Provider Spotlight: Bill Rein Helps the complex PT Patient

In order to know more about Bill Rein and one of his favorite topics, we needed to get past his least favorite.

“Yeah, I don’t really embrace talking about myself. So let’s get that out of the way,” Rein began.

Just did.

Once acknowledged, Rein spoke (quite willingly, by the way) about his passion for treating patients with chronic, persistent pain issues. He traced it back to the beginning.

“All of the professors and mentors I had were excellent working with their hands, but more than that they were great clinical decision-makers,” said Rein. “I wanted to model my career after those people.”

At Rein’s first job, he had the good fortune to work with a Fellow of the American Academy of Orthopedic Manual Therapists, a provider who completed stringent post-graduation specialization programs in the field of neuro-musculoskeletal disorders and the use of hands-on treatments of muscles, tendons, ligaments and joints.

“I worked with him for two years, and he kind of pushed me in a direction to treat spine conditions, neck, back, headaches, the sacroiliac region. I really took a liking to that,” said Rein.

That pushed Rein to earn his specialty certification as an Orthopedic Clinical Specialist (OCS). After 2,000 hours of direct patient care in orthopedics and a rigorous exam showing they have expertise in diagnosing, treating, and preventing orthopedic conditions, the OCS brings that additional level of understanding to their patients.

And that’s what Rein did. Still, there was some frustration.

“I felt I was getting four out of five patients to where they needed to be, but it was that fifth one that kept me up at night,” said Rein. “So I needed to keep searching for ways to help those I wasn’t able to treat effectively, patients with chronic issues who had been seen by multiple healthcare providers and still weren’t getting the relief they sought.”

So Rein kept at it.

Doing a lot of reading, engaging in a lot of research on his own, and teaching as part of his orthopedic residency, Rein’s work delivered him to the place he is now, where treating the most complicated patients has become his passion.

“There's something about the shared collaboration, trying to figure out with patients exactly what is going on and how we can help them, and where we, the medical establishment, may have missed the boat in treating their pain,” said Rein.

Rein feels he can take the vast majority of those challenging patients and find something that he can offer them that will help. That’s not 100%, though.

“There are still patients where physical therapy just isn’t going to work,” said Rein. “But I feel confident that I can offer things to them even if it’s just in the way of explaining what they are going through, to plant the seeds that might help them to not have to get an injection, or be on medication, or have a surgery later on, if I give them the tools they need now.”

And he strongly believes in a team approach.

“I feel very comfortable collaborating to get patients the help they need, facilitating connections with providers—a physiatrist, an orthopedic physician, a primary care specialist—who excel in these cases,” said Rein.

Rein estimates that about a quarter of his patients have chronic conditions.

“There's someone on my schedule pretty much every day that has a persistent pain condition,” he said.

Rein’s interviewer (me) admitted to having low back issues for much of his life. Is that considered chronic pain?

“I’m definitely not saying the low back issues you just described, which are fairly common, haven’t been debilitating and life-affecting for you,” said Rein. “But that's very different than the patient who's had fibromyalgia for 30 years, has severe headaches every day, and low back pain with pain radiating down the legs and is barely able to move. That’s a more challenging population.”

It’s a challenge Rein embraces.

“It’s about taking the emotion out of the pain experience, looking at it objectively, being a detective with you and trying to figure out how your body is working. When you connect the dots, it’s a very powerful thing.

Bill Rein serves patients at Advanced PT’s Appleton West location on Casaloma Drive.

He received his master's degree in Physical Therapy from the University of Wisconsin-Madison and subsequently earned his Board Certification in Orthopedic Physical Therapy. Additionally, Bill is certified in ASTYM (augmented soft tissue mobilization) and Trigger Point Dry Needling (Level 3).

His professional interests involve seeing patients who have shoulder, knee, and spinal issues.

Essential Exercises to Prevent Low Back Pain

By Joe Hanel, LAT

Back pain can be quite complex and a real hassle.

Whether you strained your back lifting something, sat for too long, or woke up with that all-too-familiar ache, back pain can really slow you down.

But here’s the good news—there are things you can do to help!

When back pain hits, it's important to take action.

Rest is a good starting point, but recovery requires more. You need to stay active and work on strengthening your back to help it heal and stay strong.

And remember, not all advice about back pain is accurate.

Let’s clear up some common myths:

• Myth 1: "If My Back Hurts, I Should Rest All Day."

  • Resting a little can indeed help when your back hurts. But too much rest can make your back worse. When you don’t move, your muscles can weaken, and stiff muscles can lead to more pain. Gentle exercises within pain limits can help reduce pain and keep your muscles strong.

• Myth 2: "Lifting Heavy Things Always Causes Back Pain."

