TABLE OF CONTENTS - Radiology, News, Education, Service · 2016-02-02 · TABLE OF CONTENTS Making a Difference as a Sonographer: ... Tennis elbow, part 1 ... essential for you to

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TABLE OF CONTENTS

Making a Difference as a Sonographer: Regeneration tips ............................................................. 3

Making a Difference as a Sonographer: Pain in the neck ............................................................... 5

Making a Difference as a Sonographer: Priorities .......................................................................... 8

Making a Difference as a Sonographer: The perils of job growth .................................................. 11

Making a Difference as a Sonographer: Foam rolling ................................................................... 13

Making a Difference as a Sonographer: Caring for the IT band .................................................... 17

Making a Difference as a Sonographer: A face to the pain .......................................................... 19

Making a Difference as a Sonographer: Tennis elbow, part 1 ....................................................... 21

Making a Difference as a Sonographer: Tennis elbow, part 2 ....................................................... 23

Making a Difference as a Sonographer: Embracing telemedicine ................................................. 25

Making a Difference as a Sonographer: Shoulder and neck pain .................................................. 27

Making a Difference as a Sonographer: Help this person ............................................................. 30

Exercises can help sonographers scan without pain .................................................................... 32

Scanning in Pain: Part 1 – A simple way to fix it ......................................................................... 36

Scanning in Pain: Part 2 – Tackling sonography's sins ................................................................. 39

Scanning in Pain: Part 3 – More of sonography's sins ................................................................. 42

Scanning in Pain: Part 4 – Final sonography sins ........................................................................ 46

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By Doug Wuebben, AuntMinnie.com contributing writer, Mark Roozen, AuntMinnie.com contributing writer

Making a Difference as a Sonographer: Regeneration tips

If you've read our articles in the past, you know we speak about doing the right moves within an exercise program. By doing the right moves at the right times, you can live a pain-free life. One element we want to discuss -- and it's a vital component to achieving work-life balance, play-life balance, and an all-around feeling of health and wellness -- is the rest, recovery, and regeneration part of a training program.

We find that the "3Rs" of rest, recovery, and regeneration are limiting factors that can make it difficult to achieve some of the prescriptions in our Live Pain Free program.

In this article, we want to cover some of the basics for you to achieve better results from the time you put into your Live Pain Free program, whether it's five to 10 minutes a few times a week or 45 to 60 minutes four to five times a week. The 3Rs are essential for you to see the best results.

Sleep

Sleep is a critical part of recovery. Most folks need seven to nine hours of sleep every night beginning and ending at about the same times. Too much sleep, too little sleep, or long naps can inhibit the body's ability to adapt to the stresses of work, life, and training. Deep sleep will encourage the release of hormones for the recovery of muscles, tendons, and ligaments, as well as the immune system.

Lighter sleeping stages help reinforce neural patterns stimulated during training sessions. Drugs, alcohol, environmental changes, delayed bed times, and illness can all disrupt normal sleeping patterns and recovery.

So, it's important to try to get the same amount of sleep each night, and to go to bed and get up at about the same time. Doing so will give you huge benefits in terms of feeling better and getting rid of stress and pains that can be associated with fatigue.

General post-training strategies

Ten to 15 minutes in a swimming pool with a regimen consisting of large, general movements of the body can relax, refresh, and speed the recovery process. A three- to four-minute hot tub session alternated with a 30- to 60-second cold plunge, repeated for three reps, can greatly foster the recovery process. For relaxation, end with a warm environment that will encourage sleep. For recovery between training sessions, end with a cold bout. The cold tub should not exceed 10° C (50° F).

Specific post-training strategies

There are a number of different types of post-training fatigue, all of which have different recovery strategies.

Metabolic fatigue

Metabolic fatigue is typically volume-related, such as by training for longer than an hour or doing multiple training sessions back to back. It can also be caused by the overall cumulative effect of fatigue. Rehydration and refueling immediately after training can help with recovery. Aim to take in some amount of drinks and food within a 20-minute window. Metabolic fatigue can be recognized by the early onset of fatigue, when normal training seems more difficult or you struggle to complete a session.

Neural fatigue of the peripheral nervous system

Also volume-related, this type of fatigue is caused by high-intensity sessions or long, low-to-moderate sessions of training. Hydrotherapy, light active and static stretching, and massage can help with recovery. Neural fatigue is expressed by low power output, heavy/slow feet, and poor technique.

Neural fatigue of the central nervous system

This type of neural fatigue is caused by low blood glucose levels brought on by high-pressure training sessions that involve rapid decisions and reactions, or just training monotony. It is characterized by a lack of motivation or passion and can be treated with a steady intake of carbohydrates during and after training, as well as rest and alternative activities such as music, movies, or video games.

Psychological fatigue

Psychological fatigue can be caused by team conflict, competitive pressures, or other outside stressors such as school and personal conflicts. This type of fatigue is expressed by loss of confidence and/or lowered self-esteem, poor interaction and communication among team members, negative attitudes, increased anxiety, and poor sleep patterns. Activities such as reading, watching movies, playing video games, etc., can help.

Environmental and travel fatigue

This is caused by the disruption of normal routines, such as sleep patterns, meal timing, sitting or standing requirements, cultural practices, climate, and time zone. The fatigue is usually expressed

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via longer warm-up needs and slower starts to the workout, greater unforced errors in early competition, and earlier onset of fatigue.

Strategies to alleviate this type of fatigue involve proper preparation and planning for training and travel. This includes adequate hydration and refueling patterns; limiting climate stressors, such as extreme heat or cold; minimizing visual fatigue with sunglasses and limited computer time; and minimizing hearing fatigue by wearing earplugs on long flights and limiting loud music on MP3 players.

We hope this article gives you some insight into how to apply the science of recovery and regeneration. It's easy to read about, but it can be very difficult to put into practice. It seems like everybody is under the constant stress and strain of always having to do more -- more appointments, more calls, more meetings, more time at the computer, etc. Not surprisingly, we are also seeing that workers are experiencing more pain and injury in areas of the neck, shoulders, and upper back. If the overuse is significant enough, we can even see problems in the lower back and hips (we'll address that in the next article).


Making a Difference as a Sonographer: Regeneration tips

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What should a sonographer do?

It would be great to do less. It would be fun not to work so much. It would be great to take more days off -- or get someone else to do those studies.

After that daydreaming session is over, we know we need to find a solution to the problem. We need a solution that doesn't take hours out of our already busy daily schedule, that can be performed while at work and in a short amount of time, and

that makes us feel amazing.

It's not impossible; you can accomplish much by following a few simple posture guidelines. During your workday, you can do simple stretching exercises and movements that help get you into proper alignment -- and keep you there.

Let's make sure that the "pain in the neck" isn't from the physical aspect of your workday.

Good posture

First, we need to make sure that your posture is putting you in the best position to help alleviate some of the problems. The normal human head weighs approximately 8 lb. For every inch forward that your head moves out of its proper position, you exponentially increase the stress and strain on the head, neck, and shoulder region. You can literally be carrying the equivalent of 30 to 40 lb of stress and strain on the neck joint.

If you maintain this poor posture day after day for long periods of time, you will run into problems. Once you learn to maintain good posture for the day and use proper body mechanics, we can then look to eliminate the pain and problems.

We also want to make sure you're in a neutral position. We don't want the shoulders too far forward or too far back. We don't want the hips tilted to the front or back. Good position and posture can, in and of itself, help clean up many of the problems we have.

What we love about the following three stretches is that you can do them at work. They can be done in a short amount of time, and the results will be immediate.

Doug Wuebben and his daughter.

Ankle grab -- deep breathing exercise

This is a simple exercise and stretch. Keep in mind: We want to learn to breathe through our diaphragm and not be a "chest breather."

How do you know if you're a chest breather? Sit up nice and tall in your chair and take five deep breaths. Did your chest and shoulders rise up and down? If they did, you are a chest breather, which can lead to a number of issues: tight neck, shoulder problems, upper back problems, headaches -- and the list goes on.

