How to Make Volleyball a Day at the Beach

By PSSM Staff

Getting down and dirty for beach volleyball can be a win every time with the right preparation.
Dr. Judelkiss Todd from Performance Spine & Sports Medicine serves up tips for this favorite sport, but she warns even the best prepared people might feel the effects of a day of beach volleyball.

“Sand is tough to play in. You’ll be slower, you’ll tire faster and your vertical jump will be reduced to millimeters,” said Todd. “The quadriceps and calves will burn, not to say your whole body will not ache. Throughout a match, you can jump well over 30 times, not to mention squatting, and performing lateral movements.”

There are both physical and practical considerations to make before stepping out onto the court. The practical advice is to wear a broad spectrum sunblock and sunglasses or a hat to protect eyes from the light, according to Todd. She said comfortable clothing is also essential and said that wearing sneakers is a bad idea. She recommends players either go barefoot, or wear a sand sock to keep the feet cool in case of hot sand.

The physical limitations of working in the sand may require some prep work to rise above the level of novice. She said the focus should be on core and lower extremity strength which is required for spiking, blocking, setting and serving. Muscles like the hip flexors, glutes, quadriceps, hamstrings, abdominals and oblique’s are among the muscles to strengthen to avoid injury.

“In volleyball, you’re often in a defensive position — bent over at the hips with your butt stuck out leaving you with inflexible hip flexors. A half kneel lunge position will stretch this muscle group in front of the hip,” she said.

The most common overuse injury reported in volleyball is patellar tendinitis or “jumpers knee.” To combat this she recommends stretching quadriceps. This can be done by pulling your heel towards your glutes in a standing position to help alleviate stress put on the knees by a contracted quadriceps.

Todd explained that the soft sand can act as a shock absorber as players run and jump through the sand, strengthening the joints. However, that same shock absorbing quality means it takes more muscle power to help propel you upwards and sideways.

Even with proper preparation injuries can occur, Todd has had trouble with a shoulder impingement from playing. She was a hitter and the repetitive overhead movements took a toll on her body. She found her way back to the sand with physical therapy. “Physical therapy helped me strengthen my muscles as well as my core to help my mechanical shoulder pain. I have not had a problem since.”

Today she is recovered and still able to play volleyball whenever she gets the chance. She also recently ran the Philly Rock and Roll Half Marathon and finished in record time.

Benefits of Coconut Water

By Gary Fuschini

The clear liquid found on the inside of immature, green coconuts is known as coconut water. It has a mildly sweet, nutty flavor and is contained in coconuts which are between 5-7 months of age. Coconut water should not be confused with coconut milk, which is extracted from the meat of the mature coconut.

Consumption of coconut water has become very popular especially among those who exercise. Containing many vitamins, minerals and nutrients, the purported health benefits are numerous. These include use as a hydrating agent with regard to exercise, hangover or diarrhea, regulation of blood pressure, prevention of stroke and heart disease and as an anti-aging supplement.

Is coconut water superior to a sport drink for hydration? Conventional sports drinks are used to replenish electrolytes lost during intense physical exertion. While it is true that we lose electrolytes through sweat, it actually takes workouts of 60 minutes or more to seriously deplete our bodies’ stores. Furthermore, the main electrolyte lost is sodium. Sports drinks also provide carbohydrates in the form of simple sugars which are burned off when we exercise.

Coconut water provides less sodium and sugar than most sports drinks. So in that respect it is not superior. It does contain fewer calories, more potassium and no artificial ingredients. Keep in mind that replenishment of electrolytes should not be necessary unless exercise isat a high intensity for greater than 60 minutes. In most cases, drinking water will be the best way to hydrate.

Bottom line is that sports drinks are often unnecessary, with water being preferred. Coconut water is an all-natural alternative for those who dislike water alone but is not the best choice for the serious athlete who requires electrolyte replacement due to prolonged, intense exercise.

Take the pressure off the little ones: how to lower stress in children

By Mahmud Ibrahim

When the pressure is on some kids lash out.

Dr. Mahmud Ibrahim of Performance Spine and Sports said there are usually signs that children are under stress and most of them are a cry for help. He said some warnings that a child is facing too much stress can be short-term behavioral changes, mood swings, acting out, changes in sleep patterns or bed wetting.

