Dr. Anique Walters, PT
Concierge and lifestyle Physical Therapy
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Empowering YOU Through Movement

Concierge Physical Therapy blog to empower patients with health, wellness, prevention and rehabilitation education to improve their lifestyle and overall well-being. 

Descartes' Pain Theory is Wrong

Descartes' Pain Theory is Wrong

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The research disproving René Descartes' 1654 pain model is as cohesive as that against the world being flat. Follow @doc_aaw for some modern truths about pain!
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What is wrong with Descartes model?
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There is no such thing as a "pain" nerve. It does not "detect" pain. It does not "send" pain.
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So what happens?
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The nerve detects some sort of change to the tissue. It sends a message of "danger" to your brain. Your brain weighs the situation based on numerous past events and sensory information and determines how much danger you are in. Your brain THEN sends your nerve a message telling it how to react.
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Pain is a complex, instantaneous conversation. A two way street. Not a one way valve.
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See my story today for more info on this process!
-AAW

Know Pain or No Gain

Know Pain or No Gain

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Follow @doc_aaw this week to get to Know Pain!
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The first step to knowing pain is recognizing that there is no pain without the brain.
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Your brain uses a compilation of all your previous experiences, knowledge, sensory information, etc to determine the "appropriate" pain response to a threat. Sometimes this system malfunctions 🤷🏼‍♀️Luckily, it is possible to re-train your brain to be more levelheaded (pun intended). We need to stop thinking of pain as having one cure or one source if we really want to change pain.
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-AAW

#FAQF... "Addiction? Opioids? Heroin?.... Physical Therapy?"
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 “Addiction? Opioids? Heroin? …Physical Therapy?”… Ok so I get that this isn't really a question but Addiction and Opioid abuse have become a tremendous epidemic in America over the past few years and it hits close to home for just about everyone I know. In fact, the CDC reported 33,091 overdose deaths in 2015 alone, and the U.S. Surgeon General reported that over 21 MILLION Americans in 2016 suffer from drug and alcohol addiction. That officially makes this disorder more common that cancer!
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This disorder knows no gender, race nor socioeconomic group. No one is immune. In fact, one of my former patients is an ER room nurse at a prestigious hospital in Santa Monica and she told me that the drug of choice in Santa Monica is heroin. HEROIN!
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YES. This is a DISORDER! As a society we need to drop the stigma behind addiction, and as a medical community we need to hold ourselves accountable for being a part of the problem. The use of Opioid pain medications has quadrupled in the US, despite an overall change in reports of pain. So IMO that means as a medical community, not only are we not actually treating pain, we are in part responsible for the 91 Americans that die every day of an Opioid overdose. This is where Physical Therapy comes into play.
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Pain is complex. Pain is misunderstood. Pain is confusing. But pain is our body’s way of asking for change. Not an addition to mask the pain. A true change.
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I have decided to take the next few posts to breakdown some Pain Science in bite size portions in order to spread the word that there is another option. Opioids are not the only choice.
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So I leave you with a quote from C. Shante Cofield in hopes of beginning to open your mind to the science behind pain… pain occurs when “the NERVOUS SYSTEM senses a problem and is asking for you to fix it. True pain is NOT something that occurs in the tissues. Rather it’s the summation of your environment and experiences in your past”. -AAW

Anique Walters
I know you can, but do you?
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The most important part of my job is to empower you to believe in you. It is OK for your why to be yourself! Please don't see this as being selfish, see this as being self-ish 😉

