 I'm your host, Maria Mera, and I'm also a financial advisor with Edward Jones. Today in Spain, Young and Hard, we're going to cover the main topic, how to stay physically healthy. And my guest is Derek Chan. He's a physical therapist at the South here in Honolulu. So welcome, Derek. Thank you for joining us. Hello. Thank you, Maria, for having me. Aloha. Let's go into it. What is physical therapy? What is physical therapy? So as a physical therapist, we help people move better so they can live a better life, really optimize their movements so they could achieve all the things that they want to do in their life, whether it's spending time with family or doing the activities that they once love, and doing it hopefully in a less painful manner. Okay. So what does, because I hear there is physical therapy, there is chiropractors, there is kinesiologist. What do you use being a physical therapist? Well, as a physical therapist, we typically prescribe exercise, but we can also use different modalities, different hands-on treatments, and so forth. So it sort of overlaps with a lot of other professions like massage therapists, chiropractor, athletic trainer, and so forth. Because we can use our hands to manipulate the soft tissue and the joints, and also facilitate certain type of movements that we want or inhibit as well. So when it comes to, I guess, thinking about, let's say chiropractic versus physical therapy, philosophy is different, but some of the treatments can be the same, such as joint manipulation, or soft tissue mobilization, massage, and so forth. And in terms of exercise physiologists, those require a different degree, but again, it overlaps because we do exercising, prescribing specific exercises for the specific problem that people may be having. So what is the difference? What education does a physical therapist need? Well, as a physical therapist in the U.S. anyways, you need a bachelor's degree first. Usually it takes an average of like four to five years for that. And it could be any sort of education, like any bachelor's degree, as long as you complete that with the required science courses required for physical therapy school. And a physical therapy school now is a three-year graduate degree. It's a doctor's degree. And after that, you can start practicing. So after high school, it's roughly about seven years. Compared to, let's say, athletic training, there are programs that are like, you know, bachelor's level and then there's master's level with chiropractic, to my knowledge, it's after a bachelor's then it's a four-year type of doctor's degree, right? So for a physical therapist, if you're working in Hawaii, can you also go and work in California or any other state in the U.S.? Yes, yes. So the great thing, you know, in the U.S., you know, in order to practice physical therapy, you attend a physical therapy education program. And then once you get the degree, you have to take a national board exam. After you take that national board exam, then you'll be qualified as a physical therapist to do practice. But in addition to that, depending on which state you want to practice in, you have to get a license for that specific state. So you just get the license depending on the state where you want to exercise your... So for me, and again, I come from Europe and there is something very well known and actually it's been very well known for in the last few years mostly, and it's called dry middling. And I live in California and it wasn't allowed. And now in Hawaii, I also found out that it's not allowed either. But it's funny because it was sort of like acupuncture, but it's like a really fast insertion of the needle in the muscle that is very constrained to just release it. It was very effective for me. Long story short, it was discovered in the US. So I wonder why some states allow to use it while some others don't allow any thoughts on that. No, that's a very good question. With dry kneeling, yes, it is using a needle, a particular size needle, and it's to penetrate the skin to aim for a tissue nodule, like a knot. So that's a philosophy with dry kneeling from a physical therapy standpoint. With acupuncture, they have different philosophies, different purposes. I don't know specifically how they practice, but it may involve a different type of philosophy like the meridians and the chi, I have no idea. But it has different philosophy basically. And it's different in different states because there's different state practice laws. In certain states like California and Hawaii, I guess there's a strong acupuncture community. And that's one of the communities that may sort of be hesitant to allow physical therapy. Yeah, right. When it comes to politics, people want to protect their own turf. Even though in Europe or in other states, they do physical therapists or physiotherapists, they do practice dry kneeling quite often. So unfortunately, it's just a state thing. What about other therapies that might not be, they might not be forbidden to use in the state, but they are not used like radiofrequency or UV or I don't know, agua therapy or something like that. It seems like there's differences in depending on where you practice physical therapy. In terms of using those type of modalities like the laser ultrasound and all those things, most of the time physical therapists can use those in every state. It's a matter of whether the therapist wants to use it and whether they use it effectively because in a lot of research, for example, like ultrasound, it doesn't really show hard research that it's going to work effectively versus just exercising in a particular way and loading and tending up. That will help more. So as a physical therapist, we have to practice evidence-based practice. So we got to make sure that we're giving you the treatment that's going to help. We're not just going to give you something that might feel good or just lather on something. Yeah, this