Posture, Posture, Posture!

April 25th, 2013

We’ve heard it over and over again.  Our mothers and fathers told us to “stand up straight”, maybe our teachers too.  In exercise classes we are told to stand tall.  But why?

Correct posture does many things.  Good alignment eases the strain on your spinal joints and muscles.  It prevents headaches by opening the area where the head meets the neck to avoid compression of the vessels and muscles in that area.  Good head positioning also puts the jaw in the ideal position during opening and closing.

Standing correctly makes our feet work properly and allows the arches to help support the weight of our bodies. It makes our balance better. Want to see great posture?  Watch an 18-month old walk and move around. They are perfectly balanced with straight spines during sitting, standing, squatting and running because they are still learning how to move.  It’s only as they get older that they start to develop poor postural habits.

Correct posture also allows our blood vessels to pump more efficiently. It allows maximum expansion of our lungs.  Our knees are aligned correctly.  There is a psychological component as well. Standing tall is a posture of confidence in ourselves – even if we don’t necessarily feel confident on the inside.

Changing our postural habits is one of the hardest physical changes to make in ourselves.  But practice, practice, practice makes it easier.  So remember – your mom was right, stand tall.

Preparing for Rotator Cuff Surgery

April 16th, 2013

You have just been diagnosed with a Rotator Cuff (RTC) Tear and are told that surgical intervention is required. What does that mean? Is it invasive? How long will it take to heal? Will I be 100% afterwards? These are all very important questions that you need to know the answer to before going into any surgery, especially RTC repair.

The first detail that you should discuss with your surgeon is the type of surgery that will be required due to the large variability of tears within the rotator cuff. The surgical incision site can vary from 3-10 centimeters with a mini-open or open repair to even smaller with an arthroscopic repair that simply inserts a small camera to perform the procedure. No matter which surgical method is performed the same postoperative precautions are observed to ensure proper tissue healing.

What to expect following surgery? Upon leaving the hospital you will be instructed to wear a sling for four to six weeks at all times depending upon the scale of the injury. During this time you should NOT actively move your arm away from your body. Within this six week restriction, you should discuss with your surgeon the appropriate time to begin physical therapy. The start of physical therapy will be based on the severity and size of the tear.

What does physical therapy consist of? The entire rehabilitation process will take about 5-6 months to return to previous activities and in some cases can take up to one year. Physical therapy will begin with regaining range of motion throughout the shoulder. Light strengthening and return to functional activities will ideally begin around week 10-12. Your physical therapist will then progress your exercise regimen accordingly so that you can gradually return to your previous activity level.  Ideally you should become pain free within 4-5 months following surgery while continuing to strengthen your shoulder muscles.

Having a shoulder operation does require a great deal of work following surgery. However, with the help of your surgical staff and physical therapist, you can return to your everyday life without the constant pain. When going into a surgery like this, be sure to ask any and all questions you may have prior, as well as during rehabilitation, to ensure having the right expectations.

Alexander Davidovich SPT

Preventing Low Back Pain with Correct Lifting Technique

March 26th, 2013


Poor lifting technique is one of the leading causes of back pain of all ages. This tends to be a topic we only think of either when we are in a lot of pain or lifting something extremely heavy. However, small repetitive strain from lifting up something as small as a pencil or a shoe can be just as damaging on our back health as lifting a heavy box. When lifting is performed repetitively or done improperly, increased strain is put on the muscles, ligaments and discs of the spine, causing the back to lose support and creating pain.

The lifting sequence begins with proper positioning, followed by execution. A few general rules to keep in mind during any lift are: 1) Keep the load as close to you as possible; 2) Bend your knees; 3) Pull your tummy in; 4) Keep back straight; 5) Exhale, or Breathe OUT, as you lift up.

During any lift it is important to know your limits. If you feel that an object is too heavy or oddly shaped to handle, ask for assistance.  If you have identified the object and you feel it is well within your means to pick up and carry, then follow the steps below.

When lifting objects from the ground the Basic Lift, or Diagonal Lift, is often a safe and controlled approach . 1) Stand close to the object with a wide stance with one foot forward and next to the object; 2) Squat down keeping back straight; 3) With one hand, reach to the front bottom corner of object on side of forward foot; 5) With the other hand, grab the closest corner on opposite side; 6) During lift keep head up/straight; 7) Push up with hips as you exhale.

Once the object is picked up, carrying and putting it back down is just as important as the initial lift. When carrying an object, it is important to keep it close to your body and to avoid twisting as much as possible. If you need to turn, then turn with your feet and not at your hips; this will put less strain on you back and will help you control your body. If you are going to put the object back onto the ground, you must take your time. Follow the same steps as lifting, just in the reverse order to prevent increased strain.

