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Osteoporosis and Multiple Sclerosis: Patient Study Part 2

The following is part two in a series documenting Deb Gulbrandson, PT, DPT's journey treating a 72 year old patient who has been living with multiple sclerosis (MS) since age 18. Catch up with Part one of the patient case study on the Pelvic Rehab Report here. Dr. Gulbrandson is a certified Osteoporosis Exercise Specialist and instructor of the Meeks Method, and she helps teach The Meeks Method for Osteoporosis course.

On Maryanne’s second visit, she reported she had been doing her “homework” and didn’t have any questions. Just to be sure, we reviewed them and I had her demonstrate. In Decompression position, she was lying supine with her hands on her abdomen, a common mistake I see. Usually this is due to tightness in pec minor with protracted scapulae. Patients unknowingly resort to the path of least resistance to take the strain off of the muscles. I explained to her that we want to use gravity to gently lengthen those muscles and “widen” the collarbones to allow for improved alignment. With her shoulders abducted to approximately 30 degrees and palms up, I propped a couple of small towels under her forearms which allowed her shoulders to relax into a more posterior and correct position.Osteoporosis Evaluation

“Today we begin the Re-alignment routine,” I said, “starting with the Shoulder Press.” I showed her how to gently press the back of her shoulders down into the mat without arching her lumbar spine. “As you press your shoulders down, exhale through your mouth as if you’re fogging a mirror. This will help activate your core muscles to keep your back in good alignment. Hold for 2-3 seconds, and then relax. Repeat 3 times.” Maryanne looked at me as if I’d lost my mind. “Did you say do 3 reps?” she asked. “I do 2 sets of 20 reps at the gym,” she said with obvious pride in her voice. “Yes, that’s where we start, and there are a couple of reasons. First, these are very site specific exercises which focus on the exact areas that need strengthening. Exercises done in a gym setting are often more general and usually involve compensation.  We are minimizing any compensation such as allowing your low back to arch. There is probably weakness in those upper back muscles as well as the tightness seen in your anterior chest muscles and we need to go slowly. Also, we are simultaneously stretching while we strengthen. Our society is so forward biased (we work on computers, drive cars, make beds, eat- it’s all forward, forward, forward), that the anterior muscles get tight and the upper back muscles get overstretched and weak. We need to reverse that pattern. Take a look at our younger population and their texting postures. Yikes! We will be layering on more exercises as your technique improves so you’ll be doing more than just 3 reps, I promise.”

After the Shoulder Press we proceeded with the Head Press, Leg Lengthener and Arm Lengthener, spending time to make sure her cervical spine stayed in neutral as she pressed her head down into the mat. Head Press (cervical retraction) performed in supine allow patients to have something to press against and helps inhibit the tendency to move into cervical extension. It can also be done standing against the wall with a small pillow or folded towels between the occiput and the wall.

We ended with Maryanne in standing at the kitchen sink to promote functional activities and weight bearing positions.  I reminded her to do the Foot Press through the floor using the Triangle of Foot Support visual. This helped to elongate her spine. “Imagine a bungie cord running from the top back of your head to the ceiling” I said which further increased her standing height. “Now I want you to imagine a shelf running straight out from your breastbone with a glass of some very expensive fine drink sitting on it. Do not spill your libation! Oh, and one last thing Maryanne. Breathe!!!” At which point she collapsed into laughter and our session was over. “Busted”, she said.

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Upcoming Continuing Education Courses

Boundaries, Self-Care, and Meditation - Remote Course

May 22, 2020 - May 31, 2020
Location: Replacement Remote Course

Oncology of the Pelvic Floor Level 1 - Remote Course

May 26, 2020 - Jun 4, 2020
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Pelvic Floor Level 1 Part 1 - Remote Course (SOLD OUT)

May 28, 2020 - May 29, 2020
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Pelvic Floor Level 1 - Chicago, IL (RESCHEDULED)

May 29, 2020 - May 31, 2020
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Boundaries, Self-Care, and Meditation - Columbus, OH (RESCHEDULED)

May 29, 2020 - May 31, 2020
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Pelvic Floor Level 2A - Syracuse, NY (RESCHEDULED)

May 29, 2020 - May 31, 2020
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Gender Diversity and Pelvic Health - Livingston, NJ (RESCHEDULED)

May 29, 2020 - May 31, 2020
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Pelvic Floor Level 2B - Maywood, IL (Rescheduled)

May 29, 2020 - May 31, 2020
Location: Loyola University Health System

Sexual Medicine in Pelvic Rehab - Remote Course (SOLD OUT)

May 30, 2020 - May 31, 2020
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Sacroiliac Joint Evaluation and Treatment - Nashua, NH (RESCHEDULED)

May 30, 2020 - May 31, 2020
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Postpartum Rehabilitation - Foothill Ranch, CA (Rescheduled)

May 30, 2020 - May 31, 2020
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Pilates for the Pelvic Floor - Valencia, CA (Rescheduled)

May 30, 2020 - May 31, 2020
Location: Henry Mayo Newhall Memorial Hospital

Building Resilience Through Nourishment

Jun 2, 2020
Location: Short Form Remote Course

Pelvic Floor Series Capstone - Salt Lake City, UT (SOLD OUT)

Jun 5, 2020 - Jun 7, 2020
Location: Rocky Mountain University of Health Professions

Pelvic Floor Capstone - Remote Course

Jun 5, 2020 - Jun 7, 2020
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Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Jun 5, 2020 - Jun 6, 2020
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Pediatric Incontinence - Grand Rapids, MI (RESCHEDULED)

Jun 5, 2020 - Jun 7, 2020
Location: Mary Free Bed Rehabilitation Hospital

Pelvic Floor Level 2A - Kansas City, MO (Rescheduled)

Jun 5, 2020 - Jun 7, 2020
Location: Centerpoint Medical Center

Pelvic Floor Level 1 - Atlanta, GA (RESCHEDULED)

Jun 5, 2020 - Jun 7, 2020
Location: Emory Healthcare

Pelvic Floor Level 1 - Washington, DC (Rescheduled)

Jun 5, 2020 - Jun 7, 2020
Location: The George Washington University

Pelvic Floor Level 1- Canton, OH (Rescheduled))

Jun 5, 2020 - Jun 7, 2020
Location: Aultman Hospital

Restorative Yoga for Physical Therapists - Remote Course

Jun 6, 2020 - Jun 7, 2020
Location: Short Form Remote Course

Pelvic Floor Level 1 Part 1 - Remote Course (SOLD OUT)

Jun 6, 2020 - Jun 7, 2020
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Trauma Informed Care - Remote Course

Jun 6, 2020
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Pelvic Floor Level 1 - Berrien Springs, MI (Rescheduled)

Jun 7, 2020 - Jun 9, 2020
Location: Andrews University

Pelvic Floor Level 2B - Bay Shore, NY (Rescheduled)

Jun 7, 2020 - Jun 9, 2020
Location: Touro College: Bayshore

Pelvic Floor Level 1 Part 1 - Remote Course

Jun 11, 2020 - Jun 12, 2020
Location: Short Form Remote Course