 Welcome to Much More On Medicine. I'm your host, Catherine Norr. You may notice that I'm not in the ThinkTech studio. I am actually at my office. Wherever you are in the world, you are staying safe during the COVID-19 pandemic. I'm sure you've seen images of people clapping and cheering for doctors, nurses, and others on the front line of this crisis. Did you know that there are other healthcare providers who play a critical role in rehabilitating COVID patients? Today, I'm pleased to be talking with physical therapist, Christine Linders, who will share important information about how physical therapists play a crucial role in the COVID-19 crisis. Christine Linders is a board-certified orthopedic clinical specialist working for East Oahu physical therapy. She's skilled at rehabilitating the most complex cases and is passionate about finding solutions for people in chronic pain. She's the host of the ThinkTech Hawaii Show Movement Matters, which is shown every other Tuesday at 11 a.m. Hawaii time. Christine recently authored an article published in a medical journal on a technique to decrease low back pain. Welcome, Christine. Thank you so much, Catherine. It's great to be here. It's great to have you here. And we're just gonna jump right in because I know you have a lot of information to provide us. So I'm gonna ask the broad question, what is a physical therapist's role in treating COVID-19 patients? Well, that's a great question, Catherine. And I think as a physical therapist and speaking for the physical therapy community, this is our time where we can shine because we have a unique ability with our training to be able to assess and treat multiple different symptoms across multiple body systems. So with the COVID-19 patient, someone that is coming out of moderate to severe disease, they have a hospital stay, they have the ability to look at their ability to breathe, their ability to stabilize their trunk muscles, their endurance, their balance, their neck or shoulder pain that they may have or back pain as a result of diaphragm weakness from being on a ventilator or deconditioning from having a hospital stay. And the shoulder and neck pain can come from their excess muscles in their neck, trying to breathe, since their diaphragm has been weakened with a hospital stay or deconditioning or isolating themselves in a room and not being able to move around a lot. So I think this is a great time for physical therapists to really embrace and get out there and help the people that have survived this COVID-19. Would you recommend that anyone who has actually recovered from COVID-19, even if they're not on a ventilator, do they need to have therapy for their diaphragm or are they okay? Yeah, I would definitely recommend that anybody that has had COVID-19 and has recovered see a physical therapist who can help them work on deep breathing, because with the disease, you get certain areas of the lung that can be compromised. So you come out without the full usage of your lung, similar to someone with pneumonia coming out and not being able to take a deep breath. And when you don't take a deep breath and your diaphragm doesn't descend all the way, you don't get the benefits of your diaphragm for getting full oxygenation to your shoes or the benefit of your diaphragm for helping to stop your symptoms of reflux or the benefit of your diaphragm working to regulate the pressures in your trunk with your pelvic floor to prevent incontinence. There's so many roles that happen with our diaphragm, but if we are shallow breathing and taking short breaths and the diaphragm is not descending deeply, we are losing out on all those potential benefits. And we might not know until you have a problem like neck pain, shoulder pain from using the accessory muscles to breathe or back pain because you're not getting the stability from your diaphragm to help with that posture support. So I think it is important. Okay. And so we're talking about a very large number of people who've suffered from the illness that could use this technique. Now, can you explain what kind of techniques that you use and if you use any particular tools in providing that treatment? Absolutely. So I will check when someone comes into the clinic whether they've had COVID-19 or not. At this point, I have not seen any survivors come to the clinic for treatment. It's so new. And on the island, we haven't had anybody come to our office, but it's important for you just a normal person to come in and assess their rib cage mobility. After a hospital stay, that can be impaired and the tissue in the rib cage and your trunk can be restricted preventing you from taking a deep breath without you even knowing it. And when I think everybody's had the flu and you're kind of in a ball in bed. So if there's a COVID-19 survivor that just was isolated in their room away from their family that was laying around more or sitting hunched over the laptop, they might not have that trunk or rib cage mobility to take a deep breath. So it's the breathing techniques and focusing on diaphragmatic breathing and getting your diaphragm to descend, taking a deep