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Charlie McDermott 0:00
This is the bridging the gap physical therapy podcast keeping you active and pain free. Hey there, Charlie McDermott, co host of the show. Welcome back, everyone. And once again and we have Dr. David Lee with us. Of course we do. What’s his show? After all, Dr. Lee, how you doing?
Doctor David Lee 0:17
I’m doing well. Thank you, Charlie.
Charlie McDermott 0:19
Well, well, welcome back to the next episode here. And we’ve covered a lot of really important topics, you know, Nixon pains and, and things that really keep your patients before they get to know you from achieving the quality of life that we all deserve. Especially in southwest Florida. There’s so many wonderful things to do here between pickleball and just simply walking and golfing and experiencing life. And today’s topic is one of those that I can’t even comprehend how scary this must be. And that’s, you know, the balance problems that some folks experience. So, are you ready to talk bounce?
Doctor David Lee 1:01
Yeah, let’s do it. I mean, the thing with balance is that you know, you need, you need a foundation to actually do the things that you want to do, right. So if you want to play golf and pickleball, if you’re not balanced, I mean, you can’t really use your body effectively. So there’s a lot that goes into balance. And I just read a stat from the CDC saying that about 69 million Americans suffer from some kind of Balance Disorder,
Charlie McDermott 1:29
and 69 million. Yeah,
Doctor David Lee 1:32
and if you do the math, what there’s about 300 million Americans, and yeah, it’s a lot. That’s a good amount.
Charlie McDermott 1:40
Why do you think that is?
Doctor David Lee 1:42
Well, it’s, there’s a lot of different things that go into balance disorders. So there’s, I can think of five right off the bat that I want to talk about. The first one being vision. So the thing is, you know, if, if you can’t see, a lot of times, what happens is that your balance isn’t, is affected by it. So that’s why a lot of falls happen at night, when you are going to the bathroom, and it’s dark, you know, things like that. So, vision is one. Yeah, and then the next one is cognitive. So basically, it’s, you know, how it alters your mind. So if you take pain medication, it can get you loopy, right. And when you’re loopy, it can affect your balance. And, you know, things that, you know, people deal with on daily basis is stress. You know, when stress is prevalent in your life, you start to tighten up, you know, certain areas of your body, which can get dizzy, which can, you know, affect your balance,
Charlie McDermott 2:53
I guess, you know, from an exaggerated standpoint, it’s like that it’s Friday night, you’re walking in town, and you see that guy that maybe had a little too much drink.
Doctor David Lee 3:02
Right? Yeah, yeah, yeah, yeah, altered state of mind, you know, it affects your balance for sure. And, you know, the thing is, you know, with, with stress, when you get stressed, you start tightening up your neck, and then all these, you know, blood vessels that go into your brain get affected, and, you know, that can lead you to be a little bit off balance and dizzy.
Charlie McDermott 3:27
And is that just, you know, everyday stress, I mean, that we tend to carry around or is that like, you get stressed in the moment, because, you know, whatever, you know, someone cut you off in traffic or something, or is that all the above,
Doctor David Lee 3:41
it can be both very true. The thing is, if you have a little bit of stress that you deal with on a daily basis, you know, that can, it can start to accumulate more and more, and you can start to get tighter and tighter through your muscles, start to affect your breathing and all these different things. And then if you have that one big stress moment, it can definitely, you know, be the last straw that broke the camel’s back, and then it can really, you know, set you back. Okay, okay. So we want to make sure that, you know, nowadays we have a lot of stress in our daily lives, you know, everyone goes through it. So we want to do things that are good for our mental health, like meditation and breathing drills, and, you know, getting outdoors and, you know, getting daily exercise and
Charlie McDermott 4:23
yeah, yeah, it and you, obviously, I know, you exercise you stay active on the same way and, you know, just a simple things like going out for a walk getting away from the stress, you know, it really changes your physiology, right. I mean, your mental outlook, your mood, your things like that. So,
Doctor David Lee 4:45
yeah, yeah, I mean, they’ve done plenty of studies where you just do 30 minutes of some kind of cardio training and it just lights up different parts of your brain. And it keeps you young, it keeps you you know, keeps you thinking clearly it keeps you focused, you know, these different things. Yeah, I rarely have people that go out on walks and do exercise and, you know, feel a lot worse after that. That’s a good point.
Charlie McDermott 5:13
Doctor David Lee 5:14
and that’s, that’s something that you know, all of us can do. If it’s not walking, it can be biking, it can be swimming, it can be, you know, these all these little things that you can do.
