You Can't Mow the Lawn

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[00:01:03] I use it every day in the clinic for virtual and live visits. I just speak to the patient and at the end hit Comprehend and a soap note's generated. I love it and you will too. Welcome back to Untold Physio Stories podcast.

[00:01:20] I'm your host, Dr. E with Modern Manual Therapy and Edge Mobility System and of course our four-month online mentoring program, Modern Rehab Mastery. So another asynchronous episode with Andrew to give his thoughts on my case I'm going to talk about.

[00:01:34] This case was referred to me by another patient who I had helped a lot with chronic pain and I wasn't quite expecting this outcome. So she was referred to me for what I thought would be some simple neck pain because the

[00:01:53] patient who referred her said that she had some neck issues. Her history revealed that she had multiple levels of cervical and lumbar fusion and has had chronic and lumbar and neck issues ever since. We're going on probably maybe between 10 and 15 years.

[00:02:13] Unfortunately the surgeons or multiple surgeons and doctors who operated on her and seen her in the past from radiologists to orthopedists to pain specialists they'd all filled her head full of maladaptive beliefs. While I didn't really expect to change her pain levels that much after giving

[00:02:33] her Greg Lehman's book which I highly recommend, Recovery Strategies. Every single one of my patients reads it. She felt a little bit better and one of her main complaints other than her pain and her stiffness that she felt was that she just can't do anything and she was

[00:02:48] also told not to do anything. She was told not to exercise, not to lift her arms past 90, don't lift heavier than five to ten pounds and even don't mow the lawn. I basically said, look, I can't promise that you are necessarily going to feel better.

[00:03:08] The more sensitized and overprotective your nerve system is the longer this has been going on it's hard to kind of reset that alarm and I use the car alarm going off when a wind blows kind of analogy and also the police station analogy.

[00:03:28] I told her, look, if you are going to hurt anyway I want you to start exercising. I want you to do the things you love. What's something that you really miss? She's like, well, I would love to mow the lawn to surprise my husband.

[00:03:39] I said, hey, you know what? I want you to go home and mow the lawn. She was psyched. She thought her husband would be so surprised and so happy because this poor guy has been mowing the lawn without any help.

[00:03:52] I don't know how big their lawn is for probably over a decade. So she was super excited about that. She also said she wanted to ride her Harley and I was like, look, you want to ride a Harley? That's fine by me.

[00:04:02] It's like super dangerous and I would never recommend it because I've even heard professional motocross racers who like jump in the air and do supermans and stuff say they would never ride a road bike because it's just too dangerous thanks to everyone else not necessarily them.

[00:04:20] So after doing that, I also put her through a breathing assessment, found that she was severely over-breathing, coached her through that. She also tended to have anxiety. She was seeing psychologists or psychiatrists and actually part psychiatrist because she was on a couple of anxiety meds.

[00:04:37] I gave her a breathing program for that and sent her on her way along with a very, very positive message. After two, three weeks, she came back. She said overall she was feeling 60% better. I mean, she was ecstatic.

[00:04:51] So I thought instead of just retesting the breathing, which showed that her carbon dioxide tolerance was just a little bit better from severely over-breathing to now moderate to severe over-breathing, I said, hey, you know what? Let's finally take a look at your neck motion because she said that

[00:05:10] she wasn't really concerned about her low back pain at this time because the neck was bothering her more. It was severely limited to the cervical rotation to the left, moderately limited to the right. Cervical flexion was only about five to ten degrees.

[00:05:24] And again, she's had a couple levels to use, at least two or three. I wasn't expecting a whole lot of motion. Just after some very simple, very light soft tissue work and some maybe grade one to two skull crushers or subcranial

[00:05:40] shear distractions, her cervical rotation improved to almost normal. And I wasn't really expecting that considering she has a couple level of fusions. Of course, it's mostly upper cervical. But again, when I see fusions, I don't expect someone to be able to get too close to normal motion.

[00:05:56] Cervical flexion improved about 50%. And extension was almost back to normal. I mean, again, she was so happy. But then, you know, I thought this podcast would end there and to see what you think. But then something kind of crazy happened.

[00:06:11] After I showed her light chin tucks with overpressure, she started saying, like, oh, you know, my tongue is really dry. Oh, man, my tongue is dry. And she's like, I can't believe how dry my tongue is. I can't believe it. Like, oh, my mouth kind of feels funny.

[00:06:27] And I'm kind of thinking, like, wow, I mean, the manual therapy that I did and the retractions that I did, I don't think it could have done anything neurologically, you know, to cause any kind of insult. I asked her if she had any dizziness, lightheadedness.

[00:06:44] Her BP was normal. Her heart rate was normal. But she had mentioned also that, you know, she had gone swimming with her grandkids all this week. Maybe she also seemed two shades darker than last time I saw her. So I was like, are you sure you're not dehydrated?

[00:07:01] She's like, no, no, no, I'm definitely not dehydrated. Then she's like, is my speech funny? And I thought that she was like, lisping a little. Not necessarily slurring her speech. And now at this point, I'm kind of like, kind of nervous, you know.

[00:07:14] Her pupils are NER and reflexes are normal. And I just said, look, let's just lie down for like five minutes. I don't want to send you out because she was worried about it was toward the end of her appointment. She needed to make her next appointment.

