Tips and Tricks to reduce the amount you sit

Cary Luitjens MPT, PT, LAT

It is said that sitting is the new smoking, but to be more specific, it is not the sitting position… but the act of being sedentary and sedentary behaviors that are unhealthy.

Many jobs have transitioned to work at home, recreational team sports have been canceled or postponed and many of us are spending more time looking at screens….computer, TV, tablet, cell phone, etc. These factors likely lead to more sedentary behaviors that are associated with increased health risks such as an elevation in blood pressure.  Sedentary behavior could be sitting in a perfect work station posture for 8 hours a day without moving at all.  Not only that, where our eyes go-like to a screen-our posture goes.

The 20-20-20 rule was designed by Californian optometrist Jeffrey Anshel. For every 20 minutes spent looking at a screen, a person should look at something 20 feet away for 20 seconds and is recommended by the American Optometric Association and the American Academy of Ophthalmology as a way to reduce eye strain and fatigue.

How about the foggy feeling you get after looking at a screen for a prolonged time? Recent evidence suggests that sedentary behaviors may be negatively associated with aspects of brain function such as reasoning, problem-solving, and decision making.  Breaking up sitting with intermittent physical activity has beneficial impacts on multiple systems relevant to brain health such as blood pressure and vascular function.

It’s pretty hard to change your gaze to an object 20 feet away and not change your posture! Eye strain can lead to mental fatigue.  Mental fatigue can lead to Tech Neck and forward head posture. Advanced Physical Therapy and Sports Medicine have several great media posts about setting up a work station, and posture tips for use of desktop computers, laptops, and cell phones. Click here to watch our Ergonomic Feedback video!

Recent research articles on sedentary behavior and prolonged sitting support the fact that frequent (every 20-30 minutes) and short (2-3 minutes) interruptions involving light or moderate-intensity walking, standing, or simple resistance exercises can improve glucose metabolism and reduction in both systolic and diastolic blood pressure.

But sit less and move more is pretty vague. Why not make it more fun!  Here are a couple of ways to liven it up.

“Roll with it” dice workout-needed: 2 dice, space to exercise, and light weights if desired.  You will complete 2 different exercises with each roll of the dice.

1)      15 crunches     1) 20 chest presses

2)      10 lunges each leg      2) 20 shoulder presses

3)      20 squats    3) 30-second plank

4) 30-second jump rope     4) 15 push ups-wall, desk or floor

5) 1-minute wall sit    5) 30-second air punches

6)      20 jumping jacks    6) 20 biceps curls

The card game workout-needed: a deck of cards and light weights if desired.  The number on the card is the number of repetitions you will do of any exercise you choose except face cards are 15 reps and jokers are 20 reps. The suit is the body area you will work on.

Hearts- upper body exercise: push-ups, biceps curls, front raises, side raises, shoulder press, bent-over rows, overhead triceps extensions

Spades-core exercise: sit up, elbow plank, bicycle crunch, hands and knees opposite arm and leg reach, Russian twist, mountain climbers

Diamonds-lower body: squats, lunges, heel raises, sidestepping, single leg balance, bridging

Clubs-cardio exercise: jumping jacks, jog in place, single-leg hopping in place, march in place, quick step-ups, jump rope.

Science is showing us that taking a short break from sitting effectively breaks up our sedentary behaviors, decreases health risks, decreases eye fatigue, improves brain health, and improves our posture. Let’s put it all together! Set a timer for every 20-30 minutes as your schedule allows.  Challenge yourself to not only look away from your screen for 20 seconds by changing your posture but actually get up and perform a light exercise or go get a drink of water.  Your eyes, brain, heart, and muscles will thank you!

REFERENCES:

1)       Dempsey, P. C. et al.  (2016). Interrupting prolonged sitting with brief bouts of light walking or simple resistance activities reduces resting blood pressure and plasma noradrenaline in type 2 diabetes.  Journal of Hypertension, 34(12), 2376-2382.

2)       Wheeler, M., Dunstan, D.W., Smith, B., Smith K. I., Scheer, A., Lewis, J., Naylor, L. H.,     Heinonen, I., Ellis, K. A., Cerin, E., Ainslie, P. N.,  Green, D. J. (2019). Morning exercise mitigates the impact of prolonged sitting on cerebral blood flow in older adults.  Journal of Applied Physiology, 126(4), 1049-1055.

3)      Keadle, S. K., Conroy, D. E., Buman, M. P., Dunstan, D. W. (2017). Targeting reductions in sitting time to increase physical activity and improve health. Medicine and Science in Sports and Exercise, 49(8), 1572-1582.

4)      Lidin, M., Ekblom-Bak, E., Karlsson, M. R. (2018). Long-term effects of a Swedish lifestyle intervention programme on lifestyle habits and quality of life in people with increased cardiovascular risk. Scandinavian Journal of Public Health, 46(6), 612-622.