To combat this and learn how to breathe from your diaphragm, try this ankle grab exercise:

1. Sit with your back straight on the edge of your chair. Try to find a chair that doesn't roll and doesn't have wheels.

2. Simply bend over and grab your ankles. Bring your chest to your thighs and work to get your head down to your knees (figure 1).

3. Now take six to eight deep breaths, drawing in for four to five seconds and blowing out for four to five seconds. You should feel your stomach and intercostal muscles (along your love handles!) start to work. Because you are "pinning" your chest down, in order to breathe you have to take air in using the diaphragm. You might also notice a nice stretch in the lower back as you sit up.

This is an excellent exercise to do four to five times throughout the day when you feel your neck and shoulders getting tight, or you feel stress. It only takes a few minutes, but it can make you feel great.

Overhead reach

We want to get ahead at work, so we spend more time at our desk, work to get in one more client, and push to do more and more. If we spend too much time working with the head forward, shoulders rolled, and hips tucked, we risk repetitive-use injuries that will start taking a greater toll on our bodies and our performance levels. We end up doing less, but taking more


Making a Difference as a Sonographer: Pain in the neck

Figure 1. All images courtesy of Doug Wuebben.

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energy to do it. We work harder to become less effective and less efficient!

So what can we do? Take a minute to perform this next exercise -- the overhead reach -- a few times a day. It can offer huge positive results, and you never have to leave your desk:

1. Sitting at your desk or standing behind your chair, reach both arms overhead as high as possible, with palms facing in and thumbs pointing behind you (figure 2).

2. Now here's the tricky part. As you extend your arms overhead, push your shoulders back -- think of pinching a pencil between your shoulder blades (figure 3).

3. Keep reaching as high as you can, and at the same time, blow your breath out as if you were blowing out five huge candles. Inhale through your nose and exhale through your mouth.

This should open up your chest, allowing you to breathe easier, while at the same time relieving stress and strain in your neck and shoulders.

Doorjamb pull

The final movement is another simple, quick exercise that you can do almost anytime during the day. All you need is a door and yourself:

1. Stand in a doorway, facing the opening. Using your arm closest to the door frame or doorjamb, put your elbow into your hip and grab the doorjamb with your hand (figure 4).

2. With the other arm, reach over the top of your head (your arm should be covering your ear and not going in front of your face or behind your head). With your hand, also grip

the doorjamb or door frame.

3. To start the stretch, push your hip forward and into the elbow that is pressed against it. At the same time, lean away from the door frame, getting a stretch through the arm that is extended overhead.

4. Hold the stretch for 20 to 30 seconds and then do the other side. A training tip here is to make sure that you're keeping your hips square or pushing the hip that is against the elbow forward. If you let your hips rotate, you'll lose some of the stretch effect from the exercise.

Finding relief

Doing these exercises throughout the day will help you find relief. When you start to feel stiffness, tightness, or any pain in the neck, shoulders, or back area, use one of these movements to help rid yourself of issues that arise from sitting, straining, and being in poor posture positions during the day.

In this article, we've given you a few simple tips to begin eliminating your pain and injuries. When we present at conferences, we emphasize that our education is not a pill that you can swallow and make everything better. Back when I had my debilitating shoulder issues, I was willing to do anything to help myself. I was lucky to find a way through my friend Mark (Rozy) Roozen, a strength and conditioning specialist.

While I was fortunate to have my colleague to turn to, I was also smart in that I listened to him. That was just the beginning. I had a lot more to learn, and once I did, the results were incredible. My reward was in the end result, but it has also come from the journey itself. You feel amazing when you not only correct a horrendous malady, but also learn and grow exponentially from it.

By the way, I would like to thank my daughter Brooke for her help in demonstrating the exercises. She is at college and Dad misses her.



Figure 2.

Figure 3.

Figure 4.

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To get more exercises, stretches, and movements that can help you live free of pain, email us at [email protected] and ask for a free copy of "The Right Moves" for wrists and arms. As sonographers, we wield a great deal of power, making a difference in the medical management of each person we work on. If you are not at 100%, you are doing a disservice to yourself as well as the patient. It's crucial to prioritize your mental and physical health.



mailto:livepainfree4u%40gmail.com?subject=%22The%20Right%20Moves%22%20for%20wrists%20and%20arms

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As sonographers, we wield a great deal of power, making a difference in the medical management of each person we work on. If you are not at 100%, you are doing a disservice to yourself as well as the patient. It's crucial to prioritize your mental and physical health.

One of the questions I ask myself when I'm with a patient is whether I'd be satisfied with my work if this were my mom or my dad. On busy days, it can be tough to reach that level, but it's always in the front of my mind, and it helps me be the best sonographer I can be.

We do a lot of work on LinkedIn, and I recently came across a great article there by Carson Tate, who is the founder and principal of management consultant firm Working Simply. In her article, originally published June 25 on FastCompany.com, Tate shares how she overcame the "busyness" of life, dealt with her fears, and worked to build a life that she lives fully.

Her words are powerful and had an immediate effect on both me and my colleague, strength and performance coach Mark Roozen (Coach Rozy). We both get caught up in the "busyness" of life, and it's always good to be reminded of what is truly important and to take the time to re-evaluate where you are. It's worth a read.

As Tate highlights in her article, it's vital to set the right priorities. If you are scanning in pain, you are not at your best and are discounting your patient and yourself. There is relief for my colleagues who scan in pain, but it's not something that can be solved quickly or just by taking a pill. There will need to be effort and education on your part.

Wrist and forearm pain

When speaking with different groups and at various events around the globe, we've had a number of folks with wrist and forearm pain approach us seeking information on what they can do to live pain-free. Below are a few ideas and what we call the "right moves" when beginning our program.

First, it's important to keep up with soft-tissue work. Thinking back to my days of gross anatomy (sometimes it's hard to remember back that far), the muscles of the forearm gave me the most trouble and were the hardest to learn and memorize. There are so many of them in a very small area.

Because sonographers use their lower arm repeatedly during long hours on the job, the forearms and wrists are common sites of serious nerve entrapment conditions such as carpal and ulnar tunnel syndromes.

If you have access to a technique known as active release, we highly recommend getting some maintenance work done on your elbows and forearms every three months or so. If you're unfamiliar with the active release technique (ART), it treats conditions related to the buildup of adhesions and scar tissue in muscles.

These adhesions can cause several problems: muscles become shorter and weaker, the motion of muscles and joints is altered, and nerves can become compressed. As a result, there is pain, decreased blood supply, and poor mobility in the affected tissues. When that happens, we have pain on the job and loss of work time -- which no one wants.

ART can help fix these issues by releasing trapped nerves and restoring the smooth movement of muscle fiber. You'll be amazed at what a difference it makes. All those little muscles love to bind together and cause trouble! By adding some stretches and active release techniques into your program, you can experience relief almost immediately.

Wrist and elbow flexibility

If we're going to focus on tissue quality with soft-tissue work, we also need to emphasize wrist flexibility. These three movements are a good way to start.

Wrist stretch

This stretching exercise improves flexibility and range of motion in the forearm, wrist, and fingers.

1. Hold your right arm up in front of you (figure 1).


Making a Difference as a Sonographer: Priorities

Figures 1 and 2. All images courtesy of Doug Wuebben and Mark Roozen.

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2. With your left hand, grab the fingertips of your right hand.

3. Slowly bring the fingers of the right hand back toward the forearm, applying gentle pressure to stretch out the wrist (figure 2).

4. Hold for a set amount of time (see recommendations below).

5. For the second movement, lightly apply pressure to the back of the right hand (figure 3).

6. Repeat for the other wrist.

Spider stretch

This stretch will help you develop flexibility and mobility in the fingers and hands. You can do it standing or sitting, and it's an easy stretch to do anytime.

1. Place your fingertips and thumbs together in front of you (figure 4).

2. To begin the stretch, simply push the palms of the hands together while keeping tension on the fingertips (figure 5).

3. The key here is not just to relax the fingers and bring the hands together. Keep the tension in the muscles of the hands and fingertips.

4. Maintain for a set amount of time (see recommendations below).

Weight grip pinch

The weight grip pinch develops grip strength and forearm strength, and you can even work up to building shoulder strength.

