Author Archive for rick-olderman

Showing Up Has Its Rewards

Last Sunday, my wife, daughter and her friends (my 12 year-old son was too cool for us and quickly split off with a friend) wandered down to the Highland Haunt (sponsored by The Amy Berglund Team, thanks Amy!) to go trick or treating. Earlier I was folding laundry from my clinic and found a threadbare sheet that needed to be retired. I decided to go retro this year and make this nearly transparent sheet an old-fashioned ghost. So I cut out two holes, black greased around my eyes, and popped my straw hat on top to hold it all in place. Took about 3 minutes.

After wandering around and looking at everyone’s creative costumes, we decided to watch a costume contest with a bunch of kids–adorable! Gradually though the contest included adults and I, as an adult male, entered at the insistence of my daughter. Granted there were only five of us but clearly these others had put in some time and thought in their costumes. I felt a bit embarrassed for myself. But after some heated debate among the judges, Spiderman and Captain America, to my shock I won second place! That’s me below being shocked.

My proud daughter and her 2nd place dad

The feeling of incredulity and complete wonderful surprise reminded me of my second place finish (or last place as my family keeps reminding me) running the Mountain Rats Heavy Half Marathon. You can read that blog here.

My second, 2nd place finish reminded me of the important life lesson that sometimes just showing up and doing something is enough. Because of this important lesson, I’ve made a commitment to show up more often–as well as listen to my daughter.

 

 

Can Hip Arthritis Cause Sciatic Pain?

Brian came into my clinic with sciatic pain in his R hip for the past 1 1/2-2 years. He also had low back pain. He did not mention any other aches and pains. Through our testing, I found some significant issues in his R hip. His hip would crack with any movement in a ratcheting fashion.

“Oh, yeah, I have an arthritic hip but I’ve had that for years”, he said.

Among other things, I found Brian had tight thigh muscles. After our third visit his sciatic pain was completely gone primarily due to lengthening his thigh muscles.

“But it keeps coming back after a couple days”, he complained.

Yet every time we stretched his thigh muscles, his pain would disappear for a couple days and then return. When I run into a pattern like this (better briefly then pain returns again) I think, “he’s doing something to cause these thigh muscles to tighten up each time”. The “he” in this instance is not so much Brian but his hip. I told him he needed to get his hip checked out by a hip specialist. Turned out Brian had significant arthritic changes in his hip and needed a total hip replacement.

“But the arthritis isn’t causing your sciatic pain” the doctor said and promptly ordered Brian to see a spinal surgeon.

This is true–to an extent. The arthritic changes happening in Brian’s hip do not in any way directly impinge against his sciatic nerve. But that doesn’t mean there isn’t a cause and effect.

The arthritis is causing the thigh muscles to contract around the painful and restricted joint, which is then causing the sciatic pain. We had already proven this through stretching his thigh muscles.

I recommended Brian please not agree to spinal surgery for now and just get the hip fixed instead. Then after rehab, we’ll see how his sciatica is. If it doesn’t clear up after the hip surgery then he can consider the spine surgery. But we have to tease out just how much this hip arthritis is contributing to his pain first.

I’ll keep you posted on the outcome if he returns.

2nd Place Finish in the Mountain Rats Heavy Half Marathon!

L to R. Tim Giesen, Ben Cornish and Me

Yesterday, I finished the inaugural Mountain Rats Heavy Half Marathon and was one hurting puppy! It was my first trail run race and the first race I’d entered in several years. The heavy half was about a 14.4 mile run out of Eagle, CO. It was a beautiful, cool (45 deg) morning. I had trained for the half marathon by running one day a week–that’s about all the time I’ve had these days. Three weeks ago I strained my right calf trying to keep up with a real runner, Tim Giesen, and hadn’t run in several weeks to let it heal.

Leading up to the race, I was increasingly nervous–would I be able to finish? Would I destroy my calf? What am I thinking?! Over the last few weeks I tended to my tender calf administering therapeutic dry needling to myself, wearing a dorsal night splint, and gentle stretching. From the very first step of the race, I felt my calf but I just did my best to not to overdo it, if that’s possible on a 14.4 mile trail run.

Heavy Half Marathon Course

The course was absolutely stunning! In late September, the Aspens had turned brilliant yellow and patches of scrub displayed earthy oranges, yellows, greens, and browns. When not focussing on the gradually increasing pain in my thighs, I was awestruck by how lucky I was to be here.

