This article is a transcribed edited summary of a video Bob and Brad recorded in September of 2018. For the original video go to https://youtu.be/xx3Jtmy4F-M
Bob: This is the number one thing you should do after a corticosteroid injection.
Brad: Right. And where are we going to get this injection?
Bob: Well, from a doctor or you don't do this on the street route is same to get from your neighbor.
Brad: Right? So, you may get it in your back, your knee, or your hip.
Bob: Oh, I see. Is that what you're talking about? Yeah. It doesn’t matter where the location is. If you're having some pain and inflammation what we're going to recommend is that you first try the conservative treatment.
Brad: Therapy.
Bob: Yeah.
Brad: Yep. Some things recommended by us or another therapist.
Bob: But there was a guideline put out by the Royal Academy of GPs. That's general practitioners in Australia. They recommended that this is something you should try or could try, a corticosteroid injection, again generally after you've tried other things.
Brad: Right. And this is oftentimes done with people who have severe arthritis in the hip or the knee.
Bob: Or, you could have a meniscus problem. I could be for the shoulder; it is just anywhere. It's amazing. What you're trying to do is break the pain cycle. Because quite often what happens, a joint will hurt and so you don't move it and then you brace it, and then it starts hurting even more because joints want to move.
Brad: Right, that's how they get their nutrition through movement. They get fluid coming in.
Bob: The synovial fluid gets propagated. It helps with everything. If you just took your arm right now and held it up for a long period of time, it would start to hurt.
Brad: Right. And then it would hurt when you initially moved it. But once you get it moving then it gets back into that movement cycle. Life is good again.
Bob: So the number one thing you need to do after a corticosteroid injection is you want to take advantage of it and you want to start moving that joint. No matter where it is, let's say the shoulder. We're going to go over all the different joints and what they should do. The other recommendation we're going to make is if you have an injection into your back, I recommend that you get the image-guided lumbar epidural corticosteroid injection.
Brad: Right. And you know, you can ask your doctor about it. It’s where they actually can see the needle and guide the needle.
Bob: Yeah, they use X-ray or CT scan.
Brad: Right.
Bob: Brad and I are old enough that we remember the days where you come in and they go, “ah, your back is hurting. I'll give you an injection.” And they almost never worked.
Brad: Yeah. You really need to get the fluid of the injection to the correct area. And the doctor who does it, they know what they're doing.
Bob: They know what they're doing. I just see so much better results now, Brad, with these. I've seen it where someone can buy another year or two of pain relief. When they get an injection. And so, let's start off at the shoulder. The shoulder is kind of a good one because quite often I don't even know that you need image guiding because they know they can get it right in the shoulder joint itself.
Brad: Right, and it may depend on the person, how their muscles are, or what kind of tissue there is around it.
Bob: So, we're not going to go into detail but we're going to show you this one exercise that you want to do after the shoulder has been injected. You want to go ahead and do the Codman’s or pendulum exercise.
Brad: Right. This is a simple general exercise. You just lean over and just let the gravity flex that arm forward here and then get your body moving, get your arm to move. You can go forward and backward, right to left with it. You can make circles. And it's a real gentle relaxed way to get the joint moving right after something like that. It's very common after surgeries and injuries as well.
Bob: Exactly. It's just a great starting point. So, then we're going to go to the hip or the knee, or both even. But if you get those injected, you're going to want to start getting some movement. A good one to do is just plain old walking. If you're still getting pain with that, we're going to recommend a bike or what we have here is the elliptical that we use in our therapy department. That's why it's so beat up. I mean, we probably have had this one for three, or four years.
Brad: Right. And it's used daily every time there's someone in here, typically they're using this for a part of their treatment.
Bob: Yeah. And we like these. The disadvantage is they're heavy. Brad made a stand for this one because usually, you must put it up on a two-by-four or something like that.
Brad: Usually, you want three inches because these are actually made for standing, is what they originally made for, but we found that, if you can sit down and you can pedal with it, you get really good ankle, knee, and hip range of motion without the weight bearing pressures, which is, in this case, what you want.
Bob: So it's the InMotion E1000, again we've bought a ton of these because we use them all the time, and they move very smoothly. Again, the only disadvantage is they're very heavy. You're not going to move it around the house very easily but look how smooth this works. You can just easily start getting some knee motion and hip motion.
Brad: Well, even the ankle, we got the knee, and we got the hip and you can vary how much you flex as far as how close you move the chair to it or if you slide the chair back. If you're in a wheelchair this is an excellent way to get your legs and hips moving if you're unable to walk and you are in a wheelchair for that reason.
Bob: And then we're also going to have to put out the knee glide. Brad and I invented this, by the way, created it. The advantage of the knee glide is it is so lightweight.
