Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin

22Oct/090

True Liberty

The love of liberty is the love of others. –William Hazlitt

As a new immigrant to the U.S., my father traveled to New York City on a quest to view a symbol. Hopping in his car and making his way toward the East Coast, he fought the traffic jams and hordes of people to make his way to Liberty Island. Though he had been in the States for several months, I believe that was the day my father first felt his freedom. Gazing up at the 250,000 lb. statue with tears in his eyes, that was also the day he vowed he would share it with everyone he met.

My dad was a visionary and a “get-it-done-er”. He was notorious for dreaming up grand schemes and making sure they came to fruition. No task was too small when it was a great idea coupled with some good, old-fashioned passion.

In the late summer of 1973, my father was a young physician practicing in Michigan. During his day, he would come in contact with other immigrant Filipinos, many of whom were employed at the same facility. He quickly recognized that the Land of Opportunity was doling out some hard lessons to most of them. Freedom came with a price and many young Filipinos were struggling to make ends meet.

He commiserated with a couple of his fellow Filipino physicians. “It is a shame that people come to this country and never get a chance to really see it,” he said. “I have a great idea. Why don’t we rent three Greyhound buses and take as many Filipinos as we can to the Cherry Blossom Festival in Washington D.C.? We can pick up some extra hours moonlighting in the ER to pay for the buses.” I can picture my dad saying it with a twinkle in his eye. I imagine his friends laughed until they realized—he wasn’t kidding.

So, the plan was put into motion. They divided the cost by three and arranged for the buses to be rented. They proceeded to invite every Filipino they ran into—some friends and some strangers—to come along for the trip of a lifetime. As the deadline for the big payment approached, his two comrades realized they would fall short of the goal. They had not been able to work the extra hours they had planned on. It appeared the big trip was off.

I imagine my father sat for a moment, picturing the disappointed looks of all the people they had invited. Not to be deterred, he flew into action. He applied for an American Express card and rented the buses. He shouldered the cost by working even more hours in the month he had to repay his debt, and I imagine he did it with joy in his heart.

The trip must have been incredible. Can you imagine being one of those invited who had never before met my dad?

“Hi. I notice you are Filipino. Would you like to go on a trip to Washington DC?... No…it won’t cost a thing…really.”

Actually, that is my version of how I think the conversation would have transpired. In reality, my father probably greeted them in his native tongue and if they answered back—they were in. Young and old. Professional and non-professional. Old friend and soon to be new friend. All were handed the gift of freedom to move about a free country.

The details of the trip are sketchy to me. I was too young to remember much of it. But at his funeral, someone told the story—and I saw the picture.

If you think you can fit a lot of Filipinos into an averaged size kitchen, just imagine how many you can pack into three Greyhound buses. The picture was worth a thousand words and probably a thousand stories since. A sea of brown-skinned people with cameras slung around their necks, grinning from ear to ear, standing aside the giant vehicles. Happy. Eager. Proud.

I looked at the photograph and smiled. So, that’s what freedom looks like.

14Oct/090

A Revolution of One

“The only freedom I have is the freedom I take for myself.” That’s what one young man once said. And I believe him.

Freedom is more than just carrying on without permission, or existing without rules. True freedom requires a choice to move in any given direction – preferably a direction that calls you with a passion.

Have you ever felt the tug of a passion? If you haven’t, then I don’t think you’re paying attention. And if you have and you aren’t chasing it, then get moving.

I say this a bit tongue-in-cheek, as I am just as guilty as the next guy for squelching these pangs of adventure in favor of a more calculated decision. I mean, let’s face it. The world is chaotic enough, and yet technologically advanced enough, that many believe that the only infallible choice is one made by a machine. We consult numbers and machines for just about every major decision we make. We attempt to rein control in an uncontrollable world – and in the process, we sometimes play it too safe.

The thing is…calculation sometimes squelches momentum. The physical principle governing inertia works both ways. A body in motion, tends to stay in motion. A body at rest, tends to stay at rest. If we spend our days preventing the future, then maybe there never is a now. And if there never is a now – a time to make a decision to navigate toward a passion – then the biggest tragedy is that we have lost our freedom. And the world never gets the gift that is us.

I’ve recently been caught in that battle between passion dreaming and “what if” reasoning. Much like a small boat is tossed in the winds of a storm. And though I’m not sorry that I questioned, I’m more thankful that I stumbled on a little book that helped me find my way out. It’s called, First you have to row a little boat by Richard Boden. In closing, I share with you one of my favorite passages from this book:

“If every man and woman were to take the meaning of their life and pursue it passionately, they would alter the social landscape overnight. In fact, that’s how lasting revolutions are made—not by the raised arm of the masses, not by the military seizure of power, not by the political coup d’etat, but by individuals asserting who they are…one at a time.”

