Adjustment Disorders

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All humans face stressful life events. Sometimes these stressful events are navigated with little difficulty. At other times they cause troubling symptoms. Adjustment Disorder may be diagnosed when a stressful event triggers symptoms. An Adjustment Disorder is a psychological response to stressors that results in clinically significant emotional or behavioral symptoms.

This may include a decrease in performance at school or work, substance use, changes in relationships and somatic complaints. Somatic complaints are complaints about the body including pain, nausea, headaches and body aches, which often have no medical explanation. This reaction to the stressful event is marked by distress that is in excess of what would be expected given the nature of the stressor, or causes a significant impairment in social or occupational functioning.

When these emotional or behavioral symptoms develop within three months from the onset of the stressor it may be an Adjustment Disorder. Symptoms may be present for several weeks and may last up to several months. The Adjustment Disorder may be considered acute when symptoms last less than six months, or chronic when longer than six months. They may occur at any age.

Adjustment Disorders are relatively common and require an identifiable stressful event that can be of any severity. This is different than Post-Traumatic Stress Disorder, which is a more familiar, but less common diagnosis that requires the presence of an extreme stressor.

Examples of the variety of triggering stressors that may lead to Adjustment Disorder include:

• Single events, like a termination of a relationship

• Multiple stressors, like business difficulties or marital problems

• Recurrent stressors, including seasonal problems at work

• Continuous stressors, like living in an area where there is frequent crime

• Developmental events, like getting married, becoming a parent, or going away to school

Adjustment Disorder may include emotional symptoms, like a depressed mood or anxiety, or both. It can also include disturbances of conduct, like angry outbursts or lying. Or, it can include both disturbances of emotions and conduct.

Adjustment Disorder is considered a short-term illness. With time and proper treatment it is likely to resolve and allow the person to return to their normal functioning. The treatment of Adjustment Disorder may include both medication and therapy. Often therapy alone can be effective in helping the person to improve their ability to cope with the stressor. These improved coping skills often include learning to use support systems more effectively, changing negative thinking and changing unhealthy behaviors.

The setting for such therapy may include outpatient therapy with a counselor or psychologist. Or, for more severe cases, it may include an Intensive Outpatient Program (IOP) or a Partial Hospitalization Program (PHP). IOP treatment is generally three hours of therapy three times a week. PHP treatment is six hours of daily therapy five times a week. It is rare that Adjustment Disorder requires inpatient psychiatric treatment. The needed level of care is determined by the severity of the symptoms and the amount of disruption to the person’s functioning. No matter what level of care a person needs there is no reason to feel ashamed for seeking treatment. Part of being human is leaning on other when there are struggles. And all humans struggle at times.

MidMichigan Medical Center – Gratiot has a Psychiatric Partial Hospitalization Program (PHP) for those who need this level of treatment. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs may visit


The Power of Our Creativity for Our Mental Health

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Over the past century it seems that every type of creative activity has grown into a type of therapy. The first four decades of the 20th century were particularly productive. While music therapy was first noted as early as 1789, its first professional organizations were founded between 1903 and 1926. Art therapy and dance/movement therapy were first promoted in the 1940s with professional organizations following 20 years later.

There are strong reasons why these creative endeavors became recognized as therapeutic. But one does not need to be, or see, a professional to gain from some therapeutic effects of the creative process. Integrating some creative activity into daily life can give many of the same benefits.

The creative process is often thought to be related to artistic activities, but in reality creativity can occur in any area. This idea has been presented by psychologist Howard Gardner who introduced the theory of multiple intelligences during the last quarter of the 20th century. He stated that every area of intellectual development is an opportunity for creativity. This includes linguistic, logical/mathematical, spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal and naturalist.

The essence of creativity is not the modality within which one works, but the process of using the imagination to produce original ideas. It is this process of making new connection that appears to have the therapeutic effect, whether it is in music, words, movement or mathematics. Participating in creative activity stimulates the brain by making new neurological connections, which improves the mood and increases mental flexibility, improving problems solving skills.   

