What types of patients get the most out of their PT treatment?

What types of patients get the most out of their PT treatment? –An observation

 

As a practicing PT, I see a myriad of people. I give similar spiels to each of them about how PT works and how it can be most effective (please see my first post  –Expectations for Your PT ) but it really seems to me that healing cannot happen without you. Sounds corny, but hear me out.

 

PT is NOT a “passive” form of treatment –or it could be, but you probably won’t see quick progress.

 

Those patients who come to physical therapy, cannot articulate their pain, or are not sure why they are in PT, will not gain as much benefit from PT as someone who has a better understanding of their injury.   

 

I’m teaching you a new skill –it doesn’t just involve how to take care of yourself. It is also trying to teach you to understand what your body is feeling and how to become aware of how your body moves. It is being able to feel and correct the flaws in how you move. It’s not an easy thing to do, and some people are naturally better at this than others. Dancers for instance, have a great body awareness and a sense of what is going on in their bodies. This is because they have honed this skill through years of dancing and moving. But some people have no idea where their body is in space.

 

Aside from being able to articulate where your pain/injury is, it is important to know when you notice it, with what movements, and what makes it better/worse. These are all very important details that help make your treatment more effective, and you will see quicker results. If not, PTs are left trying to pull the information out of you in order to give you the best treatment.

 

I once read that with back pain diagnoses, 80% of what you use to diagnose the back pain comes from the patient’s subjective report and only 20% comes from our own objective test/measures. Therefore, if you are able to articulate these things to your healthcare provider, it will help you achieve a quicker recovery.

 

Example – Patient Mr. Smith walks in with back pain with a prescription from their doctor that says back pain. Mr. Smith tells therapist – ‘I have back pain’

 

Therapist: When did the back pain begin?

 

Mr. Smith: Years ago.

 

Therapist: Do you remember a mechanism of injury or anything contributing to your pain?

 

Mr. Smith: No.

 

Therapist: Does it feel worse with sitting, standing, or walking?

 

Mr. Smith: It all hurts.

 

Therapist: Does it hurt worse at certain times of day? Or with certain activities like bending forward or back?

 

Mr. Smith: It all hurts.

 

Therapist: Can you point to where exactly you feel the pain?

 

Mr. Smith: [points to his entire back]

 

Now either Mr. Smith has a serious pathology and needs to go to the ER or Mr. Smith really doesn’t have a good assessment of his injury and just knows that he feels pain.

 

Try not to be like Mr. Smith and if you don’t know the answers to these questions right away, see if you can start to notice. In other words, start listening to your body’s cues. Your body is telling you valuable information that will be helpful in your recovery. Don’t be a passive patient, be active in your treatment plan. Try to figure what daily activities could be either aggravating or helping your injury.

 

I love trying to brainstorm with patients what they are feeling, and why they are feeling it. You then are better able to figure out how to fix it and how to correct the body mechanics that may have caused the injury in the first place. There is also a lot of research that suggests once you understand what is causing your pain, you will start to feel better, especially with chronic pain.

 

Case in point, if you come into PT, lie on the table, don’t pay attention to the treatment and do nothing on your own, your chance of success with PT is much lower. However, those who are actively participating, learning, and taking responsibility for what they do outside of their session will see the positive changes much sooner.

 

Cupping –Friend or Foe?

Cupping– Friend or Foe?

 

Recently cupping has been in the media thanks to the Rio Olympics showcasing these noticeable marks on the athletes, from swimmers to gymnasts. Wondering if cupping is just for the elite, or the average Joe as well? Cupping as a modality is nothing new, and in fact has been around for hundreds of years. It dates back in many cultures and serves as a way to draw out toxins from the area being treated.

cupping 3

As one can see from the bruises left behind –it serves to increase blood flow to that area, and thus can help with healing. It can also be used to release the myofascia which leads to freeing up muscles, which are tight.

 

This is a modality that we have at the clinic where I work. Depending on the individual’s diagnosis and how sensitive their skin is, I will use it occasionally. It’s sometimes a nice adjunct to the manual therapy I perform.

cupping 4 What it looks like initially after treatment

cupping 5  What it looks like a few hours later

I decided that with all the recent media hype, I would conduct a little experiment on some of the 3rd year medical students that cycle through the physical therapy rotation. Like all students, they spend a majority of their time at school and studying in often a very hunched over posture. Therefore, this population tends to have stiffness in their back/neck quite often.

 

These students agreed they would like to take part in this informal study. I took 2 medical students who have never been cupped before and cupped one side of their back. This way they can compare it to the other non-cupped side. I then asked their initial impressions and their impressions after 24 and 48 hrs.

Med Student #1

cupping 2 Med student # 2

cupping 1

Initially after cupping both students said they felt ‘warm,’ ‘looser,’ ‘felt like more blood flow to that side of the back,’ and that the experience felt like ‘a good pain.’