  • Your back is strong and resilient. Lifting heavy objects can hurt your back if you do it the wrong way too many times in a row for an extended period, but learning the right technique can actually strengthen your back. The key is to lift with your legs, not your back. Keep your back flat, bend your knees, and use your leg muscles to lift. If you do find yourself out of position, it’s not the end of the world but you’ll want to focus on your form with each lift if your job requires repetitive lifting tasks.

• Myth 3: "Only Old People Get Back Pain."

  • Back pain can happen at any age. While it’s true that it becomes more common as we age, kids and teenagers can experience it, too, especially if they carry heavy backpacks, play sports, or spend too much time sitting. Everyone needs to care for their back, regardless of age.

  • It’s estimated that up to 80% of Americans will experience lower back pain at some point. Low back pain and disability impact up to 62% of our industrial workforce. Low back pain can also affect our police, firefighters, and emergency response at similar rates.

So, what can you do to prevent low back pain?

Over the years, I have treated LBP patients in many ways, trying lots of different approaches and hoping something provides them relief.

I have found that preventative exercise is the best way to prevent recurrence for many of those I have treated. Often, it may not be a lower back injury or tightness causing their discomfort, so it is important to address core strength and hip mobility while examining the lower back.

Check out this exercise progression, for example:

Start with a warm-up:

1. Single knee to chest stretch: Lay on your back with knees bent, draw in belly button to engage core. Birng one knee up to your chest and hold for up to 30 seconds; switch sides.

2. Rotation stretch/knee rock: Lay on your back with knees bent. Draw in belly button to engage core. Slowly rock knees to one side and hold for up to 30 seconds; switch sides.

3. Lumbar rotation stretch: Lie on your back, then bring one knee toward your face so that your hip is flexed to 90 degrees. With the opposite hand, pull it sideways toward the floor to feel a stretch in the lower back/buttock. Keep your shoulders flat on the ground during the stretch.

4. Back bridge: With head and shoulders relaxed tighten abs and glutes. Push through your heels to raise your hips, hold for 3 deep breaths and repeat.

Move to some strengthening Exercises:

5. Contralateral Extension: Activate your lower abdominals by bringing your belly button inward and by activating your pelvic floor muscles (inner thigh). Maintain steady abdominal breathing while you lift one arm and opposite leg up towards the ceiling keeping your chin tucked in. Return and repeat with the other arm and opposite leg.

6. Bird Dog (band optional): On all fours, draw in belly button then extend one arm then the other, then one leg then the other. Focus on keeping your back flat and staying balanced. Hold in extension for 1-3 sec. then switch sides.

If that’s too easy, try moving one arm up and the opposite leg up at the same time. Focus on keeping your back flat and staying balanced. Hold in extension for 1-3 sec. then switch sides. This movement should be slow and controlled.

By working up with core strength and hip and spine mobility, you'll keep ahead of lower back tightness and pain.

—

Disclaimer: As a reminder, these exercises are for educational purposes only and should not be taken as medical advice. If you have a complex history of lower back pain, are unsure if these exercises are right for you or have pain while doing an exercise, it is recommended that you connect with one of our skilled clinicians to assess further. It may be recommended that these exercises or a different series are accompanied by manual therapy, trigger point dry needling, and therapeutic cupping to ensure that you achieve your goals and eliminate your lower back pain for good.

CranioSacral Therapy: Understanding the body’s response to trauma

“It’s not something that’s considered mainstream,” he said. “But it can be very powerful.” 

So, the discussion about cranial sacral therapy begins with Dennis Kaster, a longtime physical therapist at Advanced PT. 

Kaster has as much experience as a PT practitioner as just about anyone on the Advanced team. He confirms what his online bio states, that he has a great deal of experience in the areas of the spine, chronic pain, hand injuries, sports medicine, industrial rehab, and various manual therapies. 

One of those manual therapies is cranial sacral therapy (CST). This alternative treatment releases tensions deep in the body to help reduce pain, relieve dysfunction, and improve whole-body health and performance. Dr. John Upledger pioneered and developed CST in the mid-seventies at Michigan State University. It’s a gentle technique Kaster has used with patients for decades.  

Describe gentle. 

“When I went through training,” Kaster said, “the instructors described CST this way: ‘You’re using the same amount of pressure you’d use to bend the Legs of a fly.’ It’s that subtle.” 

CST focuses on the connection between the cranium or skull and the sacrum or tailbone to relieve tension within the body’s connective tissue, called fascia. Kaster uses it frequently with his patients suffering from chronic pain. Many of those patients are women who have suffered physical or sexual abuse.  

“There’s a lot of trauma in their past, a lot of post-traumatic stress disorder,” said Kaster. “Probably half my caseload relates to migraines and headaches, and many of those patients have PTSD. 