Chase that passion now. The world thanks you in advance.

12Oct/090

The origins of anterior/lateral meniscal pain

I've seen this three times in the last week, so I'm taking that as a sign that I am supposed to write about it.

Have you ever had a knee patient who complains of anterior knee pain with end range knee extension? They will either describe a pain at the anterior knee joint line or deep inside the knee. This is common, especially in post-surgical knee patients, and will delay healing time or possibly be the reason for a lack of terminal knee extension.

There are two primary scenarios that will create a pinch in the anterior/lateral knee with end range extension:

1. A femur that is internally rotated (check for t.p. in the anterior fibers of gluteus medius and TFL and/or in the medial gastrocnemius)

2. A tibia that is externally rotated (check for t.p. in the bicep femoris tendon and check for a posteriorly displaced fibular head)

Lat men t.p.

The trigger points may be treated with counterstrain and/or deep trigger point massage. The posteriorly displaced fibular head may be treated with MET. All of these aforementioned techniques take less than  two minutes!

Make sure you re-check end range extension after you treat the trigger points you find. Normal extension end-feel should yield a stretching sensation in the BACK of the knee.

Then make sure you address the offending tender point with exercises in the gym:

1. Gluteus medius - try medial reach with contralateral arm at waist level, heel-toe walking or carioca walking

2. Medial gastrocnemius - try gravity drop, downward dog, long strides in the ladder (make sure the toes stay pointed straight ahead) and balance board or foam roll rockers.

3. Bicep femoris - try the revolving triangle, anterior cone touch with the opposite hand or an anterior pulley low row with the opposite hand as the stance leg.

It sounds like a lot to get knee extension, but I assure you, it is the fast track to achieving a normal gait pattern and normal functioning of the lower extremity.

Until next time...

8Oct/092

Let’s Eat!

I started writing a book in January 2005. I never finished it, but lately I've been thinking about it...about the importance of people I come in contact with...about the lessons learned that I might have missed had I rushed by too quickly. About the places I've been and the people I've met.

So, I thought I'd share some excerpts from the book that will hopefully get finished one day. I am going to call it, Lessons from a Life.

Good food ends with good talk. – Geoffrey Neighor

Born and raised in a traditional Filipino home, I realized something at a very young age. Food is a good thing. No matter what the occasion or who the company, sounds of pots and pans clanging in the kitchen was a common occurrence. It seemed whenever friends and relatives came to visit, food was being prepared, or they were bringing food to be prepared or they were coming to prepare the food or prepared food was brought.

If you know anything about Filipinos, they never cook alone – and you can fit about 20 of them in an average sized kitchen. From a social perspective, preparation is just as important as consumption.

My dad’s two favorite words, “Let’s eat!” often spoken in the tone of a victorious battle cry, would result in hordes of smiling faces gathering around the kitchen table. Even then, he knew a secret that I had yet to learn: Food is our common ground. A universal experience. – James Beard

During my high school years, I attended a boarding academy. My parents would come and visit once a week, and with them would come – you guessed it – food. I had an entire drawer dedicated for my weekly stockpile of goodies. You can imagine how quickly the word spread. In fact, my parents were integral in spreading the message and as hungry kids would flock to my room each week, they would be supplied with their very own stockpile. Once the proverbial stores were filled, my dad would round up anyone – and I mean anyone – who wanted to jump in the family van, out for dinner. At times, we commandeered half of the tables at the local pizza parlor. Looking back, I realize how much my father must have spent on food for my high school friends.

“Dad, how many friends can I invite?” I would ask.

“As many as you want,” he would reply.

I graduated from high school and went off to college. My life became more of my own. I would come home on vacations and spend days catching up with my friends—eating out.

I got a job, got married and had a child and in those years, meals were rushed or “fit” into my schedule. I used to have a motto: if it couldn’t be cooked in less than 5 minutes, than we weren’t having it for dinner.

On the occasions I would visit my parent’s house, my dad would say, “Come, sit down and let’s eat.”

“Sorry, Dad.” I would reply, “I already ate and besides that, I’ve gotta go.”

If I wasn’t so busy, I might have caught the look of disappointment in his eye. But he would just smile and say, “OK, thanks for coming to visit. See you later.” I know he knew where I was coming from. His life had been just as busy as mine at one point, rushing from office to office, seeing tons of patients, being involved in extracurricular activities and raising a family. After all, I was the one most like him.

As I look back on the years before he passed away, I realize the countless invitations to the kitchen table I received from him. Some of them I accepted. I wish now I would have accepted them all. Hindsight is 20/20. The moments with my dad at the kitchen table are where I learned some of life’s greatest lessons.

