It is important to listen to your client and always hone your skills. Listen to this testimony of a client.
All of us know of parents, grandparents, neighbors, anyone that comes into your mind that you have noticed a change in their posture over the years. Is this now happening to you? Maybe? Changing posture is a very insidious occurrence. We don’t physically notice the changes until we can no longer reach high up in the cabinet for that special bowl we need. Or, our lower back becomes stiff from sitting for even as much as 20 minutes. Or we can no longer squat to the ground as we were once able. Or turning your head as you back up your car is now either stiff or painful. You then develop alternative methods because you can no longer perform these movements. Why is this? Losing the range of motion in any one joint causes changes and alterations in many other areas in your body that you are not aware of! This is especially true when there is not a traumatic event to associate the changes with. Let us review a few reasons why this occurs and then a few methods to combat the soft tissue changes that ultimately change our posture.
Soft Tissue Has Power!
Normally, we do not think of our soft tissues has having power, but they certainly do. Fascia, the newest accepted organ of the body is meant to be strong, elastic, and slide and glide as we move. It has a covering, whether thick or thin, over every part and parcel in our body. Fascia is strong and is known to have contractile powers, yet not eccentric abilities. Eccentric means the ability for a tissue, as in muscle to contract, yet become long at the same time. This means that fascia once contracted repeated over time may have the tendency to want to remain in the position. This is one reason that creates abnormal forces on tendons and joints. With this being said, static postures that is your worst repetitive motion, awkward postures, highly repetitive motions without rests, unexercising, incorrect food intake, emotional stressors, all together form to create changes within your body that you cannot detect until; until you cannot turn your head normally until you cannot squat to the floor normally until you cannot reach high into the cabinet for the bowl, and until you feel that stiffness upon standing when only sitting for 20 minutes. All of this changes your posture. Now you may notice that increased thoracic curve if looking in the mirror, or your shoulders are so far forward, you have these indents between your pecs and collar bones.
Regain Your Power Over Your Soft Tissue!
I am not the pessimist or fatalist. I am heralding a trumpet call for any individual that really wants to create optimal changes in their body. Even if you have Parkinson’s, you can maintain optimal postures for much longer periods of time. My husband is proof of this. What are some methods to create changes for an optimal body posture? It does demand commitment of daily work, 5 – 10 minutes. Your diligence will pay off. Will the changes happen quickly? It takes the time it takes. The more time you put into this the faster the results. And, no, the results are not permanent. This is a lifestyle change. First, you want to take a baseline of where you are in your joint motions:
Since pictures are worth a thousand words, here are movements that are considered normal and you should strive for:
Thank you SFMA for this picture!
These movements should not cause pain! Do not attempt if you already know you have joint movement challenges in any of these areas. This is meant to bring to your attention how malleable we can still become.
STRATEGIES TO INCREASING YOUR OPTIMAL POSTURE AND MOVEMENT
Many of us have challenges in one or more joints. Choose the least restricted joint and begin to slowly use a dynamic movement, rather than a prolonged stretch, to increase the range of motion. Laying down is a great method to use for neck, shoulders, hips, knees, and low back. Remember, this is how babies begin to increase their range of motion and strength; they are laying down first because they do not have the trunk control sit up. So, babies begin by wiggling and jiggling, and discovering a hand, a foot, and work on that movement. They do not know they are exercising and increasing in the range of motion along with muscle strength and control.
The best method is to contact a professional to educate, teach, and empower you to optimize your soft tissue so you have power over your soft tissue!
ACE your communication! How to Recognize, REFINE, Resolve Colleague and Team Expectations and Communication Challenges
Lori: “Brad, can you email me that information by this Friday, so the project can be completed?”
Brad: “I am so busy and will not be at work tomorrow. I’ll see what I can do.”
This is a common communication exchange in everyone’s life. Should Lori expect the information from Brad she asked for by a specific date? Yes? No? Whenever we communicate answers that are ambiguous, such as, “I’ll see what I can do”, “I am not sure…”, “I think I might”, “Let me get back to you”, we are not communicating very well. The above short examples are open ended without any definitive answer in response to the person asking the question that requires a definitive answer.
These forms of communication often lead to frustrations between co-workers, doubts of co-workers, and the typical office gossip between co-workers. All leads to further break down of communication and work productivity.
