NEWS-Line for Physical Therapists & PT Assistants

Regaining Function Through Self-Care

FEATURE STORY	07/01/2003
Author: Brandon Fink
Having a small, private PT practice allows Roger Rettig, MSPT, MNSMT, ATC, CCM, CSCS, to devote plenty of time to teaching patients how to manage their own symptoms. Rettig is the founder and director of the Colorado Physical Therapy Institute, PC, in Broomfield, CO. Since 1987, the institute, a Medicare-certified rehabilitation facility, has specialized in orthopedic, sports and work injuries. In addition, Rettig's clinic offers total joint rehabilitation, biofeedback, TMJ/headache management, balance and gait training, arthritis, knee rehab and complete spine rehab as well as treatment of arm and hand injuries. Rettig and his staff are also ergonomic training specialists. Rettig's undergraduate background is in physical education and athletic training. He obtained his Bachelor of Science in Physical Education and completed the athletic training curriculum at West Virginia University. He earned an MS in Physical Therapy from Beaver College (now Arcadia University) in Glenside, PA. "I had a true desire to help people, and wanted to learn more about rehabilitation after my completion of the athletic training curriculum. [Physical therapy] seemed to be a wise career choice, as there were a multitude of job openings in the field," he recalls. After working as a contract physical therapist for Humana Hospital-Mountainview in Thornton, CO, Rettig opened his own practice in 1987. He was looking for a change of pace from the hospital setting in the form of a small practice that emphasized patient education. "Our concentration is on manual therapy, exercise and physical therapy," he explains. "We do a lot of physical therapy education with handouts, booklets, posters, videos and work site evaluations." The Colorado Physical Therapy Institute also offers Pilates, injury prevention lectures and massage therapy. "I treat orthopedic cases three days a week, dealing with shoulders, knees, and upper extremity overuse injuries," Rettig says. He spends the remainder of his time on administrative tasks, presenting injury-prevention lectures or going into local businesses and industries as an ergonomic consultant. "Ergonomics" is a term that has entered many people's everyday vocabulary in recent years with the marketing of "ergonomic" chairs, computer keyboards, etc. Simply put, ergonomics is the applied science of designing, building and arranging the things and furnishings that people use in a way that promotes safety, efficiency and comfort. Rettig's practice advocates sleep ergonomics. "Getting adequate, quality sleep will make an individual less moody, increase energy, productivity and immune system function while optimizing the body's recovery to injury and daily stress," Rettig states. "If an individual doesn't get the proper amount of or quality of sleep, it can have truly adverse effects. The average adult should try and get roughly eight hours of restful sleep per night. It's important that an individual be comfortable and in good ergonomic positions during these extended times." As Rettig points out, however, getting the right amount of quality sleep becomes more difficult over time. "It's common that as we age, sleep becomes more fragmented and fragile." He promotes the use of specially designed supportive pillows and braces that keep the body in a neutral position during sleep. "Neutral positions reduce soft tissue and joint irritation by maintaining blood and lymphatic flow into the arms and legs," he explains. "Proper support and position through the night can be influential in maintaining both a healthy neck and a lower back." Rettig points out that there are also many non-ergonomic sleep aids available, such as soothing music, stretching and massage techniques, hot tubs, showers and even white-noise machines. He urges patients to do whatever they can to create an environment that is conducive to restful sleep, and says that most will notice the benefits to their health within a few weeks. In addition to free advice on sleep ergonomics and improving sleep hygiene, Rettig provides free educational material on general health and wellness, injury prevention, nutritional supplements and more. He takes particular interest in helping patients treat chronic back pain -- a condition for which there are no simple solutions or quick fixes. Chronic pain is an extremely frustrating affliction for both patient and healthcare practitioner. Theories regarding its causes and treatments abound, and pain that fails to respond to one therapeutic approach may be treatable using another method. "Simply because a particular healthcare provider can't get a patient better, doesn't mean that the patient cannot get better," says Rettig. "There's this 'If I can't find it, you don't have it' attitude [prevalent in healthcare], which is extremely counterproductive," he adds, noting that many people seem to be suffering with chronic lower back pain that may be due to overexertion, occupational hazards, or simply high levels of stress. "Back pain is in the body's core. You simply can't get away from it," states Rettig, explaining the urgency most sufferers feel to find a cure. Some obvious causes of back pain are arthritis or a specific disc injury. Although such cases are easily diagnosed, it's not uncommon to treat some of the root causes of back pain -- with apparent success, according to objective studies like X-rays -- only to have patients continue to suffer from chronic back pain. According to Rettig, "the X-ray is a very poor predictor for chronic pain. MRI is potentially better, but a great deal of normal people without pain will [also] show disc bulges and abnormalities." In light of such inconsistencies, Rettig cannot discount the role of the mind in chronic