“Some kids have physical effects, including stomachaches and headaches,” said Ibrahim. “Others have trouble concentrating or completing school work.”

There are also different symptoms to look for based on the age of children. Young children can pick up new habits like thumb sucking, hair twirling or nose picking, he said. While older children may lie, bully or defy authority.
He said if a child is stressed it’s time to take action. Parents can do this by ensuring proper rest and nutrition, for a start. Then making sure that children have time to talk about themselves and how they are feeling with their parents each day.

“Whether they need to talk or just be in the same room with you, make yourself available. Don’t try to make them talk, even if you know what they’re worried about,” Ibrahim said.

It all boils down to parents letting their children know they are important to them and that they care about their feelings. Parents can further ease stress by avoiding talk about trouble at work, finances and arguing about adult situations in front of children.

Sometimes there are more significant factors at play that may require the help of a professional, according to Ibrahim. For example, a child may start to act out when his parents start going through a divorce. The behavior will usually resolve once the stressor is removed and/or addressed by counseling.

Another possibility, especially in young children, could be developmental delays. When a child feels anxiety from difficulty with feeding or speech and can’t properly express it they may lash out. At that point Ibrahim said it’s wise to involve a pediatrician.

“Stress can affect anyone who feels overwhelmed,” said Ibrahim. “Sometimes kids just feel better when you spend time with them on fun activities.”

Text Neck: Extreme Cell Phone Usage is a Huge Pain in the Neck!

By PSSM Staff

Take a trip to the mall and look around; start counting how many people you see with their heads down looking at their phones. Some will be on the phone for a few seconds at a time; others will be on it for a few minutes at a time. Now take note of their posture. Their heads are most likely pointed downwards; ears are protruding forward past the shoulders; back is slumped forward; and shoulders are rounded in so the chest is caved in. How harmful could that be? Well some people may not be aware that this forward head posture, more popularly known as “text neck”, can be very detrimental to one’s health and cause herniated discs, muscular pain, nerve damage, or even metabolic problems!

So, what is “Text Neck”? Why the fuss?

Text next refers to the forward head posture that your body develops as you use this posture over an extended period of time. Naturally, our heads are supposed to sit in line with our torso; so if someone were to look at you from a side view, they would see that your ears line up with your shoulders. There are many muscles in the neck/back that contribute to this “balance” that keeps your ears in line with your shoulders – muscles towards the front of the neck make sure that the head to doesn’t go too far back, and muscles towards the back make sure that the head doesn’t go too far forward. Consistently holding your head forward for an extended period of time will isometrically contract muscles of the front of your neck, which are responsible for protruding it forward, and statically stretch the muscles on the back. Keeping the muscles contracted, or even stretched, for an extended period of time may develop into a strain because the muscles are being overstressed from keeping your head in place and preventing gravity from dropping your chin to your chest.1 To show that forward head postures correlate with neck pain, a study was performed that compared the measurements of head posture between patients with neck pain and patients without neck pain. What it had found was that patients with neck pain generally had a smaller angle between their seventh vertebra in their cervical spine and the tragus of their ear than their pain-free counterparts.2 In other words, patients with neck pain displayed a lateral posture that brought their heads more forward and farther away from their shoulders than patients without neck pain.

To illustrate the severity of what a forward head posture can do, Dr. Adalbert I. Kapandji, an orthopedic surgeon, used the analogy of your head sitting on your neck like a golf ball on a tee. Except your head is more like a bowling ball that weighs about ten to twelve pounds, and for every inch that your head protrudes forward, ten more pounds of pressure is added to your spine.3 This is further illustrated with the image below, and as you can see you can upwards to an extra sixty pounds of pressure to your neck! More pressure on the spine could lead to possible herniated discs and spinal nerve damage that affects peripheral body functions. Injuring the nerves in your cervical spine cause: paralysis in both arms and legs; not being able to breathe or your own, cough, or control your bladder; or could lead to impaired control of your arms and/or hands.4

Developing a forward head posture should be on the back of everyone’s minds because the body isn’t built to efficiently operate with such a posture. If left untreated, the pressure of your head on your cervical spine will eventually travel down and throw off the alignment of your thoracic and lumbar spine – which will then further impair your body’s daily functions.


