How to Properly Perform I’s, T’s, and Y’s Exercises

The purpose of I’s, T’s, and Y’s exercises on an exercise ball is to address lower and mid trapezius and scapula muscle weakness and to generally activate the posterior chain (including the lumbar spine extensors).  Poor posture due to poor thoracic mobility and poor scapular muscle strength are often major contributors to neck, shoulder, and upper back pain.  Poor lumbar extensor strength is linked to low back pain.

I’s, T’s, and Y’s exercises on an exercise ball can be helpful in treating the following: 

  • Poor posture
  • Shoulder pain
  • Cervical pain
  • Headaches
  • Thoracic pain
  • Upper and lower back pain

Begin by performing the I’s, T’s, and Y’s exercises on a Thera-Band Exercise Ball.  Please refer to I’s, T’s, and Y’s Exercises for step-by-step instructions.  Start slowly without resistance.  Keep your chin tucked and head aligned with the body.

Version One:  Move your arms slowly up and down in each position of I, T, and Y.

Version Two:  Hold each position for the specified time.

To increase the difficulty for either version, add a 1-3 pound weight in each hand.  These exercises shouldn’t cause any pain in your neck, shoulder or upper/lower back. 

When this exercise is performed correctly, it engages and strengthens many critical muscles that help control many of our most common postures and movement patterns.  A slouched posture with a forward head and rounded shoulders can be associated with many common pain syndromes including:  neck pain and headaches; upper back pain; and shoulder pain.

It’s important to try to keep the proper postural alignment with your shoulders under your ears, and the shoulder blades set in a back and down position.  This is particularly important when performing any activity while using the shoulder.  This series of exercises can help to strengthen the important muscles that can help you maintain proper postural alignment.

Be sure to check out my video post, How to Use an Exercise Ball to Improve Posture and Treat Shoulder, Neck, and Back Pain, in which I demonstrate how to perform I’s, T’s, and Y’s exercises on an exercise ball in order to address lower and mid trapezius and scapula muscle weakness.

When performing these exercises, it is important to understand that they should never be painful.  You may feel a mild to moderate discomfort because the exercises are difficult, but if you are experiencing pain (particularly, the pain you are trying to treat) please discontinue the exercise and speak to your physical therapist.

Have you tried the I’s, T’s, and Y’s exercises on an exercise ball before?  If so, what has your experience been like?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

My Top 10 Anti-Aging Tips

The science of aging and how to age gracefully and successfully continues to evolve, and the results are amazing.  The accepted norm for an aging adult is crumbling before our eyes!  This is such a wonderful time to grow older!  Many age-related declines can be counteracted with exercise, diet, and lifestyle modifications.  What are my top 10 anti-aging tips?  Let’s get started!  Continue Reading

How to Self-Treat Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS), sometimes called jogger’s foot, is a relatively common cause of pain along the inside (medial) portion of your ankle.  TTS can be a repetitive strain injury or an entrapment (compression) type injury.

The tarsal tunnel is a fibrous tunnel that is not structurally flexible.  There is limited room for swelling inside the tunnel.  This can cause nerves and blood vessels to be “entrapped” and lead to pain and other symptoms.

TTS is often caused by repeated pressure that results in damage on the posterior tibial nerve.  Similar to carpel tunnel in the hand, the tarsal tunnel is located just below the medial malleolus (the large bump to the inside of the ankle).  Basically, the tibial nerve branches off of the sciatic nerve and travels down the inside of the leg.  It eventually runs through the tarsal tunnel, which is a narrow passageway inside your ankle that is bound by bone and soft tissue called a retinaculum.  Continue Reading

Friendship is the Key to Avoiding Heart Disease

Astonishingly, over 735,000 Americans have a heart attack every year.  With heart disease being the #1 killer in western countries, including the United States, with over 17 million people dying every year due to heart disease worldwide.  Most heart attacks are preventable and most risk factors for cardiovascular disease are preventable.

Even more astonishing is that loneliness is associated with a 29% increased risk of having a heart attack and a 32% increased risk of having a cerebral vascular accident (CVA), also known as a stroke, according to a review of studies published online by the journal Heart (April 18, 2016).

