Confessions of a Virtual Physical Therapist

The world has been turned upside down by COVID-19 and the world of physical therapy has not been spared. As a physical therapist who has worked with patients from the tech-driven Bay Area for over a decade, I have educated and helped many patients improve their computer and workstation ergonomics through postural corrections, equipment changes, and by modifying activities  to improve a patient’s pain and dysfunction.

As COVID-19 virus literally went “viral”, Therapydia made the tough decision to close our doors to in-person visits in accordance with San Francisco’s Shelter-In-Place Order. We, as a team, also thought it would be better for the general health of our region if we did not become vectors for virus transmission to our patients and families. With that decision, our team had to make a quick turnaround to providing our services over virtual platforms. And with that transition, we “active” PTs used to working in a clinic had to set up laptops at home and figure out optimal ergonomic setups–some successful, some not!

As we set up our virtual clinics and began more than usual hours in front of computer screens, we all began feeling similar symptoms as those that our patients would report to us over the years!  Just like our patients, we didn’t have proper office chairs and are now working for extended periods of time at our kitchen counter or hunched over a coffee table–positions that it are not ideal for our bodies and overall health. Fortunately we could utilize our extensive knowledge of biomechanics and ergonomics and finally put our student loan money to good work on ourselves! We have begun to walk in your shoes and now present to you  our confessions and our solutions!

PT Confessions:

Greg Ohanessian, PT
Therapydia Embarcadero

Low back pain from sitting in a flexed posture:

My dining room table looked like the best place to set up my home office. Unfortunately, my dining room chairs are lower than I thought and my hips were positioned at the same height as my knees, leading to a posterior pelvic tilt. This flexed my spine more than usual which increased stress and strain on my lumbar spine discs. As I stood up I noticed an increase in pain in my low back.

Solution:

1)Find a taller chair to have my hips above my knees to lessen the flexion load on my spine
2) Sit on a pillow to raise my hips above my knees

If you’re working from home amid the COVID-19 pandemic, you might find that your makeshift office is a literal pain in the neck. Check back often for more solutions to combating aches and pains from transitioning to working from home.


Lauren Opatrny, PT, DPT
Therapydia SF – Market

Practicing what we preach is a lot harder than I thought it would be! I often educate patients on the importance of frequent position changes, especially when working on the computer. Working as a physical therapist is a very dynamic job, so I never had a problem listening to my own advice. The last time I sat and worked on a computer this much must have been in graduate school. Since working from home (which I never thought I would get to do as a PT!!), my shoulders and neck have been sore! Its so easy to forget to stand up or move every 30-45 minutes. I have a sticky note next to my computer now reminding me to stand. I plan some sort of exercise daily (walk, run, bike, yoga, body weight circuit). Having a workout buddy helps, too. If you live alone, or don’t want to workout with your roomies, try planning a virtual workout session with friends/family, or check out online workout videos. There are so many! All that said, this is a stressful time for everyone, and making sure to take time for self care, whatever that looks like to you, is important.


Jonathan Lim Sze How, PT, MS
Therapydia SF – Market

As a PT, sitting at a desk and working on a laptop most of the day is not something I will ever get used to. While working from home, the main issue that I have been dealing with is having a sore bottom from sitting for extended periods of time. Something that helps is to change positions and locations throughout the day. I sit for a bit, then stand, or work a little at the dining table, then move to the sofa and workoff the coffee table. Also, I have made it a priority to move more while sheltering in place during this outbreak. I do my best to schedule a daily 20-30 min in-home exercise session, because let’s face it, working from home = snacking all day.

3 Common Electric Scooter Injuries & How To Prevent Them

electric scooter injury prevention

If you live in San Francisco, you can look out your window to see dozens of people zooming by on electric scooters. Over the last year, the usage of these motorized scooters to get around the city has exploded with their ability to go 30 mph coupled with a riding range of 20 miles, making these scooters ideal for commuters and weekend warriors. However, with the increase in ridership comes an increase in scooter-related injuries.

