Category Archives: Physical Therapy

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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.

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What to do about TMJ Pain

Pain in your jaw or side of your head is often associated with temporomandibular joint syndrome which is also known as TMJ pain.  It’s often referred to as TMJD or temporomandibular joint disorder.  The causes of TMJ pain can be highly variable and are often multifactorial.  Pain can be mild to very severe.  Learn how to recognize the symptoms of TMJ pain and how to determine the possible cause so that you can implement simple treatment techniques.

Symptoms can include:

  • Pain in your jaw near the ear
  • Clicking or locking of the jaw
  • Pain can be on one side or both
  • Pain in the ear, face or neck
  • Pain while chewing (particularly, more difficult to chew food such as meat or raw vegetables like celery)
  • Headache pain

Potential Causes and/or Risk Factors for TMJ Pain:

  • Direct trauma, where the jaw was directly injured
  • Grinding your teeth
  • TMJ can develop rather quickly if there are other precipitating factors.  For example, if you were to eat a series of meals that required excessive and difficult chewing.
  • Over extending the jaw
  • Hypermobility (in the jaw or in general) which allows for excessive movement in the temporomandibular joint
  • Postural dysfunction (poor posture)
  • Muscle spasms within the muscles of mastication or the chewing muscles
  • Cervical mal-alignments
  • Rheumatoid arthritis
  • Osteoarthritis
  • Certain connective tissue diseases

Although TMJ is diagnosed in both men and women, it appears to be more prevalent in women.  This may be due to gender differences as women tend to have more laxity and movement in joints than men.  It may be due to a combination of other anatomical and genetic differences.

Treatment for TMJ Pain

In most cases, a combination of interventions from your dentist and from a physical therapist (PT) is the best approach.  The most important aspect of treatment is to determine which factors lead to the pain originally.  Was there one direct causative factor, such as trauma, or is the pain associated with multiple risk factors?  Due to the multifactorial nature of TMJ, often multiple treatment interventions are needed.

It’s important to have a thorough dental examination to determine if there are any specific tooth or jaw alignment issues.  The dentist can also take an X-ray of the jaw to help confirm that the diagnosis of TMJ is in fact orthopaedic in nature and not related to something more serious (such as an infection or abscessed tooth).  If grinding or clinching your teeth at night is associated with the pain, then the dentist can make a night splint.

From a physical therapy standpoint, it’s important to not only to address the TMJ joint, but also the head, neck, and spine.  Any muscle pain or dysfunction issue can be treated with massage and soft tissue mobilization.  The treatment may be intraorally to gain access to some of the deep muscle of mastication or may include addressing muscles on the outside of the head, neck, and face.  Proper cervical vertebral movement will also be checked and any cervical dysfunction should be addressed.

General treatment strategies for TMJ pain include:

  • Night splints.
  • Use of NSAIDs, such as Ibuprofen, to address pain and inflammation.
  • Ice to address pain and inflammation of the joint.  I recommend icing no more than 3-5 minutes at a time because the joint is small and superficial.
  • Massage.  Many trigger points and muscle spasms will refer pain into the head and/or jaw.  Since the likely areas of dysfunction are either cervical or intraoral, it’s best to contact a physical therapist or bodyworker that is specifically trained to treat this condition.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
  • Exercise.  A primary treatment modality and prevention technique is exercise.  This can be broken down into two primary areas: jaw mobility and cervical dysfunction. 
    • Specific exercises to address jaw mobility:  In this exercise, you will hold your tongue at the roof of your mouth and slowly open your jaw.  Only open as far as you can while keeping the tongue at the roof of the mouth and stopping before any clicking or grinding.  It’s best to perform this exercise while looking in a mirror to insure symmetry of your mouth when opening and closing it.
    • Specific exercises to address cervical dysfunction (if present):  Often TMJ pain is associated with a cervical related issue.  I often have my clients perform this cervical retraction exercise.  Sit up straight, and retract your chin straight back with your mouth lightly closed with your tongue resting on the top of your mouth.  Repeat 10-20 times.