This research validates the importance of friendship in living a long and meaningful life.  Many argue that a sense of belonging and purpose combined with a strong social support system will have more influence on the aging process than more traditionally thought of factors such as diet, weight control, and exercise.  Continue Reading

BeastNet Podcast Recap: Ben and Ted

In this podcast interview with Mike James (host of the BeastNet Podcast) and Ted Kielley (friend and Physical Therapy client), we discuss injury rehabilitation and what you need to do practically and mindset-wise to get back to obstacle course racing events (like the Spartan).  We also discuss the importance of teaming up with medical providers who actually understand your specific sport or lifestyle and how to find medical providers that can help you along the way.  Finally, we discuss best practices in preventing injury as a person ages to insure longevity as an Obstacle Course Race (OCR) athlete and how to age well in general.  Listen to the podcast

Disclaimer:  This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

Does Kinesiological Tape Really Work?

I was first introduced to Kinesiological (Kinesio) style taping during a continuing education class in 2005.  Since then, this style of taping has exploded in the mainstream with athletes and celebrities alike wearing it.  Research on this modality was initially scant.  Today there are over 540 published studies with even more antidotal testimony!  Although the research is ongoing and published regularly, I get asked all the time about what can you use Kinesiological tape for and how exactly it works.  I will review three theories on how Kinesiological tape actually works and the different reasons for using it.

Kinesiological Taping For Achilles Tendinitis

How does Kinesiological Tape Work?

  • Sensory Theory (also known as the Gate Control Theory) – The basic premise of this theory is that the Kinesiological tape, when applied to the skin, activates sensory receptors present on the skin. These receptors relay information to/from the brain.  Since the sensory receptors are faster than other types of receptors (such as pain) the brain reacts to the sensory information first.  This can lead to altered movement patterns and awareness to the area.  It can also allow for decreased sensations of pain.  This theory is similar as to why we think topical analgesics (such as Biofreeze) work as well as why transcutaneous electrical nerve stimulation (TENS units) can reduce pain.
  • Circulatory Theory – The basic premise of this theory is that the when the Kinesiological tape is applied with little tension it forms convolutions in the skin. These convolutions create channels and reduce pressure within the tissues, lymph system, and circulatory system which aids in blood and lymphatic flow.
  • Muscle Activation Theory – The premise of this theory is that when the Kinesiological tape is applied at different levels of tension on the skin over the muscles and tissues, the Kinesiological tape can either mechanically or neurological increase or decrease muscle activation via a nervous system response.

Presently the truth behind Kinesiological taping is that we really don’t know exactly how or why it works.  Based on my clinical experience, I believe that the Kinesiological tape interacts with the body’s tissues in different ways depending on how and where the Kinesiological tape is applied.  Depending on how the Kinesiological tape is utilized, any one or combination of the three theories is likely correct.

Research states that Kinesiological style taping is at least as effective as other minimal interventions for musculoskeletal pain which may include topical analgesics like Arnica montana (Arnica Rub) or Biofreeze.

Research has also shown that taping can reduce pain acutely within first week of injury and possibly even in cases of pain which has been present for as long as three to four weeks (or longer).

Research concludes that there are some improvements in muscle and joint range of motion (ROM) and a reduction of pain.  However, because the improvement isn’t significant or long standing it shouldn’t be used as a standalone intervention.  Kinesiological taping is best used in combination with other interventions (such as manual therapy based techniques and exercise) which have been proven to affect outcomes over the long-term.

When Kinesiological tape is used in conjunction with other treatments, it may help speed up the recovery as the Kinesiological tape can allow for other techniques to be utilized more effectively due to the loss of pain, swelling or easing of movements.

Although there have been hundreds of research studies performed, the effectiveness of Kinesiological tape is still questioned primarily due to issues with research design.  Many of the taping applications are based on theory and not science.  Since there isn’t a consistent application pattern, the research studies aren’t comparing the same techniques over large enough patient populations to show a true effect.  In addition, researchers still need to quantify how much tension is actually being used and the actual Kinesiological taping technique being used versus other types of techniques or interventions.

Unfortunately, without better quality research it’s unclear if the results shown in many of the studies are due to an actual effect or through placebo.  For now, none of the studies show significant benefits regarding long-term pain alleviation or improved strength or range of motion (ROM).  So for now, the main conclusion is that Kinesiological taping should be used only as a short-term treatment in combination with other treatments.  I personally use Kinesiological tape, and I often find that my clients experience success with specific tape applications for different conditions.

What do you use Kinesiological Tape for?