Some of the benefits that have been noted in research are seen in all the areas, others are area specific. Some benefits are physical. Research suggests that music can improve respiration, lower blood pressure, improve cardiac output, reduce heart rate and relax muscle tension. Dance and movement can reduce the body’s stress response, enhance disease prevention and improve coordination and mobility. Creative activities can give a boost to the immune system.

Some effects are social, emotional or psychological. Research indicates that participating in visual art production can improve communication, improve concentration and help reduce feelings of isolation, as well as increase self-esteem, confidence and self-awareness. Therapeutic effect of dance and movement include improved mood management. Participating in the creative process in any form can help people focus, discover a sense of happiness and reduce burnout. The creative process nurtures emotional and social growth.

Trying a creativity activity may seem a bit intimidating to some people. This is likely because our society has created an artificial division between “artist” and “non-artist,” with the latter somehow being less gifted. Therefore, people don’t see themselves as creative and end up denying their own creativity. While it is true that there are people who decide to become professional artists, and there is a wide variety of talent, everyone has the capability of using their imagination in creative ways. And everyone can benefit from it with improved mental and physical health.

Those who need additional help to overcome mood disorders are encouraged to seek help. The Psychiatric Partial Hospitalization Program (PHP) mental health day program at MidMichigan Medical Center – Gratiot is available for those who need additional support. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs may visit


Ten Things Not to Do if You Have Lower Limb Pain

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Tendinopathy, or tendon pain, is a term that refers to a disease in the tendons. The tendons are fibrous connective tissues that connect muscle to the bone. Tendinopathy is often characterized by tenderness to touch and pain. Gluteal, patellar, achilles and hamstring tendinopathy are examples of lower limb tendon pain. Effective strategies for tendinopathies include ongoing, exercise-based regimens that slowly build up muscle power and tendon strength. In recent years, there has been significant advancement in how we understand and treat lower limb tendon injuries. Professor Jill Cook, the world’s authority on tendon rehabilitation, gives a nice overview of what not to do if you have lower limb tendon pain. The ten points are highlighted below.

  1. Resting Completely. The old adage of “use it or lose it” applies to tendons. Just resting decreases the ability of the tendon to take the load. You have to reduce the load to the level that the tendon can tolerate and then slowly increase the tolerance of the tendon to take the load.
  2. Passive Treatments. Treatments that do not address the need to increase the ability of the tendon to take are not usually helpful in the long term. Treatments like electrotherapy and ice will only temporarily ameliorate pain, only for it to return when the tendon is loaded.
  3. Injection Therapy. Injection of substances into the tendons have not been shown to be effective in good clinical trials. Do not use them unless the tendon has not responded to an exercise-based program.
  4. Ignoring Your Pain. Managing the load on your tendon pain is a way of telling yourself that the load is too much. Reduce the aspects of training that are overloading your tendon, like running or jumping. On a very irritable tendon, isometric exercises have shown to decrease pain by 50 percent.
  5. Stretching Your Tendon. Adding stretching to most tendons only serves to add compressive loads that we know are detrimental to the tendon.
  6. Managing Your Tendon. A painful tendon is one that is telling you that it is overloaded and irritated, therefore adding further insult by managing it can actually increase your pain.
  7. Being Worried About the Images of Your Tendon. Don’t worry about MRI or ultrasound findings. There is evidence that pathological tendons tolerate loads, especially when you gradually increase the load.
  8. Being Worried About Rupture. Pain is protective of your tendon; it makes you unload it. Most people who rupture a tendon have never had pain before, despite the tendon having substantial pathology in it.
  9. Taking Shortcuts with Rehabilitation. The tendon needs to build its strength and capacity. Things that are promised of cures often give short-term improvement, but the pain comes back.
  10. Misunderstanding What Loads Are High for Your Tendon. The highest load in your tendon is when you use it like a spring, like when you’re jumping or sprinting. Other loads are low load for a tendon, although they have a beneficial effect on the muscles.

