Category Archives: Orthopedics & Neurological Rehabilitation

The Tennis Warm-Up

Many people ask me about the best way to warm-up.  I want focus on the warm-up from an injury prevention standpoint.  I am defining the “warm up” as the specific time that you spend on the court or field “warming up” against your opponent.  This time is critical in the prevention of injury but based on my experience, it is rarely used correctly.

First of all, I will explain what the warm-up should not be! It is not a time to perfect your strokes, techniques or to beat your opponent, it is a time to get your body ready for the vigorous activity that it is about to undertake and to prevent injuries.  Nothing is more irritating than warming up against an opponent who insists on crushing the ball full force giving no opportunity to warm up your strokes and muscles.

Sports research shows that warm muscles are much less likely to be injured than cold muscles.  As you start the warm-up, blood flow to the muscles increases, increasing their temperature and bringing in more oxygen.  This allows the muscles to contract more efficiently and generate greater force.  As you continue the warm-up, more and more muscle fibers are recruited and therefore less strain is put on each individual fiber.  The warm-up also primes the cardiovascular system for activity.

If you are playing in cooler temperatures, or in the winter when you come onto the court or field, make sure that you keep your layers on, until you feel comfortably warm, this does help avoid injury.

When you start playing against your opponent, start slowly, and then as the muscles get warmer, move more at your usual pace and length.  Feel that you are starting to groove on your performance and getting your brain into “play” mode.  For example, when warming up the tennis serve, make sure that you start at half pace and gradually increase to warm up the shoulder joint.  Again, this is not a time to perfect your slice serve, this is a time to get your blood flowing and warm-up your hand eye coordination.

In an ideal scenario, when you are certain of the time play will begin, the optimal way to warm-up is to do 5-10 minutes of gentle activity, such as light jogging or jumping rope, followed by a dynamic warm-up.  The “dynamic warm-up” is a more recently researched way of warming up for sporting activities and has been shown to be highly effective in injury prevention.  The dynamic warm-up is stretching with movement by using exercises such as lunges, arm swinging etc.  The older, static stretching method, is now used more as part of the after play cool down.  Current research shows static stretching that may reduce the amount of power muscles can generate.

So remember, that a well-performed warm-up is a great tool in the prevention of injury and is also a great way to maximize your performance potential!

 

 

Written by:  Reshma Rathod, PT

Headache

If you have been in any position where you head is in a forward or flexed posture for an hour (such as working on the computer/phone or reading) you may start to experience a headache.  It could be your computer/phone screen’s contrast is too low, the brightness is too high or there is glare on your screen.  However, if you have addressed those issues, or if the headache gets worse with tabletop work, you may have a joint restriction at your first and second cervical vertebrae.  Try this trick to see if you can decrease or eliminate your headache:

Grab a pillowcase and find the longitudinal seam.  Lie down on your back.  Tilt your nose up slightly and place your fingers on the middle of the back of your head.  Slowly drag your fingers down towards your neck and you will drop into a valley then hit a bump.  That first bump you feel is the spinous process of your 2nd cervical vertebrae.  This is what we will use to eliminate that headache.  Secure the middle of the pillowcase seam around that 2nd spinous process (like you’re wrapping a blanket around your shoulders, but the edge of the blanket wraps around the back of your neck).  While holding the pillowcase firm and parallel with the floor, glide your head back without tilting it “chin tuck.”  This is NOT a strong movement as excessive muscle activity between the occiput (base of the skull) and cervical spine would be counterproductive.  Sustain this posterior glide for 10 seconds and repeat the process 6-10 times.  If you can change, decrease or eliminate your headache in anyway, you have an upper cervical dysfunction or issue causing your headache.  If you have eliminated your headache, you now have a new trick!  If you eliminated or decreased it, but it continues to return, there is something else contributing to that headache.  Go see your physical therapist to eliminate it and keep it from returning!

 

Written by: Heather West, PT

 

Photo Credit: https://www.hioscar.com/blog/what-a-headache-types-causes-and-treatments

When Pain Becomes Chronic

The pain science research over the last 10 years indicates there are significant differences between acute pain and chronic pain in our bodies.   When there is an acute injury, the brain receives the signal from the injured tissue. As the tissues heal, the nervous system gradually calms down.  Normally, our bodies have a low level of excitation in our nerves.

