Category Archives: Physical Therapy

Posted on

Q & A: How Should I Treat Shoulder Pain and Impingement?

Q I suspect I have a left rotator cuff tear.  I have severe pain especially when I move my arm outwards.  It feels like a knife stabbing my left deltoid area with spasms.  There is no swelling or bruising.  The area is tender to touch.  I have trouble lying on my left side at night due to discomfort.  If I don’t move my arm, there is no pain.  Ibuprofen is not effective.  I have been applying ice.  I haven’t seen my MD yet.  When I raise my arm when I perform range of motion (ROM), I hear a cracking sound.  It has been six weeks.  Please advise, Dr. Ben! -Linda

A.  Thanks for your question, Linda!  Unfortunately, this is a fairly common scenario.  Shoulder pain can be one of worst most intense pains a person can experience.  It can be completely debilitating–rendering an arm almost useless in some cases.  The shoulder is vital for any movement of the arm which includes the hand.  It can even affect a person’s ability to utilize a computer mouse.

Linda doesn’t mention any specific causative factor which is common in these cases.  She also mentions pain at night and pain with movement.  Another very common symptom is where she describes the stabbing pain in the deltoid.  The pain is almost always located down the arm into the deltoid area.  Typically, it is located at the insertion point of the deltoid muscle.  It can migrate even further to the elbow or hand.

IMG_3759_RGB_4x6_Deltoid

In a situation like Linda’s, the source of the pain is rarely the deltoid and almost always the rotator cuff.  The rotator cuff tends to “refer pain” into this region.  Referred pain is a common phenomenon which occurs when the pain is being caused in one area of the body, but the pain is felt somewhere else.  (An example of referred pain would be left arm pain or jaw pain which is present during a heart attack.)

Linda states that the pain is present when she raises her arm.  This implies that she still has the ability to raise her arm, which tends to (but not always) rule out a full rotator cuff tear.  Typically with a full tear, the person loses the ability to raise his/her arm.  The level of pain on a full tear will vary depending on how acute or recent the tear.

To accurately diagnose Linda’s condition, I encourage her to seek treatment from her medical physician or physical therapist.  Based on her reported symptoms, she is likely experiencing either a partial rotator cuff tear or shoulder impingement.  Shoulder impingement can lead to an actual rotator cuff tear if it remains untreated.  The key to treatment (with either a partial rotator cuff tear or an impingement) is to first address the pain and inflammation.  Then the mechanical cause or causes which led to the injury must be addressed.

My Top Tips & Recommendations to Treat Shoulder Pain & Impingement include:

Reduce the Inflammation:

  • Use ice on the affected area (not directly on the skin) for 20 minutes per hour. Watch the skin carefully. If it looks white or blue and is non-blanching, then discontinue the use of ice. It is possible to frost bite your skin.
  • Rest the affected area. Stop or reduce any activities which tend to aggravate the area. This is typically overhead activities or repetitive activities.
  • When sleeping, try not to lie on the affected side. Hug a small pillow for comfort. This also promotes optimal blood flow to the shoulder area.
  • Try Mt. Capra CapraFlex. Mt. Capra, an organic goat farm in eastern Washington State, offers superior quality products primarily utilizing goat based products. Capra Flex is the best bone and joint supplement I have found. It is a blend of natural herbs and spices along with glucosamine and chondroitin. The herbal and spice formulation is designed to naturally decrease inflammation and support healing. I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level. I personally use it, and in my practice, it has helped clients recover faster and prevent injury. It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.

Address the Mechanical Causes:

  • A slouched posture with a forward head and rounded shoulders can be associated with this condition. Try to keep a good 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.
  • Improve thoracic (upper back) mobility. The more mobility your upper back has, the less likely your shoulder will impinge when moving. Your upper back, shoulder blade, and arm must work together when moving. Tightness in the upper back will throw this system off.
  • Be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  By subscribing to my e-mail list, you will automatically gain access to this FREE resource.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

Strengthen the Rotator Cuff:

  • The rotator cuff is a critical component to shoulder mobility. It is made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates and slides properly in the socket, which is made up of the scapula. The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform. When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone–leading to impingement or eventually fraying and tearing.
  • Here are my recommended Rotator Cuff Exercises  using an exercise band.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover.  My tips and recommendations are the first steps for treating and preventing shoulder impingement and pain.  Many different causative factors can lead to these conditions.  In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.

If your symptoms continue to worsen or you don’t improve, I highly recommend that you seek further medical treatment.  Many times, a person will require medical intervention, which could include anti-inflammatory medications either orally or through an injection.  A person may also need hands-on treatment from a qualified physical therapist to address other mobility issues in the shoulder, thoracic or cervical regions which are causing or contributing to the pain.  Sometimes, surgical intervention is needed to repair a fraying tendon or an acromion which is hooked and causing the impingement.

