“Movement is medicine!” -Dr. Elif Gurkan
Interview Yelda Özdeş
We talked with Therapyart Center Physical Therapy and Rehabilitation Specialist Dr. Elif Gürkan about the physical therapy methods applied today, manual therapy, the most common musculoskeletal disorders and sports injuries in our age, muscle, joint and spine disorders that we may encounter in summer, treatments and precautions that can be taken.
Yelda Özdeş: Ms. Elif, can we get to know you a little bit?
Elif Gürkan: I graduated from Hacettepe University Faculty of Medicine and then I specialized in Physical Therapy and Rehabilitation. It was an education process that lasted up to 12 years, 6 years of Faculty of Medicine and 6 years of Physical Therapy and Rehabilitation. Then I completed training programs in various countries, especially in France. These were trainings on Physiotherapy, Musculoskeletal Pain and Manual Therapy. Then I had observation and hospital studies in various cities in America, South Korea and Europe. I worked especially on the spine. I did special studies for neck, waist, back and coccyx pain, that is, for the whole spine, because I wanted to work on the transformation of physiotherapy into modern physiotherapy.
Y.Ö.: You said modern physiotherapy. What changes in modern physiotherapy?
“In modern physiotherapy, the patient’s age, profession, gender, sports, life habits, rights and wrongs are very important for us.”
E.G.: In the past, physiotherapy was only a treatment with devices, but now there is a very modern and scientific approach that includes a lot of manual and exercise therapy. We plan a treatment specific to the person and their disease. We still use the devices, but we receive special trainings for manual therapy in cases that we find as a result of the examination, for example, in diseases of tissues, joints, movement limitations, orthopedic problems, in cases where recovery after surgery is prolonged, in neck, back and waist pain that lasts for a long time and complicates daily life. These trainings must be spread over many years. The diagnosis you will find when you examine and touch a person develops only with experience. Seeing these with imaging methods clarifies the diagnosis. Then, in the treatment phase of the patient; the devices we use in physical therapy, our hands, the special medications we use and the psychological state of the patient have a great impact. What I emphasize is that the human being is a whole. A person with shoulder pain should not think that the problem is only shoulder pain. His whole body, his posture – which is what we call “posture” – the strength of his waist and back muscles, his weight, his work, how he uses his shoulder, the posture of his head, whether he has psychological stress, whether he has a physically or mentally intensive profession should be reviewed and organized accordingly. Only with these is it possible to achieve complete success… It is necessary to devote time to the patient and this is very important for a physiotherapist. Now, of course, we are lucky, because technologically there are very good imaging methods. The quality is getting better and better and we can see even fine details. Then we can do tissue-oriented treatment. In addition to physiotherapy, injections have developed a lot in recent years. In these ultrasound-guided injections, we use a number of medications, blood therapies and supportive therapies. Blood treatments can be PRP or blood and plasma treatments that we apply by waiting for 8 hours. These have a regenerating and healing effect on cells.
In modern physiotherapy, it is possible to apply natural treatments that the human musculoskeletal system and spine really want, to strengthen it, to open up some stiffness that comes with age, to regain elasticity as in youth and to make it sustainable and thus to control pain. This includes adding things like weight control and nutrition with various recommendations to the patients. This is very important because the body is a whole… The nervous system and the musculoskeletal system work together. That’s why pain is very related to both. When we find a solution for both, then we reach the real result. Our nervous system starts from the brain and spreads throughout our body like the roots of a tree, with the spinal cord and bilateral nerves coming out left and right. The most extreme points of the nerve go all the way to the tip of our finger. The nerves especially activate our muscles and vessels. While doing this, i.e. operating the movement system, they also operate our internal organs. Our pain is also affected by our emotional state and fatigue. In other words, in modern physiotherapy, the patient’s age, profession, gender, sports, life habits, rights and wrongs are very important for us. For example, two women of the same age may not have the same body structure. The same is true for men, of course. Or a woman who gives birth and a woman who does not give birth may not be the same. There may be genetic differences between people. It can be elastic or rigid. They may be strong or weak. Therefore, treatments should be planned individually.
Y.Ö.: So, when was Therapyart Center established? How long have you been here?