#FAQF... "What is all this Blood Flow stuff?"
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“What the heck is this blood flow stuff?”…. OMG you guys! I feel like a kid that just sent her letter to Santa and now I am anxiously awaiting Christmas morning. Here's a brief intro
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The concept of blood flow restriction training for rehab started in the US military. The nature of warfare is constantly changing and so too must the medical world. These medical advancements have allowed for a tremendous increase in survival rate of our soldiers, but as a result, the complexity of their traumas have also increased. To promote a healthy recovery and return to function, a big push for limb salvage began rather than immediately turning to amputation. So the Center for the Intrepid in San Antonio, TX began using this FDA approved grade one medical device tourniquet system by Delfi, that is typically used in operating rooms throughout the world, to help promote healing. The results have been remarkable and the usage for civilian life is outstanding.
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We all know how hard it is to build muscle. Not only is it time consuming, often expensive, and hard work it also is very metabolically expensive so it is difficult to see the results you want. In a rehab setting, you often are not allowed (surgical precautions, tissue loading restriction, endurance levels, etc) to reach the level of intensity required to actually build muscle. The studies show that with this system you will get equal results at 20-30% 1 RM compared to 70-80% 1RM in a HITT class. Or 15 min of cardio compared to 45 min without it.
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The implications for the general public are incredible. Post surgically we will be able to build strength earlier. Return to function will happen faster. Elderly people will be able to improve endurance and strength in a tolerable way. Strength improvements in people with neurologic disorders will be possible to a degree to which they never have before. People in comas will be able to maintain some degree of muscle tone. The possibilities are seriously endless.
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The NBA, MLB, NHL, NFL, MLS, military, and astronauts are using this technology. And once I get it in the mail, YOU will get it too!
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How can this help you?
-AAW

Anique Walters
Fight for something!
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Now that the Mayweather-McGregor fight is over and the Sunday Scaries are starting to set in, I started thinking about how important it is to fight for something.
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Over the past few weeks I have witnessed the mental, physical and emotional tenacity of a friend and a family member that are both fighting like hell for their lives. They have inspired me to want to fight harder. And I believe it takes facing something you fear head on to develop that type of grit.
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So I signed up for the LA Marathon. I recognize this does not hold an ounce of weight compared to what they are going through, but it is something I fear and that quite frankly I don’t want to do. It will take mental, physical and emotional toughness. It will hurt. I will want to quit. But I will survive. And it will teach me to fight.
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And now that I have told all of you, I can’t back out!
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What are you fighting for and what opportunities are you taking to strengthen your grit?
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26.2 I'm coming for you March 18th, 2018-AAW

Anique Walters
#FAQF... "Running? Are you crazy?"
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 “ummm…running? Are you crazy?! That is SO bad for your hips and knees!!” … This is one of the most common questions that I have gotten over the years and there is finally fantastic research to support my answer to this question. Yay!
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For 15+ years my life consisted of changing from one uniform to the next in the car, unlacing cleats and lacing up spikes, traveling around the midwest from one court to the next field. Blissful chaos. Amidst the chaos though, there was one constant. Running
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Running is so pure. So free. And so instinctually human. Hard. Yes. Tiring. Yes. But human
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If you take any able bodied human being, from anywhere in the world, she will naturally know how to run. It is a necessary survival skill. We do not teach people to run the way we teach riding a bike or swimming, we just do it. Can we say the same about any of the other “cardio” workouts we do? So how can something so inherently human be SO bad?
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I believe that it is not the movement itself that is bad, but rather poor quality of movement that is bad. My greatest skill is my ability to watch and analyze movements. To determine where your inefficiencies lie. Finding areas your body is not dissipating force how it should. I refuse to blame the exercise or the sport but rather the inability to synergistically transfer energy from one position to the next. And finally, there is some data to back this up.
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A recent Systematic Review and Meta-Analysis (the highest quality of evidence based medicine research) that complied data from 125,810 individuals has shown that control subjects (non-runners) had an overall prevalence of hip and knee OA of 10.2%. Recreational runners… 3.5%.
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Running is not the problem. Inefficient movement patterns are. Scientific encouragement for you to take the time to see a movement specialist rather than just attempting a video you see someone else do online. Please reach out with any questions or if you need help getting started- AAW

Anique Walters
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Too often I hear health care providers refer to their patients as his/her diagnosis. If you are discussed as a generic ailment rather than as a unique individual, I fear your treatment plan will also be generic. Help create a patient centric community by speaking up when you hear this type of chatter...My why is you-AAW #wellnesswisdom#beyourownadvocate #allaboutyou #awpt#simpletoseismic