Good luck, Linda!  I hope you find the information to be helpful and provide some relief from the pain you’re experiencing.  If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

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.

Posted on

Improving Balance by Using a Water Noodle

Balance is an important part of mobility.  It is usually overlooked and taken for granted until mobility is significantly affected.  Like all exercise, balance exercise should be fun and convenient.  So, how do you use a common water noodle to improve balance? Let’s get started!

WaterNoodleCollage

Integration of lower extremity muscle strength and range of motion (ROM) is important to maintaining good balance and mobility.  Your calf muscles play an important role in balance.  If your calves are tight, then you are more likely to tip over backward as you age.  The strength of the calf muscles is also important for ambulation.  Try these two exercises to stretch your calves.  Hold each stretch for at least 30 seconds twice each leg.

Calves

Your ankles and calves work together to prevent falls which utilizes a reflex known as ankle strategy.  It can help you recover from minor losses of balance.  It is an essential front to back movement of the ankle.  If you are pushed forward slightly, the ankle will bend and the calves will push you backward so you can maintain your upright stance.  If you have tightness in your calves, loss of ankle ROM, weakness or poor sensation, then this crucial strategy is affected.  The use of a water noodle can help address this issue.  (You can purchase one at your local retailer or sometimes, even at the dollar store.  I have cut mine down to about one foot in length to be more manageable.)

IMG_4811_RGB_6x4

First, stand on the water noodle.  Very slowly and under control, try to keep your balance while you rock your feet back and forth (touching your toes, then your heels).  Feel the motion of the feet and the control of the ankles.  You can practice this exercise with your shoes on or off.  For added difficulty, close your eyes!

A water noodle can also be used to work on proprioception and somatosensory integration for balance.  Somatosensory is the integration of the neurological system (the brain and nerves throughout the body) with the musculoskeletal system.  This includes all the touch and movement nerve receptors in the muscles, tendons, and joints.  This also includes proprioception, which is the brain’s ability to know where the body is located in space.  For example, if you close your eyes and lift your arms overhead, you know where yours arm are located.  Practicing balance on a softer or unstable surface helps to train the somatosensory system and helps to work the smaller stabilization muscles in the ankle.  This is also an excellent way to prevent ankle sprains!

WaterNoodleCombined

Practice standing on the water noodle.  At first, you may need to use your finger (or hand) on a counter top or chair for balance.  Practice holding for 30 seconds to start.  Then build up to holding the position for a minute.  To increase the difficulty level, try standing on the water noodle with one foot, then gently touch the opposite toe on the ground and bring it back.  The further the foot reaches out, the harder the exercise.  Imagine the numbers on a clock and work your way around the clock and back, each time gently touching a tip toe and then returning the foot back to the standing leg.  Repeat on the other side.

For additional information on the five different body systems which affect balance and how they work together to insure proper balance and mobility in our environment, please refer to How Do I Improve Balance? (Part I) and How Do I Improve Balance? (Part II).  If you desire specific advice, I highly recommend that you seek assistance from a qualified medical doctor or physical therapist that is well versed in balance related disorders.

One of the best ways to maintain your balance as you age is to remain active and move more!  Balance is an integration of many body systems, so movement is an excellent way to work on all of the body systems!

Don’t forget to subscribe to my e-mail list to receive each week’s blog post sent directly to your inbox.  You will automatically gain access to my FREE resource, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  Download the .pdf file, which is full of photos and exercise instructions, to get started!  Subscribe now by clicking on the subscribe button located on the upper right-hand sidebar.  (Or scroll down further if you’re on a mobile device.)  Thank you!

Also, if you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

3 Reasons Why You Should Subscribe to My E-mail List Today!

  1. You will receive each blog post sent directly to your e-mail making it even easier and more convenient!  Advice will be related to physical therapy related topics; physical fitness and performance; health and nutrition; injury prevention and rehabilitation; and successful aging and elder care.  I will provide useful and practical types of “how to” information, including methods to safely self-treat and manage common physical therapy related conditions.
  2. To thank you for subscribing, you will automatically gain access to my FREE resources, including the 10 Fast & Simple Ways To Stop Annoying Back Pain.  Looking for my FREE CHAPTER from my eBook, Treating Low Back Pain During Exercise and Athletics, 10 Minutes per Day Low Back Pain Prevention Guide or My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain?  No worries!  You can find them here, too!
  3. Last but not least, official e-mail subscribers will receive top priority when submitting questions to be featured in the Q. & A. section.  If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

I appreciate your support and promise that your e-mail will not be sold or misused.  Don’t delay—subscribe now by clicking on the subscribe button located on the upper right-hand sidebar.  Thank you!

P.S.  Join our community on Facebook by liking The Physical Therapy Advisor and be sure to subscribe to my YouTube channel!