Because CST isn’t mainstream, few people have been trained in the practice, and people looking for the relief it can offer can’t find clinicians to do it. Kaster says that he gets people all the time who come from a distance to see him. 

“I see patients in Stevens Point and other areas,” Kaster said. “One of my patients travels from Minneapolis to see me because she can’t find anyone there who does it.” 

So how is it done? 

For a typical PT visit (about 40 minutes), Kaster will use the technique when appropriate or combined with other approaches (such as manual therapy, functional exercise, and other interventions)

With the CST portion, Kaster is looking for a “rhythm or pulse,” feeling for the movement of the body’s connective tissues and any restrictions encountered.  

Cranial sacral therapy has differing results for patients. At times, the technique has little or no effect. With others, it’s life-changing.  

Kaster describes the technique as simply another tool in the toolbox.  

“I assess people to see if they have tightness and restrictions,” said Kaster. “For many people with headaches, any type of neck, low back, mid-back pain, tension, post concussions, chronic pain, CST can be a powerful tool.” 

By releasing the restrictions in the craniosacral system, Kaster says, you’re engaging the body’s innate healing processes, which has benefits for a wide range of physical challenges faced by his patients.

Kaster says another huge component of the technique is SomatoEmotional Release (SER), which expands on CST principles to help people rid their bodies of the residual effects of past injuries and negative experiences.  

Also a gentle process, SER facilitates the release of negative energy and allows the body to heal. Kaster describes it as working through layers of an onion. But the gentle process can bring forth some very emotional memories. 

“It’s important that the patient is working with a counselor before using SER techniques, as things can be brought to the surface that patients aren’t ready to deal with,” said Kaster. “But I’ve found it helps people to heal and get over deeply buried emotions, which is important because psychological trauma will manifest itself into physical conditions.” 

Kaster recognizes that some medical professionals will refer to CST and SER as “voodoo medicine.” That’s not his worry.   

“I’ve got 35 years of experience and a heck of a lot of training in it, and it’s helped so many of my patients,” said Kaster. “Like I said, perhaps not mainstream, but so very powerful.” 

If you have questions about Craniosacral Therapy or want to see if it’s a good fit for your treatment plan, please use our online submission form.

—

About the Author:

Dr. Dennis Kaster is a physical therapist at Advanced PT’s Stevens Point North clinic on Division St. He has been happily married to his wife Adrienne, who is also an extraordinarily talented physical therapist, for almost as long as they have been practicing. They love cycling, hiking, and traveling. They also love helping people feel better, which brings them joy.  

Tendonitis 101: What Every Industrial Worker Should Know to Stay Pain-Free

Tendonitis is a prevalent condition characterized by inflammation of a tendon, the thick fibrous cord that connects muscle to bone.

It typically results from overuse or repetitive stress and can affect various tendons throughout the body, including those in the shoulders, elbows, wrists, knees, and ankles. In a previous blog post, we discussed some stretching and strengthening exercises and ergonomic concepts an industrial worker can utilize to help avoid tendonitis.

But what if you’ve already developed the condition?

This article explores the average recovery timeline and general treatment strategies for some of the most common cases of tendonitis industrial workers develop, helping you understand what to expect and how to manage this condition effectively.

Common Types of Tendonitis for Industrial Workers:

Click here to learn more about Tennis Elbow

1. Tennis Elbow (lateral epicondylitis): This condition involves the tendons on the outside of the elbow, usually caused by repetitive wrist and arm motions.

2. Golfer’s Elbow (medial epicondylitis): Affects the tendons inside the elbow, often from repetitive gripping or wrist flexion.

3. Rotator Cuff Tendonitis: This condition impacts the tendons in the shoulder, typically due to overhead activities or lifting.

4. Trigger Finger or Trigger Thumb (stenosing tenosynovitis): This condition occurs in the hand when the tendon sheath becomes irritated and swollen. It is often caused by repetitive use of the thumb or fingers, such as gripping or pinching.

5. Achilles Tendonitis: This condition affects the Achilles tendon, which connects the calf muscles to the heel bone. It is often caused by excessive running or jumping. Heavy, stiff work boots can also irritate the Achilles tendon.

Recovery Timelines

Recovery from tendonitis varies depending on the severity of the condition, the tendon affected, and the effectiveness of the treatment plan. However, general timelines can be outlined as follows:

1. Mild Tendonitis: For cases caught early and involving minimal damage, recovery can range from a few weeks to a couple of months. With proper rest and treatment, individuals often return to their normal activities within this timeframe.

2. Moderate Tendonitis: If the condition is more established and involves moderate inflammation and pain, recovery may take 2 to 6 months. This duration includes time for therapy and a gradual return to activities.

