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In This December Edition... Annual Coats for Kids a HUGE SUCCESS! Best Wishes Angela Merry Christmas and Happy Holidays from Peak Top Five Questions after Surgery Part II Peak Performer of the Month November Contest Winner ANNUAL COATS FOR KIDS A HUGE SUCCESS! We just completed another campaign to help put warm clothes on those in our community less fortunate and in need. You all are such a blessing to others with your kind gifts of new and gently used winter clothes! WHAT A SUCCESS IT WAS! Thanks so much to our present and past patients, Peak PT teammates, and our friends from TechniPlex next door who brought in donations of winter clothing to bless those in need here locally in East Rochester. Check out these incredible numbers you achieved! 49 hats 8 scarves 3 sets of gloves 23 coats 22 headbands 6 pairs of snow pants = 111 donated items. Thanks to so many of you there are families in the community who will rest assured their kids will be protected from the cold and wind our Rochester winter will soon bring. Merry Christmas and Happy Holidays! To our Jewish friends we’ve been wishing a Happy Hanukkah for the recent 8 day celebration that just ended. And now we’re on to Christmas! The Peak Performance Team wants to say Thank You and Merry Christmas to all of you. Holidays bring a time of reflection on how very blessed we all are. At Peak PT we really look at your trusting us to help you with something so very personal and private and valuable to you as your health as an awesome GIFT to us. We take that opportunity with great respect and care, and hope that we always honor your trust and confidence in us with a smiling face, that you leave feeling encouraged and empowered that you can recover and you will improve, and that we’re always putting the knowledge and experience and skills we’ve honed to best use for your sake. THANKS to all of you who throughout the year have trusted Peak PT to be your partner in getting back to feeling comfortable, capable, and confident once again! May you and your family enjoy a Blessed and Merry Christmas, and look forward to an awesome 2016! DIGGING DEEPER…. TOP 5 QUESTIONS AFTER SURGERY Part II From that “New” Knee or Hip to the Disc Herniation They Removed: So many people either go into surgery or come out with unrealistic expectations for what exactly the surgery was accomplishing for them, how proactive they need to be or don’t need to be after surgery to contribute to that hopefully good expected outcome, and whether they expect that this problem has now been permanently nipped in the bud. In the last blog on this topic I shared the Top Five Questions you should be asking after an orthopedic surgery , but now we’ll dig a little deeper on each of these. The knowledge of anatomy, how our bodies work, and especially the skills that orthopedic surgeons have learned that allow them to literally go right inside our bodies and make corrections or remove damaged tissues is a true blessing. Our surgeon friends are a group of incredibly intelligent, dedicated, skilled and courageous professionals. But with all the great benefits that surgeries offer there remain some key limitations, perspectives, and post-op actions that all have bearing on your short and long term outcomes. You can't make the mistake of looking at surgery as a stand-alone "magic bullet" of sorts! 1. What was causing my pain? Where all the tissues that caused my pain replaced with “new” parts? That’s a great question. Think about it. You’re having pain that won’t resolve and you literally have someone go in and cut out tissue or sew together or even put a completely new part in. Amazing, but…should we expect that all of our pain is gone? This is actually a way deeper topic than this blog merits but the real question we should be asking is what caused us to feel pain. Absolutely, oftentimes it’s “broken” anatomy. A body part has been damaged and that is clearly a pain source. But don’t forget…sometimes you can also get pain from scar tissue caused by an injury’s or surgery’s healing process, or overuse and strain occurring in tissues that have come to the rescue – the “cheaters” that your body has now come to rely on since getting injured. Remember too, the stresses that damaged a certain tissue, like the pounding of running and sports over the years contributing to osteoarthritis of a knee – it doesn’t just affect the cartilage coating of the joint surfaces but we also see changes in surrounding tissues…inflammation, swelling, thickening, stiffening, weakening….etc. Consider that painful low back... Eventually diagnosed with a herniated disc and nothing seems to be working. A discectomy is scheduled to trim away the herniated disc sitting near the nerve. Great – anatomy changed right? Culprit removed. Absolutely. BUT…did you know that studies show there are many people out there with herniated discs, stenosis, meniscus tears, arthritis, and small rotator cuff tears who didn’t know they were damaged goods and who didn’t have pain? When we see anatomy that appears damaged on films or other tests, it’s a normal connection to make that our pain is being caused by that “abnormal” tissue right in the same spot. But the fact remains that there’s simply times when other tissues are contributing to your symptoms and we don’t have any way right now of knowing how much any particular tissue is at cause. Many of those conditions above, if treated non-operatively end up recovering to comparable or even better levels down the road compared to having surgery. So clearly, it’s not a “no brainer” to opt very early in the game for surgery when non-operative, conservative, low cost and low risk approaches like Physical Therapy have not been tried. So… if you have surgery you’ve got to remain realistic that sometimes there are other causes for your pain that surgery may not fully take care of. Oftentimes once major tissue damage has been handled by surgery those remaining causes for pain are better addressed by Physical Therapy. 