Tuesday, May 15, 2018

Stay Safe While Gardening this Spring!

Yard work and gardening can be hard work, but it doesn’t have to result injury. As you are gearing up for the spring and summer growing season it’s important to remember the following tips and tricks to help prevent unnecessary aches and pains.

1. While working in your garden try to avoid standing up and bending forward to work at ground level. Either squat down by bending at the knee and hips keeping your back straight, or you can utilize some helpful tools. You can find gardening stools (or any small stool) or cushions that are lightweight and easy to maneuver to different places in your garden. You can then kneel or sit down while you work to reduce the load on your low back.

2. When pulling weeds follow the advice in tip #1, trying to avoid bending forward if able. For tough to pull weeds utilize a weeder to get down at the root and limiting having to use your back or arms to pull it from the ground.

3. Don’t over do it! When mulching or planting large flats take smaller trips if 
necessary. Don’t try to push a wheelbarrow that is over full or too heavy around the yard or garden. Break the task in to more manageable amounts to prevent over straining your muscles. 

4. When trimming or working with tools with your arms above shoulder level remember to squeeze your shoulder blades together and use the larger muscles in your back to support your arms. Take frequent breaks to prevent an over use injury of your shoulder

5. When digging or tilling, use your legs to lift or move dirt. Bend at the hips and knees, back straight, core engaged, and push through your legs rather than lifting through your back. Try to keep the weight of the dirt close to your body to reduce the strain on your lower back. 

6. It’s very important to remember to stay hydrated before, during, and after working outside in your garden, especially if the weather is warm. Labor-intensive yard work burns calories, and makes you sweat, which can deplete your electrolytes. Maintaining your hydration can prevent muscle cramping and reduce muscle soreness in the days following your hard work. 

If you have unfortunately already found yourself suffering from a sore back, shoulder, knees, or any other body part due to working in your yard or garden, come in for a consult from a physical therapist at one of our 8 locations. A physical therapist will be able to determine how to help relieve you of your symptoms and assess your body mechanics during gardening tasks to prevent future re-injury, and get you back out in your garden doing what you love. 

PTW’s April Phillips, PT, DPT is a staff physical therapist at our West Norriton clinic. For an initial evaluation, call Steph at 610-630-0101 today! 

Tuesday, May 8, 2018

Running 101

"I don't know how you do it, I've never been much 
of a runner". 

Every time I hear a patient say the above statement to me, I always want to reply with, "Well neither was I." As a kid, running was something I loathed. The only time you could get me to run was in some form of sport, like soccer or basketball. I ran track for my local parish, but mainly did it so I could hang out with my friends outside of school. For some reason, I just didn't take much pride in it. If I won a 400 meter race it was cool, but to beat a girl down the court to score a lay-up? That was amazing.

As I got older things changed. On a personal note, a family member passed away when I was 17 and the way I dealt with it was by literally running away from my feelings. As I've grown up, it has become my way working away some of the stresses of daily life. There is just something so comforting about going outside, enjoying some fresh air and getting my heart rate going. And the best part of it is, you can do it alone or with someone else. I know my sister Kristen is always there if I need to talk something out over a run or if I just need a pace car since I'm horrible at pacing myself.

Running isn't perfect though and I tell my patients that. There are drawbacks and potential injuries if not done properly. So here are a few pointers if you decide to give a five miler or another race a try.

1) Have realistic goals
People train years for marathons so don't be upset that you aren't ready for one in a couple months. Starting small and progressing in intervals helps stress the body appropriately and prevent injuries.

2) Proper footwear As a runner, your feet are taking a lot pressure. Make sure to treat them kindly and you'll be able to reach your goals without getting injured.

3) Strength Training
Running is amazing for heart health. However, it can cause some changes in muscles. Since it is a very linear activity, muscles that are needed for knee and ankle stability tend to get neglected. If you're not sure what muscles need work or how to work them properly, I know a few PTs that would be willing to help…

4) Stretching
Stretch everything in your legs. Once again, since running is a linear activity muscle tend to get overused and tight which can cause discomfort or injury.

5) Proper hydration. As we get into the warmer months especially, make sure you are drinking enough water. Poor hydration can lead to dehydration and muscle cramping.

These are just a few pointers about how to start running. If you have any questions, please feel free to contact any one of the PTs at PTW. Another amazing resource at PTW to help start running is the Alter G Anti-Gravity Treadmill.