Around mile 9 or 10, I noticed my left foot beginning to drag. Crap! I was hitting a wall. Shortly thereafter I wiped out after tripping on a rock running downhill and went for nice little slide. A few cuts and bruises, I dusted myself off and was on my way again.  “Only 4.8 miles to go!” said the the amiable aid worker at the next station after I stuffed my face with gels, M&Ms, PB&J rolls and bananas–anything to get some energy back into my depleted body. This wasn’t going to be pretty.

In two more miles my thighs began cramping and seizing. I was walking more and more as I ran into a wall again and again. At one point, both thighs completely seized and I had difficulty bending my knees. I forced myself to stretch them as people passed me by whom I had passed earlier. “C’mon Rick! You will keep moving!” I chided myself, forcing me to go forward–after all it was the only way to finish the race.

At the last aid station one of the workers called out, “Looking Good!”

“No, I’m not looking good at all but thanks anyway” we all laughed.

“Just 1.7 miles to go and a little hill to climb!” she said cheerily.

“This is where I wish we didn’t have the ‘heavy’ portion of the half marathon” I joked. I stuffed my face with another gel and some M&Ms. Here we go…

Pretending to feel good

Crossing the finish line with a time of 2:58 and some change had never felt so good! My buddy Tim had been waiting for me for a half hour already (2:28 finish time). I was so relieved for it to finally be over–I was beat. Our third amigo, Ben Cornish, came in a few minutes later looking fresh as a daisy. In fact everyone looked refreshed as they crossed the line. Clearly I was alone in my struggle for survival out there.

 

Ben breezing in

 

 

 

 

 

 

 

 

 

 

 

But I finished and was very proud of myself. It’s a rare event when I can push myself to the limit like that. It was every bit as hard as my full marathon road races. I have a new respect for trail runners. I was completely caught unawares that in trail races you are either climbing or descending–there’s nothing in between.

At the awards ceremony they began with the 50-59 year-old men. “In second place, Rick Olderman!”. What?!!! Me? 2nd place? That’s crazy! I went up and got my cow bell with “2nd Place” stamped on it. I was thrilled and dumbfounded and sat back down, stunned. “In first place with a time of 2:28, Tim Giesen!”. Tim went up and got his 1st Place cow bell. We were both speechless and happy.

On the podium!

I watched as the other age group winners accepted their cow bells. In those groups, they all began with 3rd place winners. Why would they only begin with 2nd place for my age group? Then it dawned on me–there were only two 50-59 year-old men entered in the race! I told Tim that now we just need to enter ourselves in all the inaugural races–we’ll podium every time.

It goes to show that sometimes it’s just about showing up. I did and earned 2nd place (or last place depending on how you look at it). That was the icing on the cake–to have that lesson from this wonderful little race on top of the blessing of pushing my body and mind to their limits. I’m deeply content.

In spite of the pain and my very sore quads coming downstairs this morning, I’m hooked! The beauty, the challenge, the sense of accomplishment, the pain makes me feel very much alive. I can’t wait to do it again! Thank you Mountain Rats!

Bruce Springsteen is Coming to Denver!

I didn’t realize I had that much pull with The Boss!

My previous blog was lamenting the fact that Bruce had skipped Denver during his autobiographical book tour. Well one of my two subscribers (thanks Mom) must’ve contacted him because he’s coming to Denver on November 30th at the Tattered Cover!

Sorry to say, Bruce, I won’t be able to make it as the event sold out in just a few minutes but also I’m booked at my clinic that day and–like the subjects of so many of your songs–I’m a working man and my patients need me.

But I’ll make you a deal Bruce. Stop by my clinic and we can exchange autographed copies of each others’ books. Hope to see you after the event and thanks for stopping in Denver, Bruce!

Why Are You Skipping Denver, Bruce?!

Bruce Springsteen has just released his autobiography, Born to Run, and is on a book-signing tour across the US! Well, almost. He’s just signing on the east and west coasts but not stopping in Denver, I just discovered.

from www.simonandschuster.com

from www.simonandschuster.com

Bruce, why not?! We love you here! Denver’s an awesome town full of fans too. If you stop, I’ll take you out to eat at our favorite restaurants or fix your back pain! Especially this midwestern boy who grew up in a cornfield listening to and living your music, I’m saddened by this news. I know you can’t be everywhere, everything, to everyone but I was really looking forward to seeing you (even if it was from afar in the back of a bookstore).

