Jim Palmer, DPT - Positive Effects of Strength Training: Exercise and Hormones/PT for Endo Patients
Patient Awareness Day 2019: HEALTHY MIND & HAPPY PELVIS
Living Your Best Life With Endo
March 10, 2019 (8am - 5pm)
Einhorn Auditorium, Lenox Hill Hospital, New York City
Thank you very much for the introduction. All right, I'll do my best. It's been a while since I've gotten up in front of people today. I know you guys have been sitting for a long time, so congratulations for coming today and sharing all your stories. It's been very very enlightening on my behalf to listen to everything today.
Today we're going to talk about a few things. I know I'm later in the day, so I'm going to move through some slides a little bit quicker than initially I was because you don't need to hear everything again. But we are going to talk a little bit about the pain cycle, how to control your controllables, which I did not hear today, the magic pill, solutions for your pain, exercise, yeah it hurts, and what's the best exercise for me. I hope I can answer some of your questions with that.
I want to thank Dr. Seckin and The Endo Society for allowing me to speak today for all of you. I really hope that I can provide some solutions for you. How did I become a part of this? Well Dr. Lou, my lovely wife, and Dr. Seckin worked together. Dr. Seckin asked me to start to write for the Blossom about how exercise can help pain. We all know through western medicine, we go to our doctor, take this pain medication, or we go to the drugstore and we buy pain medication. It's a lot of medication, but there are other alternatives. I hope to provide some of those solutions to you today.
I started to do some research about endo. I'm a physical therapist, but did not really know what endo is, so I really felt that I needed to explore more to be more knowledgeable to come speak with you and write about it. What I became really surprised about was how these are the different women in my life, how they can be affected, even down to my 10 year old niece, my 80 year old aunt, my mom who just celebrated her 50th wedding anniversary. I was really surprised to hear about all those things.
Then went on to the Blossom and started to look about what are women talking about with endo, or what are you interested in hearing about. I found all these things that as a physical therapy I work on with patients with their elbow pain, their knee pain, their back pain, stress relief, pain relief, body image, chronic fatigue, painful menstruation, you want to gain control over your life, fatigue, insomnia. These are all things in the PT world we see all the time. Again, whether it's your neck, your back or your elbow. I said ah, okay now I've got a couple light bulbs going off. These are some things I can help.
Who has pain? Well our dog, he definitely had a lot of pain. These is Mooki. We adopted him in Phoenix. He got hit by a car before we met him and his prognosis wasn't very good. The surgeon said that we might have to have his leg removed. You can see he's wearing a cast. He was hobbling around, lots of pain. He'll come back later in the story though. But anybody out here have pain? Yeah. Anybody have pain for more than a year? Yeah. That's a long time to deal with pain.
How does pain affect our posture? What is posture? I know that term was kind of thrown around a little bit today. What is posture? Anybody have an idea of what is posture, or what is good posture, what is bad posture? Okay. Well, we've seen people ... Who looks like they're in pain? A guy who looks like this, or is it maybe someone who's like this? Or we're on the busy New York City streets, is this person in pain, or is the person kind of moving a little slower? All these things, pain can change our posture, how we sit, how we stand, how we walk. The more we start to move in these improper positions, or improper patterns, perpetuates more and more pain.
This is our homunculus guy. Anybody ever seen this guy before? Okay a couple of people. Anybody notice anything weird looking about this guy? Not at all. Maybe some accentuated features. You can see that his hands are quite big, or her hands are quite big. The lips, the mouth, very very big. The eyes wide open. But look how small the elbow is, and the shoulder, and the back and the knees are compared to the rest. Quite interesting.
Not to spend too much time on it, but this is how our brain interprets pain. This is our body draped over our brain on the right hand side here. Again, same features. We can see that the face is very big, the hand is huge, but then up top the knee is quite small. But over here on the corner, here's our abdominals, our pelvic region. What does that mean? Why is Jim showing this to us? Well, what happens when we're injured, maybe I hurt my knee, that picture of my knee becomes five times that size. If I have pelvic pain, abdominal pain, the abdominals down here, that becomes five times that size. Not literally, but how our brain interprets that. That creates and continues to foster more chronic pain. I know that was talked about earlier today, how our brain changes and how the interpretation of pain is changed in our mind.
What is the pain cycle? That was talked about today so I won't spend too much time on it, but it is important for endo. We did talk about a cycle earlier on today in some of the other topics. As you can see, we have pain up here on the right and from a physical therapy standpoint how does that change us. Well, that's my limping. That's my being doubled over in pain. Therefore if I'm in pain I can't do as much, I can't walk as far as I used to. That means I'm going to lose strength. That means I'm going to lose flexibility. That means I'm going to decrease my function. Function is again how do we move as humans, how do I walk, how do I clean things around the house, how do I lift up my child. What does that create? Well I can't walk around as much, so now I'm in even more pain. That cycle continues over and over and over and over. Finally, I'm not able to do a quarter of what I used to be able to do.