E.G.: It was established in 2003 and I have been here since 2008. This is a clinic where we provide physical therapy, sports injury treatments, manual therapies and necessary injection treatments. We have 2 doctors and 5 physiotherapists working here. We deal with very specific issues. Long-term injuries, joint pains, orthopedic problems are very common. Many patients from Turkey and abroad apply to us. Team spirit is very important for us and we have a very experienced staff here. At this point, it is much easier to get fast results with the right diagnosis and the right treatment. There are always challenging situations in medicine. The situation can be made easier by the patient’s understanding of this situation. We also ensure that the patient recognizes the disease psychologically. Health is a detailed subject and each disease has different treatment processes. We need to explain this to the patient in detail. At this point, the time we allocate to each patient here is very long. We provide a boutique service.
Y.Ö.: In which diseases and areas does physiotherapy provide services?
E.G.: Diseases of the musculoskeletal system, known as orthopedic diseases, and neurological diseases are intertwined. The patient’s knee is calcified or has undergone knee surgery and movement is limited, we work to open it up. We strengthen the muscles. We help him to return to life immediately. In other words, situations that do not require surgery and what we call postoperative rehabilitation are the most basic subjects of physical therapy and physiotherapy. Neurological diseases are various diseases such as stroke, cerebral palsy, that is, the condition we call “stroke”, or some diseases in the spinal cord or rare diseases such as Parkinson’s, MS (Multiple sclerosis), muscle diseases. In these cases, it is necessary to make the patient functionally better, to strengthen their solid structures, to do some exercises to prevent the progression of the disease, and not to restrict joint movement, to train them and to teach them to apply them at home. With the influence of technology, everyone has become very used to immobility. We are constantly on the computer and phone outside of work. This situation affects the spine very badly. For this reason, we treat a lot of diseases related to posture disorders.
Y.Ö.: So, what are the most common diseases today?
E.G.: Neck and back diseases and related low back pain… The coccyx is also affected by sitting too much. At the same time, they are gaining weight and the weight is putting downward pressure. Deformations can occur in both the lower back and coccyx due to overload. In addition to hernias, bone displacements, weak muscles around the spine as a result of inactivity can lead to rupture of the spinal discs, herniation and nerve compression even when lifting something simple.
Y.Ö.: How can we prevent these?
“The human body needs movement.”
E.G.: My most important sentence is; movement is medicine! This is my slogan and I have been using it for 20 years. The human body wants movement. Both the muscles want it and we feel good morally. Not moving makes us mentally tired, makes our bodies weak and we age rapidly. The human body is programmed to work in nature. The first people or our ancestors, our mothers and fathers used to do their own work. Now we have machines doing it for us. Everything is done digitally. Our homes have become smaller and we move less in those small spaces. All of this actually makes us weak. It reduces our muscle mass. And then we go backwards. We go into a rapid aging process and try to find artificial exercises. We have to, of course…
Y.Ö.: So, when you say artificial exercises, do you mean sports practiced in gyms?
E.G.: Yes. Gyms, pilates, etc… These are of course good exercises, things that need to be done, because this is the need of the age. In the past, people didn’t need it because they were already doing their own work. Now, with the technological life, we have to spend a lot of time in front of the computer. The social life at home also forces this. Television takes too much time. In these cases, we recommend patients to enter another kind of exercise program, and these are exercises that are done in closed city life, in closed places. Whatever we do, we have to remove lack of movement from our daily life. We have to do our own work, we have to climb stairs, we have to use the elevator less, we have to use public transportation more. We should at least take a walk in the evening after dinner. We need to push ourselves a little bit for movement and sport. We should even make excuses for ourselves to move.
Health problems arise both because we do not exercise our joints sufficiently and because our daily step count is low. Ideally, 10,000 steps should be taken daily so that a person is considered mobile and active. Anything below this number is not considered movement. This is the definition of an active person! In order to reach this number, a serious effort is required. We take a maximum of 2,000 steps to and from the office, to and from work. We need to exert some effort to complete this.
Y.Ö.: Even if we run a lot during the day, it’s not enough…
E.G.: The number of steps we take per day is important, but when we stay at 3,000 or 4,000 steps and those steps are not consecutive, we are not getting our heart rate up to a certain speed. If our heart rate doesn’t increase to a number that is appropriate for our age and capacity, we are not considered to have exercised, fat burning doesn’t take place. When fat burning doesn’t happen, we don’t spend energy, we don’t exercise. This does not help us either. The hormone estrogen protects women’s hearts until menopause, but this is not the case for men. If a person smokes, does not exercise, and the fat in the belly increases in the shape of a bagel, it means that hardening of the vessels inside the heart may occur. This can put men, especially men, at risk of heart attack from the age of 40-45. In other words, when we say that movement is medicine, we mean both for pain and for living longer. In addition, thanks to the relaxing hormones called “endorphins” that sports give us, we feel happier without taking any medication.