pain. He occasionally sees patients who appear to gain extra attention or a respite from responsibilities through their suffering. "For some people, emotional issues allow chronic pain to become an opportunity not to have to excel. Some people, on the other hand, try to tough out an injury. They wait too long for treatment, and end up compensating in other ways. Maybe they hurt their back, but [by the time I see them] their leg is numb, too." Rettig encourages his patients to take responsibility for self-care whenever possible to help them feel empowered to overcome their conditions. "You don't do too much passive stuff," he explains. "It's nice stress relief to get a rubdown three times per week, but it's better to teach the patient exercises and good posture, and how to use heat or ice at home. Folks who learn a home program are more motivated to get better. You don't let patients leave the office without doing something -- even if it's wiggling a finger. You get them to participate and to have a little fun. You try to take the time to educate folks to be as functional as possible, with coping and stretching techniques, rather than lifelong medication." Rettig encourages his patients to take an active role in their treatment. He asks them to demonstrate the self-care and therapeutic exercise techniques they learn in therapy, and frequently asks them to think about why they seem to be experiencing pain. "I have patients tell me why they are having pain. They've been asking me, and I've been telling them. This way, I can see if they know." Part of Rettig's treatments is reacquainting patients with the basics of healthy living: drinking plenty of water, eating a balanced diet and taking vitamin supplements as needed. He appreciates well-informed patients who willingly participate in their own treatment. "The patient should be able to write down questions for me, and be able to hold me accountable," he states. "The well-informed patient actually shows better progress, and working as a team makes my job fun." A big part of Rettig's job is getting injured workers back to their jobs safely and comfortably. One troubling phenomenon he sees -- one that increases the risk of a chronic pain situation -- is the common failure among injured employees to inform their employers that an injury has occurred. This is a problem that arises whether an employee is injured off-hours or on the job. Most people don't think to give their employer a call informing him/her of the injury. When an injured workers seeks treatment, in many cases the healthcare practitioner doesn't inform the employer of the situation, either, and simply advises the patient to take it easy for a week or two. This failure to communicate, notes Rettig, can lead injured workers to sit at home and worry needlessly about the security of their jobs and/or benefits. Rettig outlines how such situations can quickly get out of hand. "The employer has to take an interest in the employee. If nobody from the workplace calls, the employee gets anxious and wonders if their job is threatened. In turn, their feelings of self-worth may be threatened. Stress and anger definitely affect pain, and what can also happen is that if the employer doesn't pay enough attention, the employee can slip into more pain just to show how much it hurts. Chronic pain can be prevented by the implementation of a protocol for employers, employees and local physicians to follow. A good approach is for the employer to have a great prevention program in place, to be actively looking at ergonomic and safety issues in the workplace -- even to be proactive about shoveling snow in the parking lot. Care has to be demonstrated. Should an employee get hurt, the employer can encourage them to take off right away and see a doctor without worrying about lost work time. This makes people feel cared about, and [makes them] want to return." Rettig can relate to the emotions that can accompany disabling injuries. In August of 2000, he suffered severe injuries to his arm and shoulder while cliff diving: Rettig suffered a severe dislocation with multiple fractures, an avulsion fracture to his rotator cuff, a neck sprain and other injuries. During the 14 months that he was unable to work, he suffered from pain and numbness. "I recovered from a frozen shoulder once the fractures had healed. I'm able to use my arm well now with minimal problems," he says. Going through the sometimes arduous ordeal of rehab himself convinced Rettig more firmly than ever of the importance of helping patients take charge of their care. It also changed his entire perspective on life and allowed him to empathize with the patients he currently treats. "This episode reminded me of the important things life has to offer, such as family and friends, and the importance of providing quality therapy regardless of insurance. This experience enabled me to step into my patients' shoes, and see their reality through my own eyes. I learned a great deal and it was actually a good experience, looking back on it. It slowed me down a little and gave me time to reflect on what is important." Roger Rettig, MSPT, MNSMT, ATC, CCM, CSCS, has a Master of Science degree in physical therapy from Beaver College, Glenside, PA. He is also a certified industrial ergonomist (CIE) from Oxford Research Institute, in Denver, CO. He has been a clinical advisor for the American Running and Fitness Association since 1987, and is a certified (NATA) athletic trainer, having participated for three years on the athletic staff at West Virginia University. He is also certified in the active release technique developed by chiropractor Dr. Michael Leahy. Brandon Fink is a writer from the Philadelphia area. He is on the editorial staff of NEWS-Line for Physical Therapists & PT Assistants.
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