But, we can improve this if we add exercise, or even take out the word exercise because exercise can be scary to people, and that's okay. If we change that to activity, if we increase our activity, our strength will improve, our flexibility will improve, and then again our function can improve. If I'm not doubled over in pain, if I can start to stretch out, I can stand taller. I can care for my child better. I can groom myself easier. I can reach things around the house. I can tolerate traveling to work. Okay, well that's good. Now I'm doing a little bit more. Now my strength is increasing. My flexibility increases, and we can see that the cycle continues to move. Then as an added bonus our pain starts to diminish. As we were looking at it before in terms of the brain, how we interpret that, my five times big knee or abdominal area, how my brain is interpreting it, is now calming down and going back to a more normal size.
I don't think we heard this today in terms of the term control your controllables. What do I mean by that? Can we control the weather? No, why not? We haven't figured that out yet. We don't have an app for it. Okay in regards to the weather, what can we control today? Today it's raining out, so therefore we ... Umbrella, rain jacket, right. Therefore we controlled the controllable. Now it's the same thing when it comes to our health or pain, whether we're talking about endo, pelvic pain, knee pain, back pain, hip pain. We can start to control certain things. I can't say pain go away, or nod my head pain go away. It doesn't work that way. I can't control the weather.
What I can do is change my focus. I'm not an endo patient. I'm a person that has endo, or I'm a person recovering with endo. I'm not a total shoulder replacement. I'm not a elderly decaying person. I'm a person that's aging. You have to believe that you're going to improve. Mind is very strong. If you believe you can improve, you can improve. If you believe that man this ain't going to work, Jim you don't know what you're talking about, I'll never get better, the doctor doesn't know what they're talking about, you're right, you won't get better. I can guarantee that.
You can choose to be active or not active. We're going to talk a little bit more about that, but you can choose to stay in bed all day and feel sorry, or maybe not go to work, or not go to the gym, or maybe you get up and go for a short walk, or maybe you do a little tidying around the house. You can choose that. You can choose activities that make you happy. You can get outside and socialize. You can play with your dog. Those are all things that have been proven in science to make us happier. If we're happier, we're healthier individuals.
"The magic pill." It's exercise. It's activity. We talked about the pain cycle, how do we reverse that. If we have improved pain, we're going to have improved function. I can kneel, I can squat. In terms of being in a weight bearing position, that's being on your feet, or putting your hands down on the floor in a pushup position, putting weight through your body is wonderful for osteopetrosis, great for strength, great for your bones and pain. You can improve your flexibility, improve your balance, improve your posture. Then with yoga we talked before about the deep breathing. That relaxes your diaphragm, which is connected to your pelvic floor. You relax one, the other one relaxes too.
As I was speaking about before, exercise hurts. In the beginning I had a picture of Lori and I. We ran the Grand Canyon together about a year and a half ago, almost two years, and that hurt. In the beginning we had a picture of us smiling. This is me over here in the corner. I am definitely not smiling at this point in the day. Exercise does hurt, but it's knowing what is good pain versus what is bad pain. That to me is very important dealing with chronic pain, endo, pelvic pain, knee pain, chest pain, shoulder pain, what have you. What would be considered a good pain? Soreness, right. Soreness maybe after I go for a walk, or after I go to the gym, or maybe my legs are tired after a good run. What would be bad pain? Definitely, stabbing. What else? Shooting pain, definitely. Maybe numbness, tingling, burning. Those are bad pains.
To understand and better take control of your body, your life and your pain, knowing the difference between good pain and bad pain is imperative. I get, people approach me all the time, "Oh I tried exercise it hurt me too much. I went to PT, man that guy hurt me so much I'll never go back again." All right, well maybe it wasn't the right exercise for you, or maybe it wasn't enough for you. It's about finding that balance, but the more we can understand the difference between a good pain versus bad pain will help you tremendously.
What is the right amount? Well it's different for everybody. How much sun is too much? How much hot sauce is too much? How much salt is too much? How much alcohol is too much? It's different for everybody right. It's the same with exercise. Everyone here is different, so the answer is different for all of us. It's about finding a comfortable starting point. When people to come to me and ask me, "Jim, what's the best exercise for me?" I don't immediately rattle off one, two and three, or do this, this and this because it's different for everyone. All of us here have different goals. What is your goal? Is your goal to manage your pain, to lose weight, to get stronger? I want to run a marathon. I want to pick my baby up. I want to be able to climb two flights of stairs to my walkup again. It's different for everyone, so by identifying what is your goal can lead you into the next thing.
