 and welcome back to Movement Matters. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical. I have a very unique episode for you today where I'll be speaking with two talented physical therapists at East Oahu physical therapy to give you expert advice on how to get out of pain and back to function. First, let me shed some light on what we noticed in your first visit with us that helps us determine what is causing you to have pain and what we, meaning you and I need to do to get you out of pain. Let's look at image number one. So while this might not look too bad to you, let's look at image number two to see how your alignment is. So you'll see the head is in front of the shoulder, the shoulder is in front of the head. That needs to be in a line, otherwise you're at risk for neck pain and back pain and even sometimes pain or tingling down your arm. In image number three, we see the same thing. You might think that you're supported because you're leaning against the back of the chair, but in image four, you'll see where your head and shoulder lie and your hips so far in front. That puts a huge amount of strain on your lumbar spine, on your low back, as well as on your neck. So in the next video, we will see something that we look at in the visit. And if you wanna play that a few times, you'll see that the right arm is traveling further behind the back than the left. And why uneven arm swing when you walk is a problem because that is extra spinal rotation and you can lift with low back pain. Now in the next video, it's a little bit more subtle, but you'll see as I walk, my left foot is turned outward. That is a problem because when your foot's turned out too far it shuts down your powerful gluteal muscles and could lead to conditions like back pain, knee pain, plantar fasciitis and even bunions or bunion pain. So in the next video, you'll see something that we all look at which determines what happens when you're going up and down the stairs, getting up from a chair and that is a single leg squat. And so while you're squatting on one leg, you'll see how I'm leaning over my left leg quite a bit and that is because I don't have balance. And in this part, you'll see that's perfect alignment, the knee and the hip perfectly aligned. And in the last video, you'll see how the knee is diving in when I do a single leg squat. So yeah, there you go. See that knee just diving in right there and that is going to lead you to having minuscule tears, osteoarthritis, hip pain, back pain and plantar fasciitis. So I just wanted to share that because those are some of the things that we look at you when you just walk into the clinic or you're walking down the hall and we can tell right away some of the faults or the dysfunctions in your body that are causing pain or leading you to have pain even if it's not the place where you come in with pain. So now let me introduce you to my coworkers, physical therapist and owner of East Oahu Physical Therapy Reina Ling Hawkins and physical therapist and new dad, Ikiyama wanna flood with his daughter, Keely Nahe. Welcome to Movement Matters, guys. Thanks for coming on. Thanks for having us, Kurt. Yeah, thanks for coming on. I love it, I love it. So I've been with you guys for two years and it's been just so amazing and I wanna know from you, maybe, Kiyawa and Keely is like having such a good time. Maybe, Keely, can you tell us what you look at when a patient first comes into the clinic and you're trying to figure out what you need to do and what strategies you need to exert with them or exercises you need to give them to correct their dysfunction? I think there's a lot to stay with that one but kind of piggybacking off of what you said, we look at Keely and I, we both look at movement. We look at patterns and how that kind of correlates to anybody's pain that they're seeing or functional impairments that they talk about and trying to give them exercises to not only create awareness, but an understanding on their pain, the type of pain they have and what to do about it with movement. Very well said. So, Reina, what do you look at when someone comes into the clinic? I think I look at imbalances, they're looking at like shoulder heights, head tilt, hip, level hips or like priestess to indicate a side bend and things like that. Trying to go off the chain and then back down again and just looking at imbalances and trying to fix those and then having them corrected and followed through with their home exercise programs. I kind of feel like it's something they usually do daily. So I always ask people like, if you're side bent to the right, you kind of sit like this with your foot underneath your right hip or something, it's usually something they're doing daily that they identify before I can identify because they know what they do everything. That's a huge point. And I want all our viewers to hear that is those little things that we do every day like me liking to drive with my left hand on the steering wheel because I used to drive a stick shift or sitting on your sofa with your legs kicked off to the right or maybe you're leaning to click a mouse. Those are the little things that make such a huge, huge impact on whether or not we live in pain or live pain-free. So Kiyau, since Kili's being such a good girl, tell us a little bit about your injuries and experiences of physical therapy or advice you have for the viewers on how that kind of formed you into a physical therapist that you are today. I would say one of my