Don’t worry though, Bruce, this novice will continue practicing One Step Up on my guitar trying to recapture the wonderful angst and tension of my youth.

By the way, here’s a clip of Bruce talking about the process of writing his book. Enjoy!

 

Chronic Pain and the Gut

With many of my chronic pain patients over the years, I’ve noticed a high correlation between musculoskeletal pain and the incidence of gut issues (Crohn’s, IBS, or other digestive/organ issues ). I finally have insight into this connection.

I’m reading a fascinating book, Differential Diagnosis for Physical Therapists: Screening for Referral, 5th edition by Catherine Goodman and Teresa Kelly Snyder. In it they explain a current theory of the connection between visceral issues (heart, lung, diaphragm, kidneys etc.) and musculoskeletal pain.

All visceral and musculoskeletal systems are neurologically fed via the spine at various spinal levels. While the  nerves that supply our muscles are not the same ones that supply our organs, they do share common vertebral levels of communication. So apparently when something is wrong viscerally, this signal is fed into whatever vertebral level of the spine which supplies that particular organ. This then stimulates the musculoskeletal neurons sharing that same level contributing to musculoskeletal tension and pain. This is why heart issues can create left-sided arm or jaw pain, pulmonary issues result in scapular pain, or pancreatitis can contribute to low back pain. Because our viscera doesn’t have sensory nerves, this is a way our body signals us that something is wrong internally.

visceral-nerves

from Differential Diagnosis for Physical Therapists: Screening for Referral, 5th edition by Catherine Goodman and Teresa Kelly Snyder

I find this fascinating! The connections in our body and mind never cease to amaze me!

Full disclosure: I was probably taught these connections 20+ years ago in PT school but simply forgot them or didn’t understand their significance. Reading this book has helped me think more holistically about what I’m seeing in my practice and I thank the authors for their great work!

KISSing Hip Pain Goodbye

I recently had a patient come in with right-sided hip pain in the buttocks area. My evaluation showed an elevated R ilium about 1.5 inches higher than the L. Anterior femoral glide syndrome (where the head of the thigh bone slides forward in the hip socket), retroverted femur (a thigh bone that is rotated outward), tight hip flexors, a depressed R rib cage (sitting lower than the L by about 1/5 inch), poor gluteal timing (hamstrings fired prior to the glutes) and a right hyperextending knee when he walked.

So we set about fixing all these issues. One by one we corrected them but after 3 visits, his pain still didn’t change. Then one day he crossed his R ankle over his L knee while working for 5 minutes and when he put his leg back down, there was no pain. It’s been several days and still no pain.

He looked it up and announced that he figured out that he had piriformis syndrome and that he fixed it.

I laughed to myself because his solution was so simple while I was looking at the complex. Granted all his findings during the evaluation create an overly worked piriformis but I couldn’t tell him that. All he knew was that his pain was fixed. It’s a good lesson for me that, while looking at all the things that feed an issue–keep in mind that I still have to fix the issue too. A good lesson for me!

Chalk one up for the KISS method–Keep It Simple Stupid!

Yoga Source Conference

I just finished delivering a keynote speech and two hands-on clinics at the first annual Yoga Source conference in Simi Valley, CA this past weekend. What a great time! The theme of the conference was “The Healing Arts” and centered around a somatic understanding and application to yoga and healing. The mastermind behind Yoga Source and this conference is Jeni Winterburn–a vibrant, intelligent and spunky Brit. She has created a very special approach to yoga, whose principles very closely match my understanding of the body and healing. The two clinics I put on were “Fixing Neck & Upper Extremity Pain & Headaches” and “Hip, Knee, and Foot Pain for Runners”. If you missed it this year, I highly recommend you sign up for next year!

A Lateral Shift Correction?

I was recently working with a woman with a 20-year history of back pain and who had thrown it out in December of 2015, 3 months ago. Her MRI showed L4/5 spinal stenosis and a herniated disc. She had since received two epidural shots which helped but she still had significant pain down her left leg and low back pain. She came in on crutches and did not weight bear on the left leg.