 

After moving around a bit afterwards, they said they felt like the cupped side ‘was already warmed up.’  

 

After 24 hrs., I asked them again what their thoughts were about the cupping. They stated the next day they experienced some muscle soreness like they had worked out and the marks felt a little tender to the touch. However, one of them noted that his back did feel less tight when he was studying. He also stated that he normally would feel a twinge across his lower back, but he only felt a twinge on the non-cupped side today.

 

After 48 hrs., both students stated they were no longer feeling the effects of the cupping and were back to where they started.

 

So is it effective? Initially, you do feel some improvements but if that’s the only thing you do, the effects will probably not last too long. If you don’t mind the bruises it leaves behind, it could be worth trying. Ideally you would compound this treatment with stretches and activity modifications that could promote lasting changes.

Compensation! Compensation!

 

back pic

Compensatory pain! What the heck is that? Often times people start off having pain in one foot or one knee and then over time they develop pain somewhere on the other side of their body or their back. Now people have a tendency to either think ‘My body is falling apart!’ or ‘I must be getting old, everything hurts!’ but really it is very possible these injuries could be related.

 

When one part of your body is injured, it’s only natural to want to ‘baby’ the injury and take pressure off that side. This may mean that you start to put more pressure on the opposite side or start using the other arm more. This can contribute to overuse injuries in other areas of your body.

 

Also, your body is quite remarkable in that without even realizing it, your body will compensate for injuries in your body. If you have hypermobility in one area of your spine, your body may automatically stabilize surrounding areas causing those to become hypomobile or vice versa. If you lack range of motion in your ankle, your body will compensate by placing more torque on your knee. Or if you are a runner, and you lack some range of motion in your big toe extension, you may inadvertently compensate when you run by driving your opposite shoulder forward more and develop anterior shoulder pain! (True story!) What?! Your body does this stuff without you even realizing. This may go on for some time before you start developing pain elsewhere.  

 

In order to avoid injury, you want to make sure your range of motion and strength is symmetrical on both sides. Often times when there is a deficit in range of motion on one side, or one side is weaker than the other, this can lead to injury……because of, you guessed it, compensation!

 

So to prevent these injuries from occurring, you need to try and balance yourself out. If you have a weaker knee or ankle, do some strengthening exercises for that side. If you have a more flexible side, try to stretch more on the other to even them out. The best time to address these issues is before you have pain! In this way, you may be able to prevent injuries down the road.

 

So basically, your body is one extremely complex, unbelievably remarkable machine, where everything works together. You may not be able to make the connection, but hopefully if you are working with a talented physical therapist, they will look at your overall movement quality and be able to determine what the heck is going on! That is also why it’s important to be aware of when you are feeling the pain, or with what movements or activity.

 

If you tend to isolate your rehab to just one part of the body, you may not fully address the problem, and your pain could come back. You need to look more globally at how you are moving to potentially determine the underlying cause of your pain. If you fix the underlying cause of your injury, your pain should go away and stay away! (providing you keep up with your exercises)

Mindful Walking

Mindful Walking

Maybe you’ve heard of mindful meditation or mindful eating, but have you heard of mindful walking? When I say mindful walking, what I mean is the state of being present when you are walking. In other words, to focus on the activity you are doing while you are doing it. So instead of walking and thinking about everything else in the world, practice this exercise of walking and thinking about how you are walking.

 

Walking is a very repetitive movement that is performed everyday and can lead to overuse injuries if done incorrectly. It’s funny to think that walking can be done incorrectly when you’ve been doing it since you were 1 yr. old. But there are certain things you should think about and be mindful of if you have pain when you are walking or you want to prevent pain.

 

  1. ) Are you heel striking with every step? Or do you tend to shuffle around? One way to be aware of if you are heel striking is to listen. Do you hear a scuffle or just one solid tap with each step you take. You may think why is that important? If you fail to heel strike, meaning bringing your toes back with every step and letting your heel touch the ground first, you could literally trip over your toes. This could lead to a fall, especially in older adults. Some people are unable to pull their toes back due to weakness in their tibialis anterior. (See my post on strengthening your ankles especially the one where you pull your toes up)

IMG_1901

2.) Are you pushing off more with one foot than the other? Some people have a dominant side, but be aware that you are walking as evenly as possible in order to strengthen both sides equally.

 

3.) Are you leaning forward and looking down at the ground? Do your shoulders fall forward? Or are your shoulders back and head up? Your mom was right–mind your posture! When you are walking, too much leaning forward and you could develop a stooped over posture. Your psoas (hip flexors), pects., and cervical extensors will shorten. Your glutes might become inactive and that muscle imbalance can lead to all sorts of hip and knee injuries.