1. Grab two weighted objects that can be held (or pinched) together; the objects can be two books or two small weight plates, for example.

2. To begin, grasp the two items with one hand.

3. Start with the arm bent at the elbow to form a 90° angle (figure 6).

4. Hold the resistance for a set amount of time (see recommendations below).

5. To make the exercise more difficult, straighten your elbow



Beginner: 2 x 20 seconds for each wrist, two times a week

Intermediate: 2 x 30 seconds for each wrist, two times a week

Advanced: 3 x 20 seconds for each wrist, two times a week

Figure 3.

Figures 4 and 5.




Figure 6.

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and extend your arm, holding the objects farther away from the body. This will work your shoulder muscles as well as improve your grip strength.

6. Switch to the other hand and repeat.

Stop leaning/sleeping on your elbows

Medial elbow pain is the most common symptom of valgus extension overload, a series of elbow pathologies that Coach Rozy sees when working with his throwing athletes and lifters. One of the last in this pathology series is ulnar nerve entrapment, a condition that usually leads to numbness/tingling in the pinky and ring fingers.

Believe it or not, many people develop ulnar nerve problems not from sports and high-velocity throwing, but from excessively leaning on their elbows. So, if you're in the habit, stop! Likewise, radial nerve palsy has been nicknamed "Saturday night palsy" because it often occurs when individuals who might have enjoyed too many adult beverages fall asleep on their arms in awkward positions (imagine falling asleep with your arm over the back of a bench or couch).

Generally, the impingement occurs at the midportion of the upper arm, but the symptoms that develop typically include finger and wrist drop. If you sleep with your arms overhead and your head resting on your biceps, you might want to break the habit. Additionally, anyone on crutches should be cognizant of the problems that can arise in this regard.

If you use these simple guidelines and implement some of the basic movements into a routine two to three times a week, you can start to experience less pain and injury. To get more exercises, stretches, and movements that can help you live pain-free, email us at [email protected] and ask for a free copy of "The Right Moves" for wrists and arms.






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Making a Difference as a Sonographer: The perils of job growth

Advances in imaging technology will lead medical facilities to use ultrasound more in place of costly, invasive procedures, which means that more procedures will be conducted outside hospitals and more sonographers will be needed.

The U.S. Bureau of Labor Statistics predicts that sonographer employment will increase by 46% between 2012 and 2022, a growth rate that is among the highest on U.S. News and World Report's list of best jobs of 2015. While hospitals are the biggest employers of diagnostic medical sonographers, rapid employment growth will take place in physicians' offices and medical and diagnostic laboratories, according to the magazine.

At the same time, evidence continues to accumulate on the risk of musculoskeletal injuries for sonographers. In a study published in 2009, researchers at Yale University found that despite the use of ergonomically designed ultrasound equipment, 96% of their female sonographers experienced some type of musculoskeletal symptom within a 12-month time frame.

The study, conducted through the school's Occupational and Environmental Medicine Program, found that shoulder (73%) and lower back (69%) symptoms were the most common ailments, followed by wrist and hand issues (54%).

If you analyze the two references above, the information is startling. The healthcare industry as a whole is one of the fastest-growing career sector industries in the U.S., and realistically that likely coincides with the rest of the world.

To highlight this dynamic further:

• Ultrasound growth is exploding. More patients worldwide will be seeing the benefits of advanced healthcare using ultrasound. Sonographers will have job security at the price of being much busier, which means more patients, studies, and workload.

• Ergonomic equipment is great and necessary, but studies show that better equipment design provides minimal benefit for eliminating the pain and injuries that nearly every sonographer endures.

Increased demand

While the need for more sonographers is a great thing, the increase in the number of sonographer positions worldwide will not keep pace with the increased workload. The bean counters will get involved, and in my simple opinion, the result will be more workload for sonographers.

In my conversations with sonographers all over the world, the talk inevitably turns to "doing more with less." One extra exam during your workday will slowly creep into two. You get my point.

I've been in healthcare a long time, and I know that profit margins are very tight. A healthcare institution is, after all, a business, and the goal of any business is to make a profit. It has also been my experience that the bean counters normally get their way. Until something changes, that's the way most institutions will operate. I have my own ideas on that change, but those are perhaps best saved for another article.

The job of a sonographer is physically demanding and takes a toll on the body. Increased workload will only aggravate pain and injury symptoms. Preventing injuries is the best medicine for a sonographer to keep doing his or her job at a high level.

Taking control

If you have been following our series on AuntMinnie.com, or you've had the opportunity to sit in on one of our presentations, then you know you have options. You can be in charge of your body and eliminate the pain that plagues the majority of sonographers.

I was nearly debilitated by bilateral shoulder pain early on in my career. My colleague, Mark Roozen, a strength and conditioning performance specialist with National Football League experience, completely cured my near career-ending injury. His philosophy of training body "movement" and not muscles is amazing.

Training movement simply means that you look at the body as a whole unit, albeit with different parts and zones. All of our zones tie in with each other and need to be considered as part of how the injury process occurred -- and, more importantly, how it can be cured. Our education is tied to "corrective" exercise as opposed to "fitness" exercise.

I go to work every day no longer wondering if I am going to be able to make it through the day. I love what I do, and I'm good at what I do. I make a difference because I have passion and love for

Sonographer Doug Wuebben and his daughter.

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this field, and I am doing my job pain-free, which enables me to do my best for every patient.

Everything in our lives is the result of a choice we have made. If you want a different result, make a different choice. I feel empowered and excited about life. The trials and struggles that I went through when I thought I was going to have to leave my job also were a blessing in disguise.

As educator and motivational speaker Stephen Covey said, "I'm not a product of my circumstances. I am a product of my decisions." I took control of my situation, got out of my comfort zone, and took back my body and my life.

Since that tortured time in my life, I've learned a very important lesson. I realized that my circumstances no longer hold me back. I have the power to make positive decisions to propel me forward. My present circumstances merely determine where I start. Great stuff!

'Stretch of the weak'

Our website contains a "Stretch of the weak," every week. I've included a recent example below. There are many great tips, stretches, and exercises available on the website.

Psoas lunge stretch

Many people will do lunges, pushing the hips forward to stretch what they feel is the hip flexors and the psoas. The iliacus crossing the hip is stretched in the traditional lunge, but the psoas crosses the hip and all lumbar joints.

It can only be stretched when isolated with a lunge that includes spine lateral bending with some twist and extension motion. This can be a great stretch before, during, or after work. Stretch and hold for 20 to 30 seconds and repeat several times, going both directions.

Psoas lunge stretch. Image courtesy of Doug Wuebben.

Making a Difference as a Sonographer: The perils of job growth


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Making a Difference as a Sonographer: Foam rolling

With the combination of a heavy work schedule and the physical demands of the job, many sonographers find that their bodies start to fall apart. To combat the resulting pain and fatigue from achy knees, stiff backs, and painful shoulders, you need to use recovery techniques proactively.

Foam rollers have become increasingly popular over the past few years, being adopted by therapists, athletes, and the general population alike. Used before and after workouts, the rolling applies pressure to certain "trigger points," enabling the muscles to relax and the body to function better and like it should.

While foam rollers are a great recovery and release tool, they can be less effective for common trouble spots in the lower legs, hips, and shoulders. Luckily, there are additional tools in the toolbox, such as foam balls, bumpy rollers, and more, that can reach every nook and cranny on our body. It may seem silly to the uninitiated, but these new tools facilitate a variety of advanced exercises that can quickly, easily, and effectively target some of your harder-to-reach muscles.

How we work, play, and train can tax the muscles in our feet, ankles, hips, back, and shoulders. We discuss some trouble areas below and what steps you can take to get relief and keep pain away.

Arches

Our feet take a beating every day. This is probably our favorite drill and can be done anywhere. Rolling a ball along the arches (figures 1 and 2) can help break up tension in the foot and feels great. (Note: You can use a tennis ball to get started with this exercise and progress to a basic lacrosse ball. Move from a ball that has some give to a firmer ball. You can work up to using a golf ball.)