  • Reduce pain
  • Reduce swelling and edema
  • Support muscles and joints
  • Reduce muscle tension
  • Increase strength
  • Improve performance
  • Enhance or correct movement patterns through stimulation of sensory receptors
  • Provide compression
  • Enhance healing by slightly lifting skin away from sore or injured tissues to improve blood flow and lymphatic drainage
  • Support injured joints and muscles without impeding range of motion (ROM)

There are dozens of companies’ now manufacturing Kinesiological style tape.  There are many high quality tapes being manufactured with all kinds of colors, designs, and variations in adhesive quality and elasticity.  Personally, my favorite brands are based on price point and actual use.  This includes ease of application and how long the Kinesiological tape actual stays on.  The brands I use most include:  Kinesio Tape, RockTape, Thera-Band Kinesiology tape, Spider tape, and KT TAPE.  Although there are many more brands available, I have not personally used them.

There are many different applications Kinesiological taping can be used for.  Like any treatment modality, it can work wonders for one person and do nothing for another, but should we really be surprised?  Many of our most popular pharmaceuticals are no different.  Kinesiological taping has the benefit of rarely having significant side effects.  There are rarely side effects to utilizing this style of tape as the products utilized tend to be very hypoallergenic.  Occasional skin irritation has been the only noted side effect I have known of in my clinical experience.  In order to avoid skin related issues (including application and removal tips), please refer to Skin Care with Taping.

I have found success with utilizing Kinesiological taping as an adjunct treatment strategy and as part of a complete treatment approach.  If you are interested in specific applications for different conditions, please see the following in which I demonstrate different taping techniques.

Step-by-step guides:

Kinesiological Taping for Osgood-Schlatter Disease

Kinesiological Taping for Patellar Femoral Pain Syndrome

Kinesiological Taping for Shin Splints

Video:

How to Apply Kinesiological Tape When Treating Achilles Tendinitis

Books with step-by-step guides specific for ankle sprains and low back pain:

The Physical Therapy Advisor’s Guide to Treating Ankle Sprains and Strains

The Physical Therapy Advisor’s Guide to Treating Low Back Pain During Activity and Exercise

Have you tried using Kinesiological taping before?  If so, what was your experience like, and did it help you?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

How to Prevent and Treat Osteoporosis

There are many best practice guidelines for treatment of osteoporosis.  In many ways the treatment is quite straight forward and taking steps to prevent it is critical for health aging.  The sooner one starts the process, the better!  Regardless of age or severity of the condition, it’s never too late to start.  In most cases of osteoporosis, bone loss tends to be gradual.  Bone density tends to peak in a person’s mid-twenties and worsens as a person ages.  Statics conclude that in individuals over 50, one in two women and one in eight men will have an osteoporosis related fracture within their lifetime.

Osteopenia and osteoporosis can occur for many different reasons, but the most common reasons include:

  • Females are more likely to experience bone loss.
  • Certain ethnic groups.  White Anglo-Saxons are more likely to develop these conditions.
  • Prior family history.
  • Medication side effects.
  • Lack of proper nutrition, including vitamin deficits such as low Vitamin D3 levels.
  • Hormonal dysregulation.
  • Lack of weight bearing exercise.
  • Being bed bound.  Studies conclude that completely immobilized bones can lose up to 15% of mineral density within three months.
  • Lack of resistance exercise.
  • Certain genetic disorders.

Prevention and Treatment Strategies for Osteopenia and Osteoporosis:

Start Early 

As we age, our bones will normally start losing some bone density and flexibility.  (They become more rigid.)  It’s important to work on optimizing bone density early in life.  Bone density is best developed under 30 years of age, but it can be improved or at least slowed down at any age.

There are also studies that indicate pregnancy may also help to improve bone density.  This assumes a healthy diet with adequate calcium levels is consumed during the pregnancy and while breastfeeding. 

Weight Training

Weight training (particularly barbell training) loads the skeleton progressively over time, which can decrease bone loss and increase bone mineral density.  It also positively affects hormones, such as human growth hormone (HGH) and testosterone, needed to improve bone density and muscle strength.  Barbell training is the most effective method due to the progressive load on the skeletal system, and the muscle pull being exerted on the bone, which also stimulates bone formation.

Resistance training (other than through barbell training) can also be beneficial.  You can resistance train by utilizing strong elastic bands and cords or even machine weights.  This allows variations of pushing or pulling exercises that exert a force on the muscle, which stimulates muscle and bone development as well as optimizes vital hormone function.  Depending on the type of exercise, the resistance bands can mimic skeletal loading.

The key to maintaining and improving bone density is always axial skeletal loading and the associated pull of muscles against the bone during activity (particularly, strenuous activity).  Examples of such exercises include squats, lunges, and dead lifts.

Weight Bearing Activities

This refers to any activity, such as walking, jogging, hiking, climbing stairs, and dancing performed against gravity.  Biking and swimming are examples of exercises that are not weight bearing and therefore, they are not as beneficial for bone development.