Y.Ö.: What kind of treatments do you provide for musculoskeletal and spine problems?
E.G.: First of all, we make the diagnosis correctly. We spend a long time with the patient. The important thing is to get to the root of the complaint. After the examination, we find the root of the problem and after making the real diagnosis, we first offer our patient various suggestions about his/her life. We look at the mistakes related to his/her profession, we regulate his/her nutrition. In physical therapy, which we call physiotherapy, we use electric currents and various heat methods. We apply laser, various vacuums, treatments that mobilize the skin and subcutaneous tissue and provide blood supply and regeneration there. We apply manual therapy with our hands, directly opening the deep tissues and mobilizing the individual compressed parts of the neck, spine and joints. Afterwards, we give our patient exercise programs that they can do themselves and that we will do in our clinic. We gradually increase the exercises and we can achieve very good results in neck, back, waist and coccyx pain with 2-3 week programs. In some patients, we also use injection therapies, which I mentioned briefly earlier. Injection treatments can be different in the spine and joints. In order to treat the pain better, we combine this with physiotherapy; we apply mesotherapy applications and electrical acupuncture applications in the form of very small injections to acupuncture points in the neck, waist and back. We can also look inside the joint with the method we call ultrasonography and inject the drugs exactly to the problematic points. In other words, we are shooting at the right point. If the patient has a limitation in movement, we inject drugs into the joint to open it. Then we complement this with exercises. In recent years, there are blood therapies, PRP and different forms of PRP and we do these.
Y.Ö.: What is PRP?
E.G.: We take blood from the patient, pass it through a number of centrifugation applications, and then give the concentrated growth, that is, tissue regenerating factors in it to the damaged tissue under the guidance of ultrasonography. Thus, we inject it right into that tissue and accelerate regeneration. For example, when a soccer player has a muscle breakdown, it heals very quickly when we inject it into that tissue. It is one of the innovations in recent years that we do these with ultrasonography. Seeing the tissue exactly and injecting it into that problematic area is a much higher level treatment.
Y.Ö.: Many of us started to do sports intensively in the summer months and for fitness purposes. Which cases do you encounter the most in sports injuries and what are the treatments?
“Lifting more weight than the body can carry.”
E.G.: The most common injuries we see are those caused by movements without warming up. If the joint and muscle are not ready and the exercise is done all at once, it causes tendonitis (edema around the muscle tissue) and pain. Excessive muscle fatigue, muscle injuries and muscle strains can occur. These are more common when lifting more weight than the body can carry. Also, a person who does a lot of sports can exceed the limit. For example, they lift 50 kilograms when their body is not ready and the discs in their lower back cannot carry it. This can lead to very severe lumbar stiffness, ruptured discs and herniated discs. These problems increase in the spring and summer months when activity increases and we want to be fit. Their treatment is gradual depending on the severity of the discomfort. In a ligament injury in the knee, we start with rest, knee brace, medication and rest. After the intense swelling in the knee decreases, we ensure that the joint returns to its normal movements with physiotherapy and then we aim to strengthen the muscles around the knee and return to normal function.
Y.Ö.: What are the most common cases you receive in the summer?
“Jumping without knowing the depth of the water causes neck fractures, fractures in the back or waist.”
E.G.: Neck and shoulder joint strains in young people due to sudden jumps into the water. Knee problems also occur in the elderly because the sea shores have many stairs. People come to us with knee pain after going on vacation. If the person is not used to swimming, the muscles and ligaments around the shoulder are also compressed. In summer, we also encounter neck, waist and back stiffness related to air conditioners, in other words, the conditions we call kulunç. Here, facial nerves can also be pinched and facial paralysis can occur. If facial paralysis occurs, we need to restore the muscles with electricity.
Also, jumping into shallow water is very important. Jumping into shallow water without knowing the depth of the water causes neck fractures and fractures in the back or waist. It can lead to very serious paralysis that can lead to a wheelchair. Before entering the water, you should take your time and look at the situation around you… For young people, pranks in the water can sometimes be very dangerous. If they jump into a knee-high body of water, they can suffer very serious spinal cord injuries. This can lead to permanent paralysis with a very painful outcome. In addition, jumping backwards into the water or jumping without warming up can also trigger if there is a small cervical or lumbar hernia on the ground. In such sudden situations, our patients should immediately apply ice. This resolves the muscle spasm quickly. However, if there is severe pain in the neck, numbness and weakness in the arm, leg and fingers, you should consult a doctor immediately. Problems with the neck spread to the arm. A problem with the lower back causes severe pain and numbness in the hip and leg.