  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area which will directly affect the positioning of the jaw.  Proper posture allows for the optimal alignment of your spine, head, and jaw.  This is particularly important when eating.  Poor posture is almost always associated with muscle knots and trigger points.  Subscribe to my e-mail list to gain immediate access to my FREE resources including My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  It’s a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.
  • Acupuncture.  I am personally a big fan of acupuncture.  It’s very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, TMJ pain from muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Relaxation.  TMJ associated pain is often a condition associated with individuals with a high amount of emotional stress.  This is likely due to associated jaw clinching.  It’s important to address the underlying emotional stress that maybe contributing to the condition.  This may include counseling, deep breathing techniques or performing my recommended stretches and exercises for neck and shoulder pain to generally help alleviate tension.  The importance of addressing any and all contributing factors (including any psychological factors or emotional stress) cannot be overstated.
  • Speak with your Physical Therapist, Physician, and/or Dentist.  If you are suffering with TMJ pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  In severe cases, there are a myriad of surgical procedures that can be attempted to address the issue.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your dentist and/or physician’s opinion as well).

Although TMJ pain can be difficult to manage, don’t give up hope!  Most TMJ pain can be cured or effectively managed with proper care and by addressing the likely causative factors.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.

Have you ever experienced TMJ pain?  If so, which treatments strategies have worked the best for you?  Please share 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!

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How YOU Can Benefit from Physical Therapy

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 or describe some past experience with a physical therapist (PT).  The stories are usually exceedingly positive or as one may expect, very negative and unfortunate.  This in no way upsets me to hear about one’s personal experiences or medical history.  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 or treatment plan for a person’s particular issue is not what is expected.  For example, 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.

This real and all too common example of why a person develops shoulder pain is to illustrate why seeing a physical therapist is so valuable.  How would a person know the real cause of the shoulder pain 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 or understanding the real reason why the pain developed in the first place.

Worse yet, as the shoulder pain worsens so does one’s ability to function and his/her quality of life.  In an older adult, this so often begins a downward spiral away from healthy aging and toward an abnormal aging process.  This same example is seen in many of the most common orthopaedic complaints from foot and ankle pain to knee or low back pain.

The dichotomy of the human body is that it 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.

Physical therapy can help!  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!

Age is relative, and movement is the key to healthy living.  The goal for health aging is to improve health span, which means the length of time that a person is healthy and thriving in his or her life and not just alive.  Physical therapy can help with healthy aging by improving health span and assisting in a more successful aging process.  We are all capable of successfully aging if we are intentional about the process. 

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).

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!

If you’re interested in learning more about how physical therapy can help you to age successfully and improve your health span, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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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.

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Why You need an annual Physical Therapy (PT) Evaluation

As we age, most of us hope to experience a lifestyle that is fun, rewarding, and meaningful.  Maintaining mobility and independence are fundamental components to aging well.  Unfortunately, too many older adults in the United States experience chronic disease, illness, and debility.  Some of the most common chronic illnesses facing older adults (such as heart disease, diabetes, obesity, pulmonary diseases, and neurological disorders) are sadly considered a normal part of the aging process, when in fact they are not.

Although chronic disease, illness, and debility are common in today’s society, it’s not part of a normal aging process.  The normal aging process should allow you to maintain your most basic mobility and independence until the end of life.  To insure this happens, it’s critical to be proactive about the aging process.

Physical therapy can be an important and integral component to aging well.  As a physical therapist (PT), I’m a strong advocate for all older adults to see a physical therapist at least one time per year for a movement and functional screening examination.  This is an opportunity to develop an exercise and training prescription to address any new physical issues or impairments that are starting to occur.  A PT can help to establish a preventative training program that allows you to identify any areas of concern (such as decreasing balance, accelerated loss of muscle or bone mass).

Many of the most common chronic illnesses or impairments start off as somewhat minor annoyances.  However, when left untreated, they can develop into debilitating and life changing impairments.

For example, a case of knee pain left untreated can progress and slowly limit your function.  This can eventually lead to severe muscle weakness, ongoing chronic pain, and the loss of your ability to perform even the most basic tasks (such as standing up from a chair or toilet and walking independently).

Now imagine if your knee pain was proactively dealt with.  During your PT evaluation, you work with your PT to develop an individualized exercise and stretching prescription.  Upon implementation, your knee pain resolves!  Now you have a preventative training program to decrease your risk of developing knee pain again.  In addition, you’re set up for success in continuing your healthy and active lifestyle as part of aging well.

A yearly PT evaluation, including the opportunity to develop an individualized training program, is essential in order to address any physical impairment early in the process.  Taking a proactive stance to address noted physical impairments is a critical step in insuring a health aging process while maintaining mobility and independence which is vital to age well. 