What activities do you like to do? "Jim, I hate running." All right, don't run. "I love CrossFit. I hate CrossFit. Love yoga. Hate yoga." Okay. That's okay. It's finding what you like to do and doing it on a regular basis. I was just having a conversation with a young woman outside. She's like I don't like to exercise. I said okay. So we talked about a couple things. I said do you walk. She's like you know what I could walk. Walking is a wonderful activity for us, so simple. How much does it cost you to go out for a walk? Nothing, no gym membership required.
Start slowly. Again, everyone here is different. My starting slowly is much different than my wife's. My wife runs faster and further than me every day. One of our first dates together I said, "Hey I'll join you for a run." She says, "I'm training for the Boston marathon." "How far are you going to run?" "Well I'm going to run 22 today." "Okay, I'll join you for the last four." She still kicked my ass at the end. So start slowly.
"Hey, I don't walk." Okay, try walking for five minutes. "Hey, I did try yoga before. I wasn't too sure about it." Okay, well try a beginner's class. "I'm scared to go to the gym, I've never been before." Okay, find someone like a physical therapy that could go with you, or someone who knows what they're doing. Start off on light weights. Don't go stack it really heavy. Again, it's different for everyone. Always ... Then keep in mind you can always modify your positions. What do I mean by that? Would anyone like to come up and help me? Come on, come on up, someone help me. All right, yeah come on up. Oh, happy birthday.
Come on up, just watch your step. Hi, I'm Jim. Tina, good to meet you. Tina and I are meeting for the first time. There are different things we could do. We could say okay Tina wants to get her legs stronger so she can climb stairs or squat down and pick something up. You know how to do a squat? Yes. Can you show us a squat? Yeah, and she's crushing it already. Go ahead and try a few of those. All right. Tina says to me, "Okay you know what Jim, I can't do a squat." Okay no problem. Tina, go ahead and sit down. Okay, bring your arms across your shoulders. Go ahead and stand up. Then go ahead back down. Tina is now squatting. It's not as aggressive as she was just doing on her own. That's good, thanks. So we modified the position for her.
How about do you do planks?
Okay, yes everyone smiles. Can you show us a plank? Tina is amazing. Okay, good. This is a great plank. Lift your butt up a little bit. Okay, wonderful. Okay, that's fine. Now if that was too difficult how could you do that? On her knees, right. She could put a yoga mat underneath her or a pillow underneath her knees, she can do it on her knees. She's still getting all the strength components. Thank you. She's getting weight through her arms, which is going to make her arms stronger. She's tightening her core, which will help her back and hips get stronger. Her legs are getting stronger too because she's putting weight through there as well.
How about balance? Can you stand on one foot? Yeah, Tina is amazing. Okay.
Okay. Go ahead again. Can you do it with your eyes closed? Okay, not quite as good. All right, so go ahead and put your hand here. Good. Okay, close your eyes. Now we've modified the exercise. She can hold onto her kitchen counter. She can hold onto a friend or partner. There are many different ways we can do that. Thank you. Those are just a few examples. Thank you Tina.
Don't be discouraged if you can't do a plank, a pushup, a squat. There are many ways that you can make it easier for yourself. At the same time you can make it more difficult. If we had Tina do 100 of those, she'd probably just start to get tired.
A couple comments in regards to PT. I've been a PT for 14 years. I've heard lots of comments about PT. I've heard lots of great success stories. "Jim it was amazing. I love PT. I love my PT. I can't wait to go back." On the other side I've heard, "I didn't really benefit." I've also heard, "Man that PT hurt me. She/he, I would never go back and see she/he again." Not to say that's okay, but if it's not working for you find the right partner. I've been told that people come from around the world to see Dr. Seckin because they're looking for the right partner. They come to see him. They come to the Endo Foundation for help.
It's the same thing in regards to physical therapy. We're not here to hurt you. We get a bad rap in terms of PT pain and torture. There are therapists out there that really push patients too hard and too aggressively. If you find yourself in that situation, say thank you, but no thank you I'm going to try and find someone else. There's nothing wrong with that. Again, the idea is to give you back the power. That's another way you can do that. "Hey, you know what, I'm not really enjoying our sessions. I'm not really getting a lot from it, so let me find someone else."
Again, some take home messages. Control your controllables. Exercise and activity can be "the magic pill." Exercise does hurt. Always modify. If it's too easy, make it more difficult. If it's too difficult, make it easier. Partner with the right PT. here's our guy again, Mooki. This is actually a very recent picture. We can see he's pretty happy here. He's got his cap and gown on because he graduated from obedience school. But more for our purposes, besides him being so happy here, is that his leg is fully healed. He had, well his doctors told us initially that he's probably going to lose his leg. He definitely didn't like us touching his leg. He couldn't sit on his leg properly. He definitely couldn't walk properly. He limped. If he walked too much he wouldn't even walk the next day. Slowly, through walking, going up and down steps, by light play, he's gotten stronger. You can't even notice a difference in his legs anymore. In a sense he did the right activity, he did the right dosage, and now he's a happy guy.
Thank you all very much. I appreciate your time.