biggest motivators in becoming a physical therapist is I had an Achilles rupture. I must have been 20, 21, maybe another episode will talk about how the Achilles rupture happened. But long story short, I was given a lot of exercises to do, but I was young. So in my mind, I would think about, and I'll give it a little time. I should heal on my own. I should recover on my own. I didn't really do the exercises. And I feel like that added on a lot of other injuries. I have hip pain. I had knee pains, back pain. I got into lifting. I blew a disc. And I think a lot of that correlates to my Achilles rupture and not doing my exercises. So a big thing I tell my patients as well is even though maybe your body may recover, you may have compensated someplace else and to be aware of what your body's doing, what muscles are working, how they're working and how it carries over to what you wanna do is very, very important. One injury or the other adds up. Yeah, that's a key point right there. And I know from my experience with millions of injuries, how wanting it is so much more than just saying it. And so when you have pain and you go to physical therapy, you leave and you stretch out and you massage the muscles and they get everything to function better because the short muscles are more lengthened and the other ones are re-educated. You leave and you feel so good and then you don't do any of the follow-through. You don't do any of these little, but I tell people, I know they may sound silly, but they're critical because you came in with dysfunction, we corrected it and now you need to educate it. Like you need to teach the body how to hold that correction and then you go back and you come back in next time and say, wow, I felt so great for three days, but gosh, it hurts again. I wonder why. And so it is critical. And we learned that from experience too. You know, I learned that I was injured before. And I learned that because I was doing my shoulder exercises all the time, which I still am doing now because I want to play volleyball and I want to stay at work helping my patients. And it's been a lesson that I've learned and now I'm teaching it to my patients. And so Raina, now with your injuries and different places you've had pain, how has that formed you with how you approach a patient? I think one of my biggest long-term injuries was like the chronic low back pain radiating down my right leg, which I actually had since PT school. I kind of managed it myself, but yeah, at one point I thought I needed to get epidural, but kind of pushed through that and then just try to align myself. But recently I came to you and you were able to look at my back because it's hard to look at your own back, right? So I kind of had an idea I have scoliosis, but you were able to look at it and break it down. And I followed through and did the exercises and also noticed what I was doing in my daily life. I like to drive my car and sit like this with my leg up. And so that would make me rotate my thoracic because my lower body was rotating to the left, my thoracic would rotate to the right at L1. And so I had to, you know, figure out what it was I was doing in my life, my daily life to create that. And then you were able to help me to de-rotate me and open me up on that side. And I added the sleeping under the towel and just was really consistent with it to a point where now I stabilize my core, but I don't have to do all the little things. I think that our patients need to realize that you're gonna do some exercises for the rest of your life, for maintenance, but you're not gonna do all of those. But once you're like aligned just enough, you just need to hold it back. I love hearing that. Once you're aligned just enough, you need to hold it there. We don't need to be perfect. We just have to be better, right? That's awesome. And I know that that's the thing with us. Like you need help. We're physical therapists. We're experts at what we do, but we need help. And I'm in physical therapy right now. I saw you and Kea for my shoulder and I'm still coming on a little bit of a maintenance because I need to be able to use my arm at work and then enjoy a little bit of my activities outside of work. And I need the help because like you said, you can't see yourself from the back. You kind of feel what's going on and you can see so much, but you need someone to go at you and help you with the things. And that's what I like to tell people because we get a lot of patients that come in and they've had this pain for a long period of time. And we say, oh, did you have any injuries in the past? Oh yeah, but I was a teenager, but now they're 55. And that's why a mechanical fault they had at 15 years old that didn't cause them pain is causing pain and they're stretching and doing these things and they think they can manage. And even us, we do our best at managing, but you really do need help. You need someone to do a movement assessment on you to find those little teeny things that you and Kea are talking about that make the world of difference whether you have pain or no pain. So Kea, I know it killies me. I'm so great. I love it. So you have a little bit of an ailment going on right now. What are you doing for that? So I think this one started actually with being a daddy for the first time and doing a lot of rocking, trying to rock my daughter to bed taking about 30 to 45 minutes. Left foot, the arch started bothering me a lot. And I've had that pain off and on. Now is it