Get Ambas, P.T., is a physical therapist at MidMichigan Health.


Avoid Back Pain with Smarter Shoveling

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Research shows 1,000 people end up in Emergency Departments each year after snow shoveling, with the majority of those visits are for back injuries. Snow shoveling is one of the most common causes of back injuries during the winter months. However, this type of injury is preventable if you know the best ways to remove snow without straining the back. The following tips can help you avoid low back injuries during the snowy winter season.

Warm Up Thoroughly

Cold, tight muscles are more prone to injury than warmed up, flexible muscles. You can warm up your muscles by briskly walking for a few minutes. Then, stretch your large muscles on your back, preferably with dynamic stretching by taking the muscles through full range of motion.

Use Ergonomic Lifting Techniques

Whenever possible, push the snow rather than lifting it. When lifting snow is necessary, make sure to use ergonomic lifting techniques: Bend at the hips and not the lower back. Then, bend with your knees and lift with your leg muscles, keeping your back straight. Keep your loads light and avoid twisting the back to move the snow to a new location. Always pivot your body to face the new location.

Switch Between Lifting and Throwing Snow and Pushing and Plowing Snow

Doing activity repetitively over time can lead to muscle fatigue, discomfort and even damage to the muscles and ligaments. This is why it is best to break up activities while shoveling.

Pick the Right Snow Shovel

An ergonomic snow shovel can help take some stress off your back. A shovel with a curved handle or an adjustable handle length can minimize painful bending. Small, lightweight plastic blades can also help reduce the amount of weight you are moving.

If it’s possible, using a snow blower can be a better alternative to shoveling. If you have a significant history of lower back issues or cardiac issues, it’s best to delegate shoveling to someone else.

Get Ambas, P.T., is a physical therapist at MidMichigan Health.


Tips for Dealing with Anxiety

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Over the last year, there have been many different situations that may have caused you to feel on edge. Feelings of anxiety are a natural result – a rising heart rate, sweaty and feelings of tension in your chest and shoulders.

With so many things still unknown, particularly when it comes to the COVID-19 pandemic we’ve been battling for nearly a year, avoiding anxious feelings is simply unrealistic, and may even be dangerous in the long run. If you’re in the habit of pushing those feelings down, it doesn’t necessarily resolve the issue.

If your anxious feelings are becoming an issue, try these tips for mental and emotional relief:

Limit your social media engagement. Take time away from screens, posts and replies.

Maintain normal routines for sleep, nutrition and scheduled responsibilities.

Avoid excessive alcohol or drug use.

Focus on what you can control.

Check in with loved ones regularly to feel less isolated.

Given our current circumstances, anxiety is common and expected. But it’s important to seek help when those anxious feelings cross the line, for example, when it’s beginning to affect your day-to-day life.

Meghan Dahl is a behavioral health therapist at MidMichigan Medical Center – Midland.


Reduce Your Risk of Cervical Cancer

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January is Cervical Health Awareness Month, and there’s a lot that women can do to help prevent cervical cancer.

Cervical cancer happens when normal cells in the cervix, the bottom part of the uterus, change into abnormal cells and grow out of control. Most women whose cervical cancer is found and treated early do well.

In 2021, the American Cancer Society estimates 14,480 new cases of invasive cervical cancer will be diagnosed in the United States and 4,290 women will die from it. One of the major causes of cervical cancer is Human papillomavirus, or HPV. HPV causes 99 percent of cervical cancer. HPV can also cause vaginal, penile, anal, mouth and throat cancer.

HPV is a very common infection that spreads through sexual activity. About 79 million Americans currently have HPV, but many of them don’t even know that they’re infected. That’s because HPV generally doesn’t have any symptoms. In fact, in many cases, the body can fight off HPV naturally, but in serious cases, the body is at risk for serious complications.

