Monday, May 27, 2019

Lessons from Physical Therapy

Amerigroup expanded into Lampasas County where I live, providing me with a Medicare Advantage plan which included many of the services I have been needing for little or no co-pays: Physical Therapy (Home), Occupational Therapy (Home), Home Nurse Visits, and online Psychological Counseling. In this post, I will focus on what I've been taught by physical therapists... which includes fall prevention... as another fall could jar L5-S1, causing additional damage. I've already slipped a little further from Grade 2 to Grade 2-3, just over 50 percent.


With unstable spondylolisthesis, rocking the pelvis forward and back or twisting is a no-no. I knew I had been doing some exercises that were aggravating the condition, but didn't realize just how many.

Pelvic tilts? No! Instead, pull my belly button to my spine for 5 seconds (abdominal bracing) x 10 or more times. In addition to doing these multiple times a day, whenever I do anything like standing up, transferring in and out of the wheelchair, on and off the toilet, do ab bracing! Squeeze buttocks (bottom squeezes) for 5 seconds x 20 three-four times per day.

Therapy Ball? No! The therapy ball, because it is a ball, is too dangerous. I must not do anything that can 'rock the boat' of spondy which can happen each time I lose my balance even a tiny bit.

Kicking legs back? No. In other words, no leg extensions.

Spinal stretch twist? No. Not when lying down or sitting in a chair or reaching over to the left or the right.


Never! Just like chiropractic on this part of the spine when you have unstable spondy, traction on an already unstable area is a no-no. I just sold my inversion device.


All this time I've been using a manual wheelchair in my apartment (and to local medical appointments if I was going to a small building), I didn't know it could be lowered. I just knew it was too high. Now that it is lowered, I can sit on my favorite seat cushion and can get around easier with my feet which can now sit flat on the floor... and my arms get a rest from trying to turn the wheels. With C5-C6 radiculitis going down both arms plus carpal tunnel pain, this was a challenge.


I thought I had a great idea about using stools with wheels to get around on... and on and off of. However, just like the office chair that rolled to the left when I sat back down on it in February 2018, resulting in my slamming on my right hip as I hit the floor (and jarring my spine), transferring on and off other things with wheels is risky, too. I am safer using the wheelchair which has brakes and applying these brakes whenever I am transferring to something else or standing to reach for something.


I had been using my walker for transportation as much as possible... while sitting on the seat. I was warned they weren't designed for this, and two different therapists told me they have witnessed the frame breaking while a patient was doing this... even someone as small and as lightweight as I am. Of course, this meant I could no longer go to some of the places I had been going to... like Toastmasters meetings... which are held in the back room of a large restaurant. The person who was giving me rides can't accommodate my wheelchair.


I asked the therapist to help me with the logistics of getting to and from my car with either canes or my walker... and how my hatchback door was heavy. As for the canes, it is too dangerous as I can still lose my balance and fall. Even though it only weighs 11 pounds (I used to have one that weighed 22 pounds), I was told to never lift it. My back is too unstable.


I must learn to be my own girdle and back brace. The therapist must have told me to do this about 50 times during my last visit as I kept forgetting to.


This exercise was given to me, but the therapist can't climb inside my body to understand what happens everywhere when I stand up. I modified this one by marching in my chair.


I have a ceiling fan/light combo in each of my main rooms. When it is warm, I like having the ceiling fans on 24 hours a day. The wall switch turns them on and off along with the lights, so when I want to turn lights off, I had to stand to reach for the light chain. Fall risk. The simple solution (why didn't I think of this?) was to buy chain extenders. I even got fancy and found some with a one-inch crystal.

While I have mostly ceiling lights on wall switches, I still needed two standing lamps for additional lighting. With the one by my work station, I had to stand up to reach up and over to the switch. Fall risk. For the bedroom, the lamp was clear back by the head of my bed, the main light was with the fan which went on and off with the light switch... and the pull chain for the light was over the bed. Fall risk and frustration with getting around in the dark. The simple solution (why didn't I think of this?) was to buy a set of outlets you plug the lamps into which plug into the wall outlets which operate from a remote control device. Now, from the doorway of my bedroom, I can turn on the lamp by the bed and turn the lamp by my work station off.


...with a Shepherd's hook!! I did buy one, but I had an...


I realized I could take most of my clothes off the hangers, fold them, and move them to the cabinet with doors I have in the bathroom... where another stool lives... and brighter lights are. Of course, in order to do this, I spent hours trying to find new locations for what was in the cabinet.

But what to do with my blouses? Ahhh... I saw that if I removed the lower shelf in the built-in cabinet by the sink and put up a tension rod, I could hang my blouses! Of course, in order to do this, I spent hours trying to find new locations for what was in the cabinet.

Now, I can dress and undress in comfort without dealing with hangers and a closet. The closet can get used for STORAGE.


With chronic fatigue syndrome and fibromyalgia on top of spondy, I have yet to learn how to properly pace myself. All that work taking down clothes, taking them off hangers, folding them, and placing them into the bathroom cabinets wore me out. On top of that, the therapist had recommended I do the exercises every day--even twice a day--unless I have a fibro flare. Gung ho with now knowing the proper way to move, after being dormant for over a month, I did too much all at once. I climbed back on the recumbent stationary bike (which, by the way, I had moved from where it was because it was a fall risk to climb back into it) for about 15 minutes (with rest stops in between) and did a series of band exercises for my arms and legs. I also washed 2 shirts and 2 pair of capris in my mini Wonder Wash, prepared some food in addition to using the Vitamix which required it all get cleaned up, and did additional exercise picking up everything off the floor I had dropped. The following day, my body was screaming with major fatigue for dessert... and I found myself in the midst of a major fibro flare.