correlated to my Achilles rupture? Maybe, not sure I've compensated throughout the years, but I actually saw Chris for this as well. Made a big difference in looking not only at my foot, but kind of up towards my hips. My left hip was a lot weaker than my right. And just in strengthening my hip and working on the way I was moving and doing management for myself while I'm at work, while I'm at home, while I'm doing my daddy duties, it made a big difference. I still get a little pain on the outside of my foot, but nothing compared to it was before, but kind of as we were talking about, and what we tell our patients do, it's very important that we do things to manage as much as possible. And we do things to teach our body what it needs to be taught, which takes time. It doesn't happen overnight. Aerial is important, padding is important, and we practice what we preach. That's what we do. And I learned a lot of the advice that I impart to my coworkers, my patients, my family, my friends are things that I have figured out along the way. There weren't anything I learned in physical therapy school, but I've had plantar fasciitis. I herniated a disc and got a weak leg and gave myself a tear in my plantar fascia. And it was because of like what Kyao just said, my hip was weak from the disc injury. And so I wasn't getting the control, like I showed you in those earlier videos. So my foot was just very mobile and I didn't know it was mobile. I knew I had this pain down my leg like Reina had forever. And it was skinnier leg, but I didn't know that my foot was having that problem until all of a sudden I had terrible foot pain and I thought, wow, I actually went on crutches for it. And it was because the disc herniation in my back made my hip weak. My foot was moving all over the place and I started having these problems. So for me as a physical therapist, so many of the things that I learned to do these little manageings like you're talking about Kyao are from me trying to stand at work for years and have plantar fasciitis and a disc herniation and a shoulder pain and be able to manage that without having to sit down and do one hour of physical therapy at night. I do a little bit throughout the day like Reina was saying, if you're sitting at your desk crooked or sitting at your sofa crooked, you need to shift the other way or people at their desk, I have them do like this, like, hey, I'm doing it on TV right now. It's no big deal. You do five, your neck and your shoulders and your back, thank you. You could suck your stomach in while you're sitting, you can get up and stand up once and then sit down and then you've moved. And those are the little teeny things that can be done to make your life so much better and in so much less pain. I love it. What do you do with that? I'm actually rolling out my foot as we speak. I worked out this morning after all. Nice. Excellent. So Reina, any tips, that favorite tips that you give to people or anybody I know your work right now, any pearls that you just imparted to anyone today that we can share with the viewers? Today. So I had a patient today with scoliosis. I think one of the biggest things that helps people to realize what we're trying to do is to take a video of them, like how you showed earlier, or to take a picture of them. Because if I tell them all your side events this way and you're pinching the nerves, they're just like, it's over their head, right? So you take a picture and so cliche, but pictures worth a thousand words, they're like, oh my gosh, I look like that. And they're like this, you know? But they don't even realize it until they see the picture. And then they realize what you're trying to do. And then they actually do it because they understand what's going on. So a picture I think is one of my pearls because I take pictures of my patients that I take before and after and they're just like, oh my God, I'm so much straighter. And then they're motivated to be straighter because they can see it and they can feel better and all that. And they just have a better understanding of what we're actually trying to do. Instead of like, I just go to PT and they give me these generic exercises. No, we're actually trying to fix this side band or this rotation. And if they can see that, then it just really helps them to understand and to be on board with whatever our plan. Yes, yeah, that's true. The seeing, use another cliche, seeing is believing and getting on board with our plan. That a patient came in, I think a couple weeks ago, she's doing great. And she came in in the morning by 7 a.m. and she said, you know what? I guess the exercise that you give me, I'm doing them and they really work. And I kind of giggled behind my mask, right? And she heard me kind of giggle and I said, I'm sorry, I don't mean to laugh. Thank you for actually telling me that because from my standpoint and your standpoint and Reina and Kea's standpoint, of course they work. That's why we gave them to you. We didn't just give them to you because we wanted to tie up some of your time. That's a good bite step, Chrome, by the way, Kea. But I loved her sharing that with me because when we have a patient in the clinic and we're telling you these things, we're always explaining why, taking a photo and explaining why so they understand because you need to have a buy-in to do something. You're not just gonna go walk five miles a day because someone says, I think you should walk five miles a day. You're gonna go walk five miles a day