If you’re interested in learning more about how physical therapy can help you to age successfully and improve your health span, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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How Physical Therapy Can Help YOU Age Well

Most of us are familiar with the term life span, which is a reference to how long a person will actually live.  A newer and even more important term is health span, which means the length of time that a person is healthy and not just alive.  Physical therapy can help with healthy aging by improving health span and assisting in a more successful aging process.  We are all capable of successfully aging if we are intentional about the process. 

Successful aging has a different meaning for each of us, but commonalities exist in most scenarios.  In order to age successfully and improve health span, you will need to fully embrace what it will take to accomplish this goal.  To live safely, independently, and comfortably, consider your physical, mental, and emotional health as well as your community and any financial implications.

Mobility is vital to independence.  Independent mobility is different for everyone.  It may be through ambulation or use of an assistive device such as a cane, walker or wheelchair.  You need to maintain the ability to be independently mobile regardless of utilizing a mobility or assistive device.

Aspects of maintaining mobility include adequate balance, strength, and endurance.  As a person ages, the likelihood that additional co-morbidities (other complicating medical conditions) is also likely higher.  This means that addressing the foundations of mobility (such as balance, strength, and endurance) may not be a straight forward proposition.  In fact, it may be somewhat complicated.  We all know that maintaining your physical health is important, but complicated medical conditions can make some feel unsure how to proceed.

A physical therapist (PT) is uniquely qualified to understand your individual medical history as well as the interrelationship between “abnormal” and “normal” physiology.  A PT can guide you on how to best and safely improve the foundations of mobility in the presence of complicating medical conditions.

Increasing your life span without increasing your health span is undesirable.  We all want to have quality of life in our later years.  A PT can help you to maintain your independence through mobility.  Physical therapy can even be used as preventative medicine to ward off many of the prominent illnesses attributed to aging.  Humans were designed to move much more than our current lifestyles afford us.  Maintaining your mobility is critical for all body functions and is fundamental in avoiding chronic illness.

Three Simple Exercises for Balance and Strength

Here are three simple exercises that almost anyone can perform in order to help maintain balance and improve strength.

If you’re interested in learning more about how physical therapy can help you to age successfully and improve your health span, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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Longevity Through Physical Therapy

Healthy aging looks different for everyone.  A person’s prior health status, genetics, and life experiences can all weigh heavily on one’s ability to age well.  Part of a healthy aging process is maintaining independence in your later years.  One important component to healthy aging is how well you can maintain your mobility.  Aspects of maintaining mobility include adequate balance, strength, and endurance.

As you age, the likelihood that additional co-morbidities (other complicating medical conditions) is also likely higher.  This means that addressing the foundations of mobility (such as balance, strength, and endurance) may not be a straight forward proposition when seeking to maintain your activity level.  Research concludes that appropriate strength training and cardiovascular exercise training is a key component to the treatment and management of most chronic illnesses that affect the aging adult.

For many, the main barrier to implementing an exercise as medicine approach is uncertainty and the fear of causing more harm.  How can you properly perform the exercises needed to address the impairments requiring treatment while working around other complicating medical conditions including arthritis, joint pain (knee pain), back pain or shoulder pain?

A physical therapist (PT) is uniquely qualified to understand your individual medical history as well as the difference between “abnormal” and “normal” aging and physiology.  A properly trained PT can guide you on how to best and safely improve the foundations of mobility in the presence of complicating medical conditions.

Physical therapists and the field of physical therapy can help lead the way for those desiring to age well.  Physical therapy can even be used as a preventative medicine to ward off many of the prominent illnesses attributed to aging.

Listen to my past guest appearance on The Longevity and Biohacking Show, in which I discuss Longevity through Physical Therapy.  Jason Hartman and I specifically discuss how physical therapy can be used to manage and prevent conditions such as diabetes, osteoporosis, heart disease, and dementia.  Humans were designed to move much more than our current lifestyles afford us.  Maintaining your mobility is critical for all body functions and is fundamental in avoiding chronic illness.

As the exercise as medicine approach is coming to the forefront of recommended treatment options for chronic disease management and treatment, so has the concept of the medical fitness center (which are also known as medically oriented gyms or medically integrated health centers).  These facilities are now being recognized as an important part of a healthcare system’s continuum of care.  They are run by physicians, hospital groups, exercise physiologists or other ancillary health professionals (physical therapists).  The staff is qualified to teach, help guide, and monitor each individual on how to safely implement the proper exercise prescription to improve quality of life and prevent or manage chronic disease and illness in order to age well.