Charlie McDermott 5:24
Yeah, just do something. Right. Something active. Yeah,
Doctor David Lee 5:27
absolutely. And then the third thing about balance is what we call proprioception. So big word there. But basically, what it means is that you know, where your joints are in space. So if I wanted to lift my right arm above my head, I can do that, because I can sense what’s going on with my arm. And this is huge, because when you’re off balance, you always want to try to get into balance. But if you can’t detect, you know, if you have proper weight on each side, then it’s hard because now you have, let’s say, you know, 80% of your weight on one side, right? And it’s hard to keep out that way. Right? Right. So being able to get back into, you know, a balanced state, you know, takes what we call proprioception, knowing where everything is, so that you can actually pull yourself back there.
Charlie McDermott 6:24
She’s okay. Yeah, I can see how that could throw you off big time. Yeah, yeah.
Doctor David Lee 6:29
And a good example of this one is Stevie Wonder. So basically, Stevie Wonder is blind, for those of you that don’t know, great musician, right. And he does a lot of balance training, because he doesn’t have the vision, right. So he has to make up with it by doing a lot of balance work with, you know, like BOSU balls, like balanced stuff, just so that he can get a better sense of where his body is in space.
Charlie McDermott 6:58
Very, very interesting. Never thought of that. And you mentioned, the bosu ball, for our listeners who aren’t familiar with that, and how that helps you mind just just sharing that.
Doctor David Lee 7:09
Yeah, Bosu ball is basically like, it’s kind of like a yoga ball like those Swiss balls, but it’s on a platform. So it’s basically a flat side, and then a rounded side. And then you can use either side, but when you stand on the flat side, it kind of brings you off balance. So you have to use all your muscles to get you back into balance again. So it forces all those muscles to work a little bit harder, keeping you in balance, which is a great tool.
Charlie McDermott 7:40
And it’s all those kind of stabilizing muscles, right that you don’t maybe use on a regular basis, it really, and I could just be making this up. But I was like my interpretation. With our clubs, I used to have personal trainers that would put people on these things, and I would jump on every now and then and almost kill myself. And now I’m hitting you using a totally different set of muscles depending on on on the exercise you’re doing. And, and that was, I guess, from a balance standpoint, or, you know, obviously rehab standpoint really helps you recover or strengthen those muscles, right?
Doctor David Lee 8:15
Yeah, it’s just kind of like challenging a little bit more, right? When you’re more challenged, then you’re gonna pull in more muscles to, you know, basically complete the task. So it’s like that principle of like overloading. So basically, you want to get on that to challenge yourself and to force the muscles that you normally don’t work to work. Because if you are, let’s just say that you’re walking on sand opposed to hard ground, well, if you’re walking on sand a lot harder, right? So basically, you’re overtraining, those muscles that keep you stable. And then when you go to hard ground after you’ve been on sand, it’s a lot easier because now those muscles are a lot active. Yeah. So it’s a good way to train your balance. But you know, if you have some kind of underlying condition, you want to make sure that you know you’re doing it safely as
Charlie McDermott 9:05
well, too. Yeah, it could be one of those. Do not try this at home. Or without a professional.
Doctor David Lee 9:13
Yeah, sometimes it’s a great thought and have people do it and they’re like, oh my gosh, I hurt so bad afterwards. Like, you probably weren’t ready for that yet. And then the last one is vestibular. So this is a big one that’s coming into play. Now as more and more people know about it. It’s the ability to correct your balance with head movements and the ability for your body to sense where your head is in space. So we do this by like canals in your eardrum so we call it semicircular canals. Basically, it’s in your ears and It detects movement by these crystals that flow within these tubes. Okay, so a lot of people get vertigo, because these crystals, simply put, they get stuck in the canals, and then your body can’t sense it because these crystals aren’t filling freely throughout the canals. Okay, okay. Yep. Yeah. So the Hallmark sign of that is when you’re in bed, and then when you’re turning over in bed, the whole room just spins on you. Yeah, and you get vertigo. Yeah. And that has a big thing to do with balance, too. Because every time you turn your head a certain direction, if you’re, you know, if your world is spinning, it’s going to affect your balance. Wow.
Charlie McDermott 10:48
And how, how do you fix that?