How can someone’s ambiguous response be properly delt with that shows respect, confidence, and demonstrate the satisfied interdependence for that co-worker; or team? Whether you are working in a team situation, work closely with specific colleagues, or need to collaborate with someone you do not know yet, the principle of agreed communication expectations is foundational.
Agreed Communication Expectations = ACE
The concept on agreeing on expectations in communicating is not new, not a new religion, not groundbreaking for the 6 o’clock news. Yet, this topic continues to be written about in books that are on best sellers’ listings. There still is Dale Carnegie’s best-selling book, “How To Win Friends and Influence People”, published in 1936 with over 30 million copies sold worldwide. This book is one of the best-selling books of all time. According to Wikipedia, it was number 19 in 2011, on Time Magazine’s list of the 100 most influential books. And there are Dale Carnegie Communication classes now offered. Another best-selling effective communication book, “Crucial Conversations” by Kerry Patterson, Joseph Grenny, Ron McMillan, and Al Switzler, another New York Times best seller with over 3 million copies sold. With hordes of e-books, Kindles, Audible and the good old fashion book, combed with living in a society where technology is at our fingertips on our phones, laptops, pads, and desktops, why is communicating with each difficult? The title of the blog, Yes = Yes, No = No is the giveaway to agreed communication expectations, or ACE.
How ACE Works
The timetable to start effectual communication is anytime: anyone can require this principle, reinforce this principle, retrace this principle in a chronology of communication with another. Setting and agreeing on communication standards that includes updates, reminders, and to be able to speak up to another when the communication is not clear without being rejected, (as we are all subject to not stating clear thoughts!), that builds the success of communication, which, builds the productivity, respect, and admiration for one another. Below are 2 examples of how two or more people can agree on terms of communicating without the feeling of misunderstanding or that feeling of ambiguity of whether the expectation will be met or not.
Agree that responses to requests need to be a “Yes” or “No” answer
Of course there are instances when a simple “Yes” or “No” needs to be accompanied by negotiating a different timeline, or amount of information that was requested, or some other difference where the two, or group, can agree and then rely on. Ultimately you need to answer a “yes” with the appropriate delivery times, or “no, but I can next week, on such n such a day”.
You Cannot be “Just meat and potatoes” for responding to others
If you are the individual supplying the request, and you think you may need more time or cannot supply the entire bulk of information, then state just that and state the reasons why. This is where you cannot be that “Just meat and potatoes” person, meaning that short answers or quips is what you are about and that is how you communicate. When at work, often, you do need to fill many gaps with proper reasonings to others, so they are informed of your request for change of date of requests or amount of information you can provide. We must take into consideration that in large organizations, the same department is also divided into silos. Signifying that just because you have certain knowledge, another team member, or co-worker will not. We cannot assume others have the same internal knowledge, no matter how trivial, that we have.
Repetition Builds Collaboration Confidence
I remember when matriculating for my physical therapy degree, most of the younger students would whine and complain about hearing the “same thing again”. What they did not understand was that information repetition was building their ability to use that same information in a variety of ways. Working situations are no different. Ensuring that everyone is supplied and has responded to either requests, or changes of information, or changes in timelines are vital for not just the success of a specific project; it builds the success for better working relationships. People that work well together will accomplish much more and more efficiently.
ACE your communications!
Our society is more than full of forms: application forms, loan forms, insurance forms, and the beloved, consent form. We are so inundated with forms, almost daily, we become somewhat numb, or the level of automaticity raises to the point we do not carefully read what we sign.
The other facet to a consent form, is the development of a form. This short blog will refer to consent forms for mainly outpatient physical therapy clinics. With growing regulations at the state and Federal levels, growing methods to offer, and growing patients, a consent form is a foundational piece to any clinic.
What Should a Consent Form Contain?
Most clinics prefer to keep a consent form as simple as possible, yet, in the wake of our recent and continuing challenges of the invisible beast, outpatient clinics now have additional opportunities to offer patients. All, in my view, should be explained, disclosed, and signed by each patient, with a copy handed to them for their own records.
Basic Material in a Consent Form
- HIPAA Privacy Acknowledgement
o Includes who and who not to divulge medical history to
o Some clinics prefer for HIPAA statement to be separate
- Clinic policies of treatments that maybe used
o Should always state patient have right to refuse
- Risks and benefits of treatments
- Attendance policy
- Places for date, time, and signature of patient or legal guardian signature
Additional Items in Consent Forms
Therapy clinics are now adding a “release of liability”, “hold harmless”, in the consent forms. In a search of forms that are online at many physical therapy clinics, the liability waiver is increasing as compared to consent forms 5 years ago.