breath into your belly and your lower ribs versus the upper chest breathing. But some of the tools that are wonderful that I learned from Mary Massery who is a genius physical therapist, she's pioneered this canister coke can concept from your voice box, your vocal folds down to your pelvic floor and how we regulate our trunk pressures. She, I learned in her course this technique called the breather, which I have an image for which is an inspiratory muscle trainer. So it works on you breathing in against resistance. You can use the breather, which one of my patients just bought. She had been using a small coffee straw to increase the resistance to inhalation, but she actually bought the breather because she does suffer reflux and she has trouble with her posture and the diaphragm works as a 50% decrease in reflux because it supports the sphincter down below your diaphragm where the esophagus passes through. So it prevents your stomach contents from going back up by 50%. So she's using it for that and also the diaphragm works for postural control. And so she's strengthening her diaphragm with the inspiratory muscle training so it can handle the task of breathing, postural control, preventing reflux, perfusing oxygen to your whole entire body by enabling you to take a full deep breath to get all the oxygen in and to perfuse the alveoli in your lungs and then a full exhalation amongst other things. And that's gonna be very important for people returning post COVID-19 to be able to have the full use of their breathing and their diaphragm efficiently and effectively. And that's a great device that can work with that. So I think people are worried about getting contracting COVID-19 and that it could impair their lungs or could cause permanent lung damage. Is there any benefit from using this technique even if you haven't gotten it yet? Yeah, the problem with the COVID-19 and the moderate to severe disease is the coming out with the lung damage and coming out with the problems after being on a ventilator or a prolonged hospital stay. And there was a lot of talk in the beginning about making sure you wake up and take a deep full breath every morning and hold it for five or 10 seconds to be sure that you haven't started getting the fibrosis in your lungs. But I believe that making sure that you have the proper function of your diaphragm this is in anybody as not as a preventive but as an assistive to if you do contract COVID-19 you wanna make sure your health is optimal and you're well rested and your trunk is mobile but on the negative side of the COVID-19 disease the biggest problem is it's attack on our lung system and the fibrosis that it cause and then that immune response that can happen that overcomes the system. And so the deep breathing with the device like this or straws is not gonna prevent that if you do have let's say that overreaction of your immune system where it overwhelms your system but I believe everyone now is trying to get their rest be as healthy as they can in case they do contract it that their body has the right health to fight the disease the best it can and that's important for us now we're all tense and stressed and I think we need to try to take care of ourselves in case we do contract it that our immune system is strong to fight the disease. Okay, so I know that you've done a series of shows on movement matters about this topic can you tell us about those? Yes, so I had Dr. Mary Massery she's a physical therapist, she has her PhD and she pioneered the concept around the diaphragm and the wonderful functions that it has for breathing, posture control, reflux in consonants and venous return. So a lot of the information in my show which you can access on YouTube on Think Tech Hawaii and movement matters it's on there for everyone to watch for free is her concept and how it involves breathing and how you can improve your posture improve your ability to access breathing. So for example, I'll give a quick snippet yesterday we were talking about posture and anxiety and being using the diaphragm for breathing and she had us raise that elbow straight up and follow the hand and take a deep breath and you could feel your whole entire rib cage opening and that's great for people with poor posture that's great for people with anxiety I felt calm afterward, I took a big deep breath and it's really great for people after COVID-19 where their rib cage or their torso is more rigid because it hasn't moved they need the rib cage to be able to expand they need the tissue in our torso to move so they can take a deep breath when they are coming out of COVID-19 with residual fibrosis in their lungs. Okay, we'll be talking with you about what people that don't contract COVID-19 what can you can help them with after we come back from the break so I'm Catherine or this is much more on medicine on the think tech live streaming network series we're talking with physical therapist Christine Lenders about how physical therapists play a crucial role in the COVID-19 crisis. Aloha, I'm John David and the host of history lens on think tech Hawaii. History lens deals with contemporary