Using these basic steps throughout your day will create a good, healthy habit for your back and body. While we may only get one back, there are many things we can do to make it stronger and take care of it and proper lifting technique is a good place to start. If you are already experiencing back pain from either a specific incident or just feel like it is getting worse over the years, then schedule time with a Physical Therapist to provide you with a comprehensive and thorough evaluation and treatment plan to continue a healthy, productive life.

Alex Davidovich, SPT

What are the best positions for sleeping?

August 15th, 2012

Sleeping is essential for restoring the body’s energy and allowing us to function at our optimal capacity. Many times what keeps us from getting a good night’s rest is poor sleep positioning. Improper sleep positioning leaves us feeling unrested the next day, and it also positions our spine in poor alignment. Over time, this poor alignment can contribute to back pain. The good news is there are simple techniques you can use to keep your back in proper alignment while sleeping.

If you are a side-sleeper, your upper leg may tend to slide forward to rest on the mattress, causing your lower spine to twist (or rotate). This can contribute to hip or back pain. To prevent your spine from rotating, it is important to keep your knees and hips aligned. This can be achieved by placing a pillow between your legs. Another thing that may happen is that your top arm and shoulder will drop forward, causing rotation at your upper back as well. To keep your shoulders aligned, place a pillow in front of your chest and rest your top arm on it.

If you sleep on your back, it is important to maintain the normal curvature of the low back, which is just the slightest curve in the low back. Sleeping with your legs straight out can cause an increased curvature in your back (over-arching), placing more pressure on your low back. To relieve this pressure, sleep with one or two pillows under your knees.

It is the most difficult to find the best position for stomach sleepers. This is because the neck is in a statically rotated position. In addition, your back tends to arch, contributing to increased pressure on the low back. It is generally not recommended for people to sleep on their stomachs, but if this is the only position you can sleep in, you can try some of these techniques: if you sleep with your head turned to the right, place a pillow under your right chest and shoulder, one under the right part of the stomach, and another pillow under your right hip and thigh. This will help to get your neck in a less rotated position, while promoting a neutral curve of the spine. A body pillow may be a good option to minimize the amount of pillows needed. If you sleep with your head turned to the left, put the pillows on the left side.

Now you may be wondering which pillow is the best for you. This is a good question, as many times people are sleeping with pillows that are completely wrong for them! The best advice is to use a pillow that is thick enough to take up the space between your bed and your neck. If you are sleeping on your back, the space will not be as much as if you are sleeping on your side. If your pillow does not provide this type of support, try placing a rolled towel inside your pillowcase (pictured below). You also want a pillow that is firm enough to support your neck throughout the night. Sometimes pillows are so soft that it stays flat just minutes after laying on it.

Now that you have a little more knowledge on the best sleep position for you, I hope you will be able to find a comfortable position to rest. Good night!

Tania Yuen SPT

A Physical Therapist’s Prescription

June 18th, 2012

When hearing the word “exercise”, most people think of fitness or “getting in shape”. Exercise can and does, make us fitter, healthier, stronger and more flexible.  However to a physical therapist, exercise is not a general term, but has many different purposes.
For example, John Smith lifted a box that was too heavy and strained his back.  He can’t straighten up and his torso is shifted to one side.  When John goes to his doctor, the doctor orders an image (X ray or MRI) and gives John pain medication and/or muscle relaxants. He also sends him to physical therapy. John is nervous because his back hurts too much to “exercise.”

However, the physical therapist understands that John is in pain. He or she will prescribe Early Injury Exercise.  This exercise GENTLY stretches the spasmed muscles and keeps the area lightly moving so that stiffness does not increase and the back begins to heal in a functional position.

As the injury begins to resolve, Postural Exercise is then prescribed to correct the postural problems.  John learns exercises to coax his spine into upright standing, to correct the torso shift and to begin to get normal spinal alignment.

As John continues to improve and heal, exercise changes again to restore his spinal motion and flexibility to normal.

Finally, in the last stages of healing, exercise is used to restore the strength lost and to give John the tools to avoid straining his back in the future.

Avoid “one size fits all” exercise programs and see a professional who understands the healing process.  The correct kind and amount of exercise is a large part of a physical therapist’s prescription for the treatment of an injury.

Who needs physical therapy?

April 26th, 2012

The musculoskeletal system is a complex and ever-changing system that sometimes can confuse and baffle even the most tuned-in and self-aware person.  At these times, expert observation and intervention are what physical therapists can offer. We can help to re-establish the body’s balance and harmony which leads to healing.

There are any number of factors which can overwhelm one’s understanding of what is going on in their body and confuse us as to what to do about it.

Surgery

Although the goal of surgery is to correct pathology, the process is so alien to the realm of normal experience that it is difficult to interpret the tidal wave of sensations that are present postoperatively.  Am I pushing myself too hard? Am I pushing myself hard enough?  Is this pain normal? Am I doing harm to myself by doing this activity?

All these questions and many more go through the mind of the post-op patient and physical therapy can answer these questions and lead to a happy resolution so can enjoy the outcome of surgery.