When the level of excitation does not calm down as an injury heals, the pain becomes chronic.  The tissue injury is healing, but the nerves are still over-stimulated. The central nervous system is extra sensitive.   The brain then interprets even small inputs as pain. When the nerves are over excited, the surrounding nerves also become more excited causing the pain to spread to multiple areas.

The primary question then is how to calm the nervous system to decrease the pain.   The research suggests that one of the most effective strategies to calm the sensitivity of the nervous system is aerobic activity.    Decrease in pain levels have been seen with even small amounts of aerobic exercise such as 5-10 minutes. The main point is to start where an individual is able to move with a minimal increase in pain.  The brain needs to experience that it is “okay” to move again. The pain science research consistently shows that individuals who are afraid to move have poor outcomes.

Other strategies to calm the nervous system, include deep breathing, meditation, and general healthy habits including good sleeping patterns and healthy diet.  All of those strategies decrease the stress in the nervous system which will gradually decrease the sensitivity.

It is important to understand that the chronic pain does not mean that there is new tissue damage occurring.  The brain just needs the body to move again to decrease the sensitivity of the nervous system.

 

Written by: Stephanie Bloom, PT

Picture: https://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/chronic_pain_causes_solutions_slideshow/webmd_rm_photo_of_pain_illustration.jpg

Meditation Retreat: Part 2

In our April Newsletter we shared that current neuroscience states 8 minutes of meditation a day will change brain structure positively! Meditation: Part 1

This newsletter, we expand on the phrases presented last time to help gather and direct attention for meditation. Metta is a Pali word defined as “loving kindness,” fierce compassion or freedom of heart. Metta Meditation is a practice where one focuses on a set of phrases that sends kind thoughts first to oneself  and then to others. In comparison, Mindfulness Meditation is a practice where one focuses on the immediate present moment without judgement.

Sit comfortably with your spine supported.  Closing your eyes will help bring your attention inward.  You can keep your eyes open to read the phrases until they are easy to remember.   

It is helpful to set a timer for 5 or 8 minutes. The phrases used in Metta Meditation help gather and direct your attention. They give the mind focus, “something to do.”  Breathe in and think “May I be free….” Breathe out and think “…of enmity and danger.” Here are phrases to try:

(Inhale) May I be free… (Exhale) …of enmity and danger
(Inhale) May I have…. (Exhale) …mental happiness
(Inhale) May I have… (Exhale) …physical happiness
(Inhale) May I have… (Exhale) …ease of well-being

Direct these phrases in a cycle first to yourself, then to a benefactor, a friend, and then to a neutral person (someone you interact with but don’t know well).  Later try to expand your Meta circle to a “difficult” person then to “all beings.” For example you could include a favorite teacher, good friend, the check out person at the store, and the aggressive driver from your commute in your meditation.  It is easier to practice with those close to your heart at first.

Our perception of our experience changes when we are able to realize the fact it isn’t what is happening around us, it’s  the way we react to what is happening around us that can be upsetting.  Meditation allows us to create spaciousness between stimulus and our reaction to that stimulus on a daily basis.

Sylvia Boorstein updated the language of the classic phrases in her book Happiness is an Inside Job

You can give them a try too:
(Inhale) May I feel… (Exhale) …contented and safe.
(Inhale) May I feel… (Exhale) …protected and pleased.
(Inhale) May my physical body… (Exhale) …support me with strength.
(Inhale) May my life unfold… (Exhale) …smoothly with ease.

 

Miriam Graham, PT, DPT, MBA  May 2018

Image Credit: http://www.sylviaboorstein.com/books/

Meditation Retreat: Part 1


Sylvia Boorstein, PhD, and Miriam Graham, DPT (December 2017) with Dr. Boorstein’s books Happiness is an Inside Job and Pay Attention for Goodness Sake.

Current neuroscience states 8 minutes of meditation a day will change brain structure positively! 

Meditation is about choosing an object on which to REST your mind.  The mind frequently wanders to the past or to the future. GENTLY bring your mind back to REST on the chosen object.  Typically, you will go through several cycles back and forth, starting and restarting in any one session. That IS meditation, the exercise that brings about resilience.  Just like exercise for your body, meditation requires effort and repetition.

