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

Wednesday, December 20, 2017

How to Stay Active for the Long Term

Change the Calendar, Change Your Routines!

This time of year always brings memories back of performing in the ballet version of The Nutcracker. It really was an amazing time but it was also physically demanding. By the end of the run, I would need a few days of rest before I could get back to being my active self, even as a teenager.  When people find out I am a physical therapist that used to dance, the response is usually, "Oh, so you got into physical therapy because you got hurt at some point, right?" Actually...no. I was lucky enough to make it through my dance career without any major injuries. However, looking back, I really don't think it was all luck.

In addition to dance, I also played lacrosse. Yes, those are two very different physical activities, but that's the point. I would do weight lifting, sprinting, practice for lacrosse a few times a week and then have dance class and rehearsal the other days. By constantly changing up what my body was doing, I didn't allow for wear and tear injuries to occur and my body's strength was well rounded. I was reaping the benefit of cross training.

The metaphor I use with patients is this: when you look at the stairs of an old house, the wood is worn down in places where people placed their feet for decades. Your body is the same way; if you always do the same activities week

after week, your body gets worn down in the same ways. What wasn't a problem before is now painful or hard to do. That's why your, physical therapist/physician/trainer/chiropractor/etc might tell you to change things up in your fitness or activity routine.

Cross training is a proven concept. Professional athletes take yoga to stretch and unload joints. Factory line workers change positions on the line to prevent overuse injuries. So how does this relate to you? Someone who plays basketball often may want to do something different once a week, like a spin class. Now, you're not wearing down your body in the same way and you're making your strength well rounded. If a teacher spends all day standing, swimming would be a good way to unload joints while still working on cardiovascular fitness.

Whether you are a dancer, athlete, manual worker, or just trying to stay active for the long run (which should be everyone's goal), cross training is an important concept for everyone to practice. Physical therapists can help by evaluating your current weakness and figuring out ways to fix them. A physical therapy consult is a good way to get started.

 PTW’s Sean Vanin, DPT is the Clinical Supervisor at our Quakertown clinic. For an initial evaluation, call Sean at 215 538 9911 today! 

Why Stretch?

The Importance of Stretching!

It’s cold out… you don’t want to go to the gym…. you really don’t want to waste time stretching….
Believe me, I get it. I am definitely one of those people that needs to give their self a little pep talk in the winter to stay with my workout plan and stretching.
It is important to properly warm-up and stretch before exercising or participating in some of those enjoyable snow activities like snowball fights and skiing/snowboard and the not so enjoyable ones like shoveling.

Stretching has been shown to have many benefits:

Decrease Risk of Injury – stretching before participating in something physical prepares your muscles to function at their optimal performance.  They are now ready to adapt to the changes that your muscles go through when being physically active.

Improve Flexibility and Range of Motion – I hear daily that “I used to be able to touch my toes as a kid.” Well the reason you can’t anymore i
s because you didn’t keep up with stretching as your bones grew and muscles lengthened.  Don’t worry; you can still improve your flexibility if you work at it.

Reduce pain and stiffness – In many cases a lot of patients low back pain and knee pain is due to their muscles being very tight which causes the joints to not move properly and therefore put abnormal stresses on joints and cause pain.

Improve blood flow and circulation – Stretching helps to improve blood flow and circulation by allowing for enhanced transportation of oxygen and nutrient-rich blood throughout the body.

Minimize wear and tear on joints – Again, if muscles are at the appropriate length and tensions then they don’t cause abnormal stress on joints which can lead to premature joint breakdown and arthritis.  

Improve muscular function – Stretching helps to improve oxygen and nutrient rich blood to circulate better throughout the body and also helps to remove the byproduct lactic acid from your system more quickly. It also helps to prepare the muscles for activity which is especially true in the case of dynamic stretching.

Reduce stress – Chronic stress can cause a number of undesirable responses in the body. Regular stretching has been shown to reduce mental tension, and when combined with mindful breathing techniques, it may also help to decrease anxiety and depression.

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

Wednesday, December 6, 2017

Winter Is Coming...

Winter Is Coming...Be Prepared!