3. Severe Tendonitis: For severe cases beyond 6 months, it’s not uncommon for a tendinitis to transition to a tendinosis. This means there are actual physical changes and degradation within the cellular structure of the tendon. Depending on your symptoms, this may require intensive therapy or other medical intervention. Moral of the story here: if you’re having pain, don’t wait and see if it improves. Act ASAP!

General Treatment Strategies

Effective treatment for tendonitis involves a combination of self-care measures, medical interventions, and physical or occupational therapy. Check with your employer to see if they sponsor any on-site or near-site programs for seeing an athletic trainer, physical therapist, or occupational therapist.

Here’s a breakdown of common approaches:

1. Rest and Activity Modification:

o Rest: Avoid activities that exacerbate the pain. Giving the affected tendon time to heal is crucial.

o Activity Modification: Adjust your activities to reduce stress on the tendon. This might involve changing techniques or using different equipment. It’s essential to keep your body moving during this time, so find something that you like to do that doesn’t increase your pain.

2. Moist Heat:

o Apply moist heat: Apply moist heat (e.g., a moist heating pad) to the area for 5-10 minutes twice a day. The moist heat will promote soft tissue healing and increase the flexibility of the muscles surrounding the area.

3. Medication:

o Consult with your medical provider regarding medication usage. In general, nonsteroidal Anti-Inflammatory Drugs (NSAIDs) may be helpful; however, movement within pain-free limits may be equally as effective if done appropriately.

4. Physical Therapy or Occupational Therapy

o Stretching and Strengthening Exercises: An experienced physical therapist or occupational therapist can guide you through exercises to improve flexibility and strengthen the muscles around the affected tendon.

o Manual Therapy: Techniques such as massage, mobilization, therapeutic cupping, or trigger point dry needling may reduce pain and improve function.

5. Supportive Devices:

o Braces or Splints: These can help support the affected tendon and prevent further strain during the healing process. Consult your employer about which ones you may or may not be allowed to wear at your job.

6. Injections or Surgery:

o Things like corticosteroid injections, platelet-rich plasma and surgery may be an option if other interventions have not been helpful. When treating these conditions, seeing a PT or OT first has been proven to save you time and money.

Conclusion:

Understanding the recovery timeline and treatment options for tendonitis can help manage expectations and guide effective management of the condition.

Early intervention and adherence to a comprehensive treatment plan are essential for a successful recovery.

If you experience persistent or severe symptoms, let’s chat!

Conquering Carpal Tunnel: A Guide to Conservative Treatments

Carpal tunnel syndrome (CTS) is like an uninvited guest in your hand, but it doesn't have to stay forever. Several simple treatments can help manage CTS and make your hands feel better. Here’s how you can take control of your recovery.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome arises when the median nerve, responsible for sensation and movement in your thumb, index, middle, and half of your ring finger, gets compressed within the carpal tunnel in your wrist. This compression can lead to tingling, numbness, weakness, and pain in the hand and wrist.

What causes the compression?

It could be a combination of things: inflammation, awkward or sustained working positions, repetitive movements, operating heavy machinery, muscular strength, and mobility imbalances throughout the forearm, upper arm, and even the neck.

Combating CTS: A Multi-Pronged Approach

Conservative treatments aim to reduce pressure on the median nerve and alleviate CTS symptoms. Here's a look at some effective options:

1. Splinting: Wearing a wrist splint, particularly at night, immobilizes your wrist in a neutral position. This helps rest the median nerve and reduce pressure within the carpal tunnel.

2. Activity Modification: Mindfulness in daily activities can significantly improve CTS symptoms. Identify tasks that aggravate your symptoms and make adjustments. This may involve taking frequent breaks, using proper posture, and incorporating ergonomic tools into your workspace, keeping your wrist in neutral while you work, or changing your workspace to set yourself up for success.

3. Manual Therapy: Mobilization and manual therapy to the transverse carpal ligament and surrounding structures, trigger point dry needling to the flexor or extensor mass, depending on where the restrictions or limitations can be found, and nerve mobilizations/ gliding for the median nerve.

4. Therapeutic Exercises: Gentle hand and wrist exercises prescribed by a physical or occupational therapist can improve flexibility, nerve mobility, and overall hand function.

Wrist flexion stretching, wrist extension stretching, median nerve glides, grip strengthening, and upper extremity strengthening exercises may be appropriate depending on the severity (how intense they symptoms are and how they impact you), irritability (how much activity is required to provoke the symptoms) and nature (what other factors besides activity impact your experience) of your symptoms.

*Disclaimer: Exercises are for education only and should not be used in place of a PT or OT evaluation or free injury screen by one of our skilled PTs or OTs.