Y.Ö.: There is also a lot of sweating in the summer months. What would you like to say about the treatment of this?
E.G.: “Iontophoresis” and “botulinum toxin (botox)” are regional treatment methods. Iontophoresis is a method that is good for excessive sweating of the hands and feet. Botulinum toxin is a very good method, especially in the armpit. It can also be applied to the hands. There is also a social aspect in hand sweating. Socially, these people do not want to shake hands. There is a very serious psychological problem. There is no underlying disease, but local sweating is mostly caused by genetic reasons. However, it is necessary to look at the blood tests of the person with sweating, if they have not been done, in terms of thyroid… Local sweating does not occur at night, this is the most important detail in distinguishing general and local sweating.
The nervous system that keeps us awake and active in our body is the sympathetic nervous system. When this system is genetically activated more than normal, local sweating occurs. While sweating can be a harbinger of important diseases, local sweating is definitely not an important disease.
If there is night sweating and general body sweating, an internal examination should be performed. In armpit sweating, the method we call botulinum toxin is applied locally. With a 5-minute application, both armpit sweating is eliminated for up to 9 months. There are people who sweat excessively and cannot wear intermediate colors. They are very relaxed socially. There is no harm; it is a drug that has been used for 20 years… It is used in low doses. We also use it on hands.
Iontophoresis is a method we apply to hands and feet in physical therapy. I have applied this treatment to around 3,000 patients who have come to me. It is a treatment performed twice a week in 20-minute sessions with electric current in water. The patient himself can continue once a week by taking the device home later. The treatment has no side effects.
“Our sitting should be supported from the waist.”
Y.Ö.: You mentioned coccyx pain. Why do these pains occur and how are they treated?
E.G.: This is a subject I have been working on for many years… I worked with a professor in France who made a breakthrough in the world on this subject. For many years, coccyx pain was considered psychological in medicine. It has been proven that this is not the case. Recent X-rays and MRIs have shown that the bones of the coccyx are also edematous. The coccyx is a very deep area that people generally do not want to show and the patient applies to the doctor very late. When they do, they develop a pain that does not go away. It is a difficult area to examine… It is a disease directly related to sitting. 1,000 patients have applied to me so far. Among them, there were 4 or 5 people I could call psychological. There was always a mechanical problem with the bone underneath. Because the coccyx is an area that can be traumatized quickly and easily hit. It can be fallen on frequently. In women, there may be reasons related to childbirth. Another reason is the constant pressure on the tiny bone with too much sitting as a result of our excessive dependence on technology. With incorrect sitting, the ligaments between the coccyx bone weaken, loosen and can cause severe pain in that area.
Y.Ö.: How should we sit?
E.G.: Our sitting should be supported from the waist. Actually, it should be like 100 degrees, not 90 degrees. We should put a pillow on our waist. Then both our lower back will be supported and there will not be too much pressure on our coccyx. This coccyx pain caused by sitting is very intense, especially when getting up. These patients are very uncomfortable in cars. The quality of life decreases a lot. The disease does not progress, but the constant pain in that area creates a distressing situation. The patient’s social life is affected.
“Young people also started to come with neck and lumbar hernias.”
Y.Ö.: So, how do herniated discs affect our lives?
E.G.: Hernias are mostly seen in the neck and waist, but we also see them in the back. Genetically, it can be seen more in some families. Accidents and falls can also cause neck and lumbar hernias. For example; the discs can tear when the neck suddenly moves forward and backward by pressing the brakes in the car. Suddenly jumping into water can put a lot of strain on the neck. Some wrong sports that cause the neck to suddenly move forward and back should be avoided as much as possible. Especially after a certain age, we may not be able to do the sports we could do when we were young because our flexibility decreases. We need to test and see first. Also, hernias have increased a lot in recent years due to excessive use of phones and tablets. There is a situation where we lean our head forward and stand in the opposite direction of the spine. This is against the natural structure of the body and the spinal cord is stretched. If we do this for too long hours and do not do balancing exercises, hernias and canal narrowing occur. Multiple hernias can narrow the canal through which the spinal cord passes. This can be a very serious problem for young people. In fact, many people have very small hernias, but if we use our bodies badly, they can grow and cause nerve compression and weakness in the arms and legs. It is possible to treat the pain with physical therapy and manual therapy. In fact, there are very simple things that our body wants from us. We are not doing them. Being active, taking outdoor walks, drinking plenty of water and not gaining weight… With these simple measures, we can avoid serious diseases.
