Stretching continued

As I lay in bed last night, I thought that some of you may get the impression from my last post that I am anti-stretching. I just want to go on record that I’m not…I give stretches almost every day, I stretch myself almost daily, and I believe they have value.

So am I just a bad mom who is neglecting her child with CP?  No, I do stretches with him as well, just not an endless list and not ad nauseum.  We do stretches when he is growing, or he seems tight, or just for me to see how far a particular muscle or joint can go.  The difference is we stretch for a defined, time-limited reason.

As part of my repentance (can you tell how my last post is weighing on me?), I found some great series of posting on stretching here and here.

The key is to stretch for a reason.  Stretch because you had an injury before and you want to make sure the area is warm enough to safely complete an activity.  Use the advanced stretching technique because you are having muscle spasms and they are driving you nuts.  Just be smart about it, okay?

An Admission of Guilt

Hello, my name is Heather Branscombe, and I don’t do any daily stretches with my child with cerebral palsy.  Wow, that felt better. 

But seriously, one of the first things that we as physiotherapists like to give people with any neurological issues is stretches.  Lot and lots of stretches.  It makes sense really, since if you have a tight muscle, then just stretch it, right?

The problem is, the more clinical experience I get, the more that stretching in and of itself doesn’t cut it.  I see children where the parents admit freely that they never stretch their child and the joint never gets tight.  I have have adults who stretch consistently and who just keep getting tighter.  Okay, I know, not exactly scientific evidence but it does make you think.

So what does make some people have tight muscles that get worse and other not?  I’m not sure entirely, but I have some suspicions:

1.  Stretching isn’t enough.  Consistent positioning is a key to maintaining motion in any given joint.

2.  Positioning isn’t enough either. The best way to keep a joint mobile is to actually actively move the joint.  With your own muscle power. Lots and lots.

Us PT’s who work with people with neurological issues like stretching and positioning because it feels like we are doing something.  We stretch a muscle.  We find the best way to position a joint in different ways throughout the day.  But we need to do more.  We need to be better at giving people with neurological issues opportunities to move in functional ways.

This isn’t an idea that it original to me either.  There are some great example of programs and equipment to do just that, like this, this, and this.

I challenge all PT’s (myself included) to do more that just giving a bunch of stretches.  Because if I don’t do them, and I’m a mom who has a child with cerebral palsy, you can bet your bottom dollar that I’m not the only one.

Free Exercise Program Software (I love this website!)

I just found this program recently and I love it!  One of my new clients, recently discharged from GF Strong, came to me with a program made from this website.

Brilliant.  I plan to try it out for a few of my other clients and see how it works for me.

What do you think?

My New (Kind of) Favorite Foot Braces

As a follow up to my last post about bracing in general, I thought I’d share my new favorite foot brace supplier.

I really like the braces that Cascade is coming out with, especially their new Jump Start bracing system. I like how easy they are to fit, especially for fast growing feet, and I love how reasonable they are, especially when compared to custom bracing.

Cascade also offers some great products for adult populations.

I went to their workshop about five years ago, and I plan on going again in May of this year.  When I requested information, they were super fast in sending all sorts of helpful information. That’s what I call a responsive company.

As I begin to build my practice, I hope I can continue to make links like these that will help me to be a better PT.

Check them out for yourself and see what you think.

To Brace or Not to Brace (My Bracing Philosophy)

I get a lot of questions of when to use orthotics or other kinds of bracing.  There is quite the variation of popular opinion, so here is my philosophy:

1. Is there something to correct in the feet or legs?  If not, then stop here.

2. Is that “difference” in the feet or legs affecting the client’s functional abilities?

3.  Will bracing help to bridge that gap of functional abilities?

It sounds simple, doesn’t it?  Sometimes it’s not, but often it is.  The two things that bug me most about orthotics or bracing are:

1. Clients get support for their feet when they don’t need it.  Or…

2. Clients get no functional benefit from the bracing.

No, a better positioned foot dosn’t cut it.  If it doesn’t help Johnny or Mrs. B with their endurance, so they can finally walk to the store, or balance better so they can get up the stairs with less assistance, then why wear it?

This is my philosophy…what do you think?

Entering a Brave New World

I have recently done the scariest thing in my career thus far…I have resigned from a perfectly good and rewarding pubic position at a Child Development Center.

It’s a complicated decision really, but while some of my friends wonder why I would give up a cushy goverment job, I am excited and completely scared to start a private practice.

How many other private PT practices are there that specialize in neuro?  A few, but not many.  How many are in a clinic, and not run out of a house?  None that I could find in the Fraser Valley area anyways. 

I’ve been thinkning about why that is, and here is my unscientific list to date:

1. PT’s who like working with kids don’t generally have great business skills.  We like realtionships, and business seems a bit “cold” to most of us.

2. It’s a lot of hard work setting up your own practice (I know…I’m living it).  With so many jobs available, it seems like a lot of extra hassle.

3.It’s scary.  Most therapists who start working in neorological rehab strat in a hospital or other goverment setting.  Having worked in both private and public practice, I can tell you that they are two different worlds.  It’s scary to leave a safety zone.

Here’s to doing scary things!

Hello world!

Here I am….to save the day?  Probably not.  So why write a blog?

In no particular order:

1. To get my thoughts out and see how they look .

2.  To get some honest feedback about how I can be a better PT.

3. To rant a bit about feeling like not such a great mom to a great kid.

Who knows where this will go…but I’m happy you came to take a look!

Heather