Physical Therapy is a fascinating field since the dawn of its conception in the 1920s. Since that time the field of Physical Therapy has grown to an entity that has been pushing the envelope to what therapist can and cannot do.
Did you know Physical Therapist can treat beyond the normal orthopedic / post-op patient?
Physical Therapist can be certified and/or specialized in different methods and techniques. Many do not know therapist can treat patients with vertigo, pelvic floor dysfunctions, cardiovascular and pulmonary dysfunctions, and neurological disorders to name a few.
Did you know Physical therapist can work in a variety of settings?
With the addition of working with variety of patient populations, a Physical Therapist is present in hospitals, outpatient clinics, private practices, home health agencies, schools, nursing homes, and even the Emergency Room.
Did you know a Physical Therapist can obtain an advanced degree, Clinical Doctorate?
Many patients are surprised when they find out that Physical Therapist can hold a Doctorate degree. In the field of Physical Therapy they have been pushing forward for all Physical Therapist to obtain a Doctorate in Physical Therapy to advance our profession and scope of practice. A few years ago being a Physical Therapist you only needed a bachelor’s degree to practice. However, our scope of practice and knowledge of medicine and human movement has grown that most Physical Therapy graduate programs offer an entry-level 3-year Doctorate of Physical Therapy (DPT) degree. Physical therapists have to pass a medical board exam in order to obtain their state license to treat patients.
Did you know Physical Therapist can evaluate and treat without a MD prescription?
In many states, you can be evaluated and treated by a physical therapist without seeing your Primary Care Physician. These states have Direct Access with more states following suit. According to the APTA, currently 18 states have unrestricted patient access, 26+ states have patient access with provision, and 6 states have limited patient access. Check the APTA website to see what your state is categorized under, as of now New Jersey and Pennsylvania have patient access with provision.
“No Pain, No Gain” gets toss around a lot at the PT Gym
Although at Physical Therapy we are here to help strengthen your muscular imbalance or stabilize joints through exercises, working through pain does not always hold true.There are exceptions to this statement, such as range of motion for a patient post op total knee replacement or frozen shoulder. Most of the time, treatments and exercises should be to patient’s tolerance and pain-free.
Did you know your Home Exercise program is important to your care?
The most important aspect of Physical Therapy is that you as the patient are compliant with your plan of care and performing your prescribe exercises. There is a reason that your physical therapist puts in the time and effort in designing a home program specifically for you. Being compliant with your HEP will help your recovery and return you to your prior level of function.
Yoga has become very popular in the U.S. in recent years. It is an ancient activity involving exercise, meditation, breathing and philosophy. Some sources claim its origins date back 5000 years. Many styles of yoga have developed through the years and we can find a variety of classes within most suburban communities.
While you can benefit from any type of yoga, there is also potential for injury. It is wise to be cautious when initiating any new form of exercise and to seek clearance from your MD. If you are new to yoga, it is important to start at the proper level. Speak to the instructor if in a class and inform them that you are a beginner and of any injuries you may have. If using a video, be sure it is appropriate for your level and be extra careful not to perform any activities that cause you pain.
There are some basic yoga poses that may be helpful to introduce the beginner who is considering taking a class or to alleviate some aches which are common among those of us who have sedentary jobs or basic posture-related issues.
Child’s pose: Begin on all fours with hands directly under shoulders and knees under hips. Keeping your hands on the floor, gently shift your weight back until your butt rests on your feet or as far as you can go comfortably. Let your head rest on the floor and breathe. Try to stay in this restorative pose for a minute or more, repeating 2 or 3 times.
Bridge: Start by lying on your back with knees bent and feet flat on the floor, hip width apart. Breathe in. As you exhale, start to curl your tailbone under and lift your buttocks off the floor. Only go as high as is comfortable. Do not let your knees fall out to the side. Hold for a breath, then slowly lower yourself and repeat 10 -20 times.
Bird Dog: In the hands and knees position, keep your back level. Do not arch or round your back. Find your neutral posture then slowly and with control raise your arm and your opposite leg. Only raise as high as you can without losing your neutral spine posture. Hold for a breath then gently lower back to starting position. Repeat with the other side for a total of 10 times.
Cat/Cow: Begin on all fours with shoulders right over hands and hips right over knees. Inhale and as you exhale draw your navel in and round your spine from head to tail, trying to curl into the shape of the letter “C”. (Think of an angry cat) As you start to inhale, slowly uncurl your spine and gently round towards opposite direction. (Think of a cow’s swayback) Sync your movements with your breath. Repeat 10-20 times.
Remember to always be comfortable while practicing theses poses. There should not be pain. Always keep breathing and do not judge yourself!
We have been fortunate enough to add laser therapy to the list of rehabilitation modalities that we offer at Performance Spine and Sports Medicine. This is a tool that very few people have access to in the area. The laser that we have is a class IV high intensity laser from light force. The class IV laser allows you to get deep into injured tissue and achieve a thermal effect that the traditional class III cold laser does not. The thermal effect of the laser promotes increased blood flow to the injured tissue which helps to improve healing time. Deep Tissue Laser Therapy accelerates your body’s own natural healing process through photo-bio-stimulation.
Photo-bio-stimulation is the act of changing the condition of damaged tissue by stimulating cell metabolism which in turn improves the speed of tissue healing. This is achieved by photons from the laser head being emitted into deep tissue cells, which causes soothing warmth in the area. The photon molecules are absorbed by mitochondria in the injured cells. Mitochondria are the driving force behind energy production in a cell. Stimulation of mitochondria produces ATP, nitric oxide, and reactive oxygen species.
Increased levels of ATP will help with energy transfer within the cell.
Nitric oxide is a powerful vasodilator (which means it opens vessels to allow better blood flow) and an important cellular signaling molecule involved in many physiological processes in the human body.