is going to help. You mostly focus on the exercise, right? For me, it depends on the situation, but there's always going to be exercise involved. So how important is exercising in the life of a person? You know, it's actually very important. So important that exercise should be a daily habit in our lives. That way, we can move better, ultimately get stronger, and stay young at heart, right? So what exercise is good you recommend if you're saying we need to practice daily? And sometimes because we practice something daily, we get more injured or at least one lean proof of that. So what exercise is good that you could recommend to anyone and you could be in a safe that you know you're safe that you can do every day and you're good? Well, every day exercising that's safe for everyone. Just general walking is good. You know, I know the American Health Association recommends like five times a day at least like 30 minutes of moderate exercise. That's really good for the heart in general. Stretching is good for everyone because as you get older, we get stiffer. So we need to make sure we stay flexible. If not, it's going to limit our range of motion. And when we do certain motions, if we don't have that range of motion, then it's going to put stress elsewhere in our bodies. And it will eventually accumulate to more damage and strain in our bodies. So stretching, walking, that's good too. Yeah, yeah, I completely agree. I think walking is one of the best exercises that you can do. And people just don't underestimate it. What do you believe about applications like these phones that keep tracking you and telling you get up and fall for or they keep bound? Do you have any opinion on that? Yeah, I mean, like some people really dislike technology and they think it might, it is a distraction, but it's just another tool. And it depends on how you use it with certain phones or watches that give you like an option or feature to track yourself, especially when it comes to your well-being. It's pretty awesome because for example, there's on your watch or phone, it tracks on how many like you're walking your steps, right? So it can really show you like how active you are. A lot of times we don't know it, but we might be sitting for eight hours a day and that's very detrimental to our health. Just sitting a lot. So it's important to get moving to watch the step and increase the step count because that's the more active you are, the better you are. Yeah, yeah. And I'm very active and I've always been told to rest and but it is true what you're saying that sometimes is that get up and walk for one minute because one thing is that you might be exercising for two hours, but the other thing is that you might also be seated for two hours. So it's that that's probably not the healthiest thing to do. That's true. The more you move, the better your joints will become lubricated and then you'll maintain that flexibility. And you know, like they say, motion is lotion or it's... Okay, I never heard of that. I'll take it. So what about the other, the radical the other side of the spectrum? I heard this one physical therapist, actually, his name is Sergio Florian and he was running, I don't know if you heard, he was running the perimeter of Oahu. Oh, yes, I did. 35 miles. Did you hear that? Yes, I did. He did it in 24 hours. I am not convinced and I would love to hear what you have to say. Is that is that healthy to run 35 miles? So it's it's good to be trained for it. It's not a bad thing if you like run that much, right? Although research has shown that for the typical athletes, if they run like more than a certain amount of miles, like 20, 30 miles every week, and you keep doing that consistently until you get older, they do find that your joints do wear out a little faster compared to the average recreational runner, right? But then the person who's more sedentary actually has the most wear and tear on their type of joints is what they found. But is there a right balance? I know very few people who run every day who don't get injured. Right, yeah. So it's you will get, you have more chances of getting injured if you run more mileage, of course, but you don't necessarily need to do that. Just a healthy amount, you know, five, 10 miles every day. And as long as you train your body for it, then your body can handle it. So it's all about your training patterns. And are you able to, you know, train up to that tolerance? Okay, let's go to do, let's have a little break here. And I want to get a little bit of your idea when we come back about what influence did COVID-19 have in our, in our activity. But let's do a break and we'll be back with Derek in a minute. Welcome back. We continue our conversation with Derek Chan, physical therapist and staff. So we were mentioning right before the break, what happened during COVID-19 to our physical health? Oh, physical health. With COVID-19, it was definitely something unexpected. And as a physical therapist, I noticed a lot of patients have become less active, you know, or they are getting into these poor habits and postures because a lot of people started working from home. And at home, their setup is not necessarily, you know, ergonomically friendly, like if they were at work. So I've noticed a trend where patients have been getting more neck pain, back pain, maybe even shorter pain because of all the sitting and improper placements or their work desk at home. What were you seeing before COVID-19? Was it different type of injuries? Well, in the hospital, we always see a different varieties of injuries, you know, from shoulder replacement and just general back pain neck pain and all that. But the, it was for our patient population, it was more arthritic and this, you know, aging aches and pains and all that. But now it's just like younger people coming in and with aches and pains because of this inactivity or improper sitting or posture. Oh, and also