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.

March is National Athletic Training Month

By Kayla Schneider, LAT

“Athletic trainers are impacting change in health care. Together, with doctors, coaches, school administrators, military leaders, government officials, performing arts organizations and legislators, ATs are reshaping how injuries are treated and, more importantly, prevented. The future of health care requires action before, during and after an injury and ATs Impact Health Care Through Action.” - National Athletic Training Association (2020)

At APTSM, our very own Athletic Trainers are contributing to the health and well-being of athletes on and off the field. In the Appleton Area High Schools, St. Mary Central High School and Lawrence University, our AT’s are making strides in injury care and prevention through nutrition education, weather monitoring, working closely with coaches and strength coaches on tools and strategies for injury prevention, and acting as liaison between athletes, parents, coaching staff, PT’s and physicians to carefully coordinate care for the athletes. Off the field, our AT’s are providing services to more than 20 locations across north and east-central Wisconsin including factories, police and fire settings. These services come in the form of preplacement evaluations, ergonomics and safety programs, job counseling, supervised work conditioning programs and wellness programs and coordinating with employers, safety managers, physicians, and physical therapists. Their efforts all lead to decreasing the number of injuries, time lost on work restrictions and helping to make companies more competitive in their markets.

By taking these preventative measures, being the rapidly available medical professionals at the onset of injuries, and being able to direct care along the best path, active populations are seeing better outcomes. Athletic Trainers are leading the charge in changing healthcare for the better.

Learn more about our Athletic Trainers here.

Or call us at 920-991-2561

Hand Therapy

By ASHT (American Society of Hand Therapists)

What is hand therapy?

Hand therapy is the art and science of evaluating and treating injuries and conditions of the upper extremity (shoulder, arm, elbow, forearm, wrist and hand). Hand therapy uses a number of therapeutic interventions to help return a person to their highest level of function. It evolved from the need for a specialist with the knowledge and experience required to manage the challenging recovery of complex hand and upper extremity injuries

What is a hand therapist?

A hand therapist is an occupational or physical therapist who, through advanced continuing education, clinical experience and integration of knowledge in anatomy, physiology and kinesiology, has become proficient in treatment of pathological upper extremity conditions resulting from trauma, disease, congenital or acquired deformity.

What does a hand therapist provide?

Hand therapists bridge the gap from medical management of upper extremity conditions to successful recovery, allowing individuals to function normally in their daily lives. Hand therapists provide non-operative interventions, preventative care and post-surgical rehabilitation for a wide variety of upper extremity disorders, from simple fingertip injuries to complex replanted extremities. Patients with chronic conditions, such as arthritis, or neurologic conditions, such as a stroke, can benefit from hand therapy through education on joint protection and energy conservation, and with recommendations for adaptive equipment or devices to improve function. A hand therapist employs a variety of techniques and tools, including activity and exercise programs, custom orthotic fabrication, management of pain and swelling and wound and scar care. A hand therapist can also be a consultant in the industrial world, training employees and recommending modifications of workstations and alternative work methods to help ensure healthy work styles of all employees.

Where do hand therapists work?

• Hospitals

• Rehabilitation centers

• Industrial medicine facilities

• Privately owned therapy clinics

• Sports medicine facilities

• Academia

Why APTSM?

At Advanced Physical Therapy & Sports Medicine we have a dedicated team of Occupational Therapists who specialize in hand therapy. Our hand therapists offer a variety of treatments to develop or maintain functional living in those with certain physical conditions or musculoskeletal disorders.  They focus on the client, placing a paramount focus on client goals. If you or a loved one suffers from hand-related aches and pains, call us today and set up a free, 15-minute consultation to receive expert advice from one licensed hand/occupational therapists— 920-991-2561

Keeping your Resolution & Physical Therapy

Kris Tebo, PT, DPT

With the new year people begin to set goals and make resolutions. Losing weight, getting to the gym more often or getting into "better shape" are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly can lead to pain, injury and disappointment if your body isn't ready for it. Your physical therapist is an expert in movement and can help you safely reach your fitness goals.

People think of physical therapists as the people to see after an injury, but a visit before you change your activity level could prevent injury in the first place. An evaluation by your PT will include assessment of your strength, range of motion, and functional movement patterns - think jumping, running, squatting, carrying. Most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your assessment. They can then prescribe exercises to address the issues found and get you safely moving toward your goals.

The other common way people get injured working towards their resolution is over-training, or doing too much too soon. Physical therapists are also experts in exercise prescription and program design. Your PT can help you create a routine specific to your needs and goals that will progress appropriately and keep you out of trouble. So stop only thinking of your PT after you're injured. In this case, it's true that an ounce of prevention is worth a pound of cure. Seeing your physical therapist early on can keep you on track, injury-free, and help you reach your goals for the new year!

Check out one of our earlier blogs here to learn about what you can be doing to reach your goals.

