Why do you make physical activity a priority in your life?

Dean J Sondrol, PT

Why do you make physical activity a priority in your life? This question was a recent topic of discussion one day between myself and some of my clients at Advanced Physical Therapy and Sports Medicine, and then later on between some friends and I. It was sparked by a recent article I read on the APTA Website- see article below. 

Here are some of the responses that came up:

-to stay’ healthy (was the most common)

-to keep up or stay with my children (one of my main reasons)

-to enjoy the outdoors; hiking, kayaking, and biking

-to dance at my granddaughter’s wedding

-my wife tells me to, or my kids tell me I need to

-so I look good

-cause of my heart attack or new hip or knee

-So I can play high school sports (from some of the younger people)

-in case I get COVID (a more recent reason)

-so I can fit into that dress or pair of jeans

-my high school reunion is coming up

-so I can drink more beer, or eat more food

-it just feels good

Of course, this also led to a discussion on why we don’t make physical activity a priority in our life, (that is a topic for an article in itself).    The benefits of physical activity are well documented, we all have heard reason on TV, at the Dr office, from social media and from family and friends.  So I won’t lecture you in this article but I would encourage you to find the one or two reasons why you should make physical activity your priority.  Write it down if you want, post it on your phone, or just think about it from time to time.  I will also think of my reasons why I’m doing that activity and it makes that walk or work out all the more meaningful.  So if you see me out running, biking, or walking and ask what I’m thinking about I would probably tell you my children or how many more miles I should run so I can eat that jelly doughnut.    

You may have some of the same or have your own reason.  Please feel to share your reason with me…. Remember to keep making physical activity your priority!

From: Top 10 Benefits of Physical Activity.  From Choose PT August 2020

https://www.choosept.com/resources/detail/top-10-benefits-of-physical-activity

Most Americans do not move enough. The good news is that regular physical activity is one of the easiest ways to reduce your risk for chronic disease and to improve your quality of life.

Make physical activity a priority to:

1.    Improve your memory and brain function (all age groups)

2.    Protect against many chronic diseases.

3.    Aid in weight management.

4.    Lower blood pressure and improve heart health.

5.    Improve your quality of sleep.

6.    Reduce feelings of anxiety and depression.

7.    Combat cancer-related fatigue.

8. Improve joint pain and stiffness.

9. Maintain muscle strength and balance.

10. Increase the life span.

Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. Physical therapists treat people of all ages and abilities and empower you to take an active part in your care. After an evaluation, your physical therapist will create a treatment plan for your specific needs and goals.

Choose more movement. Choose better health. Choose physical therapy.

Speed and Agility Training

David Reybrock, MPT

Speed and agility are primarily associated with athletes training for sport; but it also occurs in our everyday activities. We are all athletes in one form or another. Whether you are in a sport, involved in recreation, participate in regular exercise, walk a dog, or play with your children; speed and agility training can help enhance your movement skill acquisition and functional mobility.

As movement specialists, Physical Therapists can use speed and agility training to provide stability by varying speeds of motion and body position.  Everyone can benefit from improved balance, quicker feet, and faster reaction time.  Speed and agility in youth can be used for injury prevention, promote exercise participation, and improve physical fitness.  Speed and agility in elderly can be used to improve coordination, prevent falls, and maintain independent living.  Adding speed and agility to an exercise routine or treatment program can help you move more efficiently and effectively.  

What is Speed, what is Agility?

Speed is defined as the ability to move the body in one direction as fast as possible. Training for speed requires strength in the arms and legs to propel your body forward. The muscles in the back of the thigh and leg create triple extension- forceful extension of the hip, knee, and ankle joints. The gluteus maximus muscle of the hip; hamstring muscles of the knee; and gastroc-soleus muscles of the ankle are the muscles used to run faster.

Agility on the other hand, is the ability to accelerate, decelerate, stabilize, and quickly change directions with proper posture. Agility training focuses on performing a variety of movements in a quick manner. It is not simply going as fast as you can, but rather adjusting movements while going as fast and as steady as possible. Training for agility requires good balance and a strong core to support the body as it moves through all three planes of motion.

The combination of speed and agility training should be used to develop movement skills that include acceleration, deceleration, dynamic balance, and change of direction. In developing these skills, appropriate stability, mobility, and sequencing of movement patterns is important for training athletes and treating patients in physical therapy.