Thankfully, the number of cervical cancer cases is declining, because of screening tests that are able to find cervical precancerous cells before they turn into cancer. The HPV vaccine also protects men and women from HPV.

At MidMichigan Health, we encourage women to begin getting regular Pap tests at age 21. Talk to your gynecologist or health care provider to determine how often you should get these screenings.

We also encourage pre-teens to get the HPV vaccine; it is most effect for boys and girls to get the vaccine between the ages of nine to 12. Teens and young adults age 13 through 26 who have not been vaccinated or who haven’t gotten all their doses should get the vaccine as soon as possible. Vaccination of young adults will not prevent as many cancers as vaccination of children and teens.

If you haven’t received a Pap test or the HPV vaccine, it’s important that you talk with your health care provider to determine a course of action that works best for you and your health. Being proactive in your health care is key!

Brendan Conboy, M.D., is a board-certified obstetrician/gynecologist who sees patients at MidMichigan Medical Center – Alpena. He received his medical degree from Wayne State University School of Medicine, and completed his residency at William Beaumont Hospital in Royal Oak. Those who would like more information about becoming a patient may contact his office at (989) 356-5228.


Sustainable Change

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The New Year is a time of change. Many embrace the season as an opportunity to create resolutions with great intentions to be healthier but are often disappointed weeks later when they are unable to sustain them. There are several reasons why resolutions prove to be difficult to maintain, but with thought and planning, one can make lasting change for the better.

A potential problem with a resolution is that it is too far outside a person’s norm. Not only is this type of resolution hard to start, it’s difficult to sustain.

For example, if someone doesn’t exercise, setting a goal of exercising 60 minutes a day may be too far outside their normal exercise time of zero. The difficulty with this type of goal is self-image. If you don’t see yourself as someone who exercises, it will be hard to sustain a goal of 60 minutes a day of exercise.

The following are some of the dos and don’ts of kicking off the new year with a commitment of
healthier habits.

 Set a goal that is too lofty to attain
 Choose something you are physically unable to do
 Expect change to be easy
 Proceed without a plan
 Give up too quickly; plans can be adjusted

 Set a small goal to begin and build from there
 Work on self-image; visualize yourself being a person who is successful at it
 Engage in deliberate self-talk like “I am choosing healthy behavior” and “I can do that”
 Work the resolution into your routine by connecting it to something you already do until it
becomes a daily, healthy habit
 Understand that even small increments of change are successes

No matter what type of change one is working on, a better chance at sustainability includes starting small, visualization, recognition that it can be accomplished and connecting it to something already present in one’s routine. Small steps become habits until the larger goal of living a healthier lifestyle is reached.

“Focus on one day at a time, one step at a time. Soon days turn into weeks and each
small step becomes a habit and helps you reach your larger goal. Remember doing something is better than doing nothing at all

Michelle Lucchesi, M.A., L.L.P., is a therapist at MidMichigan Medical Center – Gratiot’s Psychiatric Partial Hospitalization Program. To learn more about the program, call (989) 466-3253, or visit


7 Ways to Show You Care During the Pandemic

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These simple acts of kindness will help reduce community spread of COVID-19 and ensure businesses, schools and hospitals can remain open to serve you!

Wear A Mask

Wear a Mask

Protect yourself and others by properly wearing a mask that covers your nose and mouth at all times when in public. Learn more at MaskUpMichigan.

Stay Home

Stay Home

Right now, staying home unless you absolutely need to go out is one of the best ways to help flatten the curve. When you do go out for work, groceries or exercise, stay 6 feet apart, wear a mask and wash your hands.

Celebrate Safely

Celebrate Safely

Public health officials cite private gatherings such as weddings, funerals and parties among the most common causes of new outbreaks. Avoid gatherings and find safer ways to celebrate such as virtual events or dropping off food and gifts.