APTSM does offer performance training, bridge training (for those transitioning out of therapy and into a more intensive exercise program) and FREE 15-minute consultations. So call us today and schedule your appointment and get back on track with your resolutions. 920-991-2561

Some material in this blog is provided by the Prive Practice Section of APTA

Annual Movement Screens

Ron Lawrence, PT, MSPT, CSCS

Start Your Year With an Annual Movement Screen

Your car needs regular maintenance, so you probably have a mechanic. Your eyes and teeth are important, so you see your optometrist and dentist regularly. You get an annual physical from your family physician. You might even be getting ready to see your accountant to get your yearly income tax done. What about your physical therapist? Do you and your family have one? If not, you should. Your body is a lot like your car. It's got multiple systems, all of which are complex, and all of which have to be working well for it to function. Physical therapists are experts in maintaining, diagnosing, and treating the movement system. Like the braking or ignition system in a car, most people only think of the movement system when it's not working the way it should.

DON'T NEGLECT YOUR MOVEMENT SYSTEM

Similar to the systems in your car, problems with your movement system are much easier to deal with if they're caught and treated early. This prevents small issues from becoming larger ones. For example, if you have a little bit of weakness and balance that's not quite up to par, improving those early could prevent a sprained ankle, or a fall and a broken wrist.
An annual movement screen from your physical therapist can find small issues that you may not have noticed with your strength, balance, flexibility, or coordination. Many of these minor issues can be fixed with a few exercises at home, or with just a few visits.

WHAT TO EXPECT

A screen of your movement system is quick and easy. Your annual visit may include:
● A history of your injuries, as well as a health history
● Assessment of your strength, balance, flexibility, etc.
● A review of your movement goals (do you want to run a marathon? Get on and off the floor easily playing with your grandkids?)
● A review and update of your exercise program

Several APTSM locations perform Functional Movement Screens and our Appleton North and Shawano locations perform 30 min Annual Physical Therapy Wellness Check-ups.

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!

Tiny Habits Make a Difference

Written by:  Lara Bleck, PT

How many times have you made a New Year’s resolution, but either never started or only succeeded for a short time? This is probably no surprise but according to U.S. News & World Report, 80 percent of New Year's resolutions fail by February.  Forming habits can be easy. So let’s talk about how we can set ourselves up for success!

Tiny Habits might be just what you need to succeed.  BJ Fogg, PhD, Behavior Specialist with Stanford University, established the Tiny Habits method when he wanted to develop the habit of flossing his teeth daily.  Easy behaviors don’t require motivation, and small changes over time lead to long-term behavior change.  BJ Fogg defines a Tiny Habit as a new behavior that you do at least once a day, that takes you less than 30 seconds to accomplish, and that requires little effort.  It must be a ridiculously easy behavior. And it must always be introduced right after an existing, established behavior.  This after behavior is called your anchor.   Here is how it works:

Tiny Habit recipe: “After I [anchor behavior], I will  [tiny behavior].”  

Step 1: Pick your tiny habit.  Your goal at this point is to establish a routine, not ‘run a marathon’. 

Step 2:  Select the right anchor.  The tiny behavior should fit naturally into your life, so selecting the right anchor is critical.  3 characteristics of a good anchor include:

1.      Same frequency as your tiny behavior

2.      Same location as your tiny behavior

3.      Same theme as your tiny behavior

Step 3:  Get Started!  Take a moment to celebrate each time you do the behavior.  It could be a simple fist pump, but allow yourself to feel successful each time.

Step 4:  Check and adjust your tiny habit.  Remember, making the behavior super simple and built into your routine will allow you to make it an automatic part of your life.  Something about your recipe may not work perfectly right away.  You might need a different anchor, or make the behavior even more tiny.  That is OK.  Have fun revising the recipe, and just keep going.

So here is my plan: I had 3 exercises I needed to start:  squats, planks and push-ups.  I first look for existing, established behaviors I could tie the new behaviors to.  The ones I picked are: drinking a glass of water (which I do 6 times a day), going to the restroom (4-5 times a day), and taking my dog out.

Next I matched up some exercises that I would like to do regularly with those established behaviors. Using Fogg’s formulation, here’s how that looks:

·        After I drink a glass of water, I will do 2 body-weight squats.

·        After I go the restroom, I will do a 5 second plank

·        After I take the dog out, I will do 4 push-ups.

Once the routine is established, I’ll focus on scaling up.

As a physical therapist it’s easy to preach motivation and get someone fired up in the moment.  Where the strategy falls short is over time.  Motivation is unreliable as it’s based on human emotions.  Mini habits are so effective because they: eliminate the need to rely on motivation, allow you to consistently perform your desired behavior with ease, and utilize a series of small wins to snowball success.

Are you ready to start 2020 on the right foot?

Source:  BJ Fogg at TED-xFremont

(December 5, 2012)

Forget big change, start with a tiny habit

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