Doctor David Lee 10:51
Well, it depends. So like, if it’s what we call a positional thing. So we call that BPPV, which is Benign Paroxysmal Positional Vertigo, that we can, we can treat in the clinic here. Basically, what we do is we do some positioning techniques, we figure out which side it’s coming from. And then we put you in different positions to get those crystals running through the canals again. So as you get older, and as you use your head motions, less and less and less, these things start to get a little bit more stuck. Or if you’ve had head trauma, or even if you’ve had like a stroke, and you’ve had trauma to the brain, what happens is that your vestibular system can be affected. So we need to make sure that we’re clearing these things out, we need to make sure that we’re doing exercises to help with your vision to your head movements. Because that’s huge. A lot of times if your eyes can’t catch up to your head. So like in a roller coaster or something like that, what happens is that you start to get dizzy. So we need to make sure that your eyes can follow as your head stays still. And vice versa. So yeah, that’s something that we look for we trained for a year in the clinic, because that 100% can affect your balance. Wow. Yeah. Wow.
Charlie McDermott 12:15
It’s so, so interesting. So a couple questions, then. You know, because because we have listeners, obviously, in southwest Florida, who are 69 million people experienced balance issues, obviously, there are quite a few in our area, and then we have listeners all over the country. So let’s start Dr. Lee with folks in the area that are experiencing bounce trouble. What’s the process? They come through your doors? And and how do you work with them? And and, you know, how do you figure out what the issue is? And then the treatment?
Doctor David Lee 12:52
Well, the the first most important thing is we have a detailed conversation with them, right? So they figure out when their balance issues occurring. If it’s like a, like we discussed with vestibular if it’s okay, well, I turn a turn in bed, and then the world starts spinning on me that’s, you know, a huge sign that it could, you know, be a vestibular issue. If it’s just like, Oh, I lost my balance while I was playing a sport, or I lost my balance when I was just, you know, standing and walking, and I don’t feel like I’m balanced, then you know, I would check out either, I would see how they would balance on either single leg or in a harder position, just to see if it’s what we call proprioception. So if it’s their muscles not kicking in enough. And then we would check to see if there’s any kind of visual impairment. So I would have them stand on one leg and close your eyes to see if the balance is affected, you know, greatly from that. So we can definitely see exactly what’s going on. And we can just see if it’s cognitive to so if it’s you lose your balance, right after you take your medication, then we need to make sure that you are not doing things that require balance after you’re taking your medication, right. So we don’t want to do anything that is balanced heavy. After doing that kind of stuff. Yep. So it all depends. And we asked all these different questions just to see where it could be coming from. And then I always go and confirm and test just to see because a lot of times you can say something, it can be something you know, opposite as well too. So we need to check all those different things just to make sure because I can treat for one thing. And then a lot of times if people don’t feel like they’re getting better than you know, we have to look somewhere else.
Charlie McDermott 14:49
Yeah. So then my next question is because certainly you and the team at Bridging the Gap physical therapy, I mean talk about, you know, being ahead of the curve, and in all you do to stay on top of things and in the training for what’s new and what’s out there, and what’s working best. For those folks who don’t live in the area, but are experiencing bounce issues? What do you recommend that they do? Maybe there’s questions that they should ask their physical therapist or or before they, you know, even consider working with someone, because not everyone has this knowledge and understands this the way you do, is there anything you can recommend to those folks?
Doctor David Lee 15:32
Well, I think the biggest thing is getting someone that’s knowledgeable, and that tries a lot of different things with you, you know, if they’re just trying to say things, and you feel like you’re not getting better and not improving, and you express that to them, and they don’t do anything about it, well, I think that’s a, that’s a sign that, you know, you shouldn’t be continuing treatment with them. Because ultimately, it’s all about, you know, our patients getting better and being safer, and being able to resume activity and get them back to the things that they love to do. And also, I always, I always encourage people to do some kind of balance training at home, I know, it can be very scary, sometimes, because what happens is, it feels like you’re falling, it feels like you’re unsteady, it feels like you’re about to fall. But we need to, we need to challenge these things a little bit, to the right extent, right. So when I have people do balance things at home, I have them be close to something that they can hold on to either a wall or a chair. And then you know, stand on one leg and try to balance or close your eyes and try to balance or, you know, turn your head and left to right and try to balance because we need to keep doing these kinds of things. And challenges are balanced, we’ll get better. Because a lot of times what happens that if your balance isn’t right, what usually happens will, you can fall. And when you fall, you can break something. And when you break something, you’re usually sitting and resting and recovering. And when that’s happening, then you’re getting weaker usually. And then what happens when you are fine, and you want to you know, get up again, then you’re weak, and you don’t want to do it. So you end up sitting more or lying down more, and then you start to get weaker. kind of gets repetitive, like
Charlie McDermott 17:27
vicious cycle. Right. You know, it’s just that and, you know, we beginning of this podcast, we talked about the importance of me being active. And with balance challenges, you don’t probably want to be active because of the concern about firing and hurting yourself and just not feeling right. And then that, you know, the less activity, probably the more balanced problems and the harder it is to come back. And and so
Doctor David Lee 17:56
yeah, I think that’s the biggest thing is just prescribing the right exercise at the right time. appropriately. Yeah. So that we can be challenged, but yet you don’t feel like you’re about to be off balance so much and fall and things like that. So we got to challenge the body, but we got to be safe about as well to
Charlie McDermott 18:15
last question. Time, you know, and I know they’re all walks of life and different levels of balance challenges. But for listeners wondering, you know, how long until I feel a difference begin to feel like, I’m not afraid of being active? What’s your experience there?