Also added to consent forms, or are additional consents for electro stimulation, traction, or other modalities. Some clinics create a completely different form to sign, as not all patients will utilize that modality.
The topic of interest today is the telehealth consent. This is a new and upcoming form in the utilization of outpatient physical therapy and deserves some small comments. Such questions as; can you use Apple Iphone Face Time or Duolink as a telehealth method? As both ends are strongly encrypted, so far these forms of “telehealth” are allowable. Maybe not so in the future. The caveat to any telehealth visit, is the consent and understanding that the patient at home allows and understands that if he/she does not live alone, the medical conversation may be overheard and seen. It the patient wishes for the telehealth conference to be private they must ensure that on their end. The conversation should be recorded, and consent must be attained in the consent form and at the beginning of the call. This protects both parties. As this technology is new, with many many grey areas still to be configured, voice recording important; and, if the clinic is using a telehealth 3rd party company, the entire recording of voice and video can be captured.
Take Home Points?
- Semi-annually review all types of patient forms.
- Apply telehealth to the consent form, even if the use of an Iphone would be utilized.
- Obtain consents for recording conversations, even with just a follow up phone call.
- Strongly consider the Liability Waiver addition. Sometimes it is important that patients understand they are the more active person in the therapy duo. The feedback of the patient in every exercise, modality is important. If the patient is not successful, neither will your business.
- Begin to look for that 3rd party telehealth system that fits into your budget. Many clinics visualize the need, but to actively use it is another.
- Strongly consider the patient signing a consent and liability waiver each visit. This is important as patient’s values, ideologies, and expectations changes. Having them sign the form with each visit again rolls back to the statement that it is the patient who is the more active person in the therapy duo. This serves as a strong reminder.
Forms are the foundation to a strong business model. Do NOT throw money away.
Most of us can hear the echoing voices in our minds of our mothers and grandmothers, “sit up straight”, “stand up straight”. They were right. The collection of data, we call research, begins to tell a story behind what our grandmothers said regarding posture. As psychology and human factors continue the climb ladders of research and understanding, postures convey more than a good or bad habit. Postures reveal your emotions, perceptions of yourself, and certainly, how others perceive you.
Posture helps good or negative memory recall
Research: a learning curve that helps to shape how we think, do, and act. Research is a type of cell phone, many individuals rely heavily upon it, and would be in a quandary without it. History of mankind continually exposes that the peoples of the world had considerable amounts of knowledge about many things; there was no research to substantiate it. We now rely on great historians to support the knowledge of the past. Much of human knowledge can be considered “common sense”: do not walk and then stop in front a fast-moving vehicle if you want to live. Much of human knowledge also has varied parameters of opinions and conjectures, creating confusion in decision making for some. In the case of posture and different memory recalls, research does affirm erect posture will elicit better memory recall of good memories in contrast to slouching posture will recall a higher percentage of depressing memories (Erik Peper, PhD, BCB, et al., 2017). Many of us, when we stop and think, can relate times of trouble, we might remember slouching, almost an attempt to hide our faces. When assuming that posture, those unhappy and troublesome memories are easier to recall.
TAKE HOME POINT
When experiencing troubling times, sit up and stand up erect. Use your memory to facilitate positive changes that are often required when traveling through those valleys.
5 Postures, 5 Emotions
A very interesting study conducted by a group of researchers at Psychological Sciences, University of California, Merced, CA, USA, (Eric A. Walle, et al., 2017) used actors to portray 5 emotions: joy, sadness, fear, anger, and disgust. An interesting point is the study used photoshop to remove the actors’ heads and changed all photos into the same grey color as to remove as much outside influence. The focus was to only view the body, without the facial expression, as facial expressions, in past research reveal inconsistencies (Allison Winters, 2005). Anger, fear, and disgust were the most often chosen, 79%, correctly by the participants that viewed the photos. Joy and sadness had variations yet were considered to still have statistical significance.
Postures do display our internal emotional state, without looking at the face. I venture to say most of us have watched people moving about and we automatically perceive something about that person.