When examining her, I discovered that her left hip was higher than the right by about two inches and the left rib cage was lower than the right by about one-and-a-half inches. This is what I call in my back pain book a left sidebending problem. She also had a significant trunk shift laterally to the right, similar to the picture below.Lateral Shift

When asked to walk without the crutches, she was reluctant to put weight on her left leg. The reason became abundantly clear as it caused the lateral shift to increase when stepping on that leg. She was also somewhat flexed forward and attempts to stand taller increased her sciatic pain. This is a hallmark of extension problems which I also describe in my back pain book.

This woman gave me pause as I’ve never successfully reduced a lateral shift before. I rarely see these issues so I don’t have much experience diagnosing the root causes. Lateral shifts either reduce on their own or they don’t. There are some that can be manipulated back but I’ve never had success with that technique.

Our first session we corrected the left sidebending problem and she left with a level pelvis and rib cage. She was able to maintain the correction however the next visit, she stated she was still in the same pain. The shift had not realigned on its own as I had hoped. So with the sidebending problem corrected, we moved on to the second pattern–the extension pattern. We performed a neuromuscular release for this issue which relaxed her muscles significantly. Unfortunately when she returned there was no change in her pain or her lateral shift.

Next we worked on changing how she stood up. We looked at this because when she was lying down, her shift disappeared. I was hoping to find a mechanical loophole to allow her to stand up taller without triggering the shift. We also performed dry needling to her lumbar spine and the back of her left hip, the side where she felt her sciatic pain. Surprisingly none of these muscles were tender and the needles went in without so much as a yawn from the patient. This should not have been the case as those muscles would typically be expected to be in spasm and therefore react to the needles–not so. In fact, the needles higher up on her lumbar spine were the most tender.

However this did mark our first break through. She stated she had 25% less pain upon returning for her next appointment. So we performed the dry needling again, this time abandoning the hip muscles and venturing further up the spine. As we moved into the thoracic paraspinals, she became more sensitive and we stopped at about T7 level. She noted that the thoracic needles seemed to irritate the sciatica a little. Strange as the nerves that comprise the sciatic nerve are found in the lumbar spine, not the thoracic spine. What tissues would we be affecting in the thoracic spine that would then interact with the lumbar nerve roots?

I then suspected the latissimus dorsi which runs from the pelvis, lumbar and thoracic spine to the the shoulder blade and upper arm bone. When I palpated trigger points in the latissimus dorsi, she felt sciatic pain down her left leg. We found a similar issue with the left serratus anterior, a scapular stabilizer. Why in the world would the serratus and lats be referring to the sciatic nerve? Then I visualized that because she was shifted to the right, the left latissimus must be shorter, probably in spasm. I hypothesized that the left serratus and latissimus were in some way, locking in the right lateral shift, preventing it from releasing. So we targeted these muscles, working out trigger points that referred to the sciatic nerve.

The next appointment, she looked like a new woman! She was not on crutches and her right shift had reduced by at least 50%! She stated he was feeling 70% better and was beginning to have hope that this episode would finally resolve. I was very happy for her and excited that we had possibly discovered the secret to fixing lateral shifts.

She was not a fan of the dry needles so the next appointment, we just worked manually on her left lats and serratus ant, working out trigger points and stretching. That night she decided to go sit in her hot tub which always made her feel better. The wind blew the large hot tub cover down the drive and she got out and dragged it back up to the tub–a testimony to how good she was feeling.

Unfortunately that set her back to zero again and she came into the clinic in agony. The shift was back to its usual severity. She was at her wits end and decided to pursue surgery as she had been in pain for 3 months now and just didn’t want to try again. This is unfortunate as I believe we had revealed the muscle groups that locked her lateral shift into place.

Fortunately for science though, one of my other therapists also had a person with a lateral shift who was not progressing after several visits. I told her to try targeting the latissimus dorsi and serratus anterior on the side away from the shift which she did and had miraculous results. In two more treatments her patient was approximately 90% better!

Could this be the key to fixing a lateral shift? I would need more patients to refine my thinking but it’s looking hopeful!  So, if you know of anyone with a lateral shift, please send them our way to so we can get them better!

This also goes for trigemminal neuralgia and occipital neuralgia patients as I’m working on promising treatments for these patients as well.

My Interview with Robbyn Hart on Front Range Focus, KOA Radio

Earlier I was fortunate to be interviewed by Robbyn Hart (below) for her show Front Range Focus on KOA radio. What a fun experience! Robbyn asked great questions. The only problem is that I love what I do and would’ve talked all day had I been able!

Robbyn

Here’s the link to the show. Enjoy!