 

4.)  Are your feet rolling in when you walk? Check out the bottom of your shoes to see where the wear pattern is? Do you pronate? Most people tend to pronate or roll their foot in when they walk. Often people that have collapsed arches tend to pronate. If this is the case, you can try to strengthen your foot intrinsic muscles and potentially wear arch support in your shoes.

towelscrunch

5. ) Think about how you walk up/down stairs. When you go up, are you pushing through your heel? Is your foot halfway off the step? When you are coming down the stairs, are your toes leading or your heel?

 

When you are walking up the stairs, think about getting the whole foot on the step and pushing up through your heel so you are activating your large muscle groups including your glutes and hamstrings. Give your poor gastroc muscles a break and let the bigger muscle groups take over. When walking down the stairs think of leading with your toes like you are stepping into cold water and rolling through your foot.

 

6.) Did you have a recent injury and now you are limping around? Stop that limp! If you don’t, your body could memorize this new gait pattern, and that could lead to all sorts of secondary compensatory injuries. If you are still healing from an injury, you should still try and walk as normally as possible. If that means you need to use a brace, CAM boot, or cane to get around for a bit, then use it until your pain improves and you can walk more normally.

pic 2

What To Do If You Have Foot Pain?

Foot Pain Got You Down?

feetfeet2

feet 3

 

 

 

 

 

 

Living and working in NYC, many people come in with foot pain because NY is a walking city. People walk everyday to get to where they need to go, and there is nothing short of foot traffic on the streets. Couple that with subway stairs, snow/ice weather conditions, poorly paved streets, and poor shoe choices, injuries are bound to happen. And then what do you do when you can’t walk without pain?

pain image

So with most kind of repetitive injuries, when an area is weak, tight, and overused, it starts giving you pain. And with all the steps you take a day, is it any wonder you wake up with pain?

 

Here are a few things you can try if you are having foot pain.

 

  1. Look at the shoes you are wearing on a daily basis. Are they old, worn down? Do they have any support in them? Do they have a wedge or a heel attached to them? Do you wear flip flops or shoes without a back to them? These are all questions you should ask yourself when your feet begin to hurt.

feet 6   feet 5

Your shoes are supporting your full body weight every day, and they work hard on the pavement of the streets. If you are a runner, even a good pair of running shoes typically don’t last longer than 6 months. So make sure your shoes aren’t worn out. Not sure? Look at the soles of your shoes –how is the traction? Look at the insoles of your shoes? Are they torn and worn or still give some cushion. Also check to make sure they have some form of arch support. Totally flat shoes i.e. ballet flats don’t offer any support. Especially if you have pronated feet or high arches.

 

When wearing heels, every inch higher the heel is can increase the % of pressure placed on the ball of your foot, not to mention the % of pressure on your knees. I’ve seen articles that said a 3 inch heel can increase the pressure on the ball of your foot by 76%! Yikes! This can cause all types of foot pain. It also shortens your Achilles and could lead to tendinitis.

Do you wear shoes without a back to them? Even slippers in your home without a back aren’t the best idea. People tend to grip and curl their toes a little to keep their shoes on. In doing so, you are overworking the muscles on the bottom of your foot and over time this tightens the muscles. This can lead to foot pain and spasms.

feet 7

  1. Stretch out! This includes the muscles along the front and back of your lower leg as well as the bottom of your foot. If your arch is cramping or you get cramps along the back of your leg, make sure you are stretching your plantar fascia, gastroc, and soleus. (see below)

 

Plantar Fascia Stretch 

PFstretch   3x for 30 sec. hold

Use a towel to go up and over the toes as you pull the towel back towards you. Make sure your toes are extending back so you feel the stretch along the bottom of your foot.

Gastroc Stretch

GSS   3x for 30 sec. hold

Place the towel just around the ball of your foot as you pull the whole ankle/foot back towards you.

Soleus Stretch

soleuss  3x of 30 sec. hold

Similar to gastroc stretch but with knees bent. Lean forward from the hips and keep your heels on the ground. Slightly bend your knees so you release the gastroc and effectively stretch the muscle behind it –the soleus.

Tib. Ant. Stretch 

tibants  Pointing your foot and apply gentle overpressure

If you get shin splints, make sure you are stretching the front of your leg (tib. anterior)

You can also apply an ice massage to the front of your leg with an ice cube for 5-10 min.

Peroneal Stretch

peroneals Pull more with the inside hand so your foot tilts

Another area that tends to get tight are the peroneal muscles which can pull on a bone in your foot called the cuboid and actually spin that bone so it causes lateral foot pain. Sometimes that peroneal muscle will spasm –make sure to roll out that muscle if it feels tight or you have lateral foot/leg pain.