Posted on

Q & A: How Do I Improve Balance? (Part II)

In last week’s blog post, I answered a reader submitted question from Kay regarding worsening balance and what we can do to improve our balance.  The blog post addressed five different body systems which affect balance and how they work together to insure that we have proper balance and mobility in our environments.  In case you missed it or would like to review the five systems, please refer to Q & A: How Do I Improve Balance? (Part I).

This week, I will offer specific suggestions on how you may improve balance in each of the five body systems.  If you require specific advice, I highly recommend that you seek advice from a physical therapist or a qualified medical doctor who is well versed in balance related disorders.

Muscle Strength and Range of Motion (ROM) – Without adequate strength, you are unable to balance.  These specific exercises can help to improve balance.  If your balance may be due to an issue in this area, then the next step is to narrow down as to why.  To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits.

Stretch your calves. If your calves are tight, you are more likely to tip over backward as you age. It also affects your body’s normal ability to balance and recover from a loss of balance via what is known as an ankle strategy. Hold each stretch for at least 30 seconds twice on each leg.

Calves

Get stronger hips. An easy way to work on strengthening this area is to get into a quarter squat and walk sideways. Keep your toes pointed forward and go both directions. (Add an exercise band for more of a challenge.)

IMG_3847_RGB_4x6

Improve your quadriceps and buttock muscle strength by doing sit to stands. This is exactly as it sounds. Sit down, and then stand up. If this is difficult, start with using your hands, but eventually you shouldn’t need to use them. Use a standard height chair and see how many sit to stands you can perform in 30 seconds. The CDC’s 30SecondChairStandTest .pdf file provides further instructions and norm values for your gender and age. Scoring below your norm values indicates you are at higher risk of falling.

SitToStand

Stand on one leg. I would recommend being near your sink in case you lose your balance. On average, you should be able to hold a single leg stance for at least 30 seconds.

IMG_4793_RGB_4x6

Somatosensory – The somatosensory system is the integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system.  This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This system will be challenged as you work through the other activities suggested.  If you’re a diabetic, you must keep your blood glucose ranges within the parameters set forth by your physician in order to help minimize damage to this system.  Most importantly for all of us, continue to live a healthy lifestyle.

Eyesight – My first and most obvious suggestion is to visit your ophthalmologist to make sure your eyes are healthy.  If you are using corrective lenses, confirm that they are functioning effectively for your needs.  You can also work on Vestibular Ocular Reflex (VOR) by performing the following exercise.  Hold your thumb or colored object out in front of you and practice moving your head up and down, to the left and right, and at diagonals as you keep focused on the object.  Then practice moving the object while your eyes track it in all directions.  Finally, try moving the object opposite the direction you move your head while still keeping focused on the object.  If you are advanced, try reading a few words while you perform these.

VOR

Vestibular – If you’re experiencing vertigo or dizziness, ask your physical therapist to screen you for Benign Paroxysmal Positional Vertigo (BPPV), which is fairly common and easy to treat.  Otherwise, it’s best to continually challenge your vestibular system by remaining active, and in particular, moving your head more.  Try the VOR exercises described above.  Try moving your head while you stand on one foot.  Moving your head, jumping, and any bouncing activity in general not only stimulate the musculoskeletal system, but also the vestibular system.

Central Nervous System – Live a healthy lifestyle and move more.  The brain needs to be challenged.  Think “heart healthy” because anything that keeps the vascular system healthy is also good for the brain.  Also, don’t forget to drink plenty of fluids.  Like other systems in the body, the brain is primarily water.  Dehydration affects your balance in many ways (including the vestibular system) and also increases your risk of blood clots and strokes.  Discuss with your medical practitioner any changes, new onset of dizziness, or poor balance as it can be a sign of something more severe or could be a side effect from a new or old medication.

The key to helping someone improve balance is to understand why his/her balance is worsening in the first place.  Balance is affected by any one or a combination of the body systems listed above.  The brain integrates the information within one’s environment.  To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits.  That is usually the most difficult part.  If a person spends time evaluating why his/her balance has worsened, then an effective treatment program can be designed to address the issue.

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.

Posted on

Q & A: How Do I Improve Balance? (Part I)

QI have noticed worsening balance, but my knee hurts, and it is hard to do anything.  I have also seen balance problems in my mother and daughter.  What can we do to improve our balance? -Kay

A.  Kay asks a very fundamental and important question.  Balance is a very important factor in our mobility, and mobility (at its basic level) is life.  The difficult part is that balance is a very complex issue.  It is not something we are born with; it is something we develop.  We are born with many of the basic components of balance, yet it takes many years to develop into what we would consider to be “good” balance.  Kay’s question also touches on a huge issue facing many of our loved ones and our healthcare system in general.  The fundamental reason for the question is how balance affects our mobility and how balance relates to fall prevention.