Maybe most importantly, medical fitness centers are places where people with multiple medical risk factors, diseases or illnesses (such as diabetes, obesity, and osteoporosis) can feel comfortable with the care and instruction provided in a safe and appropriate environment.

If you desire to live a long healthful life, take personal responsibility and embrace the importance of a proper exercise and diet prescription while focusing attention on how to best age well.  Seek the assistance of a medical professional who can guide you through this process.  We are all capable of successfully aging if we are intentional about the process. 

If you’re interested in learning more about how physical therapy can help you to age successfully and improve your health span, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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Why Medical Fitness?

The United States spends more money (by a wide margin) than any other country on health care.  Our health care system is set up to keep us from dying, not thriving!  Sadly, our average life span barely makes it in the top 30 when compared to other nations.  Worse yet, life expectancy in the United States has decreased two years in a row!  Both 2016 and 2017 mark life span expectancy declines.  As it stands now, the American health care system is poorly equipped to help us maximize our health span.  Health span is defined as a period of time in which a person is generally healthy and free from serious disease.

Health care costs in America continue to increase without actual positive change in our health status as patients and consumers.  It is imperative that we take back control of our own health care by continuing to be proactive.  Part of being proactive is learning how to care for and manage common injuries and illnesses.  The medical system is not designed to help you to maximize your health and well-being.  It is designed to prevent you from dying and to maximize profits for the corporatocracy that controls our health care system.

Health care costs in the United States continue to outpace almost any other sector for inflation.  Unfortunately, this increase in cost has not shown any actual positive change in health status.  Not only are costs within our healthcare systems rising at near exponential levels, but we are also in the midst of a giant generational shift that will forever change the demographics of the United States and the Western World.  During this shift, the Baby Boomers are rapidly approaching elder status.  At the present pace, over 8,000 baby boomers are turning 65 every day!

Many have turned to science to find the fountain of youth to help us all live longer (without much success so far).  Maybe more importantly we must remember that, health span is just as important as life span.  How you spend your years is just as (if not more) important than your actual age.  One of the most critical components to aging well and improving health span is physical activity.

We are all capable of navigating a successful aging process if we are intentional with our behaviors.  Although successful aging has a different meaning for each of us and outcomes will vary, commonalities exist in most scenarios.  In order to age successfully, you will need to fully embrace what it will take to accomplish the goal of living safely, independently, and comfortably within your community.  We know our present healthcare system is not designed to help individuals age well, only to prevent dying.  So how then can we age well?  Enter the rise of the medical fitness centers!

We all know that exercise is good for us and that mobility is vital to independence as we age.  In fact, many of the most chronic devastating diseases individuals suffer from are actually best managed through lifestyle choices (including proper diet and exercise).

Examples of illnesses that are in many cases best managed with an exercise and diet prescription rather than medication include:

  • Diabetes
  • Obesity
  • Cardiac Disease
  • Many auto-immune diseases
  • Osteoporosis
  • Sarcopenia

While this is not an exhaustive list, it is actually difficult to find an illness that wouldn’t be better managed through improved lifestyle choices including proper exercise and diet prescriptions.

So what exactly is a medical fitness center, and how is it different from a traditional gym?

Medical fitness centers are designed to use evidence-based practices to help individuals manage many of today’s most common illnesses.

Many “typical” large chain and smaller gyms focus on programs that tend to be based on what the public perceives as “the new thing” or what feels right to them.  Typical gyms most often cater toward a younger population that does not already have medical issues.  Such gyms may not have educated staff available to help those trying to manage chronic disease and/or illness.

Medical fitness centers (which are also known as medically oriented gyms or medically integrated health centers) are now being recognized as part of a healthcare system’s continuum of care.  They are run by physicians, hospital groups, exercise physiologists or other ancillary health professionals (physical therapists).  The staff is qualified to teach, help guide, and monitor each individual on how to safely implement the proper exercise prescription to improve quality of life and prevent or manage chronic disease and illness in order to age well.

Maybe most importantly, medical fitness centers are places where people with multiple medical risk factors, diseases or illnesses (such as diabetes, obesity, and osteoporosis) can feel comfortable with the care and instruction provided in a safe and appropriate environment.

The benefit of selecting a medical fitness center versus a traditional gym is that you will be given an individualized workout routine that is right for you in addition to a personal assessment.  Rather than jumping right in without guidance or instruction, your personal baseline and needs will be assessed so you can be coached and guided through a fitness, mobility, and disease prevention and management program in order to help you to minimize the risk of injury while improving all aspects of your health.