[00:07:28] She laid down and, you know, for about five, ten minutes and got up. Her speech was still sounding slightly altered. Not necessarily slurring speech like she was having a stroke or something, but just a little like her tongue was swollen or something.

[00:07:44] She's like, oh, my tongue, my tongue just feels so weird. My mouth so dry, my mouth so dry. Unfortunately, neither I or the massage therapist I work with even had anything as close to like a Dixie cup.

[00:07:55] So we couldn't even give her a glass of water because I wanted to see if that would just alleviate it. I followed her out to the parking lot, make sure she was OK. She was Googling it at the time.

[00:08:04] I was like, look, I want to just make sure you can drive away. OK, if anything happens, if you feel like you can't drive, just pull over. She's like, yeah, my husband will come get me.

[00:08:12] So I followed up with her later that day and she said that she ended up going to that the doctor she had a follow up with. They gave her two bags of IV fluids because she was severely dehydrated. And that's all it was.

[00:08:28] So she was still happy and she said her neck motion, her neck was still feeling great. And the entire time I was kind of doing all the additional testing on her, she said, I don't think it's anything you did. I don't think it's anything you did.

[00:08:38] It just that. And I didn't think it was, but I was just nervous anyway. You know, Andrew, let me know what you think. Hello, Erson. Another interesting case as always. Andrew Rothschild here, of course, sharing in this asynchronous podcast.

[00:08:57] The first thing I want to address is very similar to what you've done with your patient. In this case, I've done with several patients as well. And when we've established that the pain that the patient is feeling is not indicative

[00:09:10] of harm or damage and that they've been avoiding doing things, especially things that they enjoy, sometimes some of the best things we can do is really empower people that it's safe to move and to do things. That it's safe to move and to do things.

[00:09:28] And that sounded like that was a really big thing for this particular patient. If they're going to have pain anyway, you're not going to make it worse. You're not going to make the actual, you're not going to cause any harm or damage.

[00:09:39] Then you might as well do things that you want to do and the things that you enjoy. In this case, weirdly, you just mow the lawn, which makes no sense to me, but we'll go with it.

[00:09:48] It was very sweet thing that she wanted to do to surprise her husband. And certainly I agree with you with riding a motorcycle. But again, it's going to meet the patient where they're at and realizing, hey, this is what you want to do.

[00:10:01] This is what you should do. And sometimes psychologically that can have a huge effect on pain when they feel that they can do the things that they haven't been doing or that they've been afraid to do and avoid they've been doing.

[00:10:15] The second part of that with the dry tongue, certainly understandably a little bit concerning when something's happening. And I definitely didn't get the sense that it was a byproduct of anything you had done. It certainly makes sense, putting the pieces together with the tan skin,

[00:10:34] being out in the sun, dehydration, especially people get to be a certain age, they're a little bit more susceptible to dehydration, probably because they don't always have the feeling of thirst and they can think they've been drinking enough because they're drinking a little bit, but really not

[00:10:49] that meets their needs, especially when they're out in the sun and are also being quite active. So, you know, the fact that it was sound like it was clearly that was the cause is good and makes total sense. And certainly you did the right things in terms of

[00:11:03] being conscientious about what she was doing and how she was behaving. And from a safety standpoint as well. But I definitely didn't get the sense of anything you had done from an intervention standpoint would have caused any sort of adverse reaction like that for sure.

[00:11:18] And the breathing thing was really interesting too. And, you know, I definitely look at people's breathing. I don't get into it in too much detail. In some cases probably could benefit from doing it into a little bit more detail.

[00:11:32] But for people listening who aren't that familiar with breathing, you know, sometimes especially people within pain, people who have a lot of psychosocial distress, people who have just gotten into these habits because of, you know, meeting societal convention

[00:11:46] or because of certain postures or positions they think they have to maintain. And, you know, not to sound sexist, but I do tend to see it more in females than in males. I don't know if, Erson, that's been your experience as well

[00:11:59] in terms of a certain breathing patterns, especially less with diaphragm, more with a chest breathing pattern, upper respiratory breathing pattern. And also even people who do do a little bit of diaphragmatic breathing, the biggest thing I notice is people just tend to be breathing a lot more rapidly

[00:12:16] and a lot more shallowly. So they're really not getting that good full inhalation and full exhalation. And it sometimes is interesting with addressing something that seems so simple on its surface and how it can have very profound effects on someone's level of relaxation, reduction in muscle tension,

[00:12:38] you know, kind of changes sometimes some of the circulating things in your body like adrenaline and noradrenaline. So we have some, you know, paradoxical effects on pain. So it can be one of those interventions that is overlooked a lot, but can be very, very important.

[00:12:54] But otherwise, another great case and look forward to talking to you in person again soon. If you found this case interesting or have any similar cases, you have a story, a big physiophilia, you want to come on the podcast, make sure to DM me

[00:13:08] or reach out on any of my socials. Make sure to please subscribe to Untold Physio Stories or wherever you listen to podcasts. Give us a five-star rating, especially on Apple and Spotify as that really helps with the algorithms and SEO.

[00:13:21] And as always, you guys have a great day.