What you can do to fix the problem, or even prevent it!

So you realize that you’re on your phone religiously and you’re starting to notice that your ears are going past your shoulders, what can you do? Aside from seeing a physician or physical therapist, one thing you can do is make a habit of performing “chin tucks”. This when you keep your head level and retract your head backwards, as if a bee were to land on your nose and you avoid the sting of death by pulling your head back (keep in mind that your not tilting your chin upwards or downwards). Hold for a few seconds, and that’s one rep; perform about 3 sets of 10 reps periodically throughout the day. The purpose of this is to strengthen your over-stretched muscles on the backside of your neck and stretch the muscles towards the front of the neck.

You can also download the “Text Neck Indicator” app onto your phone. What this does is that when your phone is being held at an acceptable position for viewing (upright), a green indicator light is displayed at the top of the phone. But when the phone is held at an unacceptable viewing angle (angled so you’ll have to look down at it) a red indicator light is displayed at the top and a notification goes off letting you know that your phone needs to be upright – or you just need to get off the phone!5


1 What are sprains and strains?. National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health. n.d. http://www.niams.nih.gov/Health_Info/Sprains_Strains/sprains_and_strains_ff.pdf.

2 Silva, A., Punt, T., Sharples, P., Johnson, M., & Vilas-Boas, J. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons. Archives Of Physical Medicine And Rehabilitation, 2009; 90(4), 669-674.

3 Painter, F. n.d. Forward head posture. http://www.chiro.org/LINKS/Forward_Head_Posture.shtml.

4 Levels of injury. Shepherd Center. n.d. Retrieved from http://www.spinalinjury101.org/details/levels-of-injury.

5 Text Next Indicator: A Mobile App. The Text Neck Institute. http://text-neck.com/text-neck-indicator–a-mobile-app.html.

Fallen and Can’t Get Up?: Balance in the Elderly

By PSSM Staff

Have you experienced recent missteps or loss in balance recently? Falls are one of the most common reasons for hospitalizations and hip fractures in the elderly. In 2013, 2.5 million nonfatal falls among older adults were treated in emergency departments and more than 734,000 of these patients were hospitalized1. As we get older and remain more independent in our homes, fall risks and fall prevention strategies must be in the forefront of our minds. Fall risks can be environmental or physical. Some environmental risk factors include rugs, bathmats, poor lighting, uneven or loose steps. Physical factors include taking more than 5 medications, blood pressure that drops when you lay down or sit up, loss of leg or arm strength, foot problems and vision problems. Even if your recent fall did not cause an injury tell your doctor about it. A trained physical therapist may help you with restoring balance, strength and teach you how to safely stand on your own after a fall.

In the meantime here are a couple of tips to prevent falls outside and inside your home:


  • Turn on the light outside your front door before leaving your home in the early evening so that you have outdoor light when you return after dark.
  • Use a shoulder bag, fanny pack or a backpack purse to leave your hands free.
  • Use a walker or cane as needed.
  • Find out about community services that can provide help, such as 24-hour pharmacies and grocery stores that take orders by phone or internet and deliver, especially in poor weather.
  • Stop at curbs and check the height before stepping up or down. Be careful at curbs that have been cut away to allow access for bikes or wheelchairs. The incline may lead to a fall.
  • Consider wearing hip protectors or hip pads for added protection should you fall.


  • Place items you use most often within easy reach. This keeps you from having to do a lot of bending and stooping.
  • Use assistive devices to help avoid strain or injury. For example, use a long-handled grasping device to pick up items without bending or reaching. Use a pushcart to move heavy or hot items from the stove or countertop to the table.
  • If you must use a stepstool, use a sturdy one with a handrail and wide steps.
  • If you live alone, consider wearing a personal emergency response system (PERS). Also consider having a cordless telephone or cell phone to take from room to room so you can call for help if you fall.

1Web–based Injury Statistics Query and Reporting System (WISQARS)[online]. Accessed May 27, 2015.

Dietary Tips to Reduce Inflammation

By Gary Fuschini

Acute inflammation in response to an injury is a helpful, normal and necessary process of the human body. When inflammation becomes chronic it is a lower level, harmful response and is thought to be an underlying cause of many common conditions and diseases.