less surgeries because we had to stop some of the elective surgeries too. What do you think about telehealth, right? It's not how you call it like for physical therapy. Physical therapy, it's awesome. Anything with telehealth nowadays, it's an opportunity to really get our services across the state, nation, even the world. And it's definitely going to be the future, especially with a lot of folks who may not be able to commute to the physical location. Maybe they live in a rural area, live very far from the city maybe. So it'll be very useful. Or even our everyday lives with working professionals, they might be very busy throughout their work week and they might not have time. They may just have like 15 minutes of just chatting on their phone. And that would be so useful for them, you know, in between like their appointments, they could easily just talk to someone on the phone, just tell the health like the provider and that would work great. Yeah, I mean 15 minutes every day at the end of the week is a lot of time. So what about prescription? Can you prescribe a patient or? With like medications, you mean? Yeah, yeah, as a physical therapist. No, as a physical therapist, no, we don't prescribe medications in the US anyways. I know in the UK, they started that practice. They are able to prescribe certain medications with additional certification. Yeah, also in Spain, at least they can prescribe some. Yeah, they're not like a doctor or like an orthopedic, like a sports medicine doctor. But yeah, there are some that you can prescribe as a physical therapist. Don't quote me here, but I've had physical therapists prescribing me. What about? And this is another topic that to me, I don't always see the benefit of it. But as I just wanted to ask you, what do you think about these steroid injections that seems like it's the go to for every injury nowadays? Oh, really? Yeah, that's it. It's unfortunate that some people will choose that as the first line of defense like and treatment because steroid injections are very useful to calm down inflammation, especially if the patient's tolerance is very low. And it's okay to use it in the beginning, but it shouldn't be dependent on it. I've had patients where they became so dependent on it. And of course, with steroid injection injections, you can only have a certain amount every year. But after they're done with that and pain keeps coming back, what are you going to do? Right? And if it's like a muscle or tendon problem, right, you have to train it, especially if it's appropriate for training. But I see a lot of patients never having physical therapy and first line of treatment was just steroid injection three four times a year. And then it actually degrades your tendon slightly. Yeah, yeah, the more the more that if you have used it, right? Yeah. Yeah. So that doesn't really help. And then it just makes your muscles weaker because it degrades your tendon. So do you do you have a lot of like, like fight fighting back or disagreements with doctors who you see that they are doing that for the patient because the patient can tolerate the pain. And is there any dialogue between the doctor and you guys just with this or with anything else? Like maybe Fortunately, for me, I've worked in hospital systems, like Kaiser and Straub right now, who are very who who have physicians who are very receptive to communication. So I've never had that issue. Because physicians know that, you know, it's important to have like a good communication among different disciplines in healthcare to really take care of the patients. So it's it's imperative to actually make sure that the patient knows there's a team behind him or her for the care. And it's just not one person making a decision. Do you do you think there is a physical literacy in Hawaii? Or do you think people know their bodies? I'm sorry, could you repeat that? I was making up this term of do you think there is a physical literacy like people know what a muscle is or what are the difference between a ligament and a tendon or do they do they know anatomy? Oh, right. Yeah. No, I think people don't really know their bodies and what muscle is or what the tendon is. In the beginning, I thought it was like, oh, it's common knowledge with it. But it's just because I'm in the field and I've studied it. Some people think that certain parts are the muscle or the tendon or even a ligament. So not enough people know it, even if you took PE in high school or middle school or whatever, it's it's not the same, especially when it comes to injuries. So yeah. So what would be your advice to people out there to get to know our bodies better? To get to know your bodies better, definitely number one, you should see your doctor for it, see a physical therapist to understand how your body's moving. When it comes to human movement relating to your everyday life, physical therapists are the ones who do the movement analysis and so forth. And yeah, number two is just number one, see a doctor number two, see a physical therapist. Number three is really move and be a little more physical so you can understand your body and you understand how it works. Not only if you're an athlete, but yes, as a regular person doing regular activities, you should at least look for a little bit of education, right? Oh, for sure. Yeah. There's a big difference between like athletes and you know, sedentary people and the only difference is the movement. Can you see as patients, are there better patients for you as athletes better patients that or they are more impatient or do you think there is a difference as a physical therapist? Can you can you see some people reacting better than others? In terms of behavior, I think it's very individual. The individual can be patient or willing to learn and whatnot, but the main difference between athlete and between someone who does an exercise is their an athlete understands their body a little