Here are some examples of speed and agility drills that can be used to train athletes and treat patients to be able to speed up, slow down, and change direction more efficiently:

Sprints or walking. Run or walk as fast as possible from a standing still position. The distance will vary based on ability and sport specificity. Add change of speed, stop and pivot turns, head movement, inclines or declines to incorporate agility.

High knees wall drill. With arms extended forward and hands on a wall for stability, alternate knees to hip level up and down as fast as possible. For agility, remove hands from the wall and perform with opposite arm swing and change of speed.

Static balance. Sit on a stability ball, stand with a wide or narrow BOS, or single limb stand.

Dynamic balance. Seated balance with arm and leg movement. Tandem forward walking, side-stepping, and carrying objects while walking.

Cone drill example:

Pro-Agility: 20-yard line sprint, 5-10-5
Purpose: Improve the ability to change direction by enhancing footwork and reaction time.
Procedure: Place each cone 5 yards apart. Start in a two-point stance at the starting line, the center cone. Sprint to the end line and touch with your hand. Turn back and sprint to the far cone (10 yards) and touch the line. Turn back and sprint 5 yards through the start line to the finish.

Image- https://mishockpt.com/speed-and-agility-training/

Agility Ladder drill example:

2 feet out, 1 foot in.

Image- https://i.pinimg.com/564x/97/db/15/97db15d22b150e4585a1caa89056b39a.jpg

Plyometrics: Jump, leap, and hop.

References:

Clark, M.A., Sutton, B.G., Lucett, S.C. (2014). NASM Essentials of Personal Fitness Training, 4th Edition, Revised. Burlington, MA: Jones and Bartlett Learning.

Better going into surgery, better coming out.

Briana Wasielewski, PTA, CCCE, BS

Having the best rehab after surgery is one of the top priorities of all surgical candidates. Many spend a lot of time getting the best surgeon in place, getting their place to rest in order, and thinking about who can help them with daily life and getting to and from appointments once the surgery is done. While these are all things one should think about prior to surgery, many do not think about what they can do to ultimately increase their chances of having a better surgical outcome: exercise prior to surgery. 

Exercise comes in many forms and is something everyone can do before surgery. If done appropriately, exercise before surgery will likely improve recovery. Who better to help figure out your unique pre-op exercise plan than a physical therapist? 

First, a physical therapist will discuss and evaluate your reason for surgery. Many times the reason a patient is thinking about having surgery is that they have pain or their movement is affected. Exercise is usually not something surgical candidates think they can or should do before considering surgery. Prehab exercise is specifically designed by physical therapists to improve the outcome of patients’ post-surgical rehab. The idea here is “the better going into the surgery, the better coming out”. Whether that means breathing exercises, simple strengthening, flexibility work, or practicing how to use crutches, seeing a physical therapist before surgery can help the healing process in the long run.  

A physical therapist prehab visit also gives the opportunity for surgical candidates to ask questions specifically about the most dreaded part of having surgery: the recovery. Physical therapists are experts in rehabilitation and can tell you exactly what to expect in recovery, and how to prepare yourself with pain management tools.  

If you are thinking about having surgery or know someone who is, make sure you prepare yourself and your body by seeing one of our physical/occupational therapists.

Head to our location page to find a clinic near you!

Does Selecting the Right Running Shoe Help Prevent Injury?

Josh Zilm PT, DPT

Does Selecting the Right Running Shoe Help Prevent Injury?

It’s spring and time to strap on those shoes and get outside.

There has been an entire industry built around providing runners with the best possible shoe.  When answering the question, “Does selecting the right running shoe help prevent injury?” one often has to tread lightly as there are many opinions.  As physical therapists, we like to turn to the scientific literature to answer a question.  Can a running shoe offer a return on energy? Is it better to run barefoot?  Are minimalist shoes better? What about orthotics?  Those are topics for another time.  This post will focus only on the running shoe’s ability to reduce injury and not attempt to answer any of those other questions that can often muddy the waters. 