Reactive oxygen species have been shown to affect many important physiological pathways including the inflammatory response.
The production of these signaling molecules in concert has been shown to induce growth factor production and improve cell proliferation (healing).Laser therapy is effective in treating chronic conditions, acute conditions and post-surgical pain. This tool allows us to expedite the healing process which creates quicker recovery times and decreased time in pain and discomfort.
The gluteus medius muscle works to abduct and rotate the hip but also functions to dynamically stabilize the leg and pelvis. Glute medius weakness can contribute to dysfunction and pain not only in the hip but in the lower back, knee and ankle as well. Furthermore, it is common due to lifestyle and movement patterns that this muscle becomes weak.
While there are many exercises used to strengthen the glute medius, one of the most basic is also one of the most effective. Simple hip abduction in a side lying position has been shown to engage a high percentage of the muscles fibers in EMG studies.
To properly perform this exercise, start by lying on your side without rolling too much forward or backward. Keeping the top leg straight at the hip and the knee, simply raise the leg up towards the ceiling. Be sure to keep the foot facing forward, do not let the hip rotate either direction and keep the hip in a straight line with the rest of the body.
Move slowly and with intention and do not raise the leg too high. Your hip should only abduct to about 45 degrees at the most. Make sure to breathe regularly. If done consistently, this exercise will keep the glute medius strong and healthy and keep you functioning optimally.
When the shoulder blade pokes out and does not lay flat on the surface of the upper back, we call it scapular winging. This is usually caused by weakness in the muscles that externally rotate and retract the scapula.
Our current lifestyles usually include too much time working on the computer and driving. These are probably the two biggest contributors to the forward posture that weakens the muscles which lead to scapular winging.
While it is unrealistic for many to reduce or limit their time on the computer or behind the wheel, it is plausible to introduce a few exercises to combat the effects of this bad posture-inducing behavior.
The scapular pushup.
Get on the floor into the standard pushup position but instead of lowering your entire body towards the floor, lock your elbows and pinch only your shoulder blades together. Next, round your upper back out by separating your blades. Your body should sink and rise slightly while performing this exercise. Keep your abdominals engaged and be sure not to let the curve of your lower back increase.
Band retractions behind head
Grasp a light resistance band overhead with hands shoulder-width apart. Squeeze your scapulae down and back tightly, and then bend your elbows to about 90 degrees. Hold for a few seconds then repeat.
External rotation arm elevated
Start with your arm raised to 90 degrees at your side with elbow bent to 90 and forearm parallel to the floor. Hold a light weight (1-2 lbs.) and slowly rotate your forearm up towards the ceiling, stopping when forearm is perpendicular to the floor. Slowly return to starting position and repeat.
Perform 1 set of 10-12 repetitions of these exercises every other day, increasing to 2 or 3 sets gradually and with no pain. Being consistent with these will reduce existing scapular winging and prevent potential new onset.
You may have heard that your mattress could be causing your back pain. You may be wondering what the correct mattress is for you. You probably know that lack of quality sleep can cause a myriad of problems and can worsen many existing conditions.
The most current studies suggest a medium-firm mattress for those suffering from back pain. This replaces the older recommendation of extra-firm. In reality, there is no one type of mattress that is going to be the best for everyone.
I believe the best course of action is to be aware of the return policy of the place you purchase a mattress. Most retailers will offer a time period within which you can exchange or return the mattress if you are not satisfied. It will probably take a few weeks to determine if you are resting more comfortably with any new mattress, so find out how long you have to test it out and take advantage of the policy. Mattresses are expensive and you are expected to have them for a long time, so don’t be afraid to keep trying until you find the one you like.
Two other popular options are the memory foam and the air mattress. Again, there are studies suggesting that both of these types can be beneficial to back pain patients. In my experience, it seems to be an individual choice.
One thing we know for sure is that an old, worn out mattress does not provide proper support and can exacerbate most spinal conditions. While expensive, a new mattress is an investment in your health so it is money well spent when you find the proper fit.
The hip flexor stretch has become a popular one to stretch in both the fitness and the sports performance realm and rightfully so. After all, we, as a society spend a lot of time sitting which lends itself to tightening of the hip flexors. Unfortunately, it is all too common to see people stretching either incorrectly or too aggressively.
Here are some key points to ensure that you are stretching the right way:
-There is a difference between stretching your quads and stretching your hip flexors. If you are indeed targeting your hip flexors focus on psoas and not rectus femoris
-Focus on one joint at a time: Many people try to stretch both at the hip and knee which incorporates both the rectus and the psoas. Unfortunately, many people can’t perform this correctly and end up compensating, which increases injury risk
-Stand up tall and contract your abdominals and glutes
-Engage your core by pushing the dowel down into the ground while at the same time keeping your elbows straight
Hip flexor tightness is very common today as many of us spend a lot of time in a seated position. When we work at a desk or on a computer, drive a car, relax on the couch or in a theater and sit down for a meal we are shortening our hip flexors. This can contribute to back and knee pain. It also makes proper posture difficult.
Performing stretches for your hip flexors regularly can reduce the impact of some of these daily activities which tighten your muscles.
Kneel on the floor so you are positioned on one knee and one foot. Keep your upper body tall and straight.
Place your hands on your hips and tilt your pelvis posteriorly. To cue this motion, place hands on hips so fingers are in front and thumbs are in back. Without moving your hands, tilt your pelvis backward to make your thumbs move downward.
Contracting your abdominals and your glutes will help tilt your pelvis posteriorly.
You should feel a stretch in the front of the hip which you are kneeling on.
Be sure to breathe and hold this stretch for 30 seconds.
Remember to switch legs and perform this stretch on both sides. Do these at least every other day if you sit for long periods and you will reduce the stress on your lower back.