Anique Walters
My WHY is YOU!
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I have recently done a lot of thinking about what the purpose of me being on social media is. I even considered just stopping all together. There is something strange about how wanting follows and likes can deter you from what is really important. To start, the word “follower” doesn’t sit right with me. I am not looking for people to merely follow my vision for change, I am looking for team members that want to advocate for my vision for change
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A recent theme in my life has been why. Not what. Not how. WHY. So today I re-start my social presence by bringing my focus back to my why. I changed my handle to something more authentic to me and I am posting part of my video to re-ground myself to my why
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My why is YOU
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We fight day in and day out to embrace our individuality and I believe your health care treatments should too. You are unique and you should be! So why should your plan of care and treatment be generic? Even if you have the same exact problem as your neighbor, your treatment needs to be different because your experience and your needs are different. Anything short of a highly individualized plan of care specific to you and your world is essentially a shot in the dark. I hear far too often that “Physical Therapy didn’t work for me” and it’s not that PT didn't work, it was simply that it wasn't the right PT treatment for you
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My page is here to inspire change within an industry that is in desperate need of an update. As PT's we have the knowledge and the skill, now we just need the support
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I invite you to be a part of my team. If you believe what I believe, please help. Share. Post. Talk. Call. Blog. As @jenniferaakersays in The Drangonfly Effect, “you don’t need money or power to cause seismic social change. With energy, focus, and a strong wireless signal, anything is possible." .

Anique Walters
#FAQF... "Umm.. what? You want me to roll around on the floor? What the heck is the point of this?"

#FAQF… “Umm.. what? You want me to roll around on the floor? What the heck is the point of this?”…Remember a few weeks ago when I posted about how important breathing correctly is? Well hopefully you have been practicing and are now ready for stage two.  

 

Rolling. 

 

Go ahead. Try it.  

 

Lie on the floor. Hands up over your head. Legs straight. Using only one arm, try and get your entire body to roll over. Stop! Don’t use your other hand or your legs! You can only use the muscles of the one arm. Did you do it? Can you roll back over? Try the other arm. Now one leg. Now the other leg. 

 

What did you find? Easy? Hard? Arms vs Legs? Right vs Left? Interesting…

 

So why is this important? Rolling is the first large scale gross motor skill that human beings accomplish and it is a key to motor development for both reflexive and intentional movement patterns.  The action requires coordination and appropriate timing of muscular engagement of your upper body, lower body, and core in a multiplanar fashion.  It requires motor planning, righting responses, control, balance, proprioception, and so so much more. All of these skills are fundamental for dynamic movement which is why I spent a few hours helping a little 7month old learn to roll this week (yes, I treat babies too).

 

Rehab specialists often lose the forest for the trees and neglect to consider factors outside of the single plane musculoskeletal world.  Sure ROM and MMT can give you some insight but look at how much we can observe the quality during rolling.  This gives me a much more wholistic and comprehensive view into your functional capability.  And after all, isn’t that what we are hoping to accomplish? Functional Freedom? 

 

If you are someone that seems to always have one body part not feel quite right despite working out regularly and doing your home exercise program, it might be time to dig a bit deeper.  Your standard exercises will no doubt help you get stronger, but most will not challenge your body in a multidimensional way thus having minimal impact on your overall motor control i.e. quality human movement. There is a reason the strongest player usually isn't the best athlete on the team. So do NOT stop strengthening, but DO strengthen smarter.  

 

Check out www.functionalmovementsystems.com to help you find a qualified specialist or look into Gray Cook.  He is the rolling guru!!

 

Now lets Rock n’ Roll.  Happy Weekend! 

 

Anique Walters
#FAQF... “ugghh…why can’t I wear flip-flops?”

This is a perfect question for the heat of the summer.  I totally get the allure of flip-flops and I am not big on giving people a hard no on stuff they like, so my advice is everything in moderation.  Come on, I wouldn't expect you to wear gym shoes to the beach (yes, I am from Chicago and I do call them gym shoes). But I will highlight a few of the real bio-mechanical reasons why flip flops shouldn't be your go-to shoe

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Your foot is made up of 26 bones, 33 joints and over 100 other structures for two main reasons. 1. to negotiate all types of surfaces 2. to disperse the force that goes through your body with every step

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So with flip flops, your toes have to grip the shoe to make sure it doesn't fall off.  This gripping changes the muscle recruitment patterns in your entire lower extremity which throws everything off. This can lead to hammer toes, bunions, plantarfasciitis, achilles tendonitis, knee pain, hip bursitis, osteoarthritis, and even low back pain… huh? How??…

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Your stride length and stance time will both be shortened, your plantarflexion (pointing your toe) will be lessened, tibialis anterior activity will sky rocket causing co-contraction of both the dorsiflexors and plantarflexors to be more active.  This essentially makes your foot and ankle complex a rigid structure (Yikes!), making it harder to walk safely on uneven surfaces and changing the ground reaction forces through your leg

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The changes don’t stop there.  Because you aren't getting normal motion through your ankle, you end up having to hike your hip to clear your foot without losing your shoe.  This hip flexion strategy just increases the work in our iliopsoas muscles which definitely do not need it! This muscle group is one of the main contributors to low back, hip, and knee pain so we do not need to make it work harder than it already does. . 

Moral of story. Try to get sandals with a heel strap. Avoid running, jumping or walking long distances in them. Stretch, wiggle your toes, and roll out your feet after. Be sure to wash your feet too! Never know what you walked through! 

Have a great weekend

Anique Walters
#FAQF..."

#FAQF… “Do I really have to warm up? What should I be doing? Can’t I just do a stretch or two?”… Yes, warm ups are key! But what you should actually be doing may look a little different than what you may think. 

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The point of a warm up is to prepare your body for dynamic movement.  This means your body needs to have both compliance (mobility) and stiffness (stability). Your body is like a spring. To jump you need to have length to get the maximum amount of oomph out of your muscle to propel you up, but you also need to have stability when you land to absorb shock so you don't fall over. 

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Our brain is the main thing that controls both of these factors.  Think about it, you have much more hamstring length when you are under anesthesia than when you are awake. So a warm up is there to help your brain stimulate the Sympathetic Nervous System (fight or flight) to increase the excitability of the tissues. Sounds pretty important when you put it that way, right?

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In order to kick the SNS into gear, you need to spark a specific type of mechanoreceptor called the Pacinian Corpuscles.  These guys will up regulate your system, turn the SNS on and will ultimately make your Proprioception, the ability to know where your body is in space, improve.  Proprioception is the key to all dynamic mobility thus making a warm up essential for performing at your best. 

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Pacinian Corpuscles are activated by quick, rapid pressure/vibration. So your warm up should include quick 10 second bursts of rapid movement. This can be on a foam roller, a ball, a stick, an IASTM tool, etc.  Now you know why Fighters jump up and down and slap themselves before they get in the ring? 

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Sustained pressure/shearing, such as a stretch, actually will stimulate a different type of mechanoreceptor called Ruffini Endings.  These activate the Parasympathetic Nervous System which actually down regulates your system, doing the exact opposite to what you want.  

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DM or email me at anique@aniquewalters.com for warm up exercises individualized for you. As always, a generic program ins’t ideal as we are all unique and require different types of input. 

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PS check out the incredible @jessielevine pictured above on @Foxnetworks episode of @superhuman! Talk about killer proprioception! 

Anique Walters
#FAQF... "What can I do for injury prevention?"

#FAQF…”What can I do for injury prevention?… So this week I got the opportunity to speak on this topic @spaldingball’s basketball IQ camp hosted by @demar_derozen which was incredible and wanted to share some of the info with you all. I want to start by saying that using the term injury prevention is false advertising.  We can REDUCE injuries, but there is no way to completely prevent injuries. Ok, now on to the good stuff.

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I am a jock. Plain and simple. Sports run through my veins. But \not everyone out there is but this information is still relevant to you so don’t stop reading! Whether you are a young superstar, a yogi, a runner, cross fitter, this information applies to you. The key is versatility. I will repeat. Versatility. 

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Yesterday I asked what MJ, Kobe, and LeBron all have in common, and it is that they all played multiple sports.  Versatility.  In fact, 222 of 253 NFL draft picks this year were multisport athletes.

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Why is this relevant? By focusing on one sport or one activity your body is only getting the input from that specific sport. To be healthy, we need multiple forms of input.  Each activity has different movement patterns, different sensory and visual input, differing aerobic vs anaerobic requirements so by participating in multiple activities you are training your body to handle more. You will be less likely to have overuse injuries. Less likely to burn out. And you will be better as an all around athlete.

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We are a competitive society so we tend to over do things. So I encourage you to not just do yoga. Don’t just play basketball. Don’t just run.  It will help save your body. 

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Allow yourself time to recover.  Recovery is essential. Hydrate.  Your muscles need fluid to work at their peak.  Sleep. Your reaction time needs rest to work at its peak. 

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And finally. Focus on the basics. Jason Wells said it best on Tuesday… “fundamentals before fancy”.

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Reach out if you have questions or want more specifics!

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Work hard. Work versatile. Work smart. 

Anique Walters
#FAQF... "They say sitting is the new smoking. Can you help me with my posture?
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#FAQF… “They say sitting is the new smoking. Can you help me with my posture? I have the whole ergonomic set up but I am so uncomfortable at my desk by the end of the day”… I LOVE this question!! And this is the topic of the majority of my corporate talks.  We all spend so much time at work and at desks that it is essential for bodies to really understand the answer to this question.

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Often times when people think of posture the words that come to mind are things like “straight” and “upright”,  both of which are static terms.  Those static words are important, but as humans, we are movers.  Our bodies were not created to be static or fixed. Rather we are meant to be dynamic and adaptable. The key to good posture is variety and variability.  Sitting in even the most ergonomically correct posture for hours on end will overload those tissues, cause shortening in the gastrocs, hamstrings, hip flexors, pecs, SCM, and upper traps.  It will cause weakness in your gluts and weakening of your abdominal wall (umm hello core?!).  It will increase the load on your Sacroiliiac Joint, SIJ ligaments, posterior annulus, and the posterior aspect of the vertebral column. Your erector muscles and middle traps will stay eccentrically loaded the whole time.  

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Rather than imposing rules and regulations on you for how exactly to sit, I want to give you a few tools that you can use throughout your day to best benefit YOUR body’s needs.

  1. Move around- walking around is best but that isn't always feasible. So try: ankle pumps, marching in place, bending and straightening your knees, cat-cow in your chair, wrist circles, shoulder circles, neck circles.  Any movement that you can do to OPEN the front side of your body and RELAX the back side of your body.
  2. Change positions- if you sit with your legs crossed, fine, just make sure you switch legs every so often. Equal opportunities. Try moving your mouse to your left hand.  Move your coffee or your water to the left side of your desk. Scooch forward in your chair. Lean back in your chair.  Stand. Sit on a stool. Sit on a ball.  Mix it up every 30 minute or so. 
  3. Drink lots of H20.  Not only will you feel better, but it will also force you to leave your desk to pee ;-) 
  4. Listen to your body.  I’ve treated thousands of people and dissected many cadavers so I can tell you for certain that no two of us are exactly a like. We are not symmetrical beings (I mean hello our lungs aren’t even symmetrical!). So do what feels best for you.  But be sure to stay moving. 

So, is sitting really the new smoking? Eh, not really. It is actually good for us to sit for certain things.  Immobility is really more like the new sitting.  It just doesn’t have quite as nice of a ring to it. DM me if you want to chat more about your posture and specific exercises for you.

 

Happy weekend.  Get out and MOVE! 

Anique Walters
#FAQF... "How come my symptoms don't always coincide with the ones on webMD?"

#FAQF… “How come my symptoms don’t always coincide with the ones on webMD?”…There are a million and one ways to answer to this question, but in honor of Father’s Day this weekend, lets break it down to the physiological basics.  Birds and the Bees. Pathophysiologically there are many discrepancies between men and women.  This means that based on our DNA, the way men and women manifest disease is actually quite different.  During late 70s to early 90s, women of reproductive age were excluded from medical studies for ethical reasons. This skewed medical research results in favor of male symptomatology. This is why, for example, left arm and severe chest pain were known as the heart attack symptoms but women rarely present this way. 

 

Understanding these variances during your rehab or training will make you safer and more successful in achieving your goals. Please be mindful that they are not for judgement, but for your own health. 

 

In gross terms, men have larger hearts and lungs, and women have larger livers, stomaches, kidneys, and thyroid glands.  Men have a higher oxygen carrying capacity but women more efficiently convert glycogen into energy. Men have larger and longer bones providing a better foundation for muscular leverage yet women have a wider set pelvis and lower center of mass allowing for better balance.  To allow for babies, women’s ligaments are more lax making them more flexible but predisposing them for injuries in sports.  