If you’re interested in learning more about how physical therapy can help you to age successfully and improve your health span, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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5 Tips on How to Self-Treat Tennis Elbow

Elbow pain is a common issue that can affect a wide range of people including CrossFitters, weightlifters, weekend warriors, and office workers.  One common type of elbow pain is tennis elbow (lateral epicondylitis) which affects the extensor muscles and tendons of the wrist.

There are many possible reasons for developing elbow pain.  Typically the cause of pain is either from an acute onset or due to repetitive motion and/or muscle imbalance issues.  Examples of an acute onset include over doing yard work or a specific injury such as a trauma.  A repetitive motion and/or muscle imbalance issue can arise from chronic poor posture while sitting at work or from performing a job that requires repeating a task to the point that the tendons are overloaded.

5 Tips on How to Self-Treat Tennis Elbow:

1. RICE

As with many injuries, the initial treatment is RICE (Rest, Ice, Compression, and Elevation).

  • Rest.  Limit any activities that cause pain.
  • Ice.  Use ice as needed for pain and edema control.  The rule for icing is to apply ice no more than twenty minutes per hour.  Do not place the ice directly against the skin, especially if you are using a gel pack style.  A bag of frozen peas can be ideal.  Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression.  Consider wearing an elbow compression sleeve.
  • Elevation.  Although it’s not too useful for this specific condition, it would be an excellent time to apply ice.

2. Identify the Offending Movement

If you’re experiencing elbow pain, try to identify which specific movement aggravates the elbow.  Once you have identified the movement, initially avoid it until the pain subsides.  Consider any issues with your technique that may have led to the pain, and address any long term muscle imbalances that may have developed.

3. Work on your Elbow Mobility

Addressing any tissue mobility issues and promoting increased blood flow can help to improve the healing response and reduce the pain.  In this video, I demonstrate how to utilize a mobility/compression band as a self-treatment method for tennis elbow.

Mobility/compression bands, such as the Rogue Fitness VooDoo X Bands or EDGE Mobility Bands, are a novel way to self-mobilize tissue.  The use of a mobility band not only helps to mobilize the tissue, but it affects blood flow to the area and speeds up healing.  A mobility band also helps to reset some of the receptor cells in the muscle tissue which cause excessive muscle tightness as a means to work on tissue mobility.  This will work to directly affect the painful tissues.  (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of aggressive, deep compression.)

4. Work on your Upper Thoracic and Shoulder Mobility

Posture plays a critical role in the positioning of your extremities with movement and activity.  Improper posture combined with poor ergonomics is a top reason to develop not only elbow pain, but also neck, upper back, shoulder, and wrist pain.  Regardless if the activity is weightlifting or typing, your posture matters!  Please refer to How to Improve Posture and Eliminate Pain.

If your elbow pain has developed from poor sitting postures or chronic repetitive stresses, then I highly encourage you to also work on upper body mobility by focusing on shoulder and thoracic mobility as well as lower body and spinal mobility.  Subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step-by-step exercise instructions and photos.

5. Trial other Methods of Self-Mobilization

Once you start to experience pain, be aggressive with your management and self-treatment.  I like to use either a tennis ball or roll PVC pipe over the forearm area which can be an effective self-mobilization for tennis elbow.  For more ideas on how to self-mobilize, please refer to My Top 3 Household Items for Self-Mobilization.

Cupping is another form of muscle tissue and fascia self-mobilization.  There are many different methods and techniques you can use.  In this video, I demonstrate how to use cupping to treat elbow pain affecting the wrist extensor muscles and tendons.

Elbow pain can be debilitating by limiting your ability to exercise and perform daily tasks.  Be proactive in your care and management.  If the pain persists, seek additional help.  Don’t let the pain linger.  The longer it’s left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Have you tried using a mobility/compression band as a self-treatment method for tennis elbow?  What was your experience 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!

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How to alleviate Elbow Pain

Elbow pain is a common issue that can affect a wide range of people.  Two of the most common types of elbow pain include:  tennis elbow (lateral epicondylitis) which affects the extensor muscles and tendons of the wrist and golfer’s elbow (medial epicondylitis) which affects the flexor muscles and tendons of the wrist.