5. Functional Exercise: Using the fundamental strength and mobility built with therapeutic exercise to perform combined movements that mimic your job tasks, life outside of work, or hobbies that you may have.

The Takeaway: Early diagnosis and intervention are crucial for successful CTS management. By implementing conservative treatments at the first signs of CTS, you can prevent further nerve irritation and regain control of your hand function.

Consulting a physical or occupational therapist is vital for proper diagnosis and crafting a personalized treatment plan to conquer carpal tunnel and reclaim pain-free hand use.

—

About the author: Ron Lawrence is a physical therapist and strength and conditioning specialist at our Shawano Clinic on Green Bay St. and with our Industrial Medicine Team. He holds advanced certifications in Dry Needling and Nutrition. He is an excellent resource for any work-related or non-work-related aches you may have!

3 Tips to Improve Your Desk Setup

As a physical therapist, I have had the opportunity to work with and support office workers in learning how to set up and use their workstations ergonomically for optimal support and comfort. I’d like to share some of the pearls I have learned.

We have all heard the saying, “Everything in moderation.” One may choose to start eating healthier and choose one less dessert at a party or cut back on the size of that favorite mocha latte. Someone with a love of shoes may decide to create a shoe budget to keep spending in moderation. In the same way, moderation also applies to physical activity and body posture. Runners prepare for a race by following a training plan that allows the body to have periods of rest to prevent repetitive injury. With stationary activities, it is just as important to have periods of movement. Designed to move, our bodies feel the impact of lack of movement. Sitting for prolonged periods can lead to reduced blood flow, stiffness, discomfort and fatigue (both mental and physical).

These simple tips will help you moderate stationary activity in order to work healthier and more efficiently in an office setting.

1. Sit Smart:

Seating Choice – office chairs with adjustable height, seat depth and lumbar support offer an individual fit to support the spine and legs.

Showing how to assess seat height, seat depth and lumbar support.

Key Seating Adjustments

Seat Height – choose a height that places the thighs parallel to the floor or slightly higher. This creates a stable base of support. If adjusted too low the hips can become stiff and if adjusted too high one may slide forward and slump.

Seat Depth – adjust to fully support the thighs, but still leave the width of a couple fingers between the front edge of the seat and the back of the knee. This is very important to distribute body weight evenly and not impede blood flow at the back of the knee.

Lumbar Support – adjust to support the curve of the lower back. This not only supports the back but also promotes healthier upper body and leg postures. In some cases, even with an adjustable lumbar support, individuals find they may need more. Rolling up a towel or purchasing an additional lumbar cushion is a simple fix.

2. Be Aligned (With Your Desk/Workstation)

Showing proper alignment with your desk

Desk Height – if able to adjust desk height, adjust so that while typing the forearms are parallel to the floor and wrists are at the same level or slightly lower than the elbows. This will keep the wrist in neutral postures and help reduce the risk for development of carpal tunnel. If the desk height cannot be adjusted, hopefully it is just a little high. To solve this problem, add a footrest and raise the chair. If too low, look for a different desk.

Keep It Close – to prevent leaning forward and slumping as well as unnecessary reaching, adjust the keyboard and mouse to be close to the edge of the desk; adjust monitor(s) to be centered in front of you, about an arm’s length away, and at a comfortable height to view the screen without needing to tip the head up or down.

3. Sit (or Stand) in Moderation

Schedule Movement Breaks – whether it is a sticky note or a phone or calendar reminder, plan to move every hour. A lap around the office, a water refill break, a longer walk during lunch break, a trip to the printer, and even 1-2 minutes of standing and shifting weight or marching in place help break the stationary cycle. If you have an adjustable desk and can stand while you work, remember it is just as important to move and avoid locking in a stationary standing posture for a long time.

Eye Breaks—Remember that our eyes need a break as well. Periodically look away from the computer screen and focus on something else in a different direction. This can reduce eyestrain and related tension headaches.

If our bodies are supported in healthy postures and given opportunities to move, we will reap the benefits of working comfortably with more energy and focus. If you haven’t already, take the time to adjust your office workstation and plan movement every day properly.

Remember to sit smart, be aligned, and of course, everything in moderation!

About the Author: Dr. Renee Anderson, PT, DPT, is heavily involved with our Industrial Medicine program and helps at our clinics in Shawano and Green Bay.

How to Decrease fatigue and reduce stiffness in 5 minutes.

Feeling sluggish or stiff at work?

Try these 5-minute breaktime exercises to boost circulation, reduce fatigue, and alleviate stress!

These short and simple exercises can be done during breaks to relax overworked muscles and activate those not used as often. This will improve your ability to perform your job with focus and reduce aches and pains. Dynamic stretches and postural reversals are critical to this process.