events and looks at them through a historical perspective or what we call a history lens. The show is streamed live on thinktech Hawaii.com. Thanks so much for watching our show we look forward to seeing you then. Mahalo and Aloha. And this is much more on medicine on the think tech live streaming network series. We're talking with the physical therapist Christine Lenders about how physical therapists play a crucial role in the COVID-19 crisis. Christine, I work at home in the mornings and I do not have an ergonomic chair. My chair that I'm sitting in now in my office is much better but a lot of times I find myself slumped on my couch not paying attention to how I'm sitting or I have my phone, I'm looking down for a long time and then I get up and I can barely move my neck and I'm in pain and then I need to give you a call. So what do you have to say about bad posture while you're working at home? Oh boy, what do I have to say? How much time do we have? So briefly, everyone please there's pillows in your house. Grab some pillows. I've been working on my futon and I have a vertical pillow, a thick one from the base of my neck to my low back to keep my chest open and I also have one of the normal square decorative pillows that I have in my low back. Use your pillows to make your surface that you're sitting on fit you so you can't slouch and if you're on your sofa, which is real squishy you might need a couple more pillows and put something under your laptop, put a couple books put another pillow under your laptop so it brings up. That's one of the things and if you do catch yourself slouching is important to get your arms up over your head and squeeze your shoulder blades. Take deep breaths to open up your chest or I used to say to stick them up squeeze your shoulder blades back, press back start working the muscles on the back and if that doesn't work for you because you have shoulder pain you can clasp your hands behind your head and press your elbows back and move side to side do something to exercise the muscles on the back of your body because those are the ones that you're just kind of hanging on when you get slouched it can be damaging to your neck damaging to your shoulder and damaging to your back and if you're in that slump position it can affect your diaphragm because it's when we slouch we bend right at the position where our diaphragm wants to descend to bring a nice big fresh breath of oxygen into our bodies and profuse our tissues. Would you recommend that people get up a certain amount of time while they're working? I do, I recommend that people everyone recommends I think that people get up every 20 minutes or so and what I just had a patient tell me this week was that her spouse sits on her laptop and she says, I just can't get up I have to finish this thing. So what I told her to do, if you cannot get up then move around, punch this, punch up stress do some circles, take some deep breaths do something to get out of that posture but the reason why we want you to get up is not just so that you don't have pain it's just that they've proven that there's not enough spin classes or zoom classes or weight routines that you can take at the end of an eight hour day to help your body, your organs, your heart all the internal things that make your body work is not enough of those classes to reverse the damage you did by not moving for eight hours and that's what the getting up is about is because of the aging of your internal organs and making sure they get the movement and they get the blood flow that they need. Okay, well that's really helpful and I do notice that when I do contract some pain because of my bad posture and laziness about moving that if I do get up and move and if I do a Zumba class or if I go for a walk sometimes I can, then I can feel better like that pain can go away. Do you have particular exercises that you recommend that people do while they're at home? Oh my gosh, yes, I have so many. So you mean while we're at home in this quarantine period or just in general? Well, you know, yeah, while we're at home in quarantine. Well, we're at home in the quarantine. So it's number one, it has nothing to do with sitting you have to stretch your calves. It's ankle joint and that's so important because we do walk around quite a bit even if we are sitting for eight hours we're walking to wash our face walking to go to the bathroom, walking to cook dinner. And it's an area that people neglect unawares. And so we need to stretch our calves. But when you're at home there's so many things you can do for an exercise. You can, I think I gave someone the make the bike with your arms up and down with your arms, push back with your arms, lift soup cans so that you have your muscles pulling on your joints if your older women, like as I get there myself having muscles pull on your bones helps prevent osteoporosis. You don't need a gym doing some squats, marching in place will get your heart rate up and let your body get blood flow to every single one of your tissues. Doing squats with bad knees with both legs just sitting back, sitting back, getting up and down from your