TAKE HOME POINT
There is always someone watching you. If you are planning an interview, an important meeting with the organization’s decision makers, a first date, your posture is talking when your lips may not be moving.
First impressions are your posture.
Postures in the Form of Exercise Movements
Yoga, Tai Chi, Qigong have a common thread: static and dynamic postures that are specific in length of time a posture is held, the sequencing of the posture, and the movement that takes place shifting from one posture to another. As a physical therapist and provider for employee injury prevention, these forms of “exercise”, are remarkably familiar. The fourth common thread that yoga, tai chi, and qigong have, as compared to exercise equipment, is the mindfulness that is integrated into these forms of exercise. History shows that these types of body and mind exercise movements are to bring the body and mind together to create a harmony of the two. Harmony brings on homeostasis, which, in turn, allows a calm emotional state of being, safety, and facilitates physical healing. American western thinking wrestles with this concept from gyms to medicine: the body and mind are separate, even though the human body and mind are one (Budiman Minasny, 2009). Body work therapists are very familiar with this concept as emotions from the past are often elicited when performing bodywork on a client (Bruno Bordoni1, et al., 2014).
Salient to these types of mind-body exercise, is the relaxation response created. Fascia, a large organ that is the holding matrix in the body is only just beginning to surface with research that correlates and upholds the mind and body as one.
“The number of receptors in the fascia far outnumber those in the muscle and around the joint [55,56]. Within these mechanoreceptors, the majority of input comes from the interstitial receptors that are intimately connected to the autonomic nervous system. Stimulation of these intrafascial mechanoreceptors leads to an altered proprioceptive input to the central nervous system, which then results in a changed tonus regulation of motor units associated with this tissue. The result is relaxed, freer moving and more pliable tissue.”
Meditative Movement, Energetic, and Physical Analyses of Three Qigong Exercises: Unification of Eastern and Western Mechanistic Exercise Theory
Penelope Klein 1,*, George Picard 1,2, Joseph Baumgarden 1 and Roger Schneider 2
Also, in conjunction with how fascia behaves and is directly linked to the central nervous system is how this tissue, when moved properly reduces inflammatory responses and assists with DNA repair, (Penelope Kline, et al., 2017). New theoretical models of how the mind and body are connected are a frontier for physical, emotional, and healing capabilities of the human body.
TAKE HOME POINT
- Emotions directly affect your posture
- Practicing mind-body exercises evokes the body’s relaxation response that facilitates stable emotions, allows for the body for physical healing, and increases physical stature and abilities
What has this to do with Safety in the Workplace?
Postures can certainly reveal our emotions internally. If we can allow ourselves to learn, recognize, then change, our emotional stability will preserve us from accidents at work, home, or sport. Changing your posture via some of the topics discussed, will also have a direct affect on your peers at work and family, not to mention your emotional stability and well-being.
Well-being ranks high in organizational surveys. Most of us, in our American culture, are facing exceedingly more stressful situations, out of our control. In the workplace, it is important for our emotions to be stable; not the yo-yo, the ups and downs, from a look, a word, added assignments, we are now thinking this is our new normal. No, it is not your new normal. How we change by being proactive will change us and others in a positive manner.
Allison Winters, M. (2005). Perceptions of Body Posture and Emotion: A Question of Methodology. The New School Psychology Bulletin, Volume 3, No. 2,.
Bruno Bordoni1, et al. (2014). Skin, fascias, and scars: symptoms and systemic connections. Journal of Multidisciplinary Healthcare, 2014:7 11–24.
Budiman Minasny, P. (2009). Understand the Process of Fascial Unwinding. INTERNATIONAL JOURNAL OF THERAPEUTIC MASSAGE AND BODYWORK, VOLUME 2, NUMBER 3,.
Eric A. Walle, et al. (2017). Postural Communication of Emotion: Perception of Distinct Poses of Five Discrete Emotions. Frontiers in Psychology, 0.3389/fpsyg.2017.00710.
Erik Peper, PhD, BCB, et al. (2017). How Posture Affects Memory Recall and Mood. Biofeedback, Volume 45, Issue 2, pp. 36–41.
Penelope Kline, et al. (2017). Meditative Movement, Energetic, and Physical Analyses of Three Qigong Exercises: Unification of the Eastern and Western Mechanistic Exercise Theory. Medicines, 4, 69; doi:10.3390.