Following are some changes you can make in your diet to reduce that chronic inflammatory response which may be responsible for your aches and pains, weight gain and premature aging.

  • Increase your water intake. We have all heard that the body is made up mostly of water. In fact, water is the single most important nutrient for the human body and to function optimally and control inflammation we require 60-80 ounces per day.
  • Stop eating foods/drinks with artificial sweeteners. More and more research is coming out to implicate these synthetic compounds as inflammatory agents.
  • Make dark green vegetables part of your regular diet. Foods like broccoli, spinach and kale are loaded with anti-inflammatory nutrients.
  • Maintain a healthy weight. Excess fat cells produce inflammatory chemicals which can promote further weight gain.
  • Be sure to move your body. While exercise is great, any type of physical activity works to increase circulation and healthy cell function. Do not sit for longer than 30 minutes at a time and enjoy gardening, housecleaning, and walking the dog as well as going to the gym or playing sports.
  • Decrease consumption of processed foods. Loaded with man-made chemicals, these foods can confuse the body and can be difficult to properly digest as we were never intended to consume the artificial additives contained in most of these foods.

Adopting these changes in your diet can go a long way to fighting chronic inflammation and helping your body feel and function its best.

Foam Rolling

By Gary Fuschini

Recently, foam rolling has gained popularity among trainers, physical therapists and fitness enthusiasts. What are the benefits of using a foam roller? Quicker recovery, decreased muscle pain and spasm, increased blood flow and less delayed onset muscle soreness (DOMS) are some of the claims.

The physical act of rolling over the foam can break up tiny adhesions and scarring in the muscles which develop from exercise, overuse, injury, faulty mechanics or stress. Left unchecked, these adhesions can begin to obstruct blood flow, impinge nerves and inhibit proper contraction of the muscle.

There are some studies which suggest performing foam rolling after a workout will reduce DOMS. It can also be done prior to exercise as a warm up and in between workouts just to keep muscles loose and to reduce muscle tension.

There is not a lot of research regarding how or why the roller works at this time, but many patients report positive results. Try rolling on a specific muscle group for 1 minute then repeat if needed. You may feel a releasing sensation, after which you can move on to the next muscle group. Foam rolling can be painful so do not overdo it and work within your tolerance.

Laser therapy: Touch-free healing

By PSSM Staff

The future of healing has been in the hands of professional athletes for years and is now available to everyone as a method of treatment at Performance Spine and Sports Medicine (PSSM).

Laser therapy has been in use by major league sports trainers and Olympic trainers for years, according to the LiteCure website, the company which provides the class IV high-intensity laser at PSSM.

Dr. Aisling Linehan, a physical therapist at PSSM said that laser therapy has been a popular treatment for about five years, but they first heard about it from their clients. She said people were saying they heard that laser therapy could reduce pain and speed up healing, so they decided try it out.

“We studied up on it. People who work in our office tried it first then we ran a trial for our clients,” said Linehan. “The results were that everybody loved it.”

After the successful trial all of the clinicians were trained to use the lasers, with some impressive results.

“I have many patients who benefited from the laser,” said Linehan. “It does a great job with accelerating the healing process of sacral/low back pain and rotator cuff strains.”

She said she uses the laser on up to 10 patients per day. She even uses it on her own hands when they get sore from working with patients.

She said the procedure is painless, most describe the sensation as that of getting out of a hot tub, when they finish with the treatment. The procedure is performed in a private room and requires no medium to work – like a gel. Successful treatment can take eight to twelve sessions, though it is sometimes used longer for patients with chronic conditions.

Linehan said the laser can be used for acute and chronic conditions. She said she has seen success for problems such as patellar tendonitis, ankle sprains, muscle strains, low back pain, pelvic pain and sacral sprain/strain.

Some patients see an instant reduction in pain, but typically after three or four visits there is a noticeable improvement, said Linehan.

Some places charge up to $50 for laser therapy treatment, according to Linehan, which has to come out of a patients pocket because it is not covered by insurance. At PSSM they make it part of the treatment plan at no extra charge.

The therapy is not for everybody, including those who have had corticosteroid injections. It is also not recommended for patients under the age of 18 or for women who are pregnant.