The industry

The running shoe industry dates back to the mid to late 1800s, but most credit the start of the modern-day training shoe to the founder of a little company called Nike when he started selling shoes out of the back of a van in the 1960s.  Since that time running and shoes have grown into a multi-billion dollar industry.  Did you know that the first New York City Marathon was held in 1970 and had 127 competitors?  That is quite a contrast from 52,812 finishers in 2018.  As the sport has grown so has the market for better shoes with an attempt to meet the needs and demands of the runner.  Research, technology, science, expert opinion, and business has delivered a vast shoe market that boast a variety spanning barefoot the ultimate support and cushion.  So with all the shoes available today, is there a shoe for your foot type that can reduce injury associated with rigors of the sport?

The Amazing Foot

The foot is designed to help our bodies absorb energy as we impact the ground in an action called pronation.  The foot and ankle accomplish these amazing feet through a team effort.  We have muscles from our trunk to our feet that actually fine-tune how the body absorbs shock and then in a split second prepares to propel us forward with each step.  Running injuries are most often associated with the loading phase of running and more specifically the rate at which we load.  Don’t be afraid I won’t get too technical, but it is important to understand that the primary focus on injury reduction regarding the shoe is slowing the rate of loading, that is how fast our bodies have to accept the load with each strike of the foot on the ground. 

Foot Type

The hard part about designing the perfect shoe is that there are 7.66 billion people on the planet with a lot of different foot types (I know they are not all runners).  Thankfully, the orthopedic and running world has been able to classify foot type to offer some order to our attempts to best categorize the variety of feet that walk or run into the clinic.  Foot type does offer some predictive value to the injuries that we typically experience.  Nature(genetics) and nurture(lifestyle) lend way to a spectrum of people have rigid high arched feet, flat feet flexible feet, and everything in between.  The shoe industry has tried to match foot type with the appropriate shoe.  For example, the rigid high arch foot type should consider a softer shoe, while the flat flexible foot could use a more supportive shoe. 

The Shoe Spectrum

The soft shoe would be categorized as a “cushioned” shoe while the more supportive shoe is given the name “motion control”.   It would be intuitive to think that a person with a poor ability to control the position of the foot would benefit from added support and the person with a rigid high arch foot may need a little more cushion because they hit the ground harder.  (funny that studies show that joint reaction forces are actually higher in a cushioned shoe versus minimal support.  The working theory is that runners hit the ground harder with a cushioned heel simply because it’s cushioned.)  This could be a multiday conversation, but my attempt is to explain the basic shoe spectrum that starts with no support(barefoot/running sandal) to motion control(high degree of pronation control).  There are many variations within this spectrum that attempt to meet the needs of the runner, but the question we are trying to answer is can we reduce injury by pairing the runner with the right running shoe?   What does the research say?

Theisen et at 2014 Br J Sport Med completed a study looking at over 200 runners.  They found:

1.      Midsole Hardness and Injury rates: no different.  The amount of cushion had no significant difference in injury rates.

2.      Energy absorption and injury risk have no scientific correlation.  A shoe that absorbs energy does not reduce injury rates.

3.      Shoe wear does not appear to have an effect on biomechanics.  You cannot correct your biomechanics by running with a shoe.

4.      1% increase in metabolic cost for every 3.5 ounces of shoes.  Heavy shoes require more energy.

The recommendation:   Promote light shoes.  Refrain from claiming that shoes reduce injury through cushion or biomechanical changes.

Ryan et al. (2011) Br J Sport Med found;

• Shoe assigned by foot posture index(match the shoe with the foot type).  Static foot type should not be the determining factor for shoe selection.  The highest rate of injury was in runners wearing a motion control shoe that were appropriately matched based on foot type. 

The recommendation: Don't use the algorithm alone in an attempt to match foot type and shoe type to dictate the choice of running shoe.

Nielsen et al. (2014) Br J Sports Med.

• Foot pronation was not associated with increased injury risk in novice runners wearing a neutral shoe.  The “Over pronator” did not experience a greater rate of injury when left unsupported versus supported.

The recommendation: Let comfort dictate.  Give the runner a starting point in shoe selection, but do not feel locked into a shoe, especially motion control. 

Conclusion

Shoe type may offer a good starting point for a new runner when selecting shoes.  Based on the current literature I would recommend starting your search with a shoe that matches your foot type, but don’t feel boxed into a certain type of shoe.  Look for something that is comfortable when you run.  In more recent literature motion control shoes have been associated with higher rates of injury which gives rise to concern for recommending a motion control shoe.