Doctor David Lee 18:37
So it’s, it’s kind of like learning a sport. So let’s say golf, for example. If I golf, and I do it, I’m golfing, I’m practicing, but I’m not doing the right things necessarily. It can take a little bit longer, right. But if I’m really doing the right things, and I’m really like sensing what’s going on in my body, and I’m trying to get myself in better position and do all the things that I aim to do. It’s a lot faster process for sure. So that’s why it’s good to have a professional look at you like, you know, same thing like as a Swing Coach, you gotta have someone look at you, so that you know you’re doing something right or wrong, right? Yep. And then you got to be able to sense it. That’s the biggest thing is if you can’t sense what’s going right or wrong, then you’re always going to do what feels natural for you, and then might not be the right thing. So I work on sensory information, a lot like awareness, and being able to actually know that if you’re in the right position, or you’re using the right things, because that’ll help you get to the endpoint faster, or get to, you know, getting improvement faster or feeling worse. steady faster.
Charlie McDermott 20:01
Yeah. Well, once again, I got to sing your praises you are what an asset you are for Southwest Florida. In past episodes I’ve shared with your audience what you’ve done for us Barb, in particular, my wife with her shoulder challenge that is, you know, I continue to say, hey, surgery, surgery surgery, and I said, But I met this awesome physical therapist, we got before we do that we got to get you over to Bridging the Gap physical therapy, and you work with Barb and I continue to be amazing. What’s it been like two years now? And and? Yeah, things you did that and your expertise. Absolutely amazing. And just listening to what you can help or what you can do for folks who are the worst? I think the worst case scenario is you want to be active, but you’re afraid. Right? You know, and, and, you know, it’s like, it’s like a prison. It’s like living in this shell that that, you know, and you think back to days when you could do things and now you think you can’t and that’s, that’s why this is so good. You’re getting this message out there. You know, there’s there are, there’s hope for folks who are in that situation and back to you and what you can do and and I hope listeners who are experienced that you get on over to your place and work with you. Heck, I wouldn’t doubt a few jump on a plane to see that good, dammit.
Doctor David Lee 21:36
Appreciate it. Yeah. Well, that’s the thing is, you know, like, like you said, I think everyone does want to get better. Yeah, but they just don’t know the means of it, or they’ve just been misled a little bit, right. So or taking the easy way out taking the pill. When you know, we just have to, you know, keep people on the right track. If we can keep people on the right track for long enough things will happen. And, you know, I’m here to tell people from my experience in all my patients that we’ve gotten people to their goals without doing anything invasive or, and you know, there are some times where you do need to have surgery, which is a small percentage. But you know, for the most part, if we start doing the right things, you know, things will start to come along.
Charlie McDermott 22:23
We know that firsthand. So well, this is episode, just another awesome show. And any any last thoughts on balance that you weren’t? We didn’t cover?
Doctor David Lee 22:37
No, I don’t think so. I mean, the biggest thing is keep on moving, keep challenging your body. And then you know, things will start to get better and better. You know, whatever it is, whatever the situation is. And then you know, always have a positive mindset. I think if we can try to maintain those things, you know, good things will happen.
Charlie McDermott 22:57
Well, we’ll see in the next episode.
Doctor David Lee 22:59
All right, Charlie, thank you so much. I appreciate it. Thanks
Charlie McDermott 23:01
for listening to the bridging the gap physical therapy podcast brought to you by health link. To learn more about how Bridging the Gap keeps southwest Florida active and pain free. Go to www dot bridging the gap pt.com or call 239-676-0546