Brad: Right. It's lightweight and it's just versatile. You can take it with you. We use these all the time after knee replacements, ACL, and meniscus injuries, and it works really well.
Bob: My wife, yeah, hurt her knee. We had her using this and she didn't like how much it stressed her ankle when it was flat, so she would flip it up on the handle.
Brad: That little stilt will get an incline.
Bob: And so now this was a lot easier on her ankles then. Then she could easily work the knee.
Brad: Right. And it does make the quadriceps work a little bit more that way. If you want to flip it the other way, it emphasizes the hamstring effort and strength. And it's amazing, that doesn't look like much but when you do that you can really feel the hamstring, particularly if you've got an injury or something, you'll definitely feel a hamstring working harder.
Bob: And then eventually you can add a little weight to it even, you can put an ankle cuff around it.
Brad: Yup, and then you can easily just put it in the closet, hang it up and it weighs all of 2.96 pounds or something.
Bob: Well, I always like to show how I can do a curl with it, Brad, I can do one finger curl. Look at that.
Brad: Yeah. You could do one-finger curls and get that index finger going.
Bob: All right, next thing We're going to talk about the back itself. Let's say you get a corticosteroid injection into your back. You want to start walking. I mean, that's, that's the number one thing but there's a lot of different exercises you can do laying down. Do you want to show the rotations and the knee to chest, Brad? And then I'll, I can show extension.
Brad: Excellent. Yeah. Sometimes walking may not be an option. Maybe it's wintertime. You cannot get outside. You live in an apartment, but you can still get some good range of motion. Particularly, I have people before they get out of bed in the morning.
Bob: Yeah, absolutely. This is a great one to do right before you get up for a lot of people. Even if you haven't had an injection, this is a great one to do.
Brad: Yeah. Both knees up, feet together, knees together, gently and I always say, just pretend your legs are like a windshield wiper on a car going right to left. this is just breathing relaxed, nothing stressful on this. If it hurts in one direction, don't go that way. Just go in the direction that doesn't hurt so much. Work in a pain-free range of motion and gently as you work it more. Particularly after the injection, you should see that range of motion improving. And then the next one you bring a knee to your chest. You might just start out with one knee, and you can use your hands obviously to help that knee. I like 10 repetitions on all these exercises. If one's going well check the other one and do 10 repetitions. If it's feeling good, then it's nice to go to both knees and work that. That flexes the back even a little bit more, helping those facet joints get some movement and get that mobility moving again.
Bob: Again, it should all be pain-free. If it bothers you to lift both at the same time, don't do that one. It could hurt your back, to do both.
Brad: Yup. Sometimes that is uncomfortable. Pretty common.
Bob: So, I'll do the extension, Brad. For a lot of people, especially if you don't have spinal stenosis or spondylolisthesis like Brad does, the movement will go on into your back to try to get some extension because this is a movement that a lot of you are going to be lacking. So, you put your hands below your shoulders and I'm pressing up and we've emphasized this one a lot. I do this one, at least three sets of 10 a day. At least.
Brad: Now Bob's pretty old. And even though he's like an old man. I'm just kidding, Bob. He's only 50-something. Look at the range of motion in his back. This is incredible.
Bob: I can go way up high.
Brad: That's really good.
Bob: Yeah. And a lot of people, what happens is, their pelvis starts coming off the bed because they don't have enough mobility. You want to work again in the pain-free zone. You want to make sure that you can eventually over time, get further and further. And a lot of times your pain levels will coincide and go down at the same time. So where are we at, Brad? Oh, in the neck. We've just got the neck left now. I don't know how often they give shots in the neck. I guess they do, don't they?
Brad: Yeah. It, it's not as common as the other places. As far as my experience.
Bob: So, with the neck, you're just going to make sure you have good posture, and just like the back, you're going to start some rotations.
Brad: Some people, you think rotation in the neck and they're moving their shoulders. You're going to stabilize or think those shoulders are grabbed by two big steel claws. That's what I tell my patients. And it's holding you there gently.
Bob: You tell your patients a lot of weird things.
Brad: Well, you know, those things stick in their heads, Bob.
Bob: I agree.
Brad: They like it. They smile, they laugh.
Bob: So yeah. Rotations and you could even do side bending too if you want to throw that one in there, and extension probably. Right.
Brad: Yep. And, and all these you're going to do them in that pain-free range. Maybe a little stretch pain a little bit. But if there's some sharp pain, for whatever reason, that's a red flag.
Bob: I always tell my patients to bump up against the pain.
Brad: Oh, bump into it. Yeah.
Bob: But don't go into it, just bump into it. I think we've talked enough now. Once again, we can fix just about anything but--
Brad: A broken heart.
Bob: There you go.
Brad: But we're working on it, say no more.
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