Also, a lighter shoe consumes less energy.  The weight of the shoe does matter.   

One of the questions I often ask in the clinic is, “Do you run to get stronger or get stronger to run” (Dr. Chris Powers, USC).  I see a lot of runners try to compensate for bad mechanics through shoes and more running, but the truth is many people lack the strength to support the activity of running.  A physical therapy running evaluation can be a great tool as you begin or return to running.  Injury reduction comes from improved biomechanics something that we are all capable of with the right instruction.  Like many things in running, there are no short cuts.  Consistent effort = results.  The right running shoe may do a lot of things for the athlete, but with the exception of protecting the bottom of the foot and toes, there does not appear to be evidence supporting the claim that they reduce injury rates in runners.

The Most Common Cause of Vertigo is also the Most Treatable

Chris Hupf, PT, DPT, CSCS

Do you ever feel a sense that you or your surroundings are spinning or moving? Do you experience bouts of sudden unsteadiness or dizziness? Vertigo is a type of dizziness defined as an illusory sensation of motion of either the self or the surroundings in the absence of true motion.1 According to the National Institute on Deafness and Other Communication Disorders, it’s estimated that close to 40% of the population will experience dizziness or balance problems over the course of their lifetime.2 

One of the most common causes of vertigo is a condition called benign paroxysmal positional vertigo (BPPV). In fact, of the 5 million people in the United States who seek care for complaints of dizziness every year, between 17% and 42% end up receiving a diagnosis of BPPV.1 

BPPV is a type of positional vertigo caused by a disorder of the inner ear. Those who have it experience repeated “spinning” sensations or unsteadiness when they move their head in a certain direction. This could occur when rolling over or getting out of bed or tipping the head back to look up. A feeling of lightheadedness and nausea can occur as well. 

It’s widely understood that BPPV is caused by small calcium carbonate crystals that become dislodged from their normal resting place and end up free-floating within one of three semicircular canals used by the inner ear to sense movement. With changes in head position, these crystals migrate within the fluid-filled canal, causing movement of fluid and subsequent pressure changes that result in an abnormal sensation of rotation or spinning.

In the clinic, a physical therapist can assist in diagnosing BPPV through physical examination and understanding your history. This includes observation of involuntary eye movements that occur when the patient is placed in specific positions that provoke their dizziness. Depending on the canal affected, treatment involves a sequence of specific maneuvers designed to clear these crystals from the canal. These maneuvers are highly effective, with studies showing a complete resolution of symptoms 74-95% of the time in as little as one visit.3-6 

Almost 90% of people with BPPV will experience some interruption to their daily lives, including anxiety, depression, an increased risk for falls and impaired performance at home or at work.1,7 And, because most people who seek treatment are unaware that physical therapists can help, many ultimately end up undergoing expensive and unnecessary diagnostic testing and treatment first.7 

BPPV is quickly and easily treated by physical therapists. Many of our therapists have undergone additional training to diagnose and treat BPPV, so please don’t hesitate to reach out and schedule an appointment. It could be your next and final step in ending this debilitating condition, allowing you to live life uninterrupted once again.

References: 

1. Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., ... & Seidman, M. D. (2017). Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1-S47. 

2. National Institute on Deafness and Other Communication Disorders. (2005). Strategic plan (FY 2006-2008). Retrieved from http://www.nidcd.nih.gov/StaticResources/about/plans/strategic/strategic06-08.pdf [PDF]. 

3. Wang, Y. H., Chan, C. Y., & Liu, Q. H. (2019). Benign paroxsymal positional vertigo–recommendations for treatment in primary care. Therapeutics and clinical risk management, 15, 719. 

4. Fyrmpas, G., Barkoulas, E., Haidich, A. B., & Tsalighopoulos, M. (2013). Vertigo during the Epley maneuver and success rate in patients with BPPV. European archives of oto-rhino-laryngology, 270(10), 2621-2625. 

5. Helminski, J. O. (2014). Effectiveness of the canalith repositioning procedure in the treatment of benign paroxysmal positional vertigo. Physical therapy, 94(10), 1373-1382. 

6. Bruintjes, T. D., Companjen, J., van der Zaag‐Loonen, H. J., & van Benthem, P. P. G. (2014). A randomised sham‐controlled trial to assess the long‐term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo. Clinical Otolaryngology, 39(1), 39-44. 

7. BPPV: Experts Update Best Practices for Diagnosis and Treatment. (2017, March 1). Retrieved from https://www.entnet.org/content/bppv-experts-update-best-practices-diagnosis-and-treatment

Image of Inner Ear: Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work.

Start the Year Right, Prevent and Treat Shoulder Pain

Phil Sorensen, PT, CSCS

From Thanksgiving through Christmas & New Years I have had more friends and family members ask me about their painful shoulders than any other body area. Not one had a specific injury. Pain developed with use/reaching, exercise, work and in most cases was interfering with their ability to sleep. The good news for them was their condition is very treatable and responds well with physical therapy. The longer you ignore symptoms and the repetitive pain with daily use, reaching, etc. the more challenging it can become to relieve. Structure of the Shoulder: In most parts of the body, the bones are surrounded by muscles. In the shoulder region, however, the muscle and tendons are surrounded by bone. If you tap the top of your shoulder, you can feel bone immediately under the skin, this is called the acromion of the scapula. Directly under this bone is the rotator cuff, a group of four muscles and tendons. In the image below, the supraspinatus is one of the tendons that are most commonly involved. It along with the bursa (a fluid-filled sack) is positioned right between the humerus (upper arm bone) and the acromion that you tapped. This structure of muscle-tendon between bones is a contributing factor to the development of impingement syndrome (shoulder bursitis, rotator cuff or biceps tendinopathy).

Muscles of the Shoulder: Proper rotator cuff (RC) and scapular muscle strength is critical in both preventing and treating shoulder pain/impingement. The RC role is to keep the ball of the humerus in the correct position with the scapula. The rotator cuff enables the other major muscles of the arm, the deltoid and Latissimus dorsi (“lats”), to properly perform their job during reaching, lifting, pushing, or pulling. Balanced strength around the shoulder blade, in the lower & middle trapezius, rhomboids & serratus anterior (scapulothoracic) muscles, is crucial for shoulder blade movement and shoulder mechanics. Weakness and imbalance in these muscles and/or the RC is another primary factor with impingement syndrome, shoulder bursitis & rotator cuff tendinopathy. Corrective Measures: Learning proper technique to balance the previously mentioned muscles in various positions then progressing to movements can be complex and is where the skills of a PT are of great benefit to optimize your time and efforts. Below is a link to a video demonstrating a great shoulder stability exercise that engages these muscles using a small looped band while doing a small forward reach. CLICK HERE

In addition to developing proper rotator cuff & scapulo-thoracic muscle strength, it’s important to address adequate shoulder, rib cage & thoracic (upper back) mobility. Your physical therapist will assess, treat and instruct you in things you can do to improve your mobility. In most cases, shoulder impingement, bursitis, &/or rotator cuff tendon injuries can be completely rehabilitated and should leave no residual effects once a person has recovered. Shoulder pain can be debilitating by limiting your ability to exercise and perform daily tasks. Start the year out right, be proactive in the care of your shoulder. Call and set up an appointment to see a PT today. The longer a condition is left untreated, the more potential for harm and tissue damage which may lead to a longer recovery process.

Contact us to start your recovery or prevention journey today!

Back Pain during Pregnancy and Postpartum

Amanda Uting, PT, DPT

Back pain is common during pregnancy, with the prevalence of low back pain during pregnancy estimated to be between 50-75%. Back pain during pregnancy increases the risk of pain after delivery; more than one-third of women that have back pain during pregnancy still having back pain at 18 months postpartum. Back pain can decrease your ability to do normal activities at work and around the house, limit your exercise, and impair your sleep.

What may contribute to increase pain during pregnancy?

· Weight gain and postural changes: Women with a normal BMI are encouraged to gain 25-35 lbs during pregnancy. This weight gain, along with postural changes related to a growing uterus and baby, puts more stress on your joints.

· Joint laxity

· Fluid retention: results in increased pressure on soft tissues

How can physical therapy help you during pregnancy and after delivery?

As musculoskeletal experts, physical therapist have an important role in decreasing pain and improving function during pregnancy and during the postpartum period. Working with a physical therapist may include the following:

• Patient education

○ Exercise and safe return to exercise postpartum

○ Posture and breastfeeding positioning

○ Healthy bladder habits

○ Scar mobilization for Cesarean deliveries

• Safe manual therapy techniques.

