Having moved to Poulsbo from Florida, Kay Bass, 64, wasn’t used to freezing rain. One morning in February, she was walking across a street, but despite being careful, she fell in the crosswalk.
“I thought it was dry, but it was really icy,” she said. “I fell in the hurdle position, right on my sit bones. And I was wearing a backpack so I had additional weight on me when I fell.”
Instantly, she knew she’d done something to her back.
“People were wanting to help me up, but I just wanted to sit there for a moment and get my bearings.”
When she did get up, she knew she was going to be sore. But she was on her way to Seattle and had things to do that could not be put off.
“There was no going home,” she said. “And that night, I was sore. I had trouble bending forward and I couldn’t roll over in bed.”
She decided to give it a couple of days to see if the pain and soreness improved, but it didn’t. So she sought out physical therapy.
“I knew my insurance would allow me to be seen by a physical therapist, and then the PT could request a prescription for treatment from my doctor,” Bass said. “I saw Kara (Bermensolo, DPT) and after a thorough evaluation, she said I should go to my doctor and request an X-ray.”
Bass did that, also receiving an MRI, and it was confirmed that she had a compression fracture of a vertebra. Her orthopedic specialist told her that the fracture would heal on its own and that she needed to return to physical therapy.
“Kara worked with me and gave me exercises that she knew would not result in any more injury,” Bass said. “Gradually, I’ve been able to increase my activity, but it’s been a long haul.”
Having been very active prior to the injury, Bass has not yet returned to her normal weight-lifting routine or rowing. But she has been able to increase the length of her workouts, just not the intensity.
“I am lifting weights again and walking my normal amount of time,” she said. “It may take six to eight months to heal completely.”
She’s now doing her exercises on her own, and recently returned to check in. She knows that if soreness after a workout remains after 24 hours, she needs to back off a bit.
“I can tell when I’ve overdone it,” she said.
Overall, she has found physical therapy, and the care she received at Kitsap Physical Therapy, rewarding.
“If Kara hadn’t sent me to the physician, I could have done more damage and been down longer, or even had to have surgery,” she said. “The care I received has been wonderful. The physical therapy has helped so much and they’ve been so reassuring.”
Physical therapist Kara Bermensolo, PT, DPT, CLT, PHC, Kitsap Physical Therapy, Poulsbo, saw Bass about a week after she fell and was injured. Because Bass had insurance that allowed her to see a physical therapist before seeing her primary care physician (Direct Access), which has been the law in Washington State since 2005, Bass got a jump on her condition. She didn’t have to wait to see her physician and then be referred to physical therapy.
Bermensolo’s first actions were to take a patient history, including details of the fall and of her routine health. This also included what medications she takes and any conditions she had previously been diagnosed with. When Bass said she had osteopenia, that raised a “yellow flag” with Bermensolo.
“I know that people with osteopenia are more susceptible to bone fractures,” said Bermensolo. “I checked her range of motion, her strength and I took a look at where she had pain along her spine.”
At each pressure point along the spine, she applied minimal pressure to try to re-create the pain. She discovered that at her mid-back there was pain with very little provocation.
Because of that, Bermensolo decided Bass should be seen by her primary care physician of record, who then sent her for an X-ray and an MRI.
“It showed that she had a compression fracture (at mid back),” Bermensolo said. “When Kay heard that, she began to worry. We talked on the phone and I assured her that in her case, with training and proper movement, she would most likely be able to return to her normal lifestyle without surgery.”
An orthopedic specialist was consulted and determined that she didn’t need surgery and that the fracture would heal on its own. To speed that process along, Bass returned to Bermensolo for physical therapy.
Together, they came up with a treatment plan that included once a week visits for two weeks, then once every other week for a month. She recently had her final visit. In all, she saw Bermensolo for eight sessions.
The therapy included education about pain including the fact that where a person feels the pain may not be the place it originates from.
“Kay was feeling pain in her low back on the right side,” Bermensolo said. “But the injury was actually at mid back.”
They worked to strengthen her core by doing isometric exercises such as banded chest presses and banded lateral chest pulls.
“This was to engage the back muscles without moving the body,” Bermensolo said. “Because of her fracture, we wanted to selectively restrict her movement until the fracture healed.”
Next, Bass advanced to neutral isometric activity such as walking and swimming. She did both activities prior to her fall and wanted to get back to her normal amount of activity.
She began with walking about a mile, and added two minutes each day, until she was back up to two miles, and then three miles. Then she added in swimming, adding laps each day.
“Her activity was paced in small achievable chunks,” Bermensolo said. “We had to retrain the body and the brain that walking wasn’t something that causes pain.”
Bass also added in functional movements like squats, getting down on all fours, and planks. For an injury like Bass’s, normal recovery time would be from six to eight weeks. But with her osteopenia, Bermensolo said it can take up to 12 weeks.
“She’s been very successful,” said Bermensolo. “Healing is very individual. In Kay’s case, she did all the right things and was patient with her recovery.”
Leslie Kelly is special sections editor for Kitsap Living and the Kitsap News Group. This story first appeared in the Spring 2017 edition of Kitsap Living: The time of your life.