Podcast - Master
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Dr. Gretchen Hawley: Hello and thank you for tuning in today. I had the honor a few weeks ago of flying to Boston and treating some of my Boston based patients with MS. And I have been doing this, gosh, for six years now. longer, maybe six and a half or seven years. And what we typically work on is something related to walking.
Dr. Gretchen Hawley: The majority of patients that I work with, whether it's in person or inside my online program, the missing link or one on one clients or group coaching is walking. And, you know, we're talking walking quality, walking speed, walking stamina, or endurance. There's so many things even just within the single goal of walking that my patients are working towards.
Dr. Gretchen Hawley: But this time on this trip, it was really unique because the majority of the patients that I work with are also missing link members, which means that even when I'm not in person with them. They are still getting access to my style of teaching, my MS specific approach that utilizes functional exercise and neuroplasticity.
Dr. Gretchen Hawley: And when I went to work with them in person, the majority of them had said, you know what? I've been really consistent with my missing link exercises and my walking is getting better. I feel like I'm all set with my walking instead. Today I want to work on, and that alone to me, just. I, even as I say it right now, my heart just like explodes with joy and happiness because, gosh, if we can improve our walking, so much throughout the day can feel easier and less cumbersome and less burdened.
Dr. Gretchen Hawley: So just the fact that they felt confident with in their walking and the exercises that they're doing to improve their walking that just spoke volumes to their consistency and also the types of exercises that are working that are inside the missing link. But today what I want to talk to you about is these other things that they now want to work on and how I approached it using a functional exercise MS specific approach.
Dr. Gretchen Hawley: The big question is. How does someone with MS actually improve their mobility, strength, energy independence, the list goes on. My name is Dr. Gretchen Holly, physical therapist and multiple sclerosis specialist. Welcome to the missing link podcast. Tune in as I share the top strategies and exercises to help you gain control over your life with MS.
Dr. Gretchen Hawley: Using research driven insights and advice from top industry experts. Whether you are newly diagnosed or have had MS for over 30 years, whether you have relapsing MS or progressive ms, this podcast is for you. You are assured to feel empowered and inspired after each episode. Ready? Let's dive in.
Dr. Gretchen Hawley: So I'm going to review. three of the patients that I worked with and these other things that they wanted to focus on. The first one was someone who wanted to focus on sitting down at a kitchen table to have dinner or any meal with her family. And I just kind of want to paint the picture of exactly what we were working on.
Dr. Gretchen Hawley: So this is a missing link member who uses a rollator the majority of the time, so the walker that has four wheels. So in order to sit down in a kitchen chair, she first needs to swivel the chair so that It's facing almost like outward at an angle. It can't stay facing the table because there's no way for her to scoot in because she's using a rollator.
Dr. Gretchen Hawley: So she has to pivot the chair to the side or a diagonal, and then she needs to back up to the chair, sit down, And then she needs to turn herself and the chair back to face the table. So she has to be able to have the core strength and leg strength and coordination to pivot the chair back towards the table and then scoot it forward.
Dr. Gretchen Hawley: Because what she could do is she could sit down with the chair facing the diagonal and she could kind of. pivot herself back towards facing the table, but she was so far away from the table that she didn't feel like she was actually sitting at the table. And it made eating more challenging as well because the table, and therefore her plate or bowl that's in front of her, was so far away.
Dr. Gretchen Hawley: And she was really self conscious about it because she felt like she wasn't Even though she was sitting there, she wasn't really at the table in the same way as everyone else. So what we worked on was first and foremost, exactly what angle to put the chair at, because there are certain angles that you can place the chair so that once you're sitting down, It's less scooting and pivoting to get it to be facing forward in the direction that you want to be facing.
Dr. Gretchen Hawley: And this is going to be different for everyone, but because I was in person with her, we were able to do a lot of trial and error. So she was standing with her rollator. And I would place the chair at a specific angle. And I would say, okay, sit down. And then I just moved the chair for her first.
Dr. Gretchen Hawley: Eventually, we did exercises for this, which I'll get into in a second. But for now, we were first focusing on the placement of the chair. So she'd sit down, I'd turn it, and I'd realize, nope, still too far away. So we would do it again. I would find a different angle. She'd sit down, we'd turn it. Nope, still too far away.
Dr. Gretchen Hawley: So eventually we did find an angle and position of the chair that was going to be best because it would mean less effort on her part for the scooting and pivoting that would come after she sat down. So that was really great because she also had a tile floor. So we were able to say, okay, for you in the future, You want this leg of the chair to be in this tile and this leg to be in this tile.