Vitamin D3

Vitamin D3 is critical to the absorption of calcium, through the intestinal wall, which is important for bone health.  Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate magnesium and Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).  Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Increase Your Intake of Vitamin K1 and K2

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function within the bone.  An osteoclast is a type of bone cell that breaks down bone tissue.  These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream.  Without adequate calcium, many critical cell functions can be affected, including heart function.  Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.

Vitamin K, found in green leafy vegetables, has anti-coagulation benefits.  If you take blood thinning medications, your physician will need to know how much you consume on a regular basis so your medication can be properly dosed.

Avoid Soda

Excessive soda intake (particularly diet soda) has been linked to poor bone density.  The exact cause isn’t entirely clear.  Many theorize that the acidic nature of the soda along with the chemicals and additives cause increased osteoclast activity in the bones.  This releases more calcium into the blood stream in order to help fight the negative effects of soda consumption.  It is clear that too much soda is bad for your health and bones.

Magnesium

Magnesium is a critical component of bone health and health in general.  Magnesium helps the body to regulate calcium levels.  This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.  Many also use magnesium as a sleep and recovery aid.  When consumed at night it can be beneficial for improved sleep.  Magnesium can also reduce muscle soreness, cramps, and/or spasms.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.

Most people are deficient in the amount of magnesium they consume on a regular basis.  It is often recommended to start supplementation with a beginning dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.

Stop Smoking

If you smoke, please stop.  It not only affects your bone density, but it has negative effects on every other body system.  It also increases your risk of cancer and heart disease.

Eat Healthy

Do not eat anything that comes in a package.  A diet with proper vitamins and minerals is not only imperative to preventing osteoporosis, but it is the key to preventing most disease and illness.  Most of our food should be from low sugar fruits and vegetables as well as protein and healthy fats (primarily from plant sources such as avocados and coconut or olive oil).  Any animal fat should be from organic and grass fed animals.  Your body tissue needs nutrients to be able to perform at a high level.

Avoid processed food as much as possible.  Limit sugary food and add more protein and healthy fat in your diet.  Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system.  Adequate protein intake is necessary to support muscle health and development.  A healthy diet equates to healthy bones.

In order to prevent or alleviate osteoporosis and osteopenia, implement weight bearing exercise and resistance training; a lifestyle free of smoking and alcohol; and regular bone density screenings.  Maintain a balanced diet rich in calcium, Vitamin D3, Vitamin K, and magnesium.  It’s never too late to implement these strategies as you maintain a healthy lifestyle.  For additional information, please refer to Q & A: How to Self-Treat Osteopenia and Q & A: Which Type of Imaging to Use.

Which strategies can you implement in order to prevent and self-treat osteopenia and/or osteoporosis?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

7 Tips to Quickly become Heat Acclimated for Your Race

Running and exercising in warmer weather tends to be more taxing on your body and requires more energy to remain cool.

Most running experts suggest performance impairments of between 1.6% and 3% in marathon times for every 10 degrees above 55 degrees Fahrenheit.  The exact ideal temperature (approximately 45-55 degrees Fahrenheit) is debatable and based also on humidity.

When you’re not acclimatized to running in heat, it takes even more effort to keep your running pace.  This increases your risk of muscle cramping, bonking (hitting the wall), and/or being unable to maintain your goal pace (which leads to a longer finishing time).  Continue Reading

Q & A: Thoracic Spinous Process Fracture

Q.  I have been diagnosed with a T-6 spinous process fracture.  I have been prescribed a thoracolumbar brace for 12 weeks.  If it takes away the pain, I’m willing to try it.  What do you think generally of braces?  I like swimming, walking, Pilates, and yoga.  All of that is out right now except the walking.  I have osteoporosis and compression fractures at T-6/7 and T-11/12.  I would love your insight on healing time or ability to get back to the activities I love.  I was encouraged to read the Q & A on the teenager who had the C-7 spinous process fracture, but my story is quite a bit different.  Thank you!  -Mary 

(Please note that the original question was much more detailed and personal, so it was truncated.  The name has been changed for privacy.)

A.  Thanks for the great question!  For general discussion purposes, I will address the following topics:  bracing; healing and recovery times; osteoporosis; and treatment.

Bracing

Lumbar and thoracic braces can be appropriate and necessary tools for the right circumstances.  Corset style braces and/or more rigid style bracing are typically prescribed for either of the following two reasons:  to stabilize an injury site that the physician is concerned that movement may compromise healing or safety or to stabilize an area in the hope of reducing pain.  In this particular case, a brace was likely prescribed for both reasons.