3.) Strengthen your foot and ankle –Do you have a history of ankle sprains? Can you spread your toes out? Can you wiggle your toes? All of them? Since we are a little kid, our feet are shoved into these leather mittens (i.e. shoes) and over time this limits the mobility in your feet and toes. It’s important to let your toes move and strengthen your foot intrinsic muscles. See below for some exercises to help strengthen your foot.

 

Toe Waves

toe wave 1  toe wave 2

3 sets of 10 – Let toes come up and push them down (note – don’t move the hand that is holding the t-band; let the toes do all the work).

Towel Scrunch

towelscrunch1  towelscrunch

2 sets of 10 reps – Think of trying to pick up the towel with your toes.

Ankle Pumps/ Ankle Alphabet

ankle pump 1  ankle pump 2

If you get pain upon your first couple of steps in the morning, try to ankle pump sitting at the side of the bed before getting up. This gets the blood pumping and loosens your ankle joints up. Do 2 sets of 10 reps.

Ankle alphabet is similar but this time try to write the alphabet with your toes.

Theraband Ankle 4-way

IMG_1901 IMG_1897 IMG_1896 IMG_1892

Good ankle strengthening exercise which is great if you have a history of unstable ankles or balance issues. Try 10x each direction first and progress to 20x in each direction.

 

Heel Raises

heel raises 3 sets of 10

Go up and down on your toes holding for about 2 sec. at a time. Make sure your heels come all the way down every time.

Single Leg Balance

balance pic  3 sets of 20 sec. hold

Try to balance on 1 foot without holding on if you can.

4.) Roll out your plantar fascia. The thick fascia on the bottom of your foot covers 5 layers of muscle! Your feet have to support your body weight all day–that’s a lot of pressure. Therefore, you need to roll out those poor muscles and fascia. For 3-5 min. per foot. Don’t forget your gastroc. You can help get trigger points out as well by using a golf ball or tennis ball. If you are in a lot of pain, try freezing a water bottle and rolling the bottom of your foot out with that instead.

footroll

5.) If you’ve been having foot pain for 6 weeks or longer, time to see your doctor or podiatrist. Especially if the pain gets worse the more you walk. They will need to take X-rays to rule out stress fractures or bone spurs that may be contributing to your foot pain.

DISCLAIMER – Although I am a physical therapist, I am not your physical therapist. Always consult with your PT or health care provider for specifics about exercises and modalities that may be best suited for you.

How Do You Use Crutches?

Tips for Ambulating with Crutches

crutch pic 5

 

Who’s ever been given crutches by your doctor only to have to learn how to use them yourself?

 

More often than not, patients are just given crutches to use by their doctor without any explanation on how to use them. Maybe you think it wouldn’t be that hard, but have you ever tried to use crutches for 1 day? How tiring is that? Using crutches requires some coordination, endurance, and strength in your shoulders, wrist, core, and hips. Not to mention some balance. Definitely harder than it looks. Especially if you are in a city where a lot of walking and stairs are involved.

 

Below I have put some helpful tips on how to ambulate with crutches.

 

  1. Before you do anything — Size the crutches for you first! And don’t go by the height that the crutches say they are, those markers are almost never right. You can use it as a starting off point, but then adjust as needed.

IMG_1839

The crutches when placed under your arm should be at a height that gives you 2-3 finger-width between your armpit and the top of the crutch. Also, when your arms are by your side, your wrist crease should line up with the handlebar of the crutch. (This rule applies for canes and walkers as well –it’s lower than you think!)

IMG_1887  2-3 finger width under arm pit to size

crutch pic 4  Line up hand bars with crease of wrist

IMG_1848  Same rule applies for measuring a cane

2. Walking with crutches if you can’t put any weight through the injured leg is called 3-point gait. Firstly, think of squeezing your arms in towards your chest to keep your crutches from slipping out. The non-weight bearing limb should be slightly bent with the knee in front of the standing leg and the foot behind it. Make sure your crutches are about 6 in. from the outside of  your foot and your elbows should be at ~30* bend.

IMG_1845 CORRECT – Knee in front of crutch and foot behind

IMG_1863 INCORRECT – Crutches more than 6″ from foot

IMG_1865 INCORRECT – Shoulders elevated; leaning on crutch

 

3. To ambulate, advance your crutches first and then bring your standing leg to the crutches, keeping your standing knee soft. (This is called step-to gait pattern). Once you get comfortable with ‘step-to’, you can advance to ‘swing through’ –having your standing foot come slightly past where the crutches land.

 

The goal should be to eliminate the up/down motion when you are using crutches, so from the waist up, you can’t tell you are using crutches.

 

Also, make sure you keep your wrist straight (you’ll realize very fast if you are not, b/c your wrist will get sore)

crutch pic 6  INCORRECT – Wrist is not straight

IMG_1867  CORRECT – Keep wrist straight

4. Changing directions – make sure to always turn towards the involved limb (non-weight bearing limb) b/c it’s less torquing on your knee. Always take 3-4 little turns to change directions (once again, less torque on the knee)

 

5. You may realize this is very tiring, and you are right! This takes a lot of energy expenditure, so be prepared for that.