Possible reasons for developing elbow pain include:

  • Poor grip strength.
  • Muscle imbalances between wrist flexion and extension strength.
  • Improper weight lifting technique.
  • Overuse/overload/overtraining.
  • Mobility related issues in the wrist, shoulder or thoracic spine.
  • Excessive mobility or hypermobility may also be an issue.  It tends to be more common in females than in males, and it’s usually associated with the shoulders or elbows.
  • Repetitive motion injury.
  • Poor posture.
  • Tackling an activity you don’t often do (such as digging holes for a new fence or trimming hedges).

Poor wrist, shoulder or thoracic mobility is also commonly related to elbow pain associated with exercise.  If the wrist cannot flex or extend properly, it not only causes wrist pain, but excessive stretching of the forearm muscles and strain on the elbow (possibly leading to pain).  Elbow pain can be very debilitating.  It can limit your ability to exercise as well as limit your ability to perform daily tasks.

Poor shoulder or thoracic spine mobility can also cause excessive strain on the elbow.  Consider exercises like the overhead lift or pull ups or even the squat.  If the shoulder cannot fully flex or the thoracic cannot fully extend (allowing proper shoulder flexion), then the elbows will absorb more of the load.  The lack of shoulder or thoracic mobility also affects proper alignment of the upper extremity during the movement.  Over time and with multiple repetitions, this overloading can cause pain and injury to the elbow.

Whenever one part of the body doesn’t have adequate mobility, another part will do more to allow for the movement to take place.  When an exercise is performed at a high speed, high relative weight or high repetitions, a lack of mobility can make you more susceptible to pain and injury.

Posture plays a critical role in the positioning of your extremities with movement and even when sitting (including office and/or computer work).  Improper posture combined with poor ergonomics is a top reason to develop not only elbow pain, but also neck, upper back, shoulder, and wrist pain.  Regardless if the activity is weightlifting or typing, your posture matters!  Please refer to How to Improve Posture and Eliminate Pain.

Excessive mobility can have a similar effect.  For example, if you’re performing an overhead lift, but your shoulders flex past 180 degrees, then the bar is too far behind your head.  This causes excessive force to be placed on the shoulders and elbows.  Again, this can lead to injury and pain particularly when performed at a high speed, high relative weight or high repetitions.

How to alleviate Elbow Pain:

RICE

As with many injuries, the initial treatment is RICE (Rest, Ice, Compression, and Elevation).

  • Rest.  Limit any activities that cause pain.
  • Ice.  Use ice as needed for pain and edema control.  The rule for icing is to apply ice no more than twenty minutes per hour.  Do not place the ice directly against the skin, especially if you are using a gel pack style.  A bag of frozen peas can be ideal.  Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression.  Consider wearing an elbow compression sleeve.
  • Elevation.  Although it’s not too useful for this specific condition, it would be an excellent time to apply ice.

Self-Mobilization

Cupping is a form of muscle tissue and fascia self-mobilization.  There are many different methods and techniques you can use.  In this video, I demonstrate how to use cupping to treat elbow pain affecting the wrist extensor muscles and tendons.

Cupping can be used to treat elbow pain, elbow tendinitis, and tennis elbow.  These CupEDGE Massage Tools are easy to use and helpful for self-treating tight and restricted areas (on other parts of the body, too).  Another option would be to use a Mini Plunger.  This technique should not cause bruising or discoloration.

Work on your Grip Strength

Developing proper grip strength is important in order to avoid elbow pain.  Easy exercises to train grip strength include:  dead lift; pull ups, and farmers carries.  You can even work on hanging from a pull up bar for time as a way to judge your fitness while gaining strength and endurance in your grip.

A common mistake when training grip strength is to under estimate the importance of improving finger and wrist extensor strength.  It’s critical to keep the appropriate balance between wrist flexors and wrist and finger extensors strength to lessen the risk of wrist and elbow overuse injuries such as tennis elbow or golfer’s elbow.

Your grip strength will improve more rapidly as your wrist and hand muscles find their optimal length tension relationship (which allows for maximum strength production).  I often recommend using a thick rubber band as a way to improve finger extension strength (as demonstrated below).  Work on extending each finger equally when performing two sets of 10-15 repetitions multiple times per week.

Elbow pain can be debilitating by limiting your ability to exercise and perform daily tasks.  Be proactive in your care and management.  If the pain persists, seek additional help.  Don’t let the pain linger.  The longer it’s left untreated, the more potential for harm and damage which potentially could lead to a longer recovery.  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Have you tried cupping as a form of self-mobilization in order to alleviate elbow pain?  What was your experience 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!