• Home exercises.

Below are some exercises that may be beneficial for you to relieve back pain and increase strength for the physical demands of motherhood.  During pregnancy, please check with your healthcare provider before starting any home exercises.

○ Shoulder blade squeezes: Squeeze your shoulder blades down and back and hold for 2-3 seconds. Perform 10-20 reps. This is a great exercise during or after feeding your baby to counteract a forward shoulders posture.

○ Chest stretch: Stand in an open doorway and rest your palms on the doorframe with your elbows at shoulder height. Lean forward to feel a gentle stretch in the front of your shoulder and chest. Hold 30 seconds and repeat 1-2 times.

○ Cat/cow: On your hands and knees, gently relax your stomach towards the floor and then arch your back up towards the ceiling. Perform 10-20 reps in each direction.                                    

○ Bird dog: From a hands and knees position, attempt to push your abdominals towards the floor, and look forward; then contract your abdominals and arch your back, as if you are trying to hug baby in with your ab muscles. Keep your back flat as you extend one arm. If this feels easy, extend one arm with the opposite leg. Hold for 1 second. Perform 10-20 reps on each side.

○ Child’s pose: From a hands and knees position, bring your big toes to touch and sit your hips back. Let your stomach relax between your knees and feel a stretch in your back as your arms stay extended forward.

In addition, pelvic health physical therapists with specialized training can help patients that experience:

· pelvic pain

· urinary frequency or incontinence

· disastasis recti (abdominal separation)

If you are interested in the benefits of physical therapy during pregnancy or after giving birth, please get in touch with Advanced Physical Therapy & Sports Medicine at (920) 991-2561.

References:

Katonis P, A Kampouroglou, A Aggelopoulos, K Kakavelakis, S Lykoudis, A Makrigiannakis, K Alpantaki Pregnancy-related low back pain. Hippokratia. 2011 Jul-Sep; 15(3): 205–210.

Kanakaris Nikolas, Roberts Craig S, Giannoudis Peter V. Pregnancy-related pelvic girdle pain: an update  BMC Medicine 2011. 9(15)

Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008;1(2):137–141.

Ostgaard H, et al. Back pain in relation to pregnancy: A 6 year follow-up. Spine. 1997; 22:2945-50.

Larsen EC, et al. Symptom-giving pelvic girdle relaxation in pregnancy. Prevalence and risk factors. Acta Obstet Gynecol Scand. 1999; 78: 105-110.

Kesikburun, S., Güzelküçük, Ü., Fidan, U., Demir, Y., Ergün, A., & Tan, A. K. (2018). Musculoskeletal pain and symptoms in pregnancy: a descriptive study. Therapeutic advances in musculoskeletal disease, 10(12), 229–234. doi:10.1177/1759720X18812449

“Exercise during Pregnancy” https://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy

“Exercise during Pregnancy” http://americanpregnancy.org/pregnancy-health/exercise-during-pregnancy/

“ACOG Committee Opinion” https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care

“Pregnancy and Low Back Pain: Physical Therapy Can Reduce Back and Pelvic Pain During and After Pregnancy”J Orthop Sports Phys Ther 2014;44(7):474. doi:10.2519/jospt.2014.0505

Can Physical Therapy lessen or stop headaches/migraines?

Dennis Kaster, PT

Did you know that physical therapists are able to significantly decrease or eliminate headaches and or migraines?  Many times headaches and migraines are triggered by muscle tension or tightness in your neck.  These muscle issues can be alleviated with some simple corrections to poor posture and muscle weakness or tightness.  There are many ways that a physical therapist can help you to get rid of your headaches and migraines.  Physical therapy is a great alternative to taking expensive medications which can be detrimental to some of your body organs— like your liver.  Treatments like Botox can be very expensive and have only temporary effects.  The corrections that a physical therapist makes can be lifelong.  Here are some ways a physical therapist can help to decrease your headaches or migraines.

Posture – If you have poor posture or are looking down a great deal, this can cause the muscles that hold your head up to pull extra hard on the back of your skull.  This can trigger headaches and migraines.  By improving your posture or modifying your work station, these same muscles will not pull as hard on the back of your skull.

