Rehabilitation Medicine

Let me say the most important thing first: sarcopenia is not “just what happens when you get old.” It’s a disease that can be detected—and one that actually improves with exercise and diet. This post is written for two kinds of people: you, if an older adult at home has recently started walking slower or can’t open jars; and you, if you’re past fifty and starting to feel your stamina isn’t what it used to be. The second group is actually more important, because the latest 2025 Asian consensus pulled the age to start paying attention forward to fifty. ...

Let’s start with the most important point: If a senior’s shoulder repeatedly swells with fluid, and you can draw out a large bottle every time, it’s mostly not “simple degeneration,” but another disease. This post is for you if you have an older family member whose shoulder repeatedly fills with fluid, has been aspirated several times, but always swells up again quickly. What is this disease? Inside the shoulder is a group of tendons called the “rotator cuff,” which is responsible for hanging the arm steadily in the shoulder socket. As we age, this tendon group can tear completely. After it tears, the humeral head moves upward, and bone rubs directly against bone. The fine calcium salt crystals ground off fall into the joint cavity, which in turn stimulates the joint lining to inflame and continue the destruction. ...

Recently I was spending time with an older adult, and he said to me: “Life really doesn’t need to be that long. I’m already in my 80s, why would I still go exercise and work out? I already go out and walk several times a day, that’s already very good!” Honestly, the first half—“life doesn’t need to be that long”—stumped me. That’s a question about the meaning of life, not something I can answer in a few sentences in clinic. But the second half—“walking several times is enough”—happens to be my own specialty, and I’m confident about this: walking is great, but for an 80-something older adult, relying just on walking really isn’t quite enough. I’ll start from here in the rest of this post. ...

While prepping for the PM&R board examination, I used an engineer’s approach to solve an old problem for myself: how exactly should I practice past exam questions so I don’t forget them right after? I ended up building a small tool called “Exam Navigator,” and figured I’d tidy it up and open it up to share with anyone who needs it. 🔗 Live Demo (built-in demo account, ready to play): https://exam-demo.drpwchen.com 🔗 Source code: https://github.com/drpwchen/exam-practice ...

Last December, I took Neurodynamic Solutions (NDS) Level 1 and Level 2, taught by Michael Shacklock himself in Taiwan. Shacklock is the founder of the clinical neurodynamics system, and having him walk us through demonstrations step-by-step was a rare opportunity. After finishing both levels, I had taken over a hundred pages of notes, and it completely changed the way I look at “nerve pain.” To be honest, very few courses out there truly target nerves for treatment, which is one of the reasons I went out of my way to take NDS. ...

Ever since becoming a resident, looking for continuing education courses has hit the same pain point every time: ultrasound, manual therapy, foot and ankle, neuro, pediatric rehab… The courses are scattered across a dozen society and institution websites. I’d have to refresh the sites every few days, and I was never sure if I’d actually seen a particular post before. Later on, I set up web scrapers for these course pages in my Home Assistant at home to automatically notify me of new courses, and things finally got a lot easier. But realizing I’d be completing residency soon, this little tool sitting at home wouldn’t be able to keep reminding the junior residents. Figuring I had Claude anyway, I just asked it to scrape all the courses and announcements from these 17 rehab-related societies and institutions, aggregate them in one place, update automatically every 3 hours, and put it on the web for everyone to use. ...

If an accident happened one day and we could only stay in bed, unable to go anywhere, how would our lives go on? Life Bedridden with Disability I saw a patient with a high-level spinal cord injury on a home visit this month. Since an accident at 27, he can only move above the shoulders. Turning over, eating, bathing, and going to the toilet all require help from others. His life has become permanently tethered to his bed. ...