because someone says, I think if you wanna climb Mount Everest next year, you're gonna need to start today by walking five miles a day to try to get yourself in fitness and all that. And the reason, the why is so important. It's so important. I know we all do such a great job, Tara and Doreen as well at East Oahu, we do such a great job of explaining the why. I hear that from our patients and I hear the coworkers in the background and patients saying, oh my gosh, yeah, I never knew that was why. I never knew because my foot was turned out, that's why my back hurt or because my foot was turned out, that's why my knee's hurting. And if any of you are watching, the reason why your knee hurts when your foot's turned out is because your foot's going one way and your upper thigh is going the other and there's a twisting at your knee. And if you don't correct that one out, it's not that your duck footed, but if you just have one foot out because you sprained your ankle or had a bunion surgery or you were limping, that's going to destroy your knee over 10 or 15 years. And those are the little things that we like to correct. So Kiyau and Keely, what else can you tell our patients about certain exercises? So you and your wiper at home with this bundle of joy, are there any ailments that you have had from keeping her happy and bouncing her? Besides your foot, I'm thinking of like neck and shoulder and wrists, nursing and... Definitely my left shoulder. I always hold her on my left arm. So I'm kind of internally rotated. If you think of your posture, right, is in this position for a long, long time, right here. All these muscles get really tight, which as we know and we discussed with our patients that will affect your shoulder blade stabilizers, your rotator cuff muscles, just your posture stabilizers, which can affect function with just moving my arm. So when I do go and work out, I have to do a little bit more to loosen up this side. Just again, prep my body in her muscular education, patterning, get my body ready for what it needs to do. Yeah, that's great. Now, what about your wife? How is she doing? She is doing good. She's also a nurse. So she's on her feet for 12 hours at a time. And she's waking up in the night feeding Kiyau. She's taking her change of diaper when she's tired. She's not in the best positions when she's breastfeeding. So a lot of it is positional posture for her, but she's getting the back pains, the hip pains, the neck pains, the shoulder pains, a lot of pains. And what we're gonna do is awareness posture. I mean, I try to work on her when I can, but a lot of it comes down to, and she's being pretty diligent about it, changing her positions and her posture, as Reina was mentioning, not being in one position for too long. And when she breastfeeds trying different positions as well. Yeah, that's great for everybody that's home as a new mom or dad. You have this beautiful baby that you're caring for, and it's one of the best things you could ever do in your life, right? And so now you have neck pain, or some people get the wrist pain from holding like this. It's the tinnocidivitis here, and your neck and your back are hurting because you're breastfeeding, and you don't really even understand why you think I'm just tired, you're not getting good sleep, and all these things. And I have given a couple shows on different things, but stretching out your chest in the doorway and doing some breast, counteracting your sport of breastfeeding, your sport of holding the baby, your sport of doing this. Like, yeah, I was saying, he's stretching out his chest at the gym because he's using that muscle more. So you can enjoy your lovely baby and all the things that go around with that. As long as you're doing some exercises, I say to counteract that sport, that sport of breastfeeding, or bouncing your baby, or bending over the crib to pick up the baby. So we have a question. Should people think about saying a physical therapy? No physical ailments, but as a way to prevent future injury? That's the question. What do you think, Reina? I mean, definitely, right? We all have things that we do one way. I mean, just a good example is just golf. I had a patient who's a golfer and he's got back pain. Of course, this is only going this way, right? So I tell him, you got to do the other way. I think prevention is huge because you don't want to end up in so much pain and it's so much harder to get you out of that as opposed to when we see you a little earlier and we're like, okay, this is a little off, a little offless practice and then you're not gonna be in pain in a year from now, right? And it's like super hard to get you out of that because you're so degraded. Yeah, absolutely. What do you think? Oh yeah, well, me, oh, you know me, I'm all on for that. I actually came up with a plan, like I don't even know when I was living in New York City eight years ago, maybe it was 10 years ago, that I think insurance should all have like two, like one massage a quarter that's free and one physical therapy, total body assessment that's free with their insurance plan. And it has to be like physical therapists that are certified with a my program of how to identify these little nuances and biomechanical faults that are predicting injuries in the future, like the toe out, like the knee diving in, like looking at their sitting habits and seeing if they're slouching or sitting sideways, looking at the things that we all are so skilled at, but not everybody's