There is a lot to think about when it starts to snow in the winter.  How am I going to shovel?  How will be able to get my car out?  How am I going to get to all my appointments?  However, one thought that causes the most fear in many people is, "What if I fall on the ice?"  What if I told you balance and strength training could reduce your risk of falls?  

In physical therapy, one of the components we constantly assess for patient's wellbeing is their balance.  There are a multitude of tests that tell us if someone is at a higher risk for falls because of poor balance.  When we discuss balance in PT, we talk about a very important system called the proprioceptive system.  This system is involved in telling your body when it is starting to sway or fall.  It then is supposed to tell your body which muscles to activate to keep yourself from falling.  This system becomes less and less effective as people age, or if it is not used.  

So why is this system so important then?  It is the safety mechanism built into your body that keeps you from falling.  Walking on the sidewalk, climbing stairs, reaching out of your base of support, etc. all activate this system, but is that enough to get you prepared to walk on slippery surfaces?  Additional balance training exercises would be required to truly prepare your proprioceptive system for the challenges that come with snowy and icy sidewalks in the winter.  This is because the only way to truly prepare for walking on unsteady surfaces is to practice on unsteady surfaces in safer conditions.  

If you're concerned about getting around this winter, talk to your PT and see if additional balance training is something you would benefit from.  Because "Winter is coming", will you be ready for it? 

PTW’s Brandon Lewandowski, DPT is a PTs at our Lansdale clinic. For an initial evaluation call 215 855 9871 today!

Wednesday, November 1, 2017

"I Was Feeling Great Until..."

“How are you feeling today?"

“I was feeling great until the cold, rainy weather started yesterday and caused my joints to hurt”

This is a very common conversation that I have with patients the day of or after we experience weather changes, especially those that involve rain, cold, and clouds.  This is not the patient’s imagination at all.  Patients with musculoskeletal conditions, such as arthritis, are more susceptible to experience increases in pain levels when the weather changes.  Patients may be attending therapy for a sports injury, post-surgical rehabilitation, balance impairments, and more.  With the addition of joint pain, secondary to weather changes, a patient could easily get discouraged and want to lay around and rest because the weather has now made their current ‘injury’ much worse.

When barometric pressure and temperature fall, as when a storm rolls in, the pressure against the body begins to fall as well. When this occurs, it is believed that the pressure change causes joint capsules and surrounding tissues to swell.  The swollen and enlarged tissues may be irritating the joints and cause associated pain.  Many of my patients know that getting heat at the end of a session makes them feel loose and relaxed.  The opposite is true with weather.  Colder outdoor temperatures can cause muscles, ligaments, and joints to become stiffer and more painful, especially when someone already has an associated musculoskeletal condition.

For example, it has been found that every 10-degree drop in temperature causes incremental increase in joint pain. Swelling then can cause inflammation and associated discomfort.  The same is true, that when the weather warms up and barometric pressure increases, pain relief may occur in the joints.

There are ways to help manage this increase in pain! Although you cannot change the weather there are things that you can do to ease pain associated with weather changes, such as:

First, stay active! Inactivity can make joints stiffer and more painful.  Many people think that rest will help to ease pain but this is usually not the case.  Stretching, walking, bike riding, doing yoga, working out in a warm pool (Like the two at PTW Lansdale), and many others are ways to increase flexibility and reduce occurrence of swelling in joints.  Give PTW a call and schedule a time to use our Alter G anti-gravity treadmills or deep water 94 degree aquatic therapy pools.  These are great low-impact ways to keep your joints moving and decrease overall pain.

Second, after a conversation with your primary care physician, taking an anti-inflammatory medication can help to decrease swelling in joints.

If you experience joint pain, keep moving, and always feel free to ask your physical therapist for suggestions on how to manage this pain.  Luckily, there are many ways to keep moving and your therapist can come up with an individualized way to manage weather-related pain.  This will allow you and your therapist to spend more time addressing the condition you started therapy for in the first place and get back to doing your favorite daily activities!

PTW’s Jackie Kern, DPT is a Staff Physical Therapist at our West Norriton clinic. For an initial evaluation, call Jackie at 610 630 0101 today!