 

Makes you think that perhaps not everyone’s body is intended to do a squat exactly the same way? Or maybe not everyone’s downward dog should look the same? Maybe there isn’t one perfect shoe? What about the perfect pillow? Diet? You catch my drift

 

These differences need to be kept in mind when comparing to normative values, setting goals, prescription exercise and analyzing movement.  We are so lucky to have access to so many exceptional blogs, websites, and instagram accounts with health, wellness and fitness advice but it is crucial to have some input from a professional to ensure that you are doing the right thing for YOUR body and who YOU are.  It is just like fashion, just because it looks good on someone else doesn’t mean it will look good on you! 

Anique Walters
What does it mean to be Humble and have Gratitude?

 Over the past few days I have come to recognize what it truly means to be humble and what it means to have gratitude. These two words are thrown around over social media as if they are easy to come by, and let me tell you, they aren’t.  We shouldn’t be made to think that they are either.  It waters down how exceptionally unique it is to find someone that is truly humble. And how rare it is to find something or someone that makes you feel genuine gratitude.  

I spent this past weekend in an anatomy lab dissecting cadavers that had zero preservatives, so they were naturally decaying donors.  Now before you get squeamish and stop reading, I challenge you to see the true beauty in the act of complete selflessness of these donors to allow me this privileged experience. They donated their entire body to help a complete stranger learn.  They do not get recognition. They do not get fame. They do not even get thanked! Now to me, THAT is a true display of what it means to be humble.  Having the power to enhance a stranger’s life with zero expectation or desire for even a response.  That is sublime. The first thing I do before beginning any dissection is give the donor a name, then shake his or her hand, and say thank you.  It is an overwhelmingly emotional ritual but it is the most graceful way I can think of to approach the experience we are about to have together. The scientist in me touched, saw, and smelled things that changed the way I think about anatomy but more importantly the human in me learned the true meaning of gratitude.  

They say true happiness comes from having gratitude with no agenda. So I welcome you to undertake an act of kindness with no expectation of thanks and to appreciate someone you may not be able to thank.  Be #humble. Have #gratitude. Pursue #happy. 

Anique Walters
#FAQF..."Whats the deal with Physio vs Chiro vs Trainer? Don’t you guys all hate each other?”

For some reason, people always think that there is a weird animosity between PTs, Chiros, and Trainers. Perhaps there is for some, but not in my world. A collaborative team amongst all three is IDEAL. I have been lucky enough to work with and learn from incredible people from all three groups. I can honestly say I am in awe of how much knowledge and skill there is to be shared with our clients/patients. 
Don't worry, I’m not all just koombaya nonsense. I will be the first one to say I have had horrible experiences with all three too. I have walked out of fitness classes, stopped Chiro’s mid treatment, and maaaannn have I seen some shit Physical Therapy being done. So as with anything there is a good, bad, and ugly. Remember it is ALWAYS ok to leave, stop treatment, or change providers. If something doesn’t feel right, it probably isn’t. Leave. Your body is too precious to mess around. 
There is a ton of overlap with these professions which lends itself to blurred lines. People tend to become territorial over “what they do” but we all need to put our #egos aside and recognize when something is not our area of expertise so we can best help our clients/patients. We all use science, math, research and experience to guide our decisions, but our foundational platforms come from different places. As a PT I am the healthcare provider version of a movement specialist. I’ll figure out why your rib popped out of place through extensive movement analysis and help give you the tools so that it doesn’t happen again, but I'm not going to be able to adjust as well as a Chiro. I am going to help you maximize your physiological potential to compete in the NFL combine with neuromuscular re-education, therapeutic exercises, manual therapy, motor control drills, etc. but I am not going to bust your ass in drills the way a Trainer will. It is not that I CAN’T do those things, but I recognize that is not my strength and it IS someone else’s. So I encourage you to utilize the resources at your disposal. Build yourself a winning team. Let me know if you need recommendations!

Anique Walters
NBA Great Steve Kerr on Rehab vs Back Surgery!
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6 time NBA Champ (3 with the Bulls, 2 with the Spurs, 1 coaching the Warriors) and the player with the all time career high 3 point percentage (45.4%) Steve Kerr urging people to consider Rehab rather than surgery! I couldn't agree more! Physical Therapy is a where it is at ya'll! Get on board and meet with a PT ( hint hint, me) before going under the knife!! Get well soon Steve! Let me know if I can help!!

http://larrybrownsports.com/basketball/steve-kerr-urges-people-rehab-over-back-surgery/364997

Anique Walters