Dynamic stretches held for just 0-5 seconds increase blood flow and improve flexibility and strength.

Postural reversals, done throughout the day, counteract the effects of prolonged postures. Incorporate these exercises into your daily routine and feel the difference immediately! 

Dynamic Stretches:  

Dynamic stretches assist with restoring physical functioning & flexibility, elevating the core body temperature, increasing circulation, accelerating energy production, and improving speed & strength.

Increased blood flow to your tissues helps delay muscular fatigue. 

Perform each exercise until the muscles feel warmed up, avoiding any movements that cause pain.* Progress slowly and always move through a pain-free range. Stop when you feel a gentle pull. They are most effective if they are done a few times per day.

• Head Circles - Rotate the head to make circles. Complete in both directions.  

• Arm Circles - Lift arms away from the body. Move in a circle. Complete both directions.  

• Wrist Circles - Bend elbows. Move the wrist in a circular direction. Complete in both directions.  

• Squat-to-Fly: Stand with feet hip-width apart and push hips back as if sitting on a chair. Cross arms in front of your chest. Bend your knees to lower yourself into a squat. Stand up while uncrossing/opening your arms as wide as you can. Squeeze your shoulder blades together.  

• Toe-Touch to Side-Bend - Stand with feet hip-width apart. Try to touch your toes, and stop when you feel tension. Return to an upright position and lift one arm above your head. Reach to the opposite side. Re-center. Bend towards the toe and then reach towards the opposite side.  

• Butt Kickers - Stand with feet hip-width apart. Bend your right knee and lift your heel toward your butt. Lower your right leg and do the same on your left side.  

• Lunges: Stand with your right foot in front and your left foot in back. Move your hips forward while bending your front knee to tolerance. Repeat on the opposite side.  

• High-Knee with a Twist - Lift knee upwards towards the chest while rotating trunk. Bring opposite elbow to knee at the same time—alternate sides.   

This is an example of a program we use for our industrial clients; however, these are great for office workers too!

Postural Reversals:  

Postural Reversals involve placing your body in the opposite position or motion. They can be done throughout the day and only take a few seconds to accomplish. Postural reversals are more effective for combating muscular tension from prolonged postures than stretching alone.

• If you’re Standing, perform 5 squats every 30 minutes of continuous standing.  

• If you’re twisting your wrists a lot, draw circles with your wrist for 3-5 reps in each direction.  

• If you’re gripping a lot, Make a tight fist and then spread your fingers out as wide as possible, returning to the starting position with 3-5 reps total.   

• If you’re forward-bending a lot, Stand hip-width apart and reach up towards the sky for 5-10 seconds. Slightly bend or curve your spine backward, using your hands to support your lower back as needed.   

• If you’re Forward Reaching a lot, Stand hip width apart, arms out to the side, elbow bent at 90 degrees into a “Happy Cactus” position, perform 3-5 reps for every 15 minutes of work.  

• If you’re sitting a lot, stand and complete 25 high knees every 30 minutes of sitting. We can do this in place or march forward.  

• If you have low back discomfort while seated, arch your back and round your back for 5-10 reps as needed.  

You can perform these exercises wherever you have adequate space or surface support, as needed. 

Dynamic stretches and postural reversals boost circulation and reduce muscular fatigue. Incorporate these into your daily routine and feel the impact on your physical and mental health. 

*Disclaimer: Please note, these exercises are general recommendations. They should not take the place of advice from a medical professional. If you would like a program developed specifically for your or your workforce by one of our physical therapists, occupational therapists or athletic trainers or feel like you could benefit from manual therapy, dry needling or cupping to compliment these exercises, contact us today!

—

About the author: Megan is a Physical Therapist Assistant at our Fond du Lac and Ripon Clinics. She is also heavily involved with our Industrial Team. She uses similar exercises to help workers thrive during their workday and prevent injuries for jobs requiring prolonged postures/positions and repetitive work.

Provider Spotlight: Ben Benesh PT, DPT, SCS

Sometimes you have to push people to get out of them what is needed.

When you interview a physical therapist with numerous specialties, advanced certifications, and the broad range of experiences that 20+ years in the profession provides, you know you’re talking with someone who can treat just about anyone who walks into his clinic.

“I love working with all my patients and getting them back to full function,” said Advanced Physical Therapy’s Ben Benesh. “It’s very rewarding.”

Yes, I understand, but is there a type of patient that is your favorite to work with?

“Well, I do love working with athletes,” he said.

BAM

“Those are probably my favorite patients and it's a pretty wide variety and wide age variety of athletes. But I do love the high school athlete, and those are the patients that often stick out in my head over the last 20 years, those kids that had ACL injuries, a reconstruction, and then they come to me,” said Benesh. “And working with them, getting them to that sports performance phase over the last few months, moving them into a guarded progression and then getting them back to their sport.”