that skilled at because we have lots of experience. And so I think it's great to come in for a movement assessment because as a matter of fact, I have three people right now, one lady has no pain, but she had some weakness from an ailment that she had and she came in and she didn't even have pain but she has one knee diving in. So I'm going to stop her from getting knee pain and a young kid came in because his doctor said, hey, I think your hamstrings are tight. You should go to a physical therapist from advice and he sits very crooked. He has scoliosis and he does have back pain but that's not why he comes and he's a computer science guy. He's 20 years old, maybe he's 18. And so those are people that I said, thank goodness you came in because we're going to just fix this little thing, the weak hip, and now you don't have to worry about in 10 years having terrible pain. I love those catches. I love those catches because I was that injured teenager that didn't have physical therapy and didn't really know about it. And so I love when I can help anybody, whether they're young or older, just stop a future injury from happening. I see your future, right? When I see you move and you're moving that way, I know that's going to cause a problem down the road. It's just not if, but when, right? Yeah, and it's amazing. It's so positive when the doctors actually are starting to do that now, like prevention, right? Yeah, what do you think about prevention? Prevention, I hope that 100% of the time with my patients as well, I mean, even though we work with them, a lot of what we're doing is trying to instill a long-term effect for them. But yeah, I always talk about prevention. I think it's very, very important. And I tell people as well, we brush our teeth two times a day to prevent cavities. Why don't we do exercises two times a day to prevent pain, right? I think I'd rather not be in pain. Yeah, that's so true. Me too, me too. I think that's great. So do you both have anything else you would like to say to our viewers about inspiring them to do their exercises or look at how they move or take the time for themselves to let someone help them with their pain? I think that an approach that we all have, all five of us, is that we look for the core, cause of the pain, the root cause, rather than just treating the symptoms. And I think a lot of people just treat symptoms and that goes along with the whole education. They're like, well, why are you treating my upper back when my pain's in my lower back? Well, the hugest apex of your curve is there and everything else has to follow because your head has to be over your pelvis, you know? So I think something that we do that's really important is we look at the whole picture rather than just kind of zeroing in on, oh, my pain's right here, okay, I'm gonna massage here. No, we need to look at why that. And I think that all five of us have that approach and I think that's really important. Yeah, 100% agree or no, that's exactly what we all look at. I always tell everyone, we're looking at treating the cause rather than the symptom and I tell them there's three things in general. I mean, there's more than three things. But number one, we have to change your postures. Number two, we have to change the way you move or they're up and down the chain. And number three, we gotta change the way in which your muscles work together and how they work together. We don't change that, it's hard to affect the cause and we're just treating just symptoms like Renan was saying, we do some massaging. Yeah, and then that way when you do it like, yeah, I'll say you're creating long-term change as opposed to, oh, I'm gonna feel better for three days and then I'm gonna be back there again, right? That's brilliant. It's one of the things that I've said since I started working with Urena and Kyao and Tara and now Dorena's. I don't know how Urena put together the team of physical therapists that you, we have there at ESOI Physical Therapy because everybody's so highly skilled, so inspiring and works so hard to help each person by looking at the big picture. I'm honored to work there. And so hats off to Urena for doing that. Well, I have to say thank you to both of you because I've learned so much from everybody, you know? We learn from each other every day, right? Yeah. And we work together. It's good to work with you Chris and Reina is a great boss. Thank you Reina. Thank both of you guys for being awesome. So we're gonna wrap it up. I am talking with Reina and Kyao at ESOI Physical Therapy and so the biggest pieces of advice that we have at the end of the show to give is do your prescribed exercises. Well, we correct these little nuances in the clinic. You need to take the part and do them at home. They will make a huge difference. Number two, small changes equal a huge payoff. Do these little silly exercises that help to stabilizing small muscles to support the internal frame. All the big muscles are usually fine and then see a highly skilled physical therapist for a movement assessment. If you have a question about something or if you have an ailment, don't wait 10 years before you have a, where you're on crutches like I was in New York City. Get some help right now. So thank you both, Reina and Kyao for coming on today and thank you, thanks to Hawaii for having us here and allowing us to be here with you today. We look forward to seeing you in two weeks and life is better when you listen to your physical therapist. Aloha.