There are many potential down sides to wearing a brace.  It can be uncomfortable and inconvenient to wear.  More concerning, bracing can lead to over dependence and the loss of important muscle stabilization strength.  This is why an appropriate exercise program should be maintained while wearing the brace.  Once you’re cleared to wean from the brace and taper back into normal activities, you can progress into a more targeted and comprehensive exercise plan.

Healing and Recovery Times

Whether or not a spinous process will heal depends on the severity of the fracture.  Is it a small fracture with the bones still attached (basically a crack) or was the spinous process separated from the vertebrae?  If the two pieces were separated, then it is likely they will not heal back like a normal fracture.  The bone will not re-attach itself back to vertebrae.  When this occurs, it’s known as a non-union.  Scar tissue and fascia will surround the injury site and in most cases, form a solid fibrous pseudo-union between the two pieces of bone.

In most cases, there aren’t any deleterious effects from the injury and healing process.  Like bone healing, this process typically takes 6 to 8 weeks for most individuals.  It can take longer based on other factors:  age; nutritional status; smoking; and other conditions such as osteoporosis or diabetes.  Even certain medications, such as NSAIDs, may impede bone healing.  Speak to your physician and pharmacist about any and all medications and supplements you are taking.

(In Mary’s particular case, there may be other compounding factors or the fractures were quite severe since the expected time frame for healing is 12 weeks.)

Compression fractures will likely take about the same amount of time to heal.  If the bone is slightly collapsed, it will not recover its previous shape.  It will remain slightly more wedge shaped.

Osteoporosis

Although bracing is often a necessary part of the recovery, it will likely weaken the surrounding musculature.  A strong core and adequate stability of the muscle around the trunk are important components to one’s recovery as well as prevention for ongoing issues (particularly in cases of compression fractures).

Be proactive in dealing with your osteoporosis.  Otherwise, you will likely continue to experience fractures and other issues.  There are medications that can help, but they all have significant potential risks.

Proper nutrition and weight training are components to managing osteoporosis.  Please refer to Why Astronauts Resistance Train and So Should You.

In addition, I recommend Sara Meeks’ book, Walk Tall! An Exercise Program for the Prevention & Treatment of Back Pain, Osteoporosis and the Postural Changes of Aging.

Treatment

Nutrition is very important for healing.  Consult with a functional medicine practitioner to dial in your nutrition and address any potential nutrient deficits or nutrient absorption issues.  Also, refer to Why You Won’t Heal – Poor Nutrition.

I recommend starting with a walking program that includes a gradual taper up to at least 3 miles per day.  Once you’re medically cleared to exercise again, find a physical therapist (PT) that specializes in osteoporosis management.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.

A PT can help you initiate a comprehensive core stabilization program along with weight training.  In many cases, a core stabilization program can be initiated around the 6 to 8 week mark, but it depends on when your physician clears you to return to exercise other than walking.

Prior to initiating a full strength training routine, begin by initially focusing on your back extension strength (which will address the spinous process fractures as well as the compression fractures).  Any rehabilitation program should be slow and steady.  Start well before the 12 week period unless there are medical contraindications for doing so based on your particular situation.

Healing times vary tremendously.  It’s based on the severity of the injuries and your individual health status.  With poor bone health or other co-morbidities, it could be prolonged.  Full healing may take 4 months or so.

With these types of injuries, pain is always highly variable.  It can vary from a couple of weeks to 4-6 months.  Pain will typically slowly decline as the healing process progresses.  The early inflammatory process that was initiated after the injury will progress through an acute to more subacute phase.  Wearing the brace usually helps with early pain management.

Thankfully, this type of injury usually results in a full return to function without many long-term deleterious effects.  The key is to allow adequate healing time, and then slowly and strategically progress back into full activity.

Have you ever suffered from a thoracic spinous process fracture?  Please share your story below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

How to Avoid Overtraining as a Long Distance Runner

http://marathontrainingacademy.com/how-to-avoid-overtraining-as-a-long-distance-runner

Marathon Training Academy

May 30, 2018

In this podcast interview with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast), we discuss Overtraining Syndrome (OTS) and how it differs from an overuse injury, the top mistakes we see runners make in regards to training and recovery, and answer questions from runners.

In this episode, we speak with Dr. Ben Shatto about overtraining, which is a leading cause of injury and burnout in long distance runners.  Listen to the podcast

Disclaimer:  This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.