 

6. Sit<>stand – if non-weight bearing when you go stand up, make sure your injured leg is kept straight out in front of you, and use your ‘good’ leg and arms to get up from the chair. Same thing applies when going to sit down –make sure you straighten your ‘injured’ leg out in front of you first before you go to sit down. This gets the injured leg out-of-the-way and allows you to sit down easier.

 

 

7. Do you have any stairs to navigate? Even 1 or 2 to get into a house or to step up or down from a curb? Using crutches and stairs seems scary, but if you have good balance and coordination you should be able to if you had to. When going up, think ‘good leg’ goes up first and then bring the crutches up after you. If you have a rail to hold on to, definitely use the rail with one arm and a crutch with the other.

 

 

Coming down stairs, keep the standing knee soft and bring your crutches down 1 stair at a time first, then bring the standing leg to it. Make sure you get your hand that is on the rail down in front of you. This way if you were going to fall forward, your arm is already in front of you to catch yourself. This takes practice. If you don’t feel comfortable, make sure someone is there to spot you and if all else fails butt scoot up or down!

 

8. Don’t ignore your standing leg -it’s working really hard! Make sure to give it some TLC. Stretch the hip – fig. 4 stretch, hamstring stretch, quad stretch, and gastroc stretch. Strengthen that ankle, knee and hip. Perform thera-band ankle 4-way, SLR x 4, and practice balance exercise on the standing leg even before you need to use crutches in order to strengthen that leg (obviously if it’s a traumatic injury you may not have time to practice, but if you are scheduling surgery where you know you will need the use of crutches afterwards, prepare in advance!)

IMG_1901

 

 

 

Ankle Thera-band exercise -4 directions

 

IMG_1888

 

Figure 4 Stretch/ Piriformis stretch

 

 

 

IMPORTANT NOTE WITH THE USE OF A CANE – If you are transitioning off crutches and using a straight cane to help take some pressure off the injured side, always carry the cane on the opposite side of injury! People always do this wrong. Don’t just put the cane in your dominant hand.  It doesn’t matter if it’s an injured foot/ankle, knee, or hip –always opposite! This mimics a more normal gait pattern b/c when your left arm swings forward, your right foot comes forward at the same time. Thus if your right foot is injured, you will bring your left arm forward with the cane at the same time as the injured right foot. Otherwise you will walk around like House MD –he used the cane wrong by the way, more robotic like.

 

DISCLAIMER: These are some helpful tips I have gathered for people to use. Before using crutches, make sure you consult your doctor or health care provider to ensure correct use of crutches.

11 Common Exercise Mistakes (that drive me crazy)

11 Common Exercise Mistakes (that drive me crazy)

1.) When stretching, make sure you are warm first. Don’t come into the gym when you are cold, and go straight into a static stretch. Your muscles aren’t warmed up yet and you could pull something. Work up a light sweat first, either by doing some light cardio or just trying to ‘lubricate’ your joints up with arm swings or hip swings. You can do your nice long stretches that you are holding at the end of your work-out.

cardio pic r

 

2.) Hamstring stretch – Don’t stretch with a stretchy strap! Stretchy straps such as thera-bands and other elastic bands are used to provide resistance in order to strengthen your muscles, not stretch. If you are stretching with the help of a strap, that is fine, but make sure it’s not working against you. It should be a material that doesn’t stretch too easily like a towel, belt, or dog leash. That way when you pull on it, it doesn’t serve as a counter force, but rather an extension of your hand.

stretch pic 1 revised  WRONG- Don’t use stretchy strap to stretch

hss 2 r CORRECT – Use a towel or strap for stretching

 

3.) Upper trap stretch – When stretching your neck, side-bend away from the side of the neck you want to stretch– just make sure you keep that shoulder down. Otherwise, you are not effectively stretching your neck muscles. It may help to use a strap or towel to keep your shoulder down if you are having difficulty with this, or use a mirror for visual feedback.