Over the last five years, scooter-related injuries resulting in hospitalization have more than tripled nationwide. Recently, I had a patient who can be described as your typical “Tech” worker who had a fall off of a Scoot in the most “San Francisco” of ways.

Our patient was commuting to work on his Scoot when the car he was following came to a stop in the right lane. The patient noticed the stop and decided to whip around the car on the right side in the bike lane. What our patient didn’t notice was that this car was an Uber. As he began to pass the car on the right, the Uber passenger opened the door and struck our patient. When our patient was struck he fell off his scoot and onto a parked Tesla! Thus sustaining a clavicle fracture from the trauma of the incident. Does it get any more San Francisco than that?!

Dr. Sara Edwards a local, prominent orthopedic surgeon and Therapydia referral source has seen a recent uptick in Scooter injuries in her practice that correlates with the increase in ridership. According to Dr. Edwards, most of the scooter injuries that she sees occur in the extremities including shoulder, wrist, ankle and knee bone fractures, along with soft tissue injuries that usually require surgery. Head injuries are of concern as well due to riders not wearing helmets during shorter rides. Dr. Edwards has also observed many injuries that occur due to scoot riders scooting while intoxicated.

Accidents Happen

Though accidents like the one detailed above are rare, accidents do happen. Here are a few common scooter injuries and how to prevent them:

Head Injuries: Concussions and other head injuries are common among riders who have accidents without wearing a helmet.
Prevention: The best way to prevent head injuries is to ensure that you wear a helmet every time you ride.

Riding While Under The Influence: Being under the influence of alcohol while riding
Prevention: Simple don’t do it!

Shoulder and Wrist Injuries: Traumas from falling onto outstretched hands
Prevention: Speak to a physical therapist regarding proper fall technique. Learning how to fall and roll will lessen the impact.

Lower Leg injuries: Bracing/braking injuries if scooting too fast.
Prevention: Slowing down your scoot is the biggest preventative measure here. When stopping making sure your feet are positioned safely so the lower legs don’t sustain excessive forces.

Injuries are prone to happen with all types of transportation modalities. With our ever-evolving transportation modes here in San Francisco and other big cities as well, Physical Therapists are ready to help collaborate with orthopedic surgeons in evaluating, treating and returning our patients to Scooting.

Get To Know Your PT: Jonathan Lim Sze How, PT, DPT

Jonathan Lim Sze How PT, DPT

Physical therapist Jonathan Lim Sze How takes some time to share his favorite ways to stay active, how he knew physical therapy was the career path for him and what he listens to to get pumped up.

 

“Gradually challenge yourself to do more and more, you will be able to achieve anything.”

 

When did you know that you wanted to be a physical therapist?

I always knew I wanted to be in a profession where I could be actively help people, while not having to sit behind a desk all day long. I realized during my undergraduate education how amazingly complex and resilient the human body is while learning about anatomy, physiology and biomechanics. This pushed me to learn more, become a human movement expert and help others, thus pursuing physical therapy as a career.

What’s your favorite song to get you motivated?

Any classic 90s rock song!

What is the biggest challenge involved in being a PT?

One of the challenges we face, in my opinion, is that our patients often take too long after sustaining an injury to come in for a consultation with a physical therapist. Often this can delay their recovery process while causing other compensating issues to surface and complicate things.

How do you like to stay active?

I became quite an avid runner over the past several years. I love the feeling of just being on my own and challenging myself both physically and mentally. When I moved to San Francisco, I got into trail running and started exploring the countless number of beautiful trails the Bay Area has to offer.

What surprised you the most about the physical therapist profession?

I was gladly surprised by how far reaching our profession is. You can find physical therapist’s working with newborns and their parents in the in neonatal units, or getting ICU patients who hooked up to several machines up and moving.