Soleus

Located just above the Achilles tendon, the soleus often gets tight from running and moving around. Using a small ball or roller elevated on a block (figure 3), allow the roller to dig into the soleus and then rotate the foot in circles. The combination of compression and movement allows the roller or ball to do its thing. Try a few different spots, as well as moving your toes. If this is too much too soon, you can start with the ball on the ground, letting the heel help to determine the amount of pressure on the soleus.

Tibialis anterior

This is the small muscle in the front of your lower leg. Often overlooked, it is commonly overworked in runners and athletes, as well as people just getting into a new exercise program. Think shin splints!

With this drill, you can stretch the tibialis anterior in a number of different ways. Kneel on a foam roller, placing the roller on your shins, and move back and forth (figure 4). As shown in figure 5, you can also use a "roll stick" -- a fitness tool similar to a kitchen rolling pin.

Finally, you can also lace your fingers around a ball, pull it into the muscle, elevate the foot, and make small circles with the ball and the foot. Again, combine compression with movement to target the muscle.


Figures 1 and 2. All images courtesty of Doug Wuebben.

Figure 3.

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Quadriceps

Common foam rollers are great, but a roller with bumps (such as in figure 6) provides some variety. Instead of simply rolling on the muscle, lie over the roller with bumps (figure 7) and then twist (figure 8). This allows the bumps on the roller to work the muscle in a new way. The bump roller is one of our favorites for the quads.

Hip flexor/psoas

Sitting is the new smoking. The combination of sitting for long periods of time and extensive front-side repetitive motion can leave your hip flexors a bit stiff and immobile. Progressing from a foam ball to a tennis ball and then a firmer ball allows you to get into the crease of the hip and groin to work on these overactive muscles (figure 9). Place the ball on one side, in the "pocket area," or in the fold of the hip -- and roll!

Glute/piriformis

This drill uses a small ball, placed in the center of the glute (butt). Lean onto your elbow and draw your knee up toward the body



Figure 4.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Figure 9.

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(figure 10). Careful on this one, it's an eye-opener! We typically begin with a tennis ball and progress to denser balls over time.

Quadriceps

Common foam rollers are great, but a roller with bumps (such as in figure 6) provides some variety. Instead of simply rolling on the muscle, lie over the roller with bumps (figure 7) and then twist (figure 8). This allows the bumps on the roller to work the muscle in a new way. The bump roller is one of our favorites for the quads.

Erector spinae (back)

This drill uses two tennis balls taped together and is performed by rolling up the center of the back. The balls dig into the erector muscles along the spine without hitting the spine directly. It's a lifesaver for people who spend a lot of time hunched over a desk, in the car, on the couch, or doing repetitive motion at work.

It's easy to make the equipment for this drill, and you can do it against a wall (figure 11), on the floor, or up against the door in your office.

Pectoralis (chest)

The pec rolling drill is beneficial for just about everyone. Most of us have hunched shoulders, and a tight chest is one of the main culprits. We typically use the foam therapy ball, but you can also use a tennis ball (figure 12) or a lacrosse ball. We even have beginners start with a larger ball (figure 13).

Latissimus dorsi (upper back)

Just like for the quads, you can use a typical foam roller on the lats. However, we prefer the roller with bumps to address this muscle; you can get in deeper and get more release. Try to roll across the muscle and from top to bottom (figure 14).

Shoulder

This can be a tender area, so start with the foam roller if you've never done it before (figure 15). After that, you can progress to the foam therapy ball or a tennis ball (figure 16). This exercise hits all of the small muscles that tie the shoulder together, including the rotator-cuff muscles and deltoids, and will loosen up your shoulder.



Figure 10.

Figure 11.

Figure 12.

Figure 13.

Figure 14.

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Back/shoulder release

We love this one to finish up. Simply take the foam roller and place it down your spine. Let everything relax, and allow your shoulders to drop and your arms to rest on the ground. Let the hips relax and drop to the floor. You can also put the roller across the back/shoulder blades and let your hips drop to relieve tension through the body.

Incorporating foam rolling

Be sure to try all of these drills, but you don't have to do them all at one time. Starting out, you may find that some of them make you feel sore and stiff, while others feel unnecessary. After identifying your trouble spots, it only takes about five to 10 minutes to address these areas.

Mark Roozen's Beyond Foam Rolling drills are a perfect prewarmup to keep your body moving and healthy. These are quick, easy, and effective release drills that anybody can do to get relief. You don't need to join a gym, and all the materials are inexpensive to purchase. Your body will thank you for it later.



Figure 15.

Figure 16.

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Making a Difference as a Sonographer: Caring for the IT band

Iliotibial band syndrome (ITBS) is primarily known as one of the most common overuse injuries for runners. But sonographers and other professionals who are on their feet all day also experience problems caused by tight IT bands.

Compared with the upper-body issues (involving the neck, back, shoulders, etc.) that nine out of 10 sonographers experience, IT band problems aren't at epidemic levels. It's definitely a problem area, though.

ITBS occurs when the IT band, the ligament that runs down the outside of the thigh from the hip to the shin, is tight or inflamed. The IT band attaches to the knee and helps stabilize and move the joint. When the IT band isn't working properly, movement of the knee -- and, therefore, movement in general -- becomes painful. In severe cases, IT band pain has sidelined individuals for weeks or even longer.

My own IT band issues occur when I scan predominantly right-handed. My right leg often sits or hangs uncomfortably while I perform the scan. There may be too much or not enough support of my upper leg. Frequently, my foot and/or lower leg will go to sleep. This situation has led to the knee issues described in this article.

ITBS symptoms

The most notable symptom of ITBS is typically swelling and/or pain on the outside of the knee; as a result, many folks mistakenly think they have a knee injury. The best way to tell if you have ITBS is to bend your knee at a 45° angle. If you have an IT band problem, you'll feel pain on the outside of the knee.

Common causes of ITBS

ITBS can result from any activity that causes the leg to turn inward repeatedly, including the following:

• Wearing worn-out shoes

• Working on a slanted downward surface or on banked surfaces

• Repetitive motions at work in the same direction

• For runners, running too many miles; for workers, spending too much time on your feet without a break

• Having a muscle imbalance

• Being tight in one area and having weakness in another area that causes stress

The IT band narrows near the knee, and rubbing can occur between the band and the bone. This causes inflammation.

Preventing ITBS

There are steps you can take to prevent IT band syndrome:

• If you feel pain on the outside of your knee, you may need to decrease the amount of time spent on your feet until you can build stability and strength, as well as improve mobility and flexibility.

• Do a dynamic warm-up before you start your job or work out.

• Check that your shoes aren't worn along the outside of the sole. If they are, replace them.

• As much as possible, make sure your work area is flat.

• When exercising, do multidirectional activities and use proper body mechanics when you change directions repeatedly.

Treating ITBS

Some experts say the best way to get rid of IT band pain for good is to rest immediately. We know, though, from working with competitive athletes and folks who need to be at their jobs that this isn't always realistic. Most people can't simply take a few weeks off and still have a job when they return.

There are some things you can do, however. If you're a runner, run fewer miles. If you're at work, try to get a few breaks and get off your feet. You should also incorporate some daily exercises and stretches to help reduce and eliminate IT band problems:

• Roll it: A 6 x 36-inch foam roller is the best tool for stretching the IT band. Lie on your side with the roller under your leg, and roll from your hip to your knee, using your body weight to knead the area. The pressure will help loosen the tendon and the fascia, almost like a self-


Echocardiographer Doug Wuebben and his daughter.

18

massage. Do this at least once a day for several minutes, and make it a permanent part of your exercise routine.

• Beef up your glutes and hips: Weak butt and hip muscles contribute to IT band impingement syndrome. Make sure your lower-body work includes multidirectional squats, single-leg squats, and multidirectional lunges.

• Prevent it: Build up your glutes (those butt muscles) to reinforce the body's largest and potentially most powerful muscle group. The stretches and exercises described below all help strengthen your glutes and hip flexors and can be added to any workout.

Glute stretch

Lie faceup on the floor with your knees and hips bent. Cross your right leg over your left so that your right ankle sits across your left thigh. Grab your knee with both hands and pull it toward the middle of your chest. Hold for 30 seconds and then repeat on the opposite side.