UT stretch 2 revised WRONG -Opposing shoulder is elevated

UT stretch 1 revised CORRECT -Keep the shoulder down

 

4.) Gastroc stretching on a stretch board – I always notice people leaning forward from their hips. You will get a better stretch if you keep your body in a straight line, so you are just hinging from your ankles, not your hips. Think of your belt buckle coming forward as you stretch.

gastroc stretch 1 R WRONG – Don’t lean forward from the hips

gastroc stretch 2 R CORRECT – Hips stay in a straight line

 

5.) Squat -When performing a squat, there are several things to remember. 1.) I hate seeing someone squat with their knees coming past their toes –bad!! Make sure your knees stay over your foot/ankle when you squat down. 2.) Also make sure your knee is tracking over your feet. Don’t let your knees roll-in. When I see this, I know there is some hip/glut weakness going on. 3.) Make sure you are sticking your butt out when you squat down. I know if feels funny, but doing a squat correctly isn’t about feeling proper here, it’s about protecting your back. You should have a small arch in your low back. Stick your butt out like you are going to sit in a chair.

squat pic 1 revised     WRONG – Knees are tracking too far over toes

squat 2 w2  WRONG – Don’t let your knees fall in

squat 3 rCORRECT – Keep knees over toes/ Stick your butt out

 

6.) Ankle thera-band exercise – When performing a thera-band exercise for your ankle, especially when you are moving in ankle inversion/everison (toes in and toes out), make sure just your knee isn’t moving. I often see people moving their knee and rotating their whole lower leg in and out, but it’s important to isolate the ankle movement.

ankle pic 1 revised   WRONG – The knee is rolling in

ankle pic 2 revised  CORRECT – Keep your knee straight

 

7.) Pelvic tilts – Often a difficult exercise to understand if you are not used to engaging your deep abdominal muscles. I instruct people to think of pulling their belly button in and pressing their low back into the floor. Remember to breathe! I always teach this by telling patients to exhale as you go into your pelvic tilt. You are less likely to hold your breath this way. Also, make sure your ribcage is dropped down, sometimes people like to splay their ribcage out.

Same thing applies when doing a plank–which you should be performing your pelvic tilt in. I thought it would be easier to see this with a plank than simply a pelvic tilt.

plank 2 r WRONG -Hips up in the air

plank 1 r CORRECT -Pelvic tilt engaged

 

8.) Tabletop Abdominal Exercise – Any time you are performing an exercise on your back with your legs at 90/90 or tabletop position, in order to effectively work your deep abdominals, make sure your knees aren’t pulled too closely into your chest. When your knees are too far into your chest, your abdominals are not engaged.

tabletop position 2 revised WRONG -Knees are drawn too far in toward chest

tabletop position 1 revised CORRECT – Hips are at a 90* angle; abdominals on!

 

9.) Heel raises – Make sure your weight is between your big toe and the second toe and your ankles are straight. I often see people shifting their weight to the little toes and this makes the outside of  your ankles stressed.

heel rise 2 r WRONG -Ankles rolled outwards

heel raise 1R CORRECT – Ankles stay in a straight line

 

10.) Lat Pull Down or any shoulder exercise – The first step should be to make sure you shoulders are down and scapulas engaged. If not, you are not effectively working your shoulder stabilizers. When working on good posture or any shoulder pain or injury, this step is really important. Make sure your shoulder blades are set in place first –you will feel this in your upper back!

lat pull down 2 WRONG – shoulder are up, back is not engaged

lat pull down 1 revised CORRECT -scapulas are set and shoulders are down

 

11.) Straight leg raise – As the name indicates, keep the working knee straight. This is true whether you are performing this exercise to the front, side, or back.

A common mistake I always notice when doing your straight leg raises to the side, (or as I call them, my Jane Fonda exercise) make sure you are not flexing in the hip. Your leg will be further behind you then you think. It should form a straight line all the way down your leg. Otherwise you are overworking your psoas (hip flexor) and tensor fasciae latae (the muscle part of your IT-band). Instead, you should be targeting your gluteus maximus, medius, and minimus.

slr 2 r WRONG – Hip is flexed

SLR 1 r CORRECT – Hip is in neutral

 

How Can I Tell the Difference Between Good Pain and Bad Pain?

Good Pain vs. Bad Pain, How Can You Tell the Difference?

knee pain

It’s very important to listen to your body, especially when venturing to new activities/exercise. Your body is always trying to communicate with you, and it’s important you pay attention otherwise you could get injured. However, being able to decipher the different types of pain may take some getting used to. My patients often ask me if what they are feeling is normal? Below I have a few questions you can ask yourself to try to determine if what you are feeling is just muscle soreness or more significant of injury pain.

1.) Where is the pain? How would you describe it?

Is the pain in your muscle? Does it feel achy and stiff,? Is it tender to the touch? If the answer is yes, sounds more like muscle soreness.

 

Is the pain in your joint, muscle, tendon, or bone? Does it feel sharp? Is there swelling? Bruising? If yes, this could be an injury

pain image

2.) How long have you had the pain?

Does the pain come on 24-72 hrs. after the activity/exercise, but then slowly get better?

This could be delayed onset muscle soreness or DOMS. Muscle soreness is normal when working different muscles.  While working your muscles, they may start to burn –that is a good thing and it means you are pushing your limit to fatigue the muscle, and therefore make them stronger. When your muscles get sore, there are microscopic tears that happen in the muscle. When your body repairs these tears, it puts down more collagen fiber to rebuild, and thus your muscles get bigger and stronger.