Here Benesh discusses a local high school athlete who suffered ACL tears in back to back years.

“About 18 months of rehab, a huge commitment,” Benesh said. “She was so strong, maybe the strongest patient in my 20 years.”

We discussed the high school athletes he’s treated and the emotional toll wrought by such devastating injuries. Those patients, said Benesh, are the ones who often end up becoming physical therapists.

So was that Benesh’s path?

“Well, I played sports and was injured a lot, but I didn’t receive a lot of PT for it.”

For Benesh, it was an opportunity as a college student to work with a physical therapist from his hometown that was the catalyst. This “one man show” of a physical therapy practice influenced Benesh in more ways than he could count.

“I loved his life, his family life, his demeanor with patients,” said Benesh. “The whole experience was fantastic. And he wrote me a really nice reference letter for my PT school application.”

Nearly a quarter century and a bachelor’s, master’s and doctoral degree later, Benesh’s special interest in sports continues unabated. He’s received additional sports medicine training in a number of areas including advanced treatment of the shoulder, concussion management, and performance running video analysis.

He’s also a Board Certified Clinical Specialist in Sports Physical Therapy (SCS), a certification that identifies those who are experts within their branch of PT. It also provides enhanced opportunities to use those skills working with local sports teams, high-level athletes, and youth feeder programs (Benesh provided on field coverage for UW-Oshkosh football as well as for the Oshkosh Flyers, a competitive youth football club for fourth through eight graders).

And it’s a commitment with rigorous requirements.

“It’s a beast of an exam,” said Benesh. “There aren’t that many of us in the state of Wisconsin with the SCS certification, but it’s worth it. Keeps you up to date on the latest on sports performance, nutrition, emergency medicine, coverage on the field, a wide range of specializations.”

Benesh is used to seeing highly motivated patients ready to take on the physical challenges of rehab, but mental and emotional components must be addressed. This is where Benesh the dad, the coach of his children’s sports teams, and the clinician all meet.

“I think that the honesty that I can have with these patients is important.” Said Benesh. “I feel like it's a positive thing for injured athletes to talk to somebody other than their coach or their mom or dad. It’s also good for the parents to have a sounding board to have a thought process. I try to keep it as objective as I can, but I have daughters and a son. I feel I'm in a good spot to understand and empathize in these situations.”

Benesh has three children, all involved in sports. And at one point he was coaching all three at the same time. That’s no longer the case, and you’d think that would result in a more stable work-life balance.

“Oh, no, it’s way easier to make schedules work for me when I’m coaching all of them,” said Benesh. “Otherwise, things conflict.”

Working at the Oshkosh YMCA location affords Benesh the opportunity to utilize facilities with his injured athletes. If he’s working with a swimmer, there’s the pool; a hockey player gets to use the ice; the soccer player is on the pitch; the hoops player is on the basketball court.

“It's really nice to have that ability to see them at this location,” said Benesh. “Usually, I'll see them weekly for three to five months, whatever it takes to get them back, and then I do a return-to-sport testing with them before I release them back to their sport.”

Sometimes you have to push people to get out of them what is needed.

That’s what physical therapists do.

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Dr. Ben provides physical therapy and sports physical therapy services at both Oshkosh Community YMCA locations in Oshkosh, WI (Downtown, 20th Ave). 920-305-7910

7 Tips and Tricks to prepare for surgery

Dr. Laura Johnson discusses how planning for your upcoming surgery can make the recovery process easier.

Whatever journey leads you to the need for orthopedic surgery, we want to make sure you are prepared for a successful recovery.

Most likely, you will have some difficulty moving around after surgery, so do as much as you can beforehand to prepare for post-surgery.   

We know you’ll be bombarded with information as you prepare for your orthopedic surgery, so we wanted to keep it simple: Prepare, Practice, Organize.

Here are some Tips and Tricks that we’ve found helpful for our patients:

• Arrange meals ahead of time.

  While you are recovering, you may not feel up to standing in the kitchen for long periods or going to the store to gather all the ingredients.

  This may involve buying frozen meals or preparing meals to freeze beforehand. 

  Whip up a batch of your favorite homemade soup for a quick warm-up meal after surgery. 

  Having the premade foods on hand will help provide your body with the nourishment it needs while it recovers.

• Get your ice packs lined up. 

  Swelling and pain are common after surgery. The general rule of thumb is to ice for 15-20 minutes, then remove it for 30-40 minutes, repeating as needed.

• Prepare to elevate. 

  Get extra pillows available to help elevate your limb.  Elevating a limb above the level of your heart allows the blood to circulate back to the heart without fighting gravity. The force of gravity will assist with moving the fluid.