Lateral band walks

Place both legs between a miniband and position the band just above your ankles. Take small steps to your right for 20 ft. Then sidestep back to your left for 20 ft. That's one set.

Hip raise/hamstring bridge

Lie faceup with your knees bent, heels pushing into the floor, and toes up. Place your arms out to your sides at 45° angles, with your palms facing up. Raise your hips so your body forms a straight line from your shoulders to your knees. Squeeze your glutes as you raise your hips. Be sure to push with your heels.

If you'd like more information or want to learn about additional strengthening and stretching exercises, you can email us or visit our website.

Making a Difference as a Sonographer: Caring for the IT band


mailto:livepainfree4u%40gmail.com?subject=http://coachrozy.com/

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Making a Difference as a Sonographer: A face to the pain

There may be folks out there who have heard our story through our series of articles, or who have had the chance to hear us speak. Either way, we hope you enjoy and benefit from the education we offer.

If you are new to us, I (Doug Wuebben) am a practicing echocardiographer who does pediatric and adult scans. Some years ago, I suffered daily from debilitating shoulder pain, a direct result of performing my job.

Luckily, I had access to a helpful friend and colleague: strength, conditioning, and performance coach Mark "Coach Rozy" Roozen. After I spoke with Coach Rozy about my pain/injury issues, he first looked at the body movements required to perform the tasks of a sonographer. He then prescribed a simple set of exercises and stretches that completely eliminated the pain. I still follow the routine to this day, and I have no pain.

As Mark and I travel to present and share our information and training program, we see the exponential increase in demand for this type of education, which is lacking and yet so necessary. We're proud and honored to be able to help folks learn how to deal with their pain and job-related injury issues.

A global issue

AuntMinnie.com has been a great partner in getting the information to sonographers around the globe. Through its reach, we've been able to connect with people around the world, including Bernadette (Bernie) Mason, a senior lecturer and clinical site supervisor with the Australian School of Medical Imaging (ASMI). Bernie was introduced to ultrasound in Australia in the late 1970s and early 1980s.

Building a friendship through the magic of the Internet, I learned that she educates sonographers in Australia about proper ergonomic protocol to reduce their pain/injury issues. Communicating back and forth, it was evident that Bernie and I had many things in common, not the least of which was job-related extreme pain and injury.

We found Bernie's story fascinating and asked her to share it with you:

My name is Bernadette Mason. I had a very exciting career, starting with nuclear medicine. Part of our training at the time was an introduction to some components of ultrasound. My interest in ultrasound grew, and I made the decision to take career advancement and make ultrasound my full-time career.

Sonography was a new and exciting field. After starting my family, I cut back my hours to four days per week, along with locum assignments. I found this to be a very challenging move. The stress levels were enormous. I needed to prove that I was a worthy sonographer, and my employers needed me to perform an adequate number of studies to justify my employment.

As the years went by, my patient list began to increase. I enjoyed challenging myself to do more studies on patients than I had done the day before. My employers also encouraged me to complete more and more studies every day. Eventually, I reached the point where I was so busy fitting in the next patient that breaks became a thing of the past. My back started to ache and my neck became painful, causing headaches to begin and then worsen. I was also busy raising a family, so in between weekly visits to the physiotherapist I became Wonder Woman and learned to work everything into my day.

I didn't realize at the time that I was putting my health and my body at risk. I was exercising, and my attitude was that I could handle anything that life threw at me. Due to my work ethic and ability to be a "high-output" employee, it became the norm to put "urgent" patients on my list. Breaks were a luxury, and I felt I owed my employer effort to meet their expectations. In Australia we have a saying: "She will be right, mate." That is what I firmly believed.

Soon the pain in my neck became constant. My back suffered the same. I was stiff and sore even after a good night's sleep. My reaction was to swim more and just keep going. I reached a point where my back started to spasm, and the physiotherapist advised more exercise and stretching to alleviate my pain. Great, I had to fit more into my already busy work week. I believed that I could do this on my day off and perhaps three or four nights per week. Physiotherapy is not cheap, which caused stress on the family budget. This precipitated me to work more, further aggravating my problems. A vicious circle.

The turning point for me came around Christmas, a time


Doug Wuebben and his daughter.

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when staff members take time off for family. This leaves a department with the same workload, yet fewer people to do the work. My workload increased during this period. It was at this point that my back went into a severe spasm. I added another medication in an attempt to control the spasms and the pain. My sister had also been diagnosed with terminal cancer, adding to my stress. On New Year's Eve of that same year, I experienced the worst pain of my entire life. I popped a disk in my neck and passed out. My employer at the time was very sympathetic and did a CT scan, and I was sent home with more medications. I was told that I was too important to be off for an extended period of time. At this point in my career, I had popped two disks laterally and had three bulging disks.

My employer soon sold the practice, and the new operators had me try office work. My injury level had become so severe by this time that I was unable to complete the office work. An unsuccessful attempt was made at workers' compensation, but eventually I was terminated. My stress level was through the roof; I was raising a family with all the bills and life expenses that that entails. I was severely injured with no known prospect at that time for relief. I had given my blood and guts to the company, and when I didn't work out anymore, I was booted to the curb like an empty soda can. There was nothing left but tears.

I took matters into my own hands and eventually found a representative to take on my case. The courts took a look at my case and decided that the fair and just thing to do was award me compensation for my years of service, dedication, and hard work. I had a normal CT scan of my neck taken years before for an unrelated issue. This was the "smoking gun" that let the courts award me a victory. I was still debilitated, neck brace and all, but I felt somewhat vindicated and recognized for my hard work and years of loyal service.

During this time in my life, a friend told me that a sonography school was set to open, and that I should consider applying as a professor. I feel very fortunate to have been hired to teach the ultrasound program. I continue to have a lot of pain and some disability, and to some degree I still worry about my income and even my ability to continue working. I've been told that I suffer from a form of post-traumatic stress disorder and am working out the details on how to deal with that.

I am also very proud to mention that I did go on to obtain a master's degree in adult education. I am on the Australian Sonographers Association Health and Well-Being Committee.

My goal is to educate sonographers all over the world with my story. I don't want anyone else to endure the pain, agony, frustration, and stress that I experienced. I can also be a leader in educating folks on the proper steps, should they find themselves in a similar situation. Working harder and taking more pills is not the answer. Australian sonographers suffer from a 25% rate of career-ending injury. I am one of them. This cannot go on. Things have to change. Thank you for hearing my voice.

We would like to thank Bernie for sharing her very powerful story. Bernie's pain and injury forced her to elevate her life in ways that she probably didn't realize she had available in her inner spirit. Unfortunately, Bernie's story in the sonography world is not uncommon.

Tears and anguish

Every single time Mark and I present at a conference or educational event, sonographers approach us with similar stories in which people are in critical, near-debilitating pain with an injury that threatens their very livelihood. Every time.

Most of the time, you can see and feel the pain with the tears and anguish that follow. Bernie knows. I know. Bernie suffered horribly but was able to move on. I was at the same place, but with the luck of having a friendship with Coach Rozy, I found help and complete relief. Two similar beginnings but with completely different endings.

If you are a sonographer with this type of story, we want to hear it. Send us an email and let us know your story. It might not be too late to change your course and travel down a new path, a path that you have control over.

The educational material that Mark offers is a philosophy of training movement. You train a professional football player's body to play the movement game of football. Likewise, you train a sonographer to condition his or her body as a sonographer, performing body movements and working through positions that sonographers do while working. In future articles, we will keep sharing our tips for doing the right moves (exercises, stretches, etc.) the right way.

We also want to expand on the rights and responsibilities of employers and employees. If your job is causing you pain and injury, your employer has certain responsibilities in those areas. Our experience tells us that most folks aren't aware of this. There is more to come on that topic in future columns.

Making a Difference as a Sonographer: A face to the pain


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Just because you don't play tennis or racket sports doesn't mean you can't come down with tennis elbow, also known as lateral epicondylitis. A painful condition caused by overuse, tennis elbow can be triggered by repetitive movements on the job, such as the daily work of a sonographer.

In those with the condition, the tendons that join the forearm muscles on the outside of the elbow become inflamed. The forearm muscles and tendons become damaged when the same motions are repeated again and again. This leads to pain and tenderness in the area of the elbow.