Ergonomic setup – if your workstation or even areas that you do crafting in are not set up correctly, this can put extra stress on your body and neck.  Simple things like wearing reading glasses instead of bifocals when you are at your computer can make a big difference.  A physical therapist can help you to set up your work stations to put less stress on your body.

Dry needling – This is a newer technique that can give instant relief for headaches and migraines.  I have seen some patients get total relief from migraines and headaches after just a couple of treatments using this technique combined with other treatments listed here.  This technique involves putting very thin needles into the sore muscles causing headaches and migraines.  It is very simple and takes only a few minutes to do.  Call one of our clinics for more details on this awesome technique.

Stretching – Muscle tightness can definitely trigger migraines and headaches.  A physical therapist can give you stretches specifically for the individual muscles that are causing your headaches or migraines.

Strengthening – Weak muscles in your neck and upper chest area can also contribute to your migraines and headaches.  A physical therapist can give you specific strengthening exercises to better support your head and neck.

Soft tissue mobilization – Many times the muscles in your neck and upper back can be very sore and have “knots” or trigger points in them, or just be tight.  A physical therapist can do soft tissue mobilization, a very specific type of massage, which will help to alleviate muscle tightness and trigger points in your muscles.

Ultrasound/Electrical stimulation – Ultrasound is a modality that helps to relax muscle tissue and promote healing.  Electrical stimulation is a modality that can help to decrease pain and inflammation in the tissues.  Either or both of these can be used to help decrease your pain or muscle tightness.

Unfortunately, one of the best-kept secrets is that physical therapy is a relatively cheap and easy way to decrease or eliminate headaches and migraines without taking expensive and powerful medications. 

Please call one of our clinics today.  We can do a free screen with you to let you know if we think we can help you.  Most insurances do not require a physician referral to physical therapy, so you can call and set up an appointment without having to see a physician first.  We look forward to helping you take control of your life and to eliminate the crippling effects of headaches and migraines.

Osteoarthritis of the Thumb CMC Joint

Written by: Tammy Vanevenhoven PT, DPT, CHT

As the season of fall hovers over us and the leaves begin to fall, the temperatures outside continue to fall as well. For those who suffer from arthritic hands stiffness and pain, it can quickly be felt by the changes in the temperature. Osteoarthritis is the most common of all joint diseases. It often affects the larger weight-bearing joints of the hips and knees, but it also commonly affects the smaller joints of the hands; especially the base of the thumb called the CMC joint (carpometacarpal joint). The CMC joint of the thumb is considered a saddle joint that allows the thumb its vast ability to grasp objects of various shapes and sizes, to open doors, jars, and packages, etc. It also allows pinching-- a more precision type movement for writing, buttoning, using scissors, picking up small objects or turning a key. We need our thumbs as they contribute to 60% of our hand function.

Signs and Symptoms of CMC joint arthritis are:

*pain at the base of the thumb after activity

*pain with active movement of the thumb especially with pinch

*morning stiffness

*joint tenderness to palpation

*crepitus (crunching noise in the joint) with thumb movement

*joint deformity with bony nodules felt at base of thumb

*weakness of hand grip (opening a jar, sealed packages, etc.) or with pinch (writing, buttoning, turning a key, etc.)

How is CMC joint arthritis diagnosed?

Usually a standard radiographic x-ray will show joint space narrowing, bony changes such as spur formation, and joint erosion. Based on the x-ray, the arthritic changes are usually classified as mild, moderate, or severe joint destruction.

What can be done non- surgically to help the painful arthritic thumb?

A certified hand therapist (CHT) or an occupational therapist can be of great help in alleviating pain in the arthritic thumb by fabricating a thumb spica splint that stabilizes the base of the thumb while still allowing use of the thumb tip for light pinch and grip activities. Stiffness can be reduced by using a paraffin bath that is composed of paraffin wax and mineral oil which is then melted to a therapeutic warm temperature which molds around the bony prominences of the hand to help soothe pain and improve movement of the joint. Your hand therapist will also educate you on joint protection by recommending built up handles on objects that are difficult to grip such as tools, scissors, writing and eating utensils. Key adapters can also be placed on your keys to allow ease with key pinch. An electric can opener can also be used to avoid stressing the arthritic thumb with a manual can opener. Protecting the hands from the cold weather is very important. Wearing mittens and using warming packs if you like to be outdoors will help keep your hands from getting stiff and painful while you cross country ski, ice fish or while taking a winter hike.