sofa up and down, up and down and timing that with some breathing or if you want to make a total body raise your arms up with your head stand up and then sit down and get your whole body involved. You noticed it when you moved that the pain, the aches they go away when you move it doesn't take much movement and you don't need many tools to make your body feel good. The motion is lotion, the joint flubricate the blood flow goes to the muscles and everything goes. Fantastic. Well, you know I have another problem and I'll, I'll grab it here. I, you know, I'll be wearing a mask and my challenge is that I'm kind of uncoordinated when I wear the mask and I have stairs to walk up or down and I get kind of nervous because if I'm walking down, like it kind of defeats the whole purpose of the mask but I have to kind of like go like this and look at the stairs to see is there any techniques that you use to help people with mobility while they're covering part of their face? I am thrilled that you're bringing this up. I actually was emailing news channels a few days ago to talk about it because at work I was wearing the mask and I pinched it tight to my nose but I am tripping on things and I kind of tripped over something that was on the floor that I usually see because it's in my field of vision but I couldn't see because this is how you're walking around the mask and I worry about people tripping and falling and I think we all need to be aware. I saw a man falling longs the day after I tripped at work and I am nervous for people because you're used to walking around your home, you're used to having maybe a little bit of clutter here and there and you know where it is because you see it every day but now you can't see and I am afraid that people will fall. I think we need to really cast your eyes down and look where you're going now because we're gonna be wearing masks for a while now to slow this spread as they're getting closer to finding a vaccine and what we can do to prevent more people from suffering with severe illness but also my first day back at work I had severe neck pain for three days because I couldn't see with my eyes looking down and my patients who are laying on the table I had to bend my head forward and I am so impressed and so amazed by the frontline I'm in the hospitals, in the clinics, in the grocery stores who've had these masks on and had to look down and compromise their posture you know that they are working so hard to save lives and help people and at the same time their body, many people are probably suffering. Right, right. So basically people need to, are you saying that they need to be looking down? Is that what you're saying? No, but I think you have to have more attention to looking ahead. You know they say when you're walking your eyes scan like five to 10 feet ahead of you I think people have to pay attention for their walking because normally when we walk around our eyes see that and they feed information to our brain we're not thinking about looking where we're going unless you're hiking or you're going over an obstacle course in which case you're looking where you're stepping because it's more technical but in our normal day to day grocery store you might not see water that's on the floor unless you're paying attention to the fact that you need to watch where you walk now because your eyes are not subconsciously feeding your brain with all the information because there's part of the visual field that's out of the way, not available to your brain because the mask stops it. So I don't want people to look down because I don't want them to have neck pain. That's why I wanted to call that an attention. You have to find a way to pinch the bridge on your nose and use your eyes to look down because when it's coming across like this without the pinch you can't see and you have to look down. So if you can pinch that one tight. Okay, so pinching. Pinching it tight. Okay. And then I have more field of vision. Yes. Okay, so the key is really right here. It is and I had to put some tape to hold it that way on myself because I think I bought the same mask and it didn't tighten around as much as the other mask that I had from a different place. And so I had to put a tape to pinch it. So the key is to get this as flat as you can then so that you have a wider, a larger field of vision here, right? Yes. And then it also blocks the air too from going into your eyes and fogging your glasses. I knocked off my head. Okay. Well, Christine you have provided us with so much helpful information and I hope that people will be curious about your shows, movement matters about treating COVID-19. And unfortunately we're about out of time but thank you so much, Christine. This was lovely. Thank you so much, Catherine for having me. All right, I'm Catherine Norr. This is much more on medicine on the Think Tech Live Streaming Network series. We've been talking with Christine Lenders, a physical therapist about how physical therapists play a crucial role in the COVID-19 crisis. Thank you for joining us today. Please take care of yourself, wash your hands and be kind to one another.