Many times, we only look at the forearm and elbow area to help relieve the pain. These areas, indeed, can be the cause of problem, but we also need to go a step further and take into account the wrist, the entire arm, and even the whole body.

We need to make sure that the neck and scapula (shoulder blade) are moving correctly and not leading to problems in other parts of the body. Even though the symptoms are in the elbow, the culprit causing the pain could be in a different area.

Folks tell me all the time that they use a brace to help relieve the elbow pain. That's great, but keep in mind that while a brace centered over the back of your forearm could help relieve symptoms of tennis elbow, it might not fix what's causing the problem.

Training and stretching exercises can accomplish that goal. First, though, here's how to tape the forearm to help secure the muscle in a position to relieve pain while working and doing corrective exercises (figures 1, 2, and 3). This can reduce symptoms by resting the muscles and tendons that are being overworked.

Keep in mind that this doesn't stop the cause of the pain; it just gives some relief. To stop the pain and to remain pain-free, do some of the following training exercises for five to 10 minutes, two or three days a week. You don't have to do all of the exercises presented here and those to come in part 2; pick one or two for day 1, and then one or two more for the next training day.

The first two exercises are mobility and stretching exercises.

Mobility/stretching

Corner stretch

The corner stretch will improve mobility of the shoulders and flexibility of the upper back and shoulders. To begin, stand in a corner and bend your arms to 90°. Place your hands, forearms, and elbows on the wall, with your left arm on the left wall and right arm on the right wall (figure 4). Slowly lean your upper body into the wall, working to bring your chest into the corner (do not lead with your head/nose).

Making a Difference as a Sonographer: Tennis elbow, part 1


Figure 1: Tape to use for bracing. All images courtesy of Mark Roozen and Doug Wuebben.

Figure 1: Roll some of the tape and place it on the thumb side of the forearm.

Figure 1: Place tape around the forearm.

Figure 4.

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Make sure that the upper arms are out straight from the shoulders and that they are not positioned too high on the wall. The arms should be at 90° angles. Next, move up the wall to 45° angles and repeat, leaning into the corner while leading with the chest (figure 5).

After that, move up the wall with your hands, extending your arms above your head. Again, lean into the corner with your chest.

Finally, work your way back down to the 90° position.

Doorjamb grab

The doorjamb grab will improve mobility of the shoulders, back, and core and also flexibility of the entire back and shoulders.

Begin by standing in the middle of the doorway. To stretch the left side, bring your right elbow to your side and brace your right hand against the doorframe. Reach your left arm over the top of your head and grab the doorjamb (figure 6).

As you lean away from the doorjamb, pushing your hips away, work to keep your right hip forward; try not to let it drop back. Hold for 20-30 seconds and then repeat the stretch on the other side.

In our second article on tennis elbow, we'll show you three strengthening and stability exercises that you can incorporate into your exercise routine.



Figure 6.

Figure 5.

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As we discussed in part 1 of our two-part series on tennis elbow, you can develop this painful condition without playing tennis or racket sports. Repetitive movements on the job, such as the daily work of a sonographer, can also trigger tennis elbow.

In the first article, we shared some simple stretching exercises to improve mobility and flexibility to relieve elbow pain. Now we'll add three simple exercises to improve stability and strength. You should train two or three days a week, and pick one stretching exercise and one strengthening exercise to perform each day that you work out.

Strength and stability

Wrist curls

First, hold some light-resistance weights in your hands. Be sure to use a weight that is easy for you to handle. Begin by sitting on the edge of a stable chair or secure bench. Then rest your forearms on your thighs with your palms facing inward and your thumbs up (figure 1).

Now bend the wrists up toward the ceiling using as much range of motion as possible. Think about keeping your thumbs up and pushing them back toward your body (figure 2).

Next, lower the weights in your hands down past your knees, working to get the little finger and outside of your hand to touch below your knee cap. Keep your elbows and forearms on your thighs during the whole movement. It's important not to get movement by lifting the elbow off the thigh.

Change your position each time you do the wrist curl exercise; each hand position will isolate or work different muscles in the forearms and wrist. The palms-up position is shown in figures 3 and 4.

The palms-down position is demonstrated in figures 5 and 6.

Stability ball walk out

The stability ball walk out develops grip hand strength, forearm strength, and shoulder and chest strength, along with stability in the core.

First, lie on top of a stability ball, with your hands on the ground and knees against the ball for support and control. Then begin to walk your hands out away from the ball, while at the same time extending (straightening) your legs (figure 7).

Walk out as far as possible, while still being able to control balance and stability. Progress from the hips to the thighs, knees, shins, feet, and toes (figure 8).

To make the exercise more difficult, keep your feet closer together and work your way farther out from the ball. This will increase the need for stability through the arms, shoulders, chest, and core. Either way, once you've reached the maximum walk-out point for you, walk your hands back toward the ball and repeat for a set number of reps.

Miniball/Medicine ball wall pushup

The ball wall pushup works the hands, forearms, arms, shoulders, and chest and can be a great core exercise for stability. By changing hand position and the position of the ball, you can also isolate, or work, different muscles in the forearm and wrist.



Figures 1 (left) and 2 (right). All images courtesy of Mark Roozen and Doug Wuebben.

Figures 3 (left) and 4 (right).

Figures 7 (left) and 8 (right).

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Begin by holding a small ball, a medicine ball, or even a stability ball lightly in your hands. Stand upright and hold the ball against the wall. Keep your body in a straight line. The ball should initially be at shoulder and chest level (figure 9).

Maintaining good balance (the wider your feet, the more stable you will be), extend (straighten) your arms while holding the ball against the wall. Then flex, or bend, the arms at the elbows to bring your chest in to touch the ball. If you cannot bring your chest all the way to the ball, use as much range of motion as possible (figure 10).

Keep in mind that the smaller the ball, the harder the exercise will be. So you may want to start with a stability ball, beach ball, or basketball/volleyball, etc. Once you feel comfortable with the exercise, you can also change the position of the ball, such as placing it at head or stomach level (figure 11).

Note that it's very important not just to move your head toward the ball or wall. The arms must bend and straighten to benefit from this exercise.



Figures 1 (left) and 2 (right). All images courtesy of Mark Roozen and Doug Wuebben.

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Making a Difference as a Sonographer: Embracing telemedicine

Telemedicine is a powerful and disruptive force in today's healthcare system. For sonographers and others on the front lines of healthcare, telemedicine can be stressful, challenging, and a big change. But it can also offer some of the very best moments for a healthcare worker.

I read with great interest an article titled "Study: Telehealth can be disruptive, threatening for nurses" by Laura Pedulli in the April 22 Ultrasound SmartBrief newsletter from the American Registry for Diagnostic Medical Sonography (ARDMS). Reprinted from Clinical Innovation + Technology, the article cited recent U.K. research that showed telehealth can be disruptive and threatening to staff. As a result, the researchers concluded that management needs to develop strategies to minimize these effects. I have a few thoughts on the topic, but first let me share some information about my background to help you understand my point of view.

For the past 15 years, I have been an echocardiographer -- that is, I do cardiac ultrasound. I am registered by ARDMS in both adult and pediatric echocardiography. I became involved in telehealth early in my career. When I was hired at my current position in South Dakota, there was a need for a pediatric echocardiographer. I gladly accepted the challenge and worked very hard not only to pass my boards, but also to become very good at what I do.

The rural nature of a state such as South Dakota can pose many challenges to healthcare; however, telemedicine can make rural areas feel smaller and facilitate the delivery of high-quality, specialized care that would be found at a larger urban healthcare system. My pediatric echo studies involved telemedicine.

Benefits

The benefits of telehealth were immediately apparent. I was able to plug my ultrasound machine into the telemedicine unit, which in turn allowed my study to be reviewed remotely; whatever was seen on the ultrasound machine's screen was also seen by the pediatric cardiologist on the other end.

A pediatric cardiologist would remotely view my study "live" and see things exactly how I saw them in real-time. This was done

over our system network and accomplished several incredible things:

• Quick performance. A technician didn't have to drive more than an hour to our site, complete the study, and drive back.