What does the surgery for CMC joint replacement entail?

CMC joint arthroplasty is the most common joint replacement of the arthritic hand. The beak ligament reconstruction, or the LRTI, is the most common surgical procedure performed. The hand has, thankfully, many muscles that perform the same function. They are called “spare parts.” The eroded CMC joint is removed and one of these extra tendons of the hand/wrist is sacrificed and bundled up to fill in the joint space at the base of the thumb. Patients are placed in a cast and often external pins are inserted for extra immobilization.  At four weeks the cast and pins are removed, and the patients are placed in a forearm-based thumb spica splint and sent to therapy to see a certified hand therapist or an occupational therapist that specializes in treatment of the hand. Therapy includes gentle progressive range of motion to restore normal movement of the thumb, fingers and concurrent wrist; which becomes stiff from being in the cast. Swelling control and pain management are treated by working on scar mobility to avoid tendon adherence. Hypersensitivity often occurs from the surgeons having to retract the superficial radial nerve to perform the operation. Therapists can ease this sensitivity by performing desensitization exercises to calm the nerve pain. Restoring functional hand strength while appreciating joint protection and education of patients for life-long care for the arthritic thumb are just some of the various ways your hand therapist can help.

If you would like more information in treating your arthritic hands you can call Advanced Physical Therapy and ask to speak to a certified hand therapist or occupational therapist that can assist you in answering your questions. APTSM New London phone: (920)982-0100.

The 4 P's of Energy Conservation

The 4 P’s of Energy Conservation

Laura Johnson, PT, DPT

Has it been exhausting for you to complete your typical morning routine, or maybe you are having shortness of breath while grocery shopping?  When individuals have a diagnosis of Chronic Obstructive Pulmonary Disease (COPD), Multiple Sclerosis (MS), or Congestive Heart Failure (CHF), or are recovering from a recent illness or surgery, it can be difficult to complete daily chores due to fatigue and decreased activity tolerance.  Your lungs and heart may not be working as efficiently as they should, so it is important to conserve energy throughout the day.

In order to succeed, there are 4 simple steps to consider, and we are going to refer to these as the 4 P’s of Energy Conservation

1.     PRIORITIZE: Decide what needs to be done today, and what can wait for a later date.  Try to scatter your household chores throughout the week.  One day for laundry, next day for vacuuming and another day for grocery shopping.  If you are partaking in a social engagement, plan to skip some daily activities to reserve some energy before the fun begins! A good quality rest period each day is best!

 2.     PLAN: Plan ahead to avoid extra trips.  Gather supplies and equipment needed before starting an activity.  For example, before showering, make sure your towel, clothes and necessary daily items are all located in the bathroom area.  Also have a chair available to provide yourself a seated rest break if needed.  Another technique is to plan to alternate heavy and light tasks.  Find a good balance between work, rest and leisure.

3.     PACE: Slow and steady pace, never rushing!  Some individuals try to complete as many tasks as possible, as quickly as possible.  Unfortunately, this leads to complete exhaustion, and inability to perform tasks later in the day.  This can also lead to a greater chance of falls due to increased fatigue: We all know a fall can be extremely traumatic.  Plan to rest before you feel tired. Provide yourself with enough time to take short, frequent rest breaks. 

4.     POSITION: Think about your body position while completing tasks throughout the day.  Bending and reaching can cause fatigue and shortness of breath.  There is adaptive equipment available to make some daily tasks less stressful on your body.   Examples are: 1) Use a reacher to grasp the cleaning supplies in the low cupboard, 2) Use elastic shoe laces to avoid bending over to tie your shoes, or 3) Use a sock aid to get your socks or compression stockings on.  Eliminating some strain when bending or reaching will allow your lungs to expand more fully, which in turn helps get more oxygen into the body. 

Conserving your energy can allow you to complete the tasks you want to complete throughout the day.  You do not want to run out of energy before the day is through and we definitely do not want you to entirely stop your activity for constant rest.  Get moving, but move smarter!

If you’re interested in developing an energy conservation plan specific to your needs, contact one of our physical or occupational therapists today to discuss it further.

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Image by Pavlofox from Pixabay