Donate Blood

Donate Blood

With state- and nation-wide blood shortages, this is one thing you can do to directly save lives. If you are healthy with no COVID symptoms, it is still safe for you to donate blood. Find a blood drive near you.

Call Ahead for Health Care

Video Visit

Don’t neglect your health, but do call ahead to your doctor’s office or Urgent Care so they can prepare for your visit and safely accommodate you. Or call your primary care provider to schedule a video visit.

Thank Essential Workers

Thank You Heroes

It seems simple, but a colorful sign in your yard or window, or a note of encouragement and gratitude on social media can go a long way to remind essential workers of your support.

Make a Donation

Hands Holding Hearts

Consider supporting non-profit organizations that are providing COVID relief, such as securing needed medical supplies or assisting vulnerable populations.


Is Sitting Down Really That Bad for You?

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Over the last few years, there have been many articles detailing how bad sitting can be for the body. You may have even seen the phrase, “Sitting is the new smoking.” But how bad is sitting down, really?

As a physical therapist, I see many people who come into my office and sheepishly admit that they sit all day long for their jobs. As our reliance on technology for our jobs increases, this becomes more and more of the norm for society.

Personally, I think sitting has gotten a bad rap, and what we really need to do is look at our lack of physical activity overall. When we sit every day for our job, it can have a negative impact on the body, but an overall lack of physical activity is much more concerning than sitting itself.

When we sit, our bodies adapt to that position. There are several things that occur, such as a tightening of the hamstrings and a forward head and rounded shoulder posture. We don’t use our core muscles when we sit, because our body is supported, so there can be a weakening of those muscles as well. Our body gets used to not having to use these muscle groups. Then, when you do try to get out and be active, or work in the yard, you might be more susceptible to injury or pain because your body isn’t used to that kind of stress.

In short, you don’t need to quit your day job to pursue a career that involves standing all day. What you really need to do is increase your activity level outside of work and incorporate some regular exercises that combat the negative effects of sitting. These exercises can include core strengthening, stretching of the hips and chest and exercises to reverse your forward posture.

If you are experiencing pain related to sitting for long periods of time, a physical therapist can help you identify a more targeted exercise program.

Physical Therapist Kyle Stevenson, D.P.T., sees patients at MidMichigan’s Rehabilitation Services location in Greater Midland North-End Fitness Center. He has a special interest in sports medicine, and enjoys working with athletes of all ages. He has completed specialized coursework and training for the throwing athletes. New patients are welcome with a physician referral by calling (989) 832-5913. Those who would like more information about MidMichigan’s Rehabilitation Services may visit


What is W-sitting, and Why is it Important?

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W-sitting is a normal developmental position that babies usually discover when they sit back straight from their hands and knees. Their legs will then form a “W.” Often, babies also transition back to a single hip, toward a side sitting position. When a baby varies his or her sitting position, W-sitting is rarely a problem.

However, when a baby sits back straight to a W-sit consistently, they don’t get the opportunity to elongate and activate lateral trunk muscles to develop their core muscles. W-sitting is a very stable position that children find useful, however, it allows them to play without developing muscle that provide the ability for kids to reach out to their sides or rotate across their midline, leading to underdevelopment of lower trunk muscles, which stabilize the pelvis.

When a child uses this position as their preference without the normal variety in movements, it can affect development. They may demonstrate an in-toeing gait, core weakness or balance difficulties. The hips are positioned in extreme internal rotation, placing stress on the hips and the knee joints. This can lead to hip and knee orthopedic issues as the child develops.

So, what can you do to prevent any development issues? Encourage your child to alternate sitting positions, such as side sitting (alternating sides), ring sitting, or, with older children, sitting in a chair or on a ball. This might be challenging initially, but once your child gets used to it, they may just need reminders.

If it’s difficult for your child to sit in alternate positions or they begin to show other developmental concerns, a referral to a physical therapist may be helpful to facilitate trunk muscle development.

Eileen McMahon, M.S.P.T., is a physical therapist at MidMichigan Health.