• Instant results. Everyone involved immediately knew the study results.

• Clinical effectiveness. Because information was obtained "live," decisions could be made quickly about the clinical course for the patient. Most of the time, this meant reassurance, observation, and a clinic visit down the road for the parents and patient. Unfortunately, there were also some clinical situations that involved an urgent flight to a more advanced tertiary facility. Telehealth enabled immediate, conclusive answers, including which tertiary facility could best handle the situation.

• Parent education. Even with the most urgent pediatric diagnosis requiring transfer, parents could be consoled and educated about what was going to happen. Sometimes knowledge is power, and even the worst news will help you prepare for the battle ahead.

• Brought remote doctors to bedside. The power of telemedicine enables doctors to be in two places at once and provided the best of care, just as if they were bedside.

• Lifesaving information. Back in 2004, I wrote an article called "The sound of success in telemedicine" (ADVANCE for Imaging and Radiation Therapy Professionals, April 19, 2004, Vol. 17:9). It detailed a specific case in which the timeliness, accuracy, and willingness to incorporate telemedicine literally allowed a newborn's life to be saved. Thanks to a quick diagnosis, proper onsite treatment, and an urgent transfer to the proper tertiary facility, the newborn survived.

Returning now to the article reprinted in Ultrasound SmartBrief, I found it to be both informative and interesting. Please don't take my next few comments as being antiresearch; I believe that research is absolutely necessary and a must-have for any clinical situation.

However, I don't need research to tell me that human beings



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are creatures of habit, and most of the time, change in life and/or work will cause stress and disruption. Research does indicate, though, that the implementation of telemedicine is threatening and causes stress and disruption.

Embracing change

As Laura's article states, insights into telemedicine's disruptions were gleaned from a longitudinal qualitative U.K. study published in April in BMC Health Services Research. Being in the healthcare field for the past 15 years has taught me many things, including the fact that the healthcare system is nothing if not constantly changing. If you cannot handle fast-paced, continuously evolving environments, then healthcare may not be a wise career choice. As a healthcare worker, you need to embrace change as a tool for growth and better service to the patient.

My 2004 article detailed four areas to consider for a successful telemedicine program:

• Is there a need for telemedicine? In the rural confines of South Dakota, for example, not only is there a need, telemedicine could and should be utilized more. The same stressors that telemedicine caused in the U.K. also exist for healthcare workers in South Dakota. Telemedicine can be scary and a big change. The point of my article was to try to decrease the stress and show that telemedicine can make a tremendous difference in patient care. Isn't that what we as healthcare workers should be striving for -- even if it is stressful and scary?

• Staff willingness. I've already beat this one to death.

• Fulfillment of needs. You might be in a situation where telemedicine is applicable and you have staff willing to take on the challenge, but would it actually accomplish what it was intended to do? Each facility and clinical situation needs to answer that question on their own terms.

• Local acceptance. In my particular case, were my pediatricians in favor of telemedicine? I'm happy to report the answer was a resounding "yes." A local pediatrician whom I take my own kids to said, "Pediatric telemedicine was the best thing the hospital has done for the pediatricians in this community in the many years that I have been here."

Over the years, our telemedicine service has grown considerably. Currently, the largest chunk of the service consists of consultations with doctors who specialize in infectious diseases regarding infections and the proper antibiotic regimen. Smaller outlying clinics and hospitals have now become telemedicine-capable and utilize the service.

Again, I'm not antiresearch. I just don't always need research to tell me the benefits of my own experience. I want to be a voice for the truly positive and lifesaving benefits that telemedicine can bring to rural areas. Some of my proudest, most tear-filled moments and most patient-benefiting endeavors have been when telemedicine was part of the package.

Making a Difference as a Sonographer: Embracing telemedicine


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Making a Difference as a Sonographer: Shoulder and neck pain

Like so many of my fellow sonographers, I suffered from debilitating shoulder pain. Without regaining the ability to scan pain-free, I would not have been able to make a difference in my career as a cardiac sonographer.

In the first article in our series, I shared an event in my life that made me realize just how important my work as a cardiac sonographer really is. To make a long story short, I had performed a cardiac ultrasound study on a 47-year-old man in our intensive care unit who had received an initial diagnosis of atrial flutter. During the scan, I also suspected the presence of a pulmonary embolus and alerted a cardiologist. My action likely contributed to saving his life.

From my perspective, there are several factors that contributed to this success story. First, I have 14 years of training and experience that helped me recognize a potentially life-threatening issue.

Second, I love my job and take great pride in what I do. I want to be the best that I can be for every patient. I take the attitude that I'm going to give the same effort for each patient as if they were my mom and dad. I don't consider myself to be just a mindless robot taking the same pictures the same way over and over again. I change some of my study protocol based on what the study is showing me.

Third, I am able to scrutinize and slow down when necessary to look at all the nooks and crannies that each study entails. I'm able to do that because I don't scan in pain or suffer from the injuries that plague so many of my fellow sonographers. Because I don't scan in pain, I'm able to take the time to look at what the study is showing me and scrutinize it until I'm satisfied that I have all the information.

Overcoming shoulder pain

Let me give you a brief refresher on why I can scan pain-free. Approximately three years into my scanning career I was suffering from debilitating shoulder pain. Fortunately, I was lucky to speak with my colleague Mark Roozen, a National Football League strength coach, about my pain/injury issues.

Mark looked at my body, my pain issues, the mechanics of my job, and how it involved the ergonomics of my body. He prescribed a set of simple exercises that he said would completely alleviate my pain. I exercised as he instructed and my pain went away -- and stays away to this day. Mark's method worked so well for me that we thought other sonographers could benefit, and we decided to

educate sonographers about corrective exercise.

You may have noticed that I used the term "corrective exercise." The stretching and exercise education that we recommend is designed more for corrective action and not for fitness purposes. Alleviating your pain/injury issues is the goal, although, as with almost any type of exercise, there will also be a fitness component.

Reaching for relief

Chronic tightness in the shoulders and neck, pain that radiates through the neck and shoulders, reduced range of motion, and that stereotypical office worker hunch are the great plagues of modern life.

The situation is made worse because of the U.S. mentality about work: To get ahead, we need to do more!

We want to get ahead at work, so we spend more time at our desk, try to get in one more client, and push to do more and more. But if we spend too much time working in a position with our head forward, shoulders rolled, and hips tucked under, we risk repetitive-use injuries that will start taking a greater and greater toll on our health and performance levels. We will end up doing less, but taking more energy to do it. We work harder to become less effective and efficient!

Very few of us feel we can afford to slow down or take time off. It's interesting to look at other countries and their model of time off, recovery, and ways of refreshing the body. But that's for another article.

Most of us don't have massage therapists sitting behind us at work or waiting in a side office so we can slip in for a quick 10-minute massage. We don't have a trainer or therapist waiting around to provide some corrective treatment throughout the day.

The good news is that for the most part, we can take matters into our own hands. The do-it-yourself approach only takes a few minutes, a few times a day.

As described by Mark Roozen, here are some simple stretches and exercises to help you live pain-free. The exercises can be performed separately or bundled together. A single exercise can be completed in less than a minute, and all three can be performed together in less than five minutes. Another huge benefit is that you can do these sitting at a desk or standing behind your chair; you won't break into a sweat and have to run


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to the restroom to prep yourself to get back to work!

Exercises

Movement No. 1: Overhead reach

Sitting at your desk or standing behind your chair, reach both arms overhead as high as possible, with palms facing in and thumbs pointing behind you (figures 1A and 1B).

Now here's the tricky part: As you extend your arms overhead, push your shoulders back and imagine that you're pinching a pencil between your shoulder blades (figure 1C).

Keep reaching as high as you can, and at the same time exhale as if you are blowing out five huge candles (figure 1D). Inhale through your nose and exhale through your mouth. This should open up your chest, allowing you to breathe easier while at the same time relieving stress and strain in your neck and shoulders.

Movement No. 2: Thumbs-back reach

Sitting at your desk or standing behind your chair, extend both arms down by your side. This time, open the palms to the outside, rotating the hands so the thumb is again pointing behind you (figure 2A).