We also have patients who work very hard, who are businessmen, scientists, professors, bankers. After a certain age, brain fatigue occurs. This starts to affect the neck and back. These people are very busy people and are under intense stress. This combines with sleep problems after a while. You can be very successful, but you can also be very tired inside. To avoid this, it is very important to take some time for yourself, to balance your sleeping hours and to walk for 20 minutes a day, even if you cannot do sports. They have intense neck and back pain, and their backs are like bones. People who have taken the burden of life on their backs.
Also, the use of tablets and phones in children causes a lot of neck problems. This kind of posture is against human nature, against the spine… As a doctor, I am worried about the increase of the disease called spinal canal narrowing in young people in the future. Spinal narrowing is very difficult to treat. It can be operated on, but at the moment it is mostly performed on elderly patients, but in the future, much younger people may face the problem of spinal stenosis.
Parents should make their children do the movement with their head thrown back and their face facing the ceiling for 5 seconds every hour. Children who do not do sports, who are overweight are also increasing and problems with the spine may increase in the future and cause neurological problems, because young people at the age of 14-15 started to come to us with neck and lumbar hernias.
Y.Ö.: You also have patients from athletes and artists we know, right?
E.G.: Yes, I have had many patients from the art and sports world over the years. They are all very busy working people and they want to recover and return to work as soon as possible. In fact, some of our theater patients were on tour outside the city, fell and broke their coccyx, had injections and continued the play the next day, and were so enthusiastic about their work. They aim to appear in front of the public again as soon as possible. Our clinic also receives a lot of applications for sports diseases. Of course, you need to be a little more patient in sports; there can be more severe injuries. In high-level sports, you need to give time for the tissue to heal.
Y.Ö.: Do you have different, interesting patient stories?
“You add positivity to a person’s life.”
E.G.: Yes, there are many. We had a patient who was studying at university in Paris. He fell and found us on the internet and came. The next day we immediately started treatment. The bone had shifted to the side. It was brought to a plane that could be seen from the outside. Coming early and being conscious has great benefits. Helping people both with scientific support and by understanding their psychology is the best part of our profession. For example; I am very touched when I receive calls from our young patients who come from many parts of Turkey with sweating problems and who are very withdrawn, saying that they got married and had children after the sweating decreased. You add positivity to a person’s life. When young children have a coccyx fracture, you prevent that child from living with that problem for the rest of his/her life by explaining it to the family and correcting it with manual therapy through the anus. This is a great happiness for me… In addition, patients who are cut off from life for a few months after orthopedic surgeries but recover after physical therapy sessions, patients who can return to their profession, sports, with the treatment they receive after sports injuries are also pleasing.
Y.Ö.: Thank you. Do you have any last words for our readers?
“Do not let go of your own health!”
E.G.: People should not postpone problems related to their health. Everything in the body is a whole. Our psychology is also very important. We need to be active in musculoskeletal diseases. We need to drink plenty of water, not smoke, pay attention to what we call “ergonomics” – sitting and standing, our chair, the height of the computer, our position in the seat, sitting upright. And exercise! That’s why it would be correct to say that movement is medicine. For example, if you have been sedentary at home for too long, make time for a walk. This is very necessary for the veins as well as for the musculoskeletal and nervous system. Medicine is becoming very specialized now. They need to research and go to places that address their own problems… Problems now have solutions; very rarely are they unsolvable. Medicine is constantly advancing. We are not like 20 years ago. Imaging methods are getting better. These provide us with great convenience in diagnoses. It is better not to stay away from medicine and not to resort to alternative methods at first, but to use them as complementary… First you need to know what your diagnosis is. This is a very important point and the question “What is wrong with me?” should be asked to the doctor. In other words, “What are you treating me for? And what should I pay the most attention to?” is very important. If you understand and apply these, I believe that your quality of life will improve a lot. You cannot find everything on the internet and make your own diagnosis. The diagnosis should be made by a specialist. You should consult a doctor first. Unfortunately, there are many people who are not doctors. So don’t give up on your own health!