bit better so they can activate certain muscles in a better sequencing and it's easier for them just because they've moved so much, they understand how to move. Yeah. What about pain? I think athletes are more used to tolerate pain like if you're a runner, you're suffering and just run through the pain. Is that a good thing to ignore the pain and just keep pushing yourself? Yeah. No, like there's a certain amount that you should that you can push yourself off before they say, oh no pain, no gain. Yeah, that's true with when it comes to muscle development and when you're young, but once you're getting older, if you're putting too much strain on a certain joint or muscles, then you might even go into that injury zone, right? Yeah. It can even actually be worse for your body if you kind of keep pushing that way because then your body will become very sensitive to the pain and you're putting more strain to it. So listen to the pain or listen to your body. I heard this sentence from a massage therapist in San Diego and I always, I kept it as a, there is such a thing as good pain and bad pain, right? Some of it, like if they are giving you a deep tissue massage that hurts but it's actually a good pain versus running and your knee hurts, that would be a bad pain. Yeah, yeah. So the description of pain is very important. So I communicate with my patients and making sure that it feels like a good type of pain per se. If it's a bad pain, like sharp numb and all that, that's not really good for it. Yeah. So why pain comes right away and then it takes so long to go, right? It seems like in one day you get injured and then it takes four months to finally get rid of it. Yeah, well, pain is not necessarily always a bad thing. In fact, it's just an alarm system in our bodies that lets us know, oh, something's not right and it's healthy. That means you're alive if you can feel pain because if you don't feel pain, then you might do dangerous activities like leaving your hand on a hot stove and it's just going to cause more pain, right? So it's an alarm system for us to protect us. Sometimes, depending on how much injury or how much damage is caused, then it may take more time to actually recover. Now sometimes when that is activated, right, that pain system, sometimes it sort of lingers a little longer. So this alarm system stays a little longer and it turns on and alerts you a lot more and that's how it starts to go into like a chronic pain pattern because then you think of it as like, oh, it's very sensitive and every time you do certain things, it's just going to immediately just spike and you're going to feel the pain. But that's why you have to understand how pain works because you have to understand that it will heal and the things that you do may seem sensitive, but small introduction back to the activity can help reintroduce that stimulus to your body and it will adjust it back depending on how long it has been and what activities that you do. And that's what I was going to ask you. When do we consider it a chronic illness versus an acute episode? Right. When healthcare providers use those terms like acute, subacute or chronic, they usually go with time frame. Acute could be anywhere from less than a month and chronic could be anything from more than three months considered chronic, but it depends on the condition whether when you have the injury, are you still doing things that injure it and that's why it's accumulating that injury or is it like, even though you rest but you still have pain, okay, it could be chronic, but is it because you're not putting enough load to it? You're not introducing it back to your body, so that's why your body's not used to it and that's why it feels that discomfort and sends these pain signals to you. So yeah, most of the time it will become our body's heal, so just know that our bodies will heal and you have to give it time, you have to protect it, you have to load it up again. And keep the faith. Derek, you've been my physical therapist in a number of occasions, so I would like you to and definitely keep the faith, it was very important to me and just trusting the process. So I would like you to just as a goodbye to our audience, give a couple of advice or whatever you want to tell to patients out there or potential people who might get injured in the future. Right, yeah, so it's definitely a pleasure to work with you and with patients or whoever's seeking care from physical therapists, if it doesn't work out at first, don't stop, don't assume that, you know, don't generalize that physical therapist doesn't work. Definitely you have to keep searching because everyone practices a little differently and that's what gives you the right as a patient to take an opinion, third opinions, maybe even fourth. And you have to make sure that you understand what you're going through and don't just assume that oh, just because someone is a healthcare professional, they're going to do this procedure on you or give you these treatments and it should make it work. Sometimes it doesn't and sometimes you have to sort of, you have to understand it, understand your condition yourself. So I try to educate my patient so they understand how they're going to get better by themselves using these exercises. And you do a great work, I'm not just saying this, I'm leaving it, I'm leaving the process. Thank you very much, Derek. If anyone wants to contact you, what's the best way? If anyone wants to contact me, they could reach me on my Instagram, you know, send me a DM, it's Derek on the Scorch Un, pretty easy to find me. Okay, excellent. Well, thank you very much, Derek. Thanks for saying your knowledge and spending your generosity with your time. Thank you so much for having me. Of course, our pleasure. And to everybody else, just keep moving. Moving motion is lotion. Okay, we'll see you in the next episode of staying young and hard. Until then, keep moving. Aloha.