 

Does the pain go on for 7 days or longer? Does it tend to linger?

 

When starting a new exercise it is important to increase the stress on the tissue gradually, especially when it comes to your tendons, bones, and cartilage. If you increase the load too fast, too soon, this could lead to injury. It is important to determine your individual activity threshold. That is the sweet spot between working your muscles to get stronger and over-working them. When doing a new exercise that point is when you are not able to do another rep with correct form. If you are sacrificing form to get in that last rep, it’s better not to do that last rep. Only do as many as you can perform with proper form!

 

3.) What makes the pain feel better?

Does stretching help or moving around make it feel less painful? If it’s just muscle soreness, stretching and doing some gentle cardio should make it feel much better.

stretching

Does only rest and ice make it feel better? Could be injury pain 🙁

 

4.) What makes the pain worse?

Does sitting still for a period of time make the stiffness/soreness worse?

Does movement make it feel worse? If moving the painful area makes the pain worse, this could signify something more than muscle soreness.

Let me know if you have any questions!

Why Is My Injury Not Getting Better?

Why Is My Injury Not Getting Better?

Nothing is worse than having an injury that seems to be taking a long time to heal, especially if you feel like you are doing everything right! Have an open conversation with your physical therapist about your prognosis and brainstorm together reasons why your healing time may be delayed. Below I have outlined just a few questions to ask yourself if you feel like your injury is taking a really long time to heal.

  1. Are you doing your homework? Are you doing your exercises? You knew this one was coming– I’m a PT after all.  A lot of people don’t want to put in the work to make themselves better, and this can lead to nagging injuries. If you take your rehab seriously off the bat and follow your physical therapist’s instructions, this can help tremendously. It’s really the most important part of any treatment plan, but the one people most often take for granted. That ultrasound you get in PT isn’t healing you–but the exercises given to you definitely will. Exercise is probably one of the only forms of treatment that is scientifically backed by research time and time again, and there is a reason for that it works! So do your homework!

exercise 2

(Side note: Sometimes when people start feeling better, they stop doing their exercises all together. But it’s important to remember these exercises and incorporate them as part of your maintenance routine.)

2. Do you smoke? If so, better drop that habit. Along with a slew of other reasons smoking is bad for you, it can also delay healing an injury. If your blood is not able to travel oxygen to your injury effectively, this can delay healing.

no smoking

3. Are you getting enough sleep? Back to the sleep conundrum. Your body does a lot of healing while you sleep, so if you are not logging in 7 or 8 hours a night, you could be doing your body a huge injustice.

baby sleeping

4. Are you stressed? Having a lot of psychological stress can definitely impact your body’s ability to perform a plethora of functions, one of which is healing. Plus stress can make your pain feel worse than it is. Those feelings of being stressed and depressed over a nagging injury can also play a role on healing. Set yourself up for success and try to focus on your mental health and your physical health could improve as well.

stressed

5. Are you nourishing your body with the proper foods? Are you eating processed refined foods or whole foods with good quality nutrients? Eating protein helps your body repair its muscles, tendons, and bones. Bone broth is one great example of a nutrient dense food that can help support healing. For an easy bone broth recipe, see below.

soup 2

http://balancedbites.com/content/easy-recipe-mineral-rich-bone-broth/

When trying to heal your body, make sure to remember that your body works as a whole, but it is made up of many parts. This incorporates everything from your heart, brain, mind, lungs, and GI tract. Your body is a complex machine and with so many moving parts, everything has to work together. This is why I think it is so important to address full body healing and wellness. If one thing is off, there could be a chain reaction. Help your body out and set yourself up for proper healing!

Let me know if you have any questions? 🙂

How to Help Your Neck Pain

Are you a slave to your i-device?

neck pain

http://cbsminnesota.files.wordpress.com/2014/11/spine-study.pdf

Are you constantly looking down at your smart phone, tablet, laptop during the day? Do you have neck pain? Ever get headaches? Any numbness/tingling down your arms? If so, these tips could help you.

Nowadays, we are constantly plugged in and looking at electronic devices during the day –one of the consequences of this could be a tight painful neck. If ignored, it could lead to nerve impingement, herniated discs, and migraines. So what to do? I’ve listed out a couple of tips that could help alleviate some of the problem and also described some activity modification that will be necessary if you want to prevent the pain from coming back!