2. What made me so limited in life? Where all the tissues that limited my function replaced with “new” parts? Let’s consider the knee replacement patient for example... Before surgery they had debilitating knee pain but also developed a very stiff joint that couldn’t straighten maybe to better than 15 degrees bent or intentionally bend to more than 95 degrees, for example. They were too weak to use that leg for squatting motions like getting to and from low places like a toilet or couch, and certainly not for stairs. The wear and tear damage to the joint surfaces absolutely is a factor. But let’s consider after the knee replacement. New surfaces are put on the ends of the knee bones. Excellent – no more bony osteoarthitis! “NEW” parts must = great function now right? Well, for some that’s true but for plenty it seems their function is still significantly compromised. I’ve seen plenty of post –op patients express such disappointment…and frustration….and, for some, even regret. Remember, the ends of the bones are NEW…but what about the joint capsule/ligaments/connective tissue that hold your knee together? Nope – that’s the same one you had before surgery. Ok, well what about the muscles and tendons in that “NEW” knee? Well, hate to tell you but those are the same “OLD” ones you had before. Remember?….the ones that wouldn’t let you straighten or bend your knee all the way or weren’t strong enough to let you go down the stairs. Yep – same ones! How about that herniated disc? After that’s gone I”ll be able to bend and lift things again right? Just like new. Bad tissue gone = back to normal right? Well….not necessarily. You see, it’s pretty likely that a lower back that developed a herniated disc needing surgery probably also resides in a body that has some typical issues. Issues that aren’t resolved by simply removing the herniated portion of that disc...like tight hamstrings and buttocks muscles that limit proper bending at the hip for low reaching, for squatting, and climbing. Oftentimes also we see weak legs and low back/core muscles – another definite nail in the coffin of ever being able to use “proper” lifting mechanics. Don’t’ forget the deconditioning that’s happened over all the while you were in pain. Oh, and you’ve also got to account for the bad habits (compensations) you had to adopt just to get by during your bad days. Those issues don’t all just take a hike and hit the road when a surgery removes damaged tissues or a repair is done or even full blown replacement is done. The take-home point is that even though your pain may be resolved and you “feel” better, there is still a high likelihood that you need some help getting your body to actually BE better….to have normal motion or strength or technique. Remember, the point ultimately is to be capable and resilient enough to not just make it back to the things important to you but to stay back instead of getting reinjured and painful again. So be realistic about what surgery does and does not do for you. Avoid putting “all your eggs’ in the basket of surgery – expecting all will be totally fine after the tissue is taken out, or repaired or replaced. Surgery has it’s place but there’s often work that should be done beforehand to optimize your outcomes…and certainly rehab work that needs to be done after wards to deal with those issues that aren’t fixed by the surgery itself! STAY TUNED FOR PART III (where we’ll dig deeper into #’s 3-5) PEAK PERFORMER OF THE MONTH: THOMAS FARINA Thomas Farina, a Fairport HS football and basketball player fractured his ankle back in August, very early in his high school football season. He had to be immobilized in a walking boot for weeks to allow healing and missed the entire season. He wasn't sure he would make it back in time or be well enough to compete in basketball. Tommy says: "I came to Peak Performance after breaking my ankle in August. I missed my entire football season so my goal was to be 100% for basketball season. Andrew helped push me to devote myself to exercises that sped up my recovery time drastically while enjoying it! I am back on the court and playing at a level I never thought possible a few months earlier!" Andrew Neumeister says: "Tommy has a "can do" attitude, takes initiative with his rehab, and always performs at the top of his ability. Tommy overcame the stiffness and control issues that limited him and got himself back to being the excellent athlete he knew he could be. Tommy made the varsity team despite breaking his ankle just 3 months prior! Great job Tommy...Looking forward to seeing you play this year!" Peak Performance will donate on behalf of Tommy to Lollypop Farm. November Harvest Contest Winner: Sally Kahn Sally had the winning ticket! She took home a basket full of goodies and a gift certificate for Leo's Bakery. This was just in time for Thanksgiving. Who wouldn't be excited about extra delicious goodies that you don't have to prepare? ENJOY!! From your Peak PT team.