Dr. Gretchen Hawley: So she'd be able to replicate this even when I am not there. So once we figured that out, then we moved on to the exercise part. And the exercise part was a lot of core strengthening in the sense of strengthening her abdominals and her hips. and weight shifting. So being able to shift your body from one side to the other, forward and back, because in order to, for her to sit at the table in the way that she wanted to, she needed to be able to pivot to this side, and scoot forward.
Dr. Gretchen Hawley: So we worked on exercises, and if you're in the missing link, you'll know what these are. If you're not, I'll try to do my best to explain them. But we focused on exercises like the ab lean back, which is basically like a seated crunch. This is a phenomenal exercise to improve your core strength from a seated position.
Dr. Gretchen Hawley: But we also work on scooting. Gosh, this is such an underutilized exercise, and it's such a good one for your core and your hips. Essentially, what you do is you sit in a chair and without using your hands, if possible, you scoot forward. So if you're, if you start sitting in the back of your chair, you want to try to scoot your body forward, maybe, I don't know, three or four times, and then scoot backwards a few times and then forward and backwards again, if you're in the missing link, we have a video on this.
Dr. Gretchen Hawley: So you can watch that. But this is a great exercise to work on core and hip strength and the coordination of moving forward and backwards and the weight shifting in order to scoot forward or backwards without using your hands. And honestly, even if you do use your hands, you need to first be able to shift your body weight towards one side of your body so that you can use the side that doesn't have your body weight to move it forward or backwards.
Dr. Gretchen Hawley: And then you need to be able to shift your body weight to the other side of your body so that you can move the side that doesn't have the body weight forward or backwards. So you have to be able to shift your body weight side to side. in order to scoot forward or backwards, or even side to side. So that is the next thing that we worked on.
Dr. Gretchen Hawley: And then the third component. So by now, over time, she'll have the core strength needed and the coordination and weight shifting needed to move around in the chair. But then the final thing that we focused on was her grip strength. So she had the strength to reach down. and hold the bottom of the chair and lift it up into her bottom so that when she's scooting forward or backwards or when she's pivoting, the chair moves with her.
Dr. Gretchen Hawley: Because otherwise, again, if we're picturing the initial situation where the chair is kind of pivoted, it's diagonal facing out, not towards the kitchen table. When she sits down there, You can pivot and move your body, but the chair just stays where it is. And then in that case, you can be facing the table, but your chair is not.
Dr. Gretchen Hawley: Your chair is still facing out. And she wants to feel and look like she's sitting at the table just like everyone else, which means the chair has to come with her. And so we focused on sitting on the chair, reaching down to touch the bottom of the seat that you're sitting on and pulling it up as hard as she could into her bottom so that she could then scoot and pivot with the chair moving with her.
Dr. Gretchen Hawley: So that's what we practiced. We practiced her pulling that chair up into her bottom and then I would tell her, okay, so Scoot forward and bring the chair with you. Scoot backward and bring the chair with you. Scoot sideways, whatever it was. So that was the three step approach. And this was all within 60 minutes, I would say.
Dr. Gretchen Hawley: So that's very fast. Obviously, she's not going to see like full results within that time. She felt more knowledgeable that she now knows what she needs to work on and she actually had said that it was easier already just from knowing how to appropriately do this specific activity. So she felt really confident and I felt really confident leaving that session knowing that she now has the tools and exercises that she needs to do to improve that very specific situation.
by the way, I have some questions for you. Do you want to be able to walk stairs better, walk longer distances with less fatigue, Or scuff your foot less when walking. If so, the Missing Links online program was literally made for you. Inside the program, my members are learning MS specific exercises and strategies to get stronger, improve their balance, and you guessed it, walk better.
Our members report real life improvements. Like shopping without holding onto the shopping cart, safely climbing stairs, and gardening with ease. With two weekly exercise classes and expert trainings, you'll get over 10 hours of MS specific physical therapy guidance each month. Interested? Check the show notes to learn more about the missing link online program to see if it's a good fit for you and your goals.
Dr. Gretchen Hawley: Moving on to the second patient who had said My walking's going really well. Let's work on something else today. So what she was working on was something very different from her legs. It was more so her breathing and her swallowing. Her breathing has been starting to feel labored. Her swallowing has been starting to feel labored and sometimes even light choking.
Dr. Gretchen Hawley: And she started noticing the MS hug. And so she was telling me all of these symptoms and she was saying, you know, what can we do? I don't even know if there's anything that we can do for this. So we talked, More, and I got really specific information about exactly what her MS hug felt like, what her breathing felt like, and where in her body she felt it, and more about the swallowing.