Again, think of pinching that pencil between the shoulder blades while sitting or standing as tall as possible (figure 2B).

While continuing to reach back as far as you can, once again blow out those five huge candles. Inhale through your nose and exhale through your mouth. This is another great movement to open up your chest and allow you to breathe easier while at the same time relieving stress and strain in your neck and shoulders.

Movement No. 3: Head-to-shoulder reach

In a seated or standing position, make yourself as tall as possible. With this movement, imagine that someone is pulling you straight up from the top of your head (figure 3A).

At the same time, push your shoulders down and back, pinching that pencil once again.

Slowly tilt your head toward your shoulder. Picture trying to place your ear on top of your shoulder (figure 3B).

Now, slowly and gently rotate your head, bringing your chin up toward the ceiling, while still trying to keep your ear on your shoulder (figure 3C). Be sure to do both the right and left side to get great neck relief and relieve muscle tension in the upper neck/shoulder area.

Figures 1A and 1B. All images courtesy of Mark Roozen and Doug Wuebben.

Figures 1C and 1D.

Figures 2A and 2B.

Figure 3A.


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You can do all three of these exercises two to three times a day, or any time you start to feel tension build up throughout the day. In our next session, we'll show you some great movements to help relieve tightness in the chest, shoulders, and lower back.

Figures 3B and 3C.



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Making a Difference as a Sonographer: Help this person

Much of the time, daily life throws you the same old "stuff." The daily humdrum of life is inevitable for all of us. Monday turns into Wednesday, Wednesday runs into the weekend, one week runs into the next, and pretty soon you've made it through another month.

Work, home, kids. Work, home, kids. And so the cycle continues. As a sonographer, you go from one patient to the next, trying to make it through another busy day with too much to do and not enough time or help to do it.

Every once in a while, though, life throws you a curve ball that changes your perspective. I had one of those the other day, and I wanted to share it with you. It was a great reminder to me that simply doing my job well makes a difference in the lives of others.

A 47-year-old man had come into the emergency room with symptoms of fatigue and shortness of breath. An electrocardiogram showed that the relatively young man was in a cardiac arrhythmia called atrial flutter. For my noncardiac sonographer readers, that means the heart's electrical circuitry is out of whack.

In essence, the top two chambers of the heart are not communicating with the bottom two chambers. This would cause symptoms of fatigue and shortness of breath. The man was admitted to our intensive care unit (ICU) and started on our atrial/fib/flutter protocols, including an echocardiogram.

Remembering the 'why'

I have been doing echo for about 14 years now and have worked on thousands of patients. I know what I'm doing. I'm good at it, and I pride myself on providing quality work. But at times I have forgotten the "why" behind what I do.

During this patient's echo, there were several echo indicators that revealed evidence of a pulmonary embolus (PE), which is a blood clot or clots in your lungs blocking blood flow to the lungs. This condition can be life-threatening if it is not treated and recognized quickly.

After completing the echo, I contacted the cardiologist and relayed my findings and my suspicions about the pulmonary embolus. The cardiologist

then ordered a PE protocol and the patient was taken to CT for a lung scan. While en route from CT back to the ICU, this patient coded twice. Both times he was successfully resuscitated.

The CT showed a massive PE, treatment was initiated, and ultimately it was successful. The patient fully recovered and is now back at work and able to undertake the demands and responsibilities of family life.

After the process had run its course, my cardiologist approached me and thanked me for calling him. He explained that PE initially was not one of the differentials, and that the echo I did and the recognition that it was a likely PE probably saved the patient's life. He praised me and gave me recognition that, while unnecessary, sure felt good.

Going the extra mile

The whole process got me thinking. How many times do we go through our day, working on each patient just to get the procedure done for the doctor to read? We do what we have to, but do we go the extra mile? It happens to me; does it happen to you? This one study really helped change my perspective.

This may be your 10th study of the day, and you are worn out and tired. After you leave work, the lawn needs to be mowed, kids need to be picked up, and supper needs to be made. Then there's homework, laundry, cleaning, bills ... a lot of "stuff."

Everybody has a lot of stuff. I have a lot of stuff. What I also have, though, is an obligation and a duty to every patient whom I work on. It is to give each patient my best attention and the best study I can based on my skills, abilities, and experience.

Does this sound grandiose, altruistic, and unrealistic? It is none of the above. Think about if you were working on your mother, father, spouse, or child. Would you bring a different level of work, intensity, and focus? Even if you were tired and had a lot of stuff to do?

When you are working on someone, think of them as your family. Do the best that you can, and get it as perfect as possible. Anything less is unacceptable.

'Help this person'

I recently read an article, "Three Words That Will Transform Your Career," by Bruce Kasanoff. Bruce wants us all to realize what a difference we can make in people's lives and in our lives, if we



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just follow these simple words: Help this person.

Whenever you encounter someone during your day, flash that mantra into your head. If you are at a coffee shop standing in line: Help this person. If you are at the grocery store: Help this person. If you are at work: Help this person. If we all took that mantra, think of what a better country this would be.

It sounds odd, but since reading that article I've taken the phrase to heart and used it over the past couple of days. Since then, I have been a better person. I've been a better husband, a better father, and I've done better at work, all while feeling better about myself.

Life isn't meant to be as crazy complicated as we make it. Help this person: It's simple but effective. I will never be president of the United States. I will never run a large organization. I will never make a $1 million salary. I know that, and I am at peace with that.

My place on Earth has to do with making a difference, doing what I do. This is one way that I make an impact. The only person who will know if I do or do not follow this credo is me.

In this article series, my colleague Mark Roozen and I will discuss how taking time to care for yourself and making the best "you" enables you to have a huge impact on the life of others and on yourself.

Making a Difference as a Sonographer: Help this person


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Exercises can help sonographers scan without pain

I was scared and stressed out. With my shoulder areas in constant, near-debilitating pain, I didn't know if my body was going to allow me to physically be able to continue my career as an adult and pediatric sonographer. And I know I'm not the only one who has been through this experience.

However, for several years now, I have been able to scan completely free of pain, all thanks to a movement training program. I was lucky because I had access to a National Football League (NFL) strength coach, Mark Roozen. After complaining to him one day about my issues, Mark took a look at the mechanics and the ergonomics of my job and gave me some great news: Exercise would help me.

Mark showed me how to exercise by doing the right exercises in the right ways. I did what he said, and in a short period of time, my pain lessened and then ultimately went away. I don't worry about the pain coming back. I do my exercises and life is good. I not only get the benefits of pain-free scanning, I get the benefits of the exercise itself.

I didn't have to spend hours in the gym or hundreds of dollars a year on gym memberships or home workout stations. I saw the majority of my improvement using just resistance rubber bands. A 20-minute workout, three times per week, gave me the joy of pain-free scanning. Once I started my exercise routine, I found that it wasn't hard to incorporate more of a wellness-centered approach into my workout and my life.

Here are some movement training exercises from Mark that can help improve back, hip, and shoulder pain. For additional information, see AuntMinnie.com's previous four-part Scanning in Pain series: part 1, part 2, part 3, and part 4.

Multidirectional exercises

During training, we need to remember that we must train movement and not just muscle. What do we mean by this? A person can't just do bicep curls and leg extensions and expect to move better and have the body function better as a whole unit. As we look to set up training programs, the majority of the program should be exercises that include multiple body segments, with some muscles being used for movement, others being used for stability, and others for support. By training in this method, the body can function better as a whole unit, which allows for better "performance," whether that is doing a job, enjoying a hobby, or just improving your everyday life.

The following combination of exercises are great for working the hips, lower back, abdominals, shoulders, and upper back. Doing all the exercises in order will allow the body to train like it moves; in multiple directions, with muscles working in different combinations based on the movement. This allows the individual to feel the whole body work, not just one isolated muscle. It's a great workout for beginners, and as you progress into your workout program, it's a great warm-up that takes less than 10 minutes to accomplish.

To begin, lie on your back on the floor. A mat can be used to soften what you are lying on, but you don't want it so soft that you don't have some type of support for proper movement.

Same arm and leg, from the supine position

While lying on the floor on your back, extend your arm over

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