For my dad, it was never about the food—it had always been about the time. For as busy as we both were, the kitchen table was a sanctuary all its own. A place where we could stop the rollercoaster of life, slow down, catch up and just be in the moment.

Life Lesson #1

The best gift you can give the ones you love

is a good meal at a nice table,

relished with flavor,

time

and great conversation.

It will fill not only fill the stomach,

more importantly…

it will quench the appetite of the soul.

8Oct/091

Adhesive Capsulitis (and a weak shoulder)

For anyone that has ever had a "weak" shoulder, this case might really help you out.

For the lay person, here is the major point: Weakness with lifting your arm up may be due to your shoulders not being the same level (check this in the mirror!) and a trigger point on your infraspinatus muscle (lower angle of your shoulder blade), which you would only notice if someone poked it. The good news is, it's fixable! But it takes some corrections in places nowhere near your shoulder... like your hips and your thoracic spine and maybe even your ankles.

For the clinician: I had the opportunity to evaluate a Marine who had sustained a gunshot wound that pierced his left 6th intercostal space and exited through his right external oblique. After 15 months of multiple surgeries and rehab, he is now complaining of left shoulder weakness and limited range of motion. He had a soft tissue endfeel at approximately 140 degrees of elevation.

Visual observation reveals his R shoulder significantly higher than his L. He stands with his L foot slightly externally rotated. (This is a classic Leaning Tower R scenario, for all of you Missing Link alumni) - R leg more supinated, L leg more pronated.

His range of motion is limited to about 140 degrees of elevation by a soft tissue restriction. Isometric MMT revealed 4 flexion and 4 abduction strength with mild pain noted in the posterior shoulder region with resistance.

Trigger points were palpated in the R upper trapezius, L iliopsoas, L piriformis and L quadratus lumborum.

Here is the assessment of his three key rotational spots:

Hips: Tight hamstrings bilaterally (90/90 test approx. -40 degrees); (+) R FABERs test (hip won't externally rotate); Normal piriformis test bilaterally.

Thoracic spine: 50% rotation bilaterally. R limited primarily due to hip and thoracic spine limitations (restored with piriformis inhibition, ITB release, thoracic NAGs and posterior rib mobilization). L limited primarily due to hip restrictions (restored with piriformis inhibition, ITB release and lateral hip mobilization).

Ankles: L>R tightness on the gravity drop; Severe hypomobility of the L>R subtalar joints into eversion. Incidentally, prior to his injury he had a history of L ITB friction syndrome and has used Brooks Beast shoes (their most stable motion control shoe) for years.

He presented with R SI joint dysfunction. I corrected an inflare and a posterior rotation, L on R sacral torsion.

Following correction of all of the above, his shoulder height was symmetrical. He still had mild pain/weakness with resisted shoulder abduction (4 MMT).

I palpated a significant trigger point on the L infraspinatus (inferior angle of the scapula). After counterstraining that tender point, his MMT was 5/5 and pain-free.

How did that happen?

Well, if you look at a picture of the infraspinatus, you will find that a trigger point in the inferior angle would have to be caused by one or m0re of the following:

1. An upwardly rotated scapula which would put the supraspinatus and deltoid in a long/weak position

2. An abducted scapula (which would put the rhomboid in a weak position

3. Or an elevated scapula (which was not the case here).

Normalization of shoulder strength after counterstrain to the infraspinatus would lead us to believe that the first scenario was the case. The deltoid/supraspinatus were weak because the infraspinatus trigger point was creating upward rotation of the scapula, placing them in a long/weak position.

The manual therapy fixes were mentioned above, primarily to normalize his posture and rotational movement patterns and inhibit the infraspinatus.

The exercise fix:

1. Strengthen the rhomboid in the short position. By they way, this gets compromised with abnormal rotation of the opposite hip.

2. Lower the opposite shoulder by encouraging thoracic rotation: backstroke, prone alternating arm lifts, plyoball throws, prone sky reaches, STEMs, etc.

3. Get that L hip to work! Shoulder flexion drives off of the L hip, which in this case was shown to be a major cause of his postural asymmetry (remember the trigger points in the iliopsoas, quadratus lumborum and piriformis?). Those trigger points will all inhibit the gluteus maximus.

Try some anterior cone reaches, pulley low rows (hip dominant), wall airplanes, the yoga warrior series to wake up that L hip.

4. Normalize ankle dorsiflexion with the gravity drop, downward dog, BOSU or foam roll rockers, Warrior I.

5. THEN put the shoulder to work with all the ways you normally do that.

Well, that's a lot of stuff to work on, so I'll let you get to it.

Have a great day.

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