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The worst bone to break

April 30, 2019

What do you think is the worst bone to break?  Most people would probably say the thigh bone, pelvis, or maybe the jaw. 

Occupational therapists see things differently.

According to Courtney Engel, OTR/L, her years of experience have proven that “The elbow bones are the worst bones to break in the whole body.”

Occupational therapy—despite the name—does not have to do with a person’s job.  At least, not entirely.  They help people manage and improve their day-to-day activities, including their jobs and all other activities that go into daily living.  Putting on a coat, brushing hair or teeth, getting in and out of bed, reading with vision loss, and the list goes on.  OTs even help patients with Parkinson’s Disease find ways to manage their fine motor skills through adaptive equipment and improve reaction times of stroke patients by teaching verbal and visual cues.  OTs combine strengthening exercises, tools for making tasks easier, and cues to retrain how patients think and respond.

The breadth of what goes in to daily living is difficult to summarize.  Occupational therapists enable people of all ages to live life to its fullest by helping them promote health and live better with injury, illness, or disability.

When accidents or surgeries immobilize part of the body, the challenge is finding a balance between adapting to the lack of use and trying to exercise it enough that recovery can happen.  For example, when someone has broken fingers, it does not take long for them to adapt to relying more on the other hand, the remaining fingers, or using other parts of the body to accomplish whatever is needed.  Adapting is good.  However, patients can become too comfortable using alternative strategies; when the fingers are healed enough, it is more important to practice range of motion and strengthening of the fingers.  If they are not exercised enough, the joints could stiffen and the muscles could weaken, making the recovery much longer and full motion more difficult to achieve.

That is the challenging part about elbows.  First of all, the elbow is extremely important for controlling where your hands can reach and how much you can carry.  When the elbow is broken, it is difficult to pin the bones in place because there is so little tissue around it.  By the time the elbow is healed enough to safely exercise and begin rehab, it is already on its way to stiffening.  As a result, regaining full motion in the elbow is difficult.  Despite the challenges presented by the elbow, OTs are trained to apply an array of techniques and exercises to gain and maintain as much function as possible.

Many people do not know what Occupational Therapy is, or confuse it with Physical Therapy.  PTs focus more on leg strength, balance, and mobility.  Regardless, every patient referred to medical rehab is assessed by both an OT, such as Courtney, and a Physical Therapist, to find out what needs to be improved. 

Courtney said she starts her assessment with one request:  “show me how you put on your socks.”

(Perry Memorial Hospital's Medical Rehab Department offers Physical, Occupational, Cardiopulmonary, and Speech Therapy.)