Dr. Gretchen Hawley: And from her answers, I was able to determine that it sounded like more of an issue of, again, core. Core was definitely the theme of this trip, but also posture. So, one thing that we all can try right now if you're up for it, is really slouching and really rounding your body as much as possible. And try to take a deep breath in, and then let it go.
Dr. Gretchen Hawley: And now sit up tall, as tall as you can, and take the deepest breath you can in, and then let it go. For most of us, when you're sitting up tall, when you have better posture, it's so much easier to take a deep breath in to get more oxygen. And all we changed was your posture. We didn't change anything about your lungs.
Dr. Gretchen Hawley: I also realized after talking with this patient that posture could be a huge thing that could help with a little bit with the MS hug, but definitely with the breathing and the swallowing. This patient had okay posture. She, she's not slouching a lot. I would say posture like the rest of us, you know, a lot of us, including myself, we tend to slouch a bit or a lot throughout the day.
Dr. Gretchen Hawley: And when we're slouching, our neck comes forward and that affects our throat. Our throat is no longer in a good alignment for swallowing. So what we focused on was was some stretching exercises and this was more so to help with the MS hug. So it was things like reaching overhead towards one side. So you're stretching the side of your body and then doing the same thing on the other side.
Dr. Gretchen Hawley: So one arm's overhead reaching. So you feel a stretch on the We also discussed a stretch where you are twisting. So you're twisting out your torso one way, and then you twist in the other way, and then we also mentioned some cat and cow. So if you think of yoga, cat and cow movements, you can do the same thing but seated.
Dr. Gretchen Hawley: So you're sitting, your hands are on your knees, and you round just like we did before. Round as much as possible, head goes down. And then head comes up and back arches and you're trying to arch as much as you can. And so doing some repetitions of this with not, not long holds, just maybe two second holds.
Dr. Gretchen Hawley: Those exercises were more for her MS hug. And then we focused on posture by stretching out the front of her chest, like the pectoral muscles, and we used one of my favorites, which is a doorway stretch. You go in a doorway, put both hands on, one hand on one side of the doorway, the other hand on the other side, and lean through, and you can feel a really nice stretch in your pec muscles.
Dr. Gretchen Hawley: So we did that combined with a few exercises for upper body upper back strengthening. And so one of my favorites is you're sitting up tall, your elbows are pinned to your side and at a 90 degree angle and you squeeze your shoulder blades back and together and then release. And this is a great strengthening exercise for your upper back.
Dr. Gretchen Hawley: The muscles are called your rhomboids. And we did a few others, but that's the gist of what we worked on. And I just want to share a text with you that I received from this patient. So, five days later, I received this from, from the patient. Hi Gretchen, I want to give you an update. The breathing and posture exercises are helping me a lot.
Dr. Gretchen Hawley: Three exclamation points. I'm breathing better and I have a lot more energy. I definitely have less fatigue and the exercises for my mid torso are working. I have less tingling and burning around my midsection. Thank you. Thank you. Thank you. And every sentence ends with an exclamation point, which I absolutely love.
Dr. Gretchen Hawley: I feel like exclamation points are my love language. But that was just five days. And so the reason why I wanted to share this story with you is that when you have specific exercises for your specific symptoms, results can be that quick. I think so often with MS, we think, gosh, it's going to take a year to see results.
Dr. Gretchen Hawley: And that is the case in some cases, but it's not the case for all symptoms and all the things that you're struggling with. So I just wanted to share that with you. Now let's move on to our third patient. This patient is still working on her walking, but she has an upcoming abdominal surgery. So her mindset was more focused on, I want to get my core as strong as possible so that when I get surgery, hopefully my core strength won't completely disappear.
Dr. Gretchen Hawley: And I love that this is what she wanted to work on because this is the definition of prehab. And if this is your first time hearing the phrase prehab, check out Missing Link Podcast, episode number 203. I discuss what it is and how it relates to multiple sclerosis. But regardless, she wants to work on her core strength.
Dr. Gretchen Hawley: And core is always a good thing to work on. So many movements throughout our day will be easier when we have a stronger core. But when it comes to surgery of anything in the core region, it is so important to get as strong as possible before, because we know that your core will be weaker after a core based treatment.
Dr. Gretchen Hawley: surgery. So you want to get as strong as possible so that you got that strength and that muscle memory before the surgery. Then after the surgery, it should theoretically, your core strength should come back a bit quicker than had you not done these exercises. So I built out a full core seeded core based program for her.
Dr. Gretchen Hawley: because she's busy. She's got a lot going on. And the position that she's in the majority of the day is sitting, whether that be due to her working or when she's not working, she's relaxing on the couch. So I wanted to choose exercises that she could easily implement without having to get down to the floor, which would take tons of energy and strength to stand up or If you're lying down in bed or the couch, which would take less energy than getting down to the floor, you're not really in your bedroom most of the day.