The phrases used in meditation help gather and direct your attention.  You can sit, stand (or walk slowly if it is more comfortable to be on the move).  If possible, close your eyes while sitting or standing, this will help you bring your attention inward.  Comfortably support your spine. It is helpful to have a timer to set for 2, 4, 5 or 8 minutes. Try this mindfulness phrase to exercise being in the present for 2 minutes:

Breathe in: May I be present in this moment.
Breathe out:   May I meet it as a friend

Once you feel comfortable with 2 minutes, challenge yourself to 4 minutes.  Remember the exercise is to bring yourself back to the phrase and breathing.  You ARE doing it RIGHT if you have to redirect yourself back from wandering onto your grocery list or starting to fall asleep… That is the exercise!

Last December I attended a 6-hour meditation retreat lead by Sylvia Boorstein and Sharon Salzberg. Both women were engaging speakers and I appreciated how simply they presented “Metta” or “Loving Kindness” meditation.  Metta is a Pali word that is translated as “loving kindness,” fierce compassion or freedom of heart. Next installment we will introduce a cycle of phrases to practice a Metta Meditation.  Until then, enjoy the respite of taking just a few minutes to withdraw and rejuvenate in this moment.

 

Written by Miriam Graham, PT, DPT, MBA  

Dr. Mistry’s Oral Hygiene Benefits & Tip

It’s Spring Cleaning  Time … even for your TEETH !

Visiting your dentist regularly has many health benefits overall.

Regular dental visits are important because they help keep your teeth and gums stay healthy. Residue on teeth after eating and drinking all day can cause plaque and tartar to buildup and not only cause tooth decay, but can erode the mouths gum tissues. When this happens, you end up getting an infection called gingivitis.  As gingivitis progresses, the tissue that attaches gums to teeth can break down and cause a more serious condition called periodontitis which can cause eventual tooth loss.  A dental professional can offer treatment to correct such gum disease.  

One way to minimize food residue on your teeth and the associated plaque build up is to lubricate you teeth with drinking water.  Gently swish the water between your teeth paying particular attention to direct the flow of water to the front and back teeth–both tops and bottoms before and after you eat.  

Don’t wait for sudden unexpected  tooth pain before seeing a dentist … go for a tune up of your mouth  this SPRING to prevent Tooth trouble!

 

Written by Bhavana Mistry, DDS 

Manual Therapy Treatment for Concussions

Following a concussion, symptoms such as headaches, light sensitivity, dizziness, cognitive difficulty, emotional irritability, depression, and sleep disturbances can often linger. Waiting for the symptoms to improve is a frustrating experience that can impact all areas of an individual’s life. Physical therapists skilled in manual therapy including Craniosacral Therapy, Visceral Manipulation, and Neural Manipulation have observed improvement in many clients’ symptoms post-concussion. These specific manual therapies are gentle therapies that follow the osteopathic principles that structure and function are interrelated. Craniosacral therapy improves the motion restrictions in the craniosacral system which consists of the meninges, bones, and cerebrospinal fluid from the head to the coccyx (base of the spine). Visceral manipulation is a manual therapy developed by a European osteopathic physician Barral that uses gentle, but specific manual forces to improve the mobility of the organs and the connective tissues. Barral Neural Manipulation works to improve the fascial mobility that surrounds all of our nerves allowing the freedom of motion needed for optimal function.

A recent study published by Gail Wetzler and colleagues confirms manual therapy can improve concussion recovery. In the study of 11 male retired professional football players, these specific manual therapies resulted in statistically significant improvements in pain intensity, ROM, memory, cognition, and sleep. For specific changes observed, here is a link to the research study. http://online.liebertpub.com/doi/abs/10.1089/acu.2017.1222

Gail Wetzler PT was here at Restore Motion this weekend teaching the therapists who already have trained in these manual techniques how to better use these skills to treat individuals with post- concussive symptoms.

 

Written by: Stephanie Bloom, PT

 

“For information on what to do if you or your loved one sustains a concussion, please refer to https://www.cdc.gov/traumaticbraininjury/recovery.html

Image Source: https://www.flagspin.com/youth/youth-flag-football-concussions

 

Safe Pain Management: Choose Physical Therapy

choosept

Avoid Addictive Opioids.  Choose Physical Therapy for Safe Pain Management.

No one wants to live in pain.  But no one should put their health at risk in an effort to be pain free.

Since 1999, Americans have increasingly been prescribed opioids—painkillers like Vicodin, OxyContin, Opana, and methodone, and combination drugