used to do only spinal adjustments. Today they are using the same modalities as physical therapists. Before, occupational therapists were working mostly on the effects of neurological conditions, like stroke. Now people with upper body injuries are most likely to be referred by their physicians to occupational therapists rather than physical therapists. Five to ten years ago, it was considered laughable if massage therapy was mentioned as an adjunct to healing. Today massage therapy is recognized by insurance companies. So patients can go directly to massage therapists for help rather than to see a physical therapist. Today, even athletic trainers use the same modalities as physical therapists. So to succeed in private practice physical therapy, you need to be not just good: you need to be outstanding.

Training

Physical therapists have the best training to use the necessary modalities to work with the various conditions patients bring to us. But, we need to have better practical experience. Pain management physicians work hard in hospitals. It’s difficult to become a pain management specialist. Before licensing, physicians are scrutinized on both their theoretical and practical experience with how they treat patients. Chiropractors have both theoretical and practical experience. But not physical therapists. To obtain a license you don’t have to do a practical test. Physical therapists go to school mostly for theoretical knowledge. Thirty years ago there was a practical test for physical therapy licensing. Now the concentration is on theoretical knowledge to obtain a license.

In music, even if they become a recognized musicians, most go to listen to other great performers. This can give them ideas on how to become a better performer. How soon you, as a physical therapist can get personal treatment from a senior physical therapist, the better it is for you to learn the sensations of touch, the intensity of it, and the changes it brings in your own body. Also, as you move on in your training and become more accomplished, it is a good idea to seek out everyone close to you, family and friends and ask them to let you work on them. That will enable you to learn how their reactions to your work.

No one physical body is perfect. Physical therapy is performed on newborns and people in comas, on people who run marathons and people with breathing difficulties.  Age differences, physical conditions and disabilities offer the physical therapist a wide range of therapeutic possibilities. And you must be prepared to handle them. If you have learned about your own body by doing a lot of physical activity, you have developed instincts about how your body reacts. Later, when working hands-on with patients you will train your hands to become your eyes and ears and develop your own instincts about the body you are treating. If you ask a great pianist how they do what they do, they cannot tell you. When you ask a physical therapist, many cannot explain what they do, but they can do. Some can explain but can’t do very well. In society there are ‘healers’ who can’t explain how they do what they do, but they succeed in healing. In rare cases, the physical therapist can explain and can do. In any case in a good physical therapist, instinct plays a large part in how to deal with a patient’s physical problems.

Learning Beyond Training

In a concert hall there are not many people who can truly tell the difference between good and mediocre playing. Unfortunately, the same thing is true for physical therapy. Patients may continue going to a physical therapist even though they are not pleased with the results they are getting. They need to be encouraged to pay attention to what is happening in their bodies. Do they like the therapist’s touch or not? Are they feeling better? Are they in less pain? If not, they need to find another physical therapist. If you wish to be the best physical therapist you can be, think of it as if you wished to become the best and most creative chef. You can apprentice at McDonald’s or you can work with a great French chef. You need to learn the basics, the well known methods, like Maitland or McKenzie, and many therapeutic modalities. A great pianist starts out with scales and arpeggios and then gradually learns Bach, Chopin, Schubert, and much more so that he/she will a choice of repertoire which can be called upon at any time for any audience. Accordingly, physical therapists need to learn traditional techniques and modalities, and then develop their ‘repertoire’ in order to be creative with each patient who comes with a different physical problem.

The secret to becoming a successful physical therapist is to study hard in school and later: practice, practice, practice!

Implants and narcotic drug therapies carry risks along with the possibility of easing pain. We are all aware now that what was once considered an innocuous pain reliever, acetaminophen, is known to cause liver failure when used in large doses. And, ibuprofen and other anti-inflammatory medications, even aspirin, can cause stomach bleeding.

In the area of pain management, medications do not heal the body. But in the hands of a competent physical therapist, that is, one who is licensed and who has a minimum of 10 years of experience and who works hands on with the patient for at least 30 to 40 minutes, physical therapy can alleviate pain, whether it is from a structural problem, an injury, or has been longstanding and chronic.

Physical therapy is derived from what was called physiotherapy and also from massage therapy. In my practice many massage techniques are used as well as yoga techniques. Every well trained physical therapist knows many different massage techniques; shiatsu, Swedish, deep tissue and uses them according to their assessment of the client. Many also incorporate the use of Eastern methods, like acupuncture. Western physical therapy concentrates on the manipulation of large parts of the body, Eastern style on small points, about one centimeter in width, manipulating them sometimes with fingers or laser or infra-red to either stimulate or cool down the points.

Whatever the path taken by the physical therapist, it is the hands-on  therapy that is of exceptional benefit to the patient. The hands of the physical therapist become his eyes and ears. For instance, if my patient is complaining of pain in the hip, I hold the hip and listen to the response from the body. If I feel the body is irritated and not moving as it should I start to cool down the body. If there is a lot of pain I am very careful, and use soft, gentle movement. If, on the other hand, there is not much pain I can be stronger and go deeper to see what is happening deeper in the patient’s body mechanics. And here, the patient needs to be the guide. For instance, if a chef cooks up spicy food and the diner cannot tolerate spicy food, then it is not a happy situation for the diner. And so it is with physical therapy, some patients prefer a slower, sure approach rather than a great deal at once. And I listen to the patient, no matter whether I believe differently.

Just as we have our primary care physicians and dentists who get to know our bodies and our problems, we also need to have a physical therapist we trust and visit him regularly so that he gets to know our bodies and can see when things are not as they should be and help correct the situation before it becomes a painful problem. I suggest a private physical therapist, one who does not work for a hospital or an insurance company so that the therapist is not constricted by what the insurance allows but who can spend time and do what is necessary. And what is of added benefit to the patient, a good physical therapist will make referrals to physicians if he suspects something for which a physical examination is necessary. For instance, some back pain can be from gynecological problems; shoulder pain can warn of an imminent heart attack.

So, if you are experiencing pain in your body for which your physician has no ‘cure’ or for which medication has not been the solution, consider physical therapy. But once again, I wish to say how important it is to find the right physical therapist for you. Ask people who are happy with their physical therapists. Try that person and if you are not satisfied, try another and another until you have found the one who helps you. Pain can destroy our lives. We don’t have to live with it. And one of the solutions may be just a phone call away to a physical therapist.