Dr. Gretchen Hawley: And the couch could work, but it's a little bit finicky because one side is open, the other side has a back. And so I just decided let's make it as easy as possible and do seated exercises. And so we have a full core program built out for her that includes five core based exercises. A lot of them are in the missing link and or my total core program.
Dr. Gretchen Hawley: So I can put those down in the caption. But the one that I want to share with you that we can all do right now is sitting up tall and putting both of your hands on one knee. And then push down into the knee at the same time as you're mentally focusing on tightening your abdominals. And you can breathe out or exhale at the same time.
Dr. Gretchen Hawley: So you push, breathe out and tighten your core and then relax. And then you do that a few times and then you move your hands over to the other side of your body and you do that a few times. That is a way that you can work your core in a seated position to get stronger in any all of the abdominal muscles, your transverse abdominis, which is the deepest muscle, your obliques, and even the front of your muscles as well, the front of your abs, the rectus abdominis.
Dr. Gretchen Hawley: So that was just one of the exercises that we did in addition to some others. Another one that is easy to explain and that you could try is sitting and relaxing in the back of your chair, And then without using your hands, come all the way back up and then relax from in the back of your chair and then come all the way back up from a seated position.
Dr. Gretchen Hawley: If that's easy, scoot further away from the back of your chair so that you have a longer distance to go. So anyways, lots of core exercises for her and core strength takes time. But even just by the end of that session, she had felt confident that she could feel the exercises where she was supposed to.
Dr. Gretchen Hawley: Oh, and I forgot to mention we did a breathing exercise too. So much of our core is breath work related and breathing. And so knowing how to breathe to activate your core and how to breathe to relax can be really important. But yeah. Bye bye. We ended that session with her feeling confident that she was feeling the exercises in her abdomen, which she wasn't prior.
Dr. Gretchen Hawley: So that's a really great sign and confident that she knows exactly what to be doing leading up to the surgery. And then once she's approved for exercises after the surgery, she's going to start with these ones again. Working Um, with patients and brainstorming ways to work on specific symptoms, like what these patients that I just explained we're, we're working through in specific goals is my favorite thing about being a physical therapist.
Dr. Gretchen Hawley: I love getting creative and brainstorming. And one thing that I launched recently was group coaching virtually. So this is a way that we can kind of do the same work that. that I just explained that I was working with on these three patients, but in a group setting and virtually. So I launched the first round of group coaching in November, and it went so amazing.
Dr. Gretchen Hawley: It was so great to see these six women. I only work in small groups. So it was so great to see these six women working towards their goals that often overlapped. And we hopped on three different Q& A calls where I created an exercise program for each individual person. And then the Q& A calls were where we could discuss troubleshooting.
Dr. Gretchen Hawley: What was too easy? What was too hard? Do you feel like there's anything missing? And we do that in a group setting. And it was so cool because so many people had similar exercises that were challenging. So I was able to discuss other ways to do the exercises and they felt excited about it because they now had a solution that could work.
Dr. Gretchen Hawley: And by the end, they were so excited because they were already in just six weeks starting to see improvements towards their goals. One of our members inside group coaching actually said after just nine days of doing the exercises, she said, You know, I'm normally a negative person, but I just feel like I have to share that from doing these exercises, driving is already a bit easier for me because I'm able to lift my ankle and move my foot easier.
Dr. Gretchen Hawley: And so it was just such an honor working with these women and the community aspect of group coaching was also really fun. It was around Thanksgiving. So of course we talked about. exercises and accountability, but we also got to connect on a deeper level of what we're doing for Thanksgiving, what things are hard movement wise around Thanksgiving and mentally around being around family and holidays.
Dr. Gretchen Hawley: So it was really great to See them progress just through the community and accountability aspect, but also physically towards their goals. I am going to be offering another round of group coaching in the very near future. So if you are interested, I do have an application just to make sure that it's the right fit.
Dr. Gretchen Hawley: So I'll put the application link down in the show notes.
Dr. Gretchen Hawley: Thank you for listening to today's show. I am so grateful to have you as a listener. If you'd like extra resources, such as a video of one of my seated exercise classes, my favorite core exercises, and the opportunity to ask me your questions, head to missing link. com forward slash. Insider. That link will be shared in the show notes along with links to my social media handles.
Dr. Gretchen Hawley: If you loved this episode and think a friend or family member with MS would benefit from listening, please go ahead and text or email this podcast to them right now. Sharing this podcast will help me educate and empower as many MS warriors as possible. Thanks again for joining and be sure to tune in next week for another episode of the missing link podcast.