If you're training for any race (like the Broad Street Re-Run) or just putting a lot of miles on the pavement, the Alter G is helpful to take some of the pressure off your joints while maintaining that cardio heart rate.

PTW’s Lauren Nederostek, PT, DPT is the Clinical Supervisor at our Montgomeryville clinic. For an initial evaluation, call Steph at 215 855 1160 today! 

Sign Up for this year's Broad Street ReRun online at www.broadstreetrerun.com! Online registration ends Wednesday, May 16th!

Tuesday, January 23, 2018

What A Pain In the Neck (Literally)!

A Strengthening Approach to Non-Specific Neck Pain

Neck pain is something that affects approximately 30% to 50% of the general population and causes extensive issues in an individual’s personal and professional lives. The complexity and sheer number of the structures located in this area contribute to its widespread effects and make it difficult to effectively apply a standardized and generalized treatment; potential pain generators include nerves, bones, discs, fascia, ligaments, and muscles. Mechanism of injury is an additional factor to consider; pain will present differently if caused by trauma (i.e. whiplash stemming from a car accident) or if by degeneration (normal wear and tear). In this blog, we will briefly discuss nonspecific mechanical neck pain, which first needs to be defined.

In short, nonspecific mechanical pain refers to a source of pain other than a nerve issue (with radiating pain down into the arm), fractures, rheumatological disease, tumors, or systemic disease. Essentially, when an individual has been screened for red flag symptoms (tumors, arterial insufficiency, fractures, instability, etc.) they are left with a number of mechanical drivers of pain that lies with one or more of the structures listed above. What this means is that after you are cleared from having anything like a cervical fracture, spinal cord compression, etc, there are a number of ways to identify the culprits and treat your pain.

Often times, we ignore our pain and simply assume it will go away on its own. A study by Ylinen et al, JAMA 2003 set up 3 groups in an experiment: a home stretching program without skilled physical therapy, a supervised strengthening program, and a supervised endurance program. The strengthening and endurance program both had significant changes in pain and (not surprisingly) strength measurements as compared to the non-supervised home stretching program (the people who hope it will go away). Perhaps the most exciting thing about this study was that these changes were still significant at the 3 year follow up.

Celenay et al. discovered that manual therapy (when physical therapists put their hands on you to help mobilize joints and tissues) was additionally helpful. In fact, the group in this study that received manual therapy in addition to neck stabilization exercises had greater outcomes than just the stabilization group in relation to improving disability, pain intensity at night, rotation motion (think driving!), and quality of life.

Another study looked at EMG activation of different cervical musculature, and what they found is significant. In those without neck pain, there was less activation of the superficial neck muscles (the ones you can see in the mirror when you move your neck) and greater activation of the deep neck flexor muscles, longus colli and longus capitus (these muscles are deep and cannot be felt).The reverse was also true: in those who had neck pain, they tended to have greater activation of their superficial muscles and did not activate their deep neck flexors effectively. What this means is that in those with mechanical neck pain, it is potentially helpful to learn how to activate those deep neck muscles: longus colli and longus capitus.

One test to assess a patient’s ability to recruit their deep neck muscles is the aptly named Deep Neck Flexor Endurance Test. This test is completed with the patient in supine and knees bent. They then tuck their chin and lift their head 1 inch from the table. Any dropping of the head or substitution from those superficial muscles is the end of the test. Normative data suggests that in those without neck pain, men scored 38.9 seconds and women scored 29.4 seconds. However, those with neck pain were found to have significantly decreased deep neck flexor endurance, average of 21.4 seconds. Weakness of the deep neck muscles and over-activation of the superficial ones commonly leads to a position of forward head postures, as we often see in those who work with computers.

In short, there are ways that physical therapists can help identify the pain-causing structures in your neck and apply an evidence-based effective treatment to get you back to living life without that nagging injury.

Matthew J. Brennan PT, DPT
The Physical Therapy & Wellness Institute

PTW’s Matt Brennan, DPT is a staff physical therapist at our West Norriton location. For an initial evaluation, call Matt at 610 630 0101 today! 

Celenay, Seyda et al. A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients with Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial. Journal of Orthopedic and Sports Physical Therapy. 46:2.2016
Domenech MA, Sizer PS, Dedrick GS, McGalliard MK, Brismee JM. "The Deep Neck Flexor Endurance Test: normative data scores in healthy adults." PM R. 2011 Feb. Web. 08/18/2012.
Fall et al. Spine 2004
Kay et al. Cochrane Database. 2005.

Ylinen et al, JAMA 2003