  You can combine elevating and icing at the same time to especially help with your swelling.    

• Practice makes perfect part 1.

  If you must use an assistive device, such as crutches, a knee scooter, or a walker for mobility after your surgery, PLEASE PRACTICE transferring, walking, and navigating stairs with the assistive device before surgery. 

  Getting used to these assistive devices can be a balancing act, so practice, practice, practice! Manipulating around your home with an assistive device can also be a bit cumbersome, so practice this before surgery. 

  You may need to adjust furniture to provide larger pathways, remove throw rugs, add a chair cushion, etc.  

• Practice makes perfect part 2.

  Be aware of any weight-bearing and/or movement restrictions you may have to follow post-surgery.  Practice that weight-bearing restriction (i.e., non-weight bearing, partial weight bearing), as it may be more challenging than you imagine. 

  If there are movement restrictions (e.g., you must keep the knee fully extended and limit the amount of trunk flexion), practice following those restrictions prior to surgery and adjust your home setup as needed. 

  You may be in an arm sling, so your toilet paper roll needs to be switched to the opposite side.

  Little adjustments beforehand will make a huge difference after.  

• Start your exercises.

  If there are any prescribed pre-operative exercises to perform before surgery to help strengthen muscles and improve flexibility, jump on board!

  Get into the routine of sticking to an exercise program. 

  This can aid in post-surgery recovery.   

• Ask for Help.

  Inform your family and friends about your surgery and ask for help, especially during your initial recovery. 

  Also, ask for assistance with outdoor chores, household cleaning, meal prep, transportation, etc. 

  Individuals may be more willing to help than you expect, ask!  

  If you have questions or concerns about your surgery, get them answered beforehand. The more prepared you feel for surgery, the better your outcome may be!  

Working through these recommendations with a skilled physical therapist can be very helpful, especially when practicing your restrictions and guiding your exercises. If that interests you, contact us today, and we will help set you up for success.

If therapy is part of your recovery, please contact Advanced Physical Therapy and Sports Medicine. We will be happy to guide you back to an active lifestyle!  

Happy Recovery! 

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Dr. Laura Johnson is a physical therapist at our Appleton North Clinic on Enterprise Dr. and Touchmark Clinic on Touchmark Dr. She is a post-surgical physical therapist specialist and certified in LSVT-BIG to help people with Parkinson’s thrive.

Should I be stretching or strengthening?

Dr. Chandler contemplating the deep questions of the PT world.

“Hey, Siri, I have had months of pain in my lower back, and every doctor has told me that I need to stretch my hamstrings because they are tight. Do I need to stretch, or should I go work out like my friend from the gym tells me?” 

Ah, to stretch or to strengthen, that is a great question. 

“When is it a good idea to stretch?” 

Let's look at what the research says: 

When and how you stretch is important and heavily depends on your goals! 

When added throughout the day, stretching has many benefits, including increased tolerance to muscle tension and improved flexibility. It is also suggested that it reduces soreness following activity.  

Prolonged stretching for 30 seconds or more before activity has been shown to reduce maximal strength. Therefore, prolonged stretching after activity is recommended. This includes your standard hamstring stretches, calf stretches, upper trap stretches, etc.

Dynamic stretching can improve motion for activity without impacting strength. That’s why dynamic stretching is recommended before an activity. Some examples of dynamic stretching include air squats, lunges, high knees, butt kicks, side shuffles, cross-over stepping, leg swings, arm circles, cat-cows, thoracic rotations, etc.

“I’ve been stretching for a while but still have pain and tightness...Why is that?” 

That's because muscle weakness can also disguise itself as tightness.  

Mind blown, right!? 

Don’t worry, ours was, too, when we first learned about it. 

If you’ve been stretching one area, such as your back, hamstring, upper traps, etc., and the tension keeps returning, it’s time to consider a progressive strengthening program and load those tissues. This helps build tissue resilience to your symptoms at bay.

A proper evaluation from a Physical Therapist is the best tool for determining the root cause of your muscular aches and pains and working with you to determine the best course of action. 

Life, including stretching and strengthening, is about balance. 

Let’s work together to rebalance your approach and abolish your aches and pains for good.

To schedule an appointment with Dr. Chandler at our Appleton North clinic on Enterprise Dr., call 920-991-2561.

Or click here to find a location most convenient for you.

*Disclaimer: Stretching may not be the best option if you have an acute muscle sprain (e.g., you were sprinting, felt a pop or slipped on ice, did the splits, and felt your muscle pull with immediate pain after the incident). In these cases, follow up with a physical therapist ASAP to assess further and direct your journey. 

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Not sure if PT is right for you?

We do offer Free Screens to assess further and determine the best course of action with you.