1.)    Lifestyle modifications –I’ve listed this as number 1.) for a reason. It’s because if you make no modifications to overuse activities that bring on this pain, you can stretch til you’re blue in the face, but don’t expect lasting results. If your job includes long hours in front of your computer make sure you bring your screen up! Whether it be a smart-phone, tablet, or looking down at your computer screen, all these activities encourage you to look down. Instead of looking down constantly, try to bring the device up to eye level so your neck isn’t in a hyper-flexed position for a prolonged period of time. This tip is important in order to prevent the reoccurrence of neck pain. Look at your own activities and try to identify what movement patterns are causing this pain. This is where physical therapy can really help. They can help you modify and work on muscle/movement imbalances that may relate specifically to you. (see below for a few general exercises)

 

2.)    Mind the position of your neck when you sleep. Do you use multiple pillows at night under your neck? You could be perpetuating this forward head posture, pushing your head up while you sleep. Use just 1 medium-sized pillow to cradle the back of your neck, or a small towel roll under the crook of your neck to support it. Personally, I’m not a big fan of contoured pillows because if you don’t fall asleep in the same position every night, or you move around a lot while you sleep those pillows don’t move with you. Your neck could end up in a worse position before morning, and then you wake up with a terribly stiff neck! Therefore, don’t waste your money. The best positions to sleep in for your neck is either on your back or side with pillows for support. Sorry stomach sleepers, this is the worst position for your neck because you are forcing your neck to be rotated to one side the entire night. Ideally, you want your neck in a neutral position. See example below.

sleep position 2

 

3.)    Postural exercises! Yay! Over time, if you keep your head in a forward head posture you could actually change the length of your neck muscles. Usually with forward head posture comes rounded shoulders as well. This is perpetuated by tight pect. muscles. The muscles along the suboccipitals (back of the neck, where your skull meets your cervical spine) become stretched out and lengthen so it’s hard for you to contract them and therefore bring your neck back. Therefore, we need to strengthen them –here comes the chin tucks! See some postural strengthening exercises below.

Rows – with theraband, strengthen in between your shoulder blades to help you keep your shoulders back.  3 sets of 10 with squeezing shoulder blades together.

exercise rows pic

Chin tuck – 10x with 10 sec. hold (or work your way up to holding for 10 sec.)

chintuck 1   Step 1.) normal head posture -note forward head

chin tuck 2  Step 2.) think of making a double chin (glamorous I know 😉

4.) Neck Stretches – Your strengthening exercises mean nothing if tight muscles keep pulling your neck back to the position it was in. Below are 3 stretches that will help.

Upper trap stretch  – 3x for 30 sec. hold (each side) -Ear to shoulder on each side, with slight over-pressure with your hand. Make sure you are keeping the opposite shoulder down.

UT stretch

Levator scap. stretch, – 3x for 30 sec. hold (each side) – Nose to armpit with slight over-pressure with your hand on the top of your head.

LS stretch

Pect. stretch  -3x for 30 sec. hold – the one shown below is on a foam roller in what I call a ‘touch-down’ position. This is just one way to do a pect. stretch. You can also perform a stretch in a door-way. See below.

foam roller stretch

 

5.)    Modalities to help with pain/stiffness

  • Moist heat as mentioned in an earlier post, helps relax muscles and promotes blood flow to the area. Apply to neck and upper back for 15 -20 min.

hot pack

  • Biofreeze (Biofreeze) – pretty good topical analgesic used to help you with pain in your muscles. You’ll only need a dime sized amount and rub in until it’s absorbed. A little goes a long way. Also, be sure to wash your hands after use!

biofreeze

  •  Kinesiology Tape (Rocktape Kinesiology Tape) – everyone has their own opinion on this kind of tape, but in my experience it helps patients feel better. The thought is that is helps the fascia crinkle and move blood blow to the area. Kinesiology tape is taping for movement, NOT to stabilize or prevent you from moving. It’s supposed to help you move easier. It pretty much feels like a hand is on the back of your neck. See picture below for one type of taping technique for posterior neck pain. Keep tape on for 2-3 days, but not much longer because it can eventually irritate your skin. Make sure skin is clean when you put it on. Careful when taking it off, ideally after you shower, or with the use of baby oil to protect your skin.

neck tape

Rocktape Kinesiology Tape (click to purchase)

– Thera Cane Massager – Self torture device. A way for you to work out some of the adhesions/knots in your upper shoulder and back. You can use this for many areas of your body to work out the ‘kinks.’

theracane pic
t-cane exercise

Thera Cane Massager (click to purchase)

  • Manual therapy – whether that be a massage or if you are going to a physical therapist this can definitely aid in decreasing your pain and improving your ROM in the neck and shoulders. Research is varied on various manual techniques, but from personal experience I can tell you it helps.

massage pic

Word of note: none of these listed above modalities will do a lick of good if you aren’t making activity/lifestyle modifications because the tightness and pain will just come back!

DISCLAIMER – Although I am a physical therapist I am not your physical therapist. Always consult with your PT or health care provider for specifics about exercises and modalities that may be best suited for you. Also, if you have neck pain with any kind of numbness/tingling down your arms, I would suggest a visit to your doctor to rule out nerve related pathology.