Are you currently pursuing any further education/certifications?

I am really interested in public health and health policy making and may pursue this path in the future.

What’s your go-to breakfast?

A nice cup of black coffee in the morning.

What do you wish everyone knew about PT?

We are not the “torturers” you think we are. We will always motivate you to do more and challenge yourself because we are your “cheerleaders”.

What is the most important personality trait that a PT must have?

In my opinion, patience is a very important trait for any physical therapist to have. Patience to really listen to and empathize with our patient’s issues, as well as having the patience to work with each patient at their own pace.

What do you do to de-stress/unwind?

Playing some tunes on my guitar.

Finish this sentence: On Saturday mornings, you can usually find me…

In a perfect world, I would be up early and laced up, ready for a morning run, or on my way to a good fishing spot.

What is your favorite piece of wellness advice to offer?

Get Moving!!! I know it is easier said than done, but if you pick an activity you like, have a solid plan, start easy and gradually challenge yourself to do more and more, you will be able to achieve anything.

 

On the Run with TPSF: How to Avoid Running Injuries

This issue of On the Run is written by Lindsay Haas, PT, DPT, OCS.  Lindsay is a physical therapist at TherapydiaSF and enjoys working with runners, dancers, and all athletes for rehabilitation from injury and improved sport performance.

The good news is that you signed up for a race.  It may be your first or your twenty-fifth, but you are ready.  Of course you want to stay healthy.  Especially when you are gearing up and looking forward to completing your upcoming race!  The bad news is that rates of injuries in runners is high, and its even higher when training for an event.

The #1 risk factor for injury in running was a history of injury, usually within the past 12 months (1).  Most injuries in running are caused from overuse, which is defined as repetitive microtrauma to the musculoskeletal system.  Increased training loads (such as running more when training for an event) can exacerbate an old injury.  Also, you may have changed your running pattern to compensate for your previous injury and as a result overloaded another part of your body and created a new injury.

The second highest risk factor was the weekly distance.  Runners who complete more than 40 miles per week were found to be more likely to sustain an injury (2). When you run more, you can overload the musculoskeletal system to the point where it can’t recover, thus creating an injury.

So how do you stay healthy throughout your training?

1.  Change it up.  Since most running injuries are caused by overuse and repetitive strain, its important to introduce variety to your training.  You should already be active in strength training (shown to decrease the risk of injury and improve performance!) but you should also be changing up your runs.  Try running on trails, or try altering your pace.  Even if you’re not participating in a training program that incorporates tempo runs and speedwork, there should be some variety in your runs.

2.  Watch your form. It is important to have good running form.  Your cadence is the number of steps taken per minute, and should be more than 170 steps per minute on both feet.  If its too slow, you may be putting too much stress on your body.  Increasing your cadence will help with over-striding.  Focus on taking short quick steps and keeping your feet under your hips.

3.  Treat injuries before they start.  Don’t wait until something hurts.  Using ice and self-myofascial release (such as the foam roller) are good tools for when you are sore, but there are ways to be proactive as well.  Listen to your body, if you need to adjust your workout or take a day off its okay.  When you are running keep track of your heart rate and level of fatigue to know if you need to slow the pace or even stop for the day.  If you are feeling sharp or stabbing pain, you need to stop. Avoid the ‘three too’s’: too much, too soon, too fast.  Pushing yourself too hard can compromise your ability to recover.

Still worried about getting injured while training?  Schedule a Fitness Screen with one of TherapydiaSF’s physical therapists.  We will identify any potential risk factors to injury or decreased performance and create a customized exercise program to help you meet your training goals.

(1)http://sprunig.net/wp-content/uploads/What-are-the-Main-Risk-Factors-for-Running-Related-Injuries_2014.pdf

(2) Walter SD, Hart LE, McIntosh JM, et al. The Ontario cohort study of running-related injuries. Arch Intern Med. 1989;149:2561–4.