Chronic Pain

We often think of an area of chronic pain as the tip of an iceberg.  The 20% above the water (representing the area of pain) is maintained and perpetuated by the 80% below the water.

That 80% below the water is silent and unknown to most.  The expert eye of the physical therapist can see areas to work on that aren’t obviously connected.

Injury

When the musculoskeletal system is injured (i.e. when you throw your back out or sprain your ankle), the body’s healing power begins its miraculous job.  In most cases, time does heal all.  There are two key words in the above sentence that warrant a response.

The first key word is “time”. If all we had to do was sit around and convalesce, all would be well, but the pressures of our life require us to get better sooner, rather than later.  Physical therapy can usually speed up that process significantly.

The second key word is “most”.  There are injuries that don’t respond to time and convalescence. These are the injuries that become chronic (greater than 6-8 weeks). Once again the physical therapist can become a problem-solver and seek to discover the non-obvious factors that are preventing the timely recovery of injury.

The title, physical therapist, says a lot.  We provide help with physical problems. Problems of the MS system are our specialty at ABA Physical Therapy.  Let us help you through the recovery process.             Steve Anderson PT

Starting a Regular Exercise Program

April 2nd, 2012

At ABA Physical Therapy, we encourage regular exercise in all its forms, whether it be stretching, strengthening, or cardiovascular. The choices are many: Yoga,Tai Chi, Pilates, weightlifting, swimming, walking, running, biking, etc. How do you decide what’s best for you?

The first consideration is that it should be something that you enjoy doing! If you try to ride a stationary bike, but are bored, you’ll be much less likely to make it a regular routine. You should also take into consideration any pre-existing conditions or joint problems. If you have knee or back problems, swimming or biking may be a better choice than running. If you have shoulder issues, weightlifting or swimming could be problematic, or could be helpful if you do the appropriate exercises or choose the best swimming stroke for your particular problem. Your physical therapist can help you determine what type of regular exercise routine will be best for you.

Your PT can also give you guidance as to how to progress your program. Sometimes the best intentions lead us to over-do our workouts, only to aggravate an existing problem, or create a new one. When beginning a new routine, or returning to an old routine after a lay-off, progressing gradually is the best move to ensure you can maintain consistency, without re-injury.

Full disclosure – A Holistic View of the Body

March 26th, 2012


Often when we consult a doctor or physical therapist we have a particular problem we are looking to address.  There is always a medical history form to fill out and sometimes we fill it out as quickly as possible and omit things that we do not believe are related to the problem at hand. What difference does it make what’s happened to us in the past or what medications we are now taking?  Providing a full picture of your health status gives the healthcare practitioner a better picture of your overall health so that he/she is able to help you more effectively.

Knee pain may be in your family but its sudden onset could be unclear.  Understanding that you suffered an ankle sprain years ago, which may have influenced how you have walked ever since could more thoroughly help your recovery.  Old rib injuries may have changed how your upper body now supports your neck.  Previous surgical scars sometimes leave adhesions which act as barriers to full movement without you noticing.  Our jobs, as physical therapists, is to restore motion in the most efficient and effective way.  Sometimes that includes how other parts of the body are contributing to the problem site.  When we see the connections of the whole body we see how miraculous it really is!

How do you use a cane or crutches properly?

March 19th, 2012


Have you ever seen an episode of “House” on TV?  The main character uses a cane often because of a painful leg but, he holds the cane on the same side as that painful leg.  His character does it to be cantankerous and it’s NOT the right way!

When a foot or leg is unable to bear weight fully and we need assistance from a cane or crutch the opposite hand should be utilizing that device.  When you step forward with the affected leg, support for that leg should come from the opposite arm.  Watch anyone walk any distance and you will notice how the upper body rotates to swing the opposite arm forward as a leg advances.  This is called “cross pattern walking.” Walking by moving the same side arm and leg forward makes us look robotic and strange!  Keep that same, natural cross pattern of movement happening even while you are getting help from a cane or crutch.  Your balance will be better and you’ll feel much more stable.

Exercise Enhances Physical Therapy

March 8th, 2012

Home Exercise is a vital adjunct to physical therapy treatment.  Since we are primarily a manual therapy clinic, we spend a good part of every session trying to gain ease and movement where there is restriction. For example, a common postural tightness occurs in the front of the hips.  We spend a great deal of every day sitting – at work, watching TV, reading.  Long hours in a sitting position create a shortening at the front of the hip joints. Therefore, much of physical therapy treatment would be spent doing manual release for the psoas and quadriceps muscles to create a more effortless, upright posture.

However, we only see you for an hour or so weekly.  It is very important that you carry through with exercises at home so that you don’t lose what you gain in a manual therapy session.  Correct performance of exercise is not busy work.  It’s a necessary continuation of corrections gained during our sessions with you.  So Do Your Exercises!