Before we can adequately answer the question, let’s establish what “balance” is and which body systems affect balance.  Let’s also discuss why balance is so important–particularly as we age.  We are concerned about balance because we are concerned about falling (and we should be).  Falling is the number one cause of hip fracture.  Nearly 20% of all hip fractures in the elderly will result in death within the first year, and 50% of people will never regain their prior level of function.

Poor balance and the fear of falling are one of the primary reasons for declining mobility with aging.  Lack of mobility leads to further decline including: even worsening balance; worsening arthritis and pain; and negative effects on diabetes, heart disease, and osteoporosis.  It generally leads to a declining quality of life.  Mobility is an important element of life.  The worse one’s balance becomes, the more difficult it is to be mobile.

Understanding Balance

Balance is primarily affected by five different body systems working in combination with each other:

  1. Muscle Strength and Boney Stability – In general, we have to have the strength and bone structure to actually hold ourselves upright. If we don’t have this, the other aspects of balance don’t mean much. Consider a baby or someone with paralysis. Without adequate strength or if you have a severe fracture, you are unable to balance.
  2. Somatosensory – This is the integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This also includes our ability to distinguish between hot and cold. One term you may be familiar with is proprioception. It’s a fancy word describing our brain’s ability to know where we are located in space. For example, if we close our eyes and lift our arms overhead, we know where our arms are located. A common problem affecting the somatosensory system is neuropathy. One very common form of neuropathy is from diabetes. Neuropathy is when the nerve cells (typically in the extremities like hands and feet) will die. This may be due to poor blood supply, trauma, infection, disease, or even side effects from medication. The death of the nerve is the “neuropathy” which presents initially when a person may feel cramping, shooting, or burning pain. Ultimately, it affects the person’s ability to feel sensations which causes numbness. Having numb feet makes it very difficult to balance!
  3. Eyesight – Humans are very eyesight dependent when it comes to balance. We rely heavily on our eyesight for mobility and to know where we are located in our environment. Have you ever tried closing your eyes when standing or been in a room that was so dark it was hard to tell which direction was up? Now imagine you have an eye condition such as glaucoma, cataracts, or you wear bifocals. This affects your ability to see and your depth perception—ultimately, affecting your balance. Your eyesight is not just about the acuity at which you see, but is also important when you think of how you see. Gaze stabilization is how well you can stabilize a target in your field of vision. For example, can you stay focused on a moving object or can you move and keep the object in focus? Your eyes must be able to hold an object in focus or quickly move from one object to the next. Your eyesight is also interconnected with your vestibular system.
  4. Vestibular System – Our vestibular system is our inner ears. It provides us with information on head acceleration and gravity. It also works closely with our brains to process information on the head’s position in its environment. It helps us produce reflexes which affect our sense of equilibrium and our eyes’ ability to hold a gaze on a desired target. If you have ever experienced vertigo, then you understand how bad it feels when your vestibular system is malfunctioning. Like a child on the merry-go-round, this system may be fun to stimulate. The vestibular system is one of the more adaptable systems, and with practice, it can be improved.
  5. Central Nervous System – The brain is responsible for coordinating all of the information gathered by the body’s other systems. If the brain is damaged through trauma such as concussions, motor vehicle accidents, and war, then its ability to process information relating to balance could be affected. Another factor could be infections from virus, bacteria, fungal, or a disease process such as Alzheimer’s or Parkinson’s disease. Strokes or aneurisms can also affect balance. If a person has been affected by any of these, treatment should be sought from a qualified medical practitioner.

The key to helping someone improve balance is to understand why his/her balance is worsening in the first place.  Balance is affected by any one or a combination of the body systems listed above.  The brain integrates the information within one’s environment.  Determining the best intervention to address balance-related issues can be difficult and is typically multifactorial.  The first step is to determine what the primary cause is for the decline in balance.

Now that we understand some of the basic components to balance it is easy to understand why answering Kay’s question is more difficult than you might expect.  To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits.  That is usually the most difficult part.  If a person spends time evaluating why his/her balance has worsened, then an effective treatment program can be designed to address the issue.  Thank you, Kay, so much for this question!

In next week’s follow up post, Q & A: How Do I Improve Balance? (Part II), I will offer very specific and practical approaches to improve balance in each of the five categories.  Stay tuned!

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.

Posted on

5 Ways to Improve Range-Of-Motion (ROM)

Most of us think stretching is stretching is stretching.  Who likes it?  Why do we need it?  Yes, some days I’m personally still in that camp!  Stretching is actually more nuanced than that.  The real question is: why are you stretching in the first place?

There are potentially different reasons to stretch.  One reason is to decrease pain.  Stretching an ailing muscle or muscle spasm can activate internal stretch receptors in the muscle tendon unit, which helps the muscle to relax.  It can also change the blood flow to the area or affect the input on the nerve–all resulting in some pain relief.

We instinctually want to stretch.  Consider yawning.  Our outward arm motions during a yawn are nothing more than primitive stretch reflexes.  Babies begin stretching in utero!  We continue to voluntarily stretch for the rest of our lives (or in the case of a yawn, involuntary).  Animals (dogs, cats, horses, and even birds) also stretch daily.

Stretching releases positive endorphins and neurotransmitters in the brain which helps us to feel better.  Depending on the location of the stretch and the intensity, it can cause relaxation or alertness.

Stretching is used to improve range-of-motion (ROM) of a joint, but why?  The most common reason is that the joint ROM is limited and is somehow affecting performance of a desired activity.

Stretching is also used as a preventative measure.  For example, if ROM is limited asymmetrically (unequally) in the hamstrings, then it could lead to a pelvic torsion and low back pain.  Another example is a shoulder which has limited ROM, yet a person continues to reach up overhead or perform an overhead weight lifting technique.  If the individual doesn’t have adequate ROM to perform the lift, then either he or she will perform the lift incorrectly (risking injury).  The body will be forced to compensate somewhere for the lack of shoulder mobility (again, likely leading to injury).

As a physical therapist, I work weekly with people who have injuries from compensating for lack of ROM and mobility in the body.  This problem is prevalent due to current American culture.  We spend most of our day either sitting (driving, working on the computer, watching TV) or hunched over while sitting or standing (washing dishes, picking up children, general slouching).  As a society on average, we don’t move or stretch enough to live healthfully.  A joint must go through its full ROM on a daily basis to remain healthy.  Without the full ROM, a nutrient rich and internally lubricating fluid known as synovial fluid cannot properly circulate and coat the joint surface.  Over time, this will lead to stiffness, dysfunction, and joint deterioration such as arthritis.

One potential issue to address is that all stretching methods aren’t created equal and certainly aren’t appropriate in every circumstance.  The research indicates that stretching, when done improperly or at the wrong time, can either help or inhibit performance.

Let’s review five different methods of stretching or improving ROM:

Static Stretching – Static stretching is basically holding a tissue in an elongated form.  This can be performed across one joint or multiple joints, depending on the muscle or tissue being stretched.  The minimum length of time should be 30 seconds to around 60 seconds at a mild to moderate discomfort.  If you want to maximize results, then the stretch should be held for a longer duration of at least five minutes.  Typically, this is not practical for most people.  Static stretching before your athletic performance causes loss of performance.  If the goal is to gain ROM, then static stretching should be performed, but only after the activity or at a separate time.

Dynamic Stretching – This is a more active type of stretching where you are moving in and out of your available range of motion.  This can be progressed into ballistic stretching, which is taking a joint actively and usually quickly, through its available ROM and into a near end range stretch without exceeding the physiologic maximum ROM for the joint or muscle/tendon tissue.  As a warm up, dynamic and ballistic stretching can improve performance and joint ROM.  If the goal is to prepare for an activity, then a dynamic warm up should be performed.  Ballistic stretching is not indicated for novice athletes or beginning stretching.  It is definitely not indicated when recovering from injury.

Myofascial Release with Foam Rolling – Research is limited presently, but it indicates that foam rolling can help improve joint ROM without the deleterious effects of static stretching.  It can be performed prior to athletic performance and not provide a negative effect.  Clinically and personally, I find foam rolling to be an effective method in improving ROM.  Foam rolling should be a frequent post-workout activity, and at times, it would be indicated as a pre-workout activity.  It is also a fantastic way to release stress and tension, and it may improve recovery times.  (Please refer to a recent post, Does Foam Rolling Help or Hurt Your Performance?)

Proprioceptive Neuromuscular Facilitation (PNF) – PNF stretching is a very quick and effective method of utilizing the body’s neurologic stretch receptors within the muscle and tendon units to assist in producing increased ROM.  There are many different types of PNF stretches and exercises.  The most basic and easiest to utilize individually is a technique known as Hold/Relax.  Move the extremity and joint to a point of feeling a mild stretch, and then lightly resist any further stretch for approximately 10 seconds.  After 10 seconds, progress further into the stretch and hold for approximately 30 seconds.  I tend to work in sets of three to four when performing this technique.  It is also important to remember that it should never result in pain, only a stretching sensation.

Neuromobilization or Neural Gliding – This is probably the least understood of all methods to improve ROM.  There are many factors to consider regarding neural mobility.  First, the nerves are covered in a protective sheath which is meant to be very flexible.  Unfortunately, when the sheath is irritated or damaged, it tends to lose its flexibility.  This typically leads to neural pain.  Sciatic nerve pain from a bulging disc is an example of when this may occur.  Trying to directly stretch a nerve is a bad idea as it usually makes it worse.  Specific neural gliding and mobilization techniques have been developed to assist with improving ROM and pain.  As a physical therapist, I use clinical signs to help guide my treatment diagnosis, which ultimately can help guide the treatment for the client.  If you are experiencing neural tightness and pain, please seek medical advice to insure you are getting proper care.  There are times when neural tension can be present without pain or other symptoms.  It may be caused by poor spinal alignment, poor posture, or other medical illnesses.

The science of stretching is as diverse as the reasons why you may want or need to stretch.  Stretching is critical to maintaining flexibility.  Flexibility is a critical component to a healthy and optimally functioning body.  Although flexibility and stretching are often overlooked, they are truly critical to optimize health, prevent injury, and maximize performance.  Stretching should never be done to the point of causing pain.  It is possible to cause injury by over aggressively stretching.  The best results are usually through consistency and a mild to moderate stretching sensation.

Please email contact@thephysicaltherapyadvisor.com if you have a question that you would like featured in an upcoming blog post.

Posted on

Q & A: How to Jumpstart a Sedentary Lifestyle

QHey, Ben!  I am SO EXCITED that you are doing this blog!  I think you can help so many of us who are clueless and trying to figure things out, all the while making things worse.

What would you suggest for those of us who have been (shamefully!) too sedentary for too long and desire to get back to a pain-free, in shape lifestyle?  Where do we start?  Arthritis and excess weight make much exercise seem daunting.  I am deathly afraid of injury because I need to care for my family. Here is what I’ve been doing lately:

  1. Tracking everything I eat on MyFitnessPal app
  2. Reducing gluten (it swells my joints)
  3. Walking 1.5 miles in the morning at a 3 mph pace, including one hill; 20 minutes of deep stretching; 30 sit-ups; and 3 sets of bicep curls and triceps extensions.

I need to do more!!  I need to lose 80 lbs., but I can’t yet do the heavy cardio stuff because I don’t want to get hurt.  I’m 45 years old this year.  I hurt when I move.  Please help me get started with something that will lead to fitness if I stick to it!  Thanks, Ben.

-Erin

A.  Thanks, Erin!  This is a wonderful question because there are many of us who feel exactly the same way you do.  There are many points to ponder about this question, but let’s first acknowledge the positive.  You are aware of your need to address this issue.  It is not too late–45 years is not old (especially when you consider you are likely to live into your 90s).  You are already taking action!

Where we are now in our physical lives is the sum total of choices we have made, and a few random events all sprinkled with the genetics we inherited.  We need to accept ourselves for where we are presently and acknowledge that our fitness and our health is not a destination, but a journey.  Each person’s journey is different.  We need to be realistic with our goals and give ourselves time to undo what we have done to ourselves for years. Let’s get started!

    • Put away the scale. Health is not a number, it’s a feeling. How do you feel? Are you feeling more energetic? Experiencing less pain? Motivated to continue your new lifestyle? If so, you’re on the right track. Never weigh yourself more than once per week.
    • Aim for 1-2 pounds loss per week.
    • Walk daily after dinner. Your walking program is good, but it would be better if you could walk after meals. I would consider after dinner walks. It has a greater benefit on your metabolism and can reduce the risk of diabetes. If you can only walk in the morning, I would suggest walking before your morning meal.
My daughter Alexis and I out for an evening stroll/bike ride.

Alexis and I out on an evening stroll/bike ride.

    • Perform High Intensity Interval Training. Apart from your walking program, perform your cardio in short bursts ranging from 30-60 seconds at a time followed by a one to two minute recovery. The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high. You should be breathing heavy. If you are overweight or have arthritis, this may be performed while using a stationary bicycle or in the pool. You can also walk uphill at a quick pace, then stop and rest. This is performed in intervals. Review high intensity training (HIT) or high intensity interval training (HIIT). This type of training will produce the best results for weight loss and fitness. HIIT is a superior way to increase cardiovascular fitness; improve hormonal regulation; increase insulin sensitivity; and burn more calories and fat in a shorter amount of time. The biggest drawback is that it is not easy.
    • Don’t fear heavy weights. The key to increasing your metabolism is lifting weights. This is critical for muscle development and proper hormonal regulation. You must lift heavy things and concentrate on the large muscle groups. For example, start with chair squats or weighted squats. Women in particular tend to fear lifting weights for fear of bulking up. (Don’t worry–you won’t.) If you are a novice, seek reputable advice by consulting a trainer or a physical therapist. Look for the following credentials: NSCA certifications; CSCS certifications; physical therapists with strength training backgrounds; or better yet, get a personal recommendation. There are many qualified trainers, but be careful of many novices. If their recommendations don’t make sense to you, then they probably wouldn’t to me either. You don’t need fancy, just consistency.
    • Test for food sensitivities. Food sensitivities can affect your pain, your energy level, and your hormonal regulation. Request a food sensitivity blood test run from a functional medicine practitioner. http://www.functionalmedicine.org/ If you don’t get your hormones on board with this plan, you will not be successful. A functional medicine doctor can help you work toward health. 
    • Do not diet.
    • Do not eat anything that comes in a package. Most of our food should be from low sugar fruits and vegetables, and 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.
    • Move more! New research suggests that it is not just about the amount of time spent exercising, it is also about the time spent not moving. The longer you sit, the higher your risk of death. In a recent study, those sitting more than eleven hours a day have a 40% higher risk of death. Move more, more frequently! http://www.medicaldaily.com/sitting-more-11-hours-day-raises-premature-death-risk-40-240006
    • Start slow, but be consistent. Work to progress regularly, and don’t do this alone! Find a group, a friend, or a trainer, but don’t give up!

Healthy living is something to strive for.  To be healthy, we need to address all aspects of our bodies.  We need to work on cardiovascular health, which is best done by HIT followed by regular movement and activity; weight training; good sleep of seven to nine hours on average; plenty of water intake; and healthy eating.  Remember our physical bodies are only part of the equation.  Let’s not forget the social, psychological, and the spiritual aspects that must also be in balance.

Injury is always a concern when we start something new, but it is a risk that we must take.  We either risk orthopaedic injury from an active lifestyle or we can guarantee an unhealthy life full of heart disease, cancer, depression, and diabetes.  However, we must be smart about our activities and slowly taper to a level that is appropriate for each of us.  As a physical therapist, I see just as much arthritis and debility in people who didn’t move much in life as those who over-did.  Our bodies must move to be healthy.  Lack of movement and activity doesn’t prevent orthopaedic breakdown.

This question hit at the heart of what I hope to address on The Physical Therapy Advisor blog.  This answer is by no means all-encompassing.  I will continue to address these topics.  Thank you, Erin, so much for this question!

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.

Posted on

Does Foam Rolling Help or Hurt Your Performance?

Let’s set the stage.  Imagine that you have been training hard for weeks.  Your muscles are sore, and your body is achy.  You are definitely pushing into your overreaching phase and fast approaching over-training.  Then your overly helpful friend and neighbor mentions, “Hey, I just got this foam roller—it’s great!  My buddy says it helps him run faster, jump higher, and he never hurts.  You need one!”

Is foam rolling another gimmick or does it really help?  All of the local gyms and sporting goods stores have them.  Should you use one?

Surprisingly, the actual research on foam roller use to improve performance has been minimal.  The foam roller is traditionally used as a method of self-massage or self myofascial release.  By using the foam roller, it is thought that the fascial system can be changed and manipulated.  Hopefully, improving either performance or recovery by affecting how the neuromusculoskeletal system functions.

The standard definition of fascia is soft and sometimes fibrous connective tissue system that penetrates and surrounds muscles, bones, organs, nerves, blood vessels and other structures and extends from head to toe, from front to back, and from surface to deep in an uninterrupted, three-dimensional web binding some tissues together while allowing others to slide smoothly over each other, though all layers are connected there are distinct layers with differing function (LeMoon, 2008, and http://en.wikipedia.org/wiki/Fascia).

Research indicates the following regarding the use of the foam roll for performance:

  • Foam rolling likely has a positive effect on arterial stiffness and can improve arterial and vascular function while also positively affecting joint range-of-motion (ROM).
  • The change in arterial and vascular function may in part be why foam rolling (after training) seems to have a positive effect in reducing muscle soreness.
  • Foam rolling may promote more blood flow to the area, which allows the body to eliminate waste more efficiently while providing much needed nutrients to aid in recovery.
  • Improved recovery is important if you plan to participate in multiple events over multiple days such as a relay or weekend tournament.
  • Improved recovery may also allow for more intense and frequent training while (hopefully) reducing injury.
  • It may aid training during certain cycles when the intensity or volume may be higher or during an overreaching phase of training. Overreaching is typically a very short and deliberate phase in your training when you have a spike in training volume for a week or two followed by a return to baseline or below which can lead to improvements in performance. Care must be taken though because overreaching can easily turn into over-training.
  • Foam rolling also appears to have a beneficial effect on ROM, and more importantly, it can help improve ROM without negatively affecting performance. In contrast, static stretching can impede performance.

As a physical therapist, I highly recommend using the foam roller for athletic performance because:

  • It appears to help improve joint ROM and doesn’t impede performance.
  • It can likely help with recovery, either by reducing soreness or reducing post work out tightness. By promoting improved blood flow, it allows for improved nutrient delivery which can improve recovery times.
  • Improving recovery may allow for more intense or frequent training sessions or prepare you for multiple events with little rest.
  • Alleviating soreness prior to activity can have a psychological boost, which shouldn’t be overlooked as an important outcome.

How should I use the foam roller?

  • I typically recommend one to three minutes of body weight rolling (if it is tolerated) per extremity, and the same for the thoracic, low back, and buttock area.
  • A good rule of thumb is to roll out an area that is tender and sore, or recently worked, until it no longer feels tight and sore.
  • Again approximately one to three minutes per area although this may vary based on your size. Increased time will be needed the more developed your muscles are.
  • Foam rolling is generally not advised for anyone on blood thinning medications or with blood clotting disorders.

What has been your experience with using the foam roller? Is it worth the effort? Can you notice any specific improvements in performance? Please share your comments or questions!

Posted on

How Can Physical Therapy Benefit You?

I can’t tell you how many times someone will ask me what I do for a living, and upon hearing that I am a physical therapist, he or she will immediately divulge his/her complex personal medical history about a health issue.  This in no way upsets me that they ask.  However, it is concerning that so many people live with chronic aches and pains and (apparently) aren’t able to resolve the problem.  I can’t promise that physical therapy is the panacea of all cures for what ails you, but I have seen it work miracles in people’s lives.  The most amazing thing is the diversity of people I have had the privilege to interact with and help!

Often the answer to the problem is not what is expected.  Let’s review a common issue with many of the CrossFit athletes who I work with.  In that particular “box”, we have a very large age range of athletes from teenagers to people in their sixties and seventies.  It’s a wonderful atmosphere for all ages.  A common complaint is shoulder pain.  Many people struggle to lift overhead properly and often have shoulder pain.  This pain is typically from what is known as shoulder impingement syndrome leading to tendonitis of the rotator cuff.

There are many “standard” treatments for this ailment depending on the medical practitioner you ask.  For example, a physician is likely to offer pain medications (and possibly an anti-inflammatory medication); advice on icing and taking it easy; and if particularly progressive, a physician may even provide a hand out regarding elastic band exercises.  Some physical therapists would likely offer similar advice, such as icing and elastic band exercises to strengthen a muscle group known as the rotator cuff muscles.  (The rotator cuff is a group of four muscles that are important in the movement and stability of the shoulder.)

Time and time again, after a thorough examination of the client, I understand why the shoulder is hurting.  The person has no thoracic mobility likely due from: years of poor posture; office work; washing dishes; taking care of children; or sitting watching TV for hours.  Maybe these activities have led to a very rigid and immobile thoracic spine.

Poor thoracic mobility is a big deal when it comes to shoulder mobility.  The shoulder joint is made up of the scapula (shoulder blade) and humerus (the arm bone to the elbow).  The shoulder blade and the thoracic spine also make a type of joint.  If the thoracic spine is stiff, the shoulder blade is unable to rotate correctly–affecting the way the ball of the humerus spins in the socket of the shoulder blade.  This leads to impingement of the rotator cuff and biceps tendon which causes pain.  If you don’t treat the lack of thoracic mobility, it will be very difficult to ever resolve the shoulder pain.

Here lies the problem.  How would a person know that if he or she didn’t ask a physical therapist?  The answer is that he or she wouldn’t know.  Unfortunately, he or she would likely go round and round from one treatment to the next without fully recovering.

The human body is very simple and fragile, yet a complex and robust machine!  The body is truly remarkable and full of surprises.  Many of the most common aches and pains a person may have can be described in a similar scenario like mentioned above.  My purpose is to introduce you to physical therapy and show you how it may help and how I may be able to assist you in uncovering the reasons behind the musculoskeletal problems and pain you are having.  Some issues are not so black and white.  Many issues are like peeling an onion with many layers to the problem.  I believe it is crucial to have a physical therapist on your team to help you live a long, happy life performing the activities that you want for as long as you want!  Remember age is a relative, and movement is the key to healthy living.

Ask YOUR questions via e-mail at contact@thephysicaltherapyadvisor.com.  I look forward to answering them in an upcoming blog post! 

In addition, I have included information below about physical therapy and physical therapists.  Physical therapists can help you improve, restore or maintain your ability to move and function in your daily life.  As a physical therapist, I help people participate in life, whatever that may be for each individual.  To learn more about physical therapists, visit the American Physical Therapy Association (APTA).

Where do physical therapists typically work?

  • Hospitals
  • Rehabilitation Centers
  • Out-Patient Clinics
  • In Your Home
  • Schools and Work Places
  • In the Community / Health Promotion Centers
  • On the Battlefield and Armed Services Triage Centers

How Can Physical Therapy Benefit You?

  • Assist in recovery from a surgery (assisting in complete recovery and integration back into daily life or sport)
  • Assist in recovery from a stroke or heart attack
  • Assist in improving strength or endurance after an illness or prolonged inactivity
  • Assist in improving balance and walking ability to prevent falls
  • Maintain independence
  • Pain management including low back pain, shoulder pain, hip or knee pain and/or arthritis pain
  • Improve athletic performance by optimizing movement patterns
  • Health and injury prevention in sport and in life (work or play)

Physical therapists can help guide you through any array of recovery or rehabilitation: return to work, sport, running, and CrossFit.  Whatever your desired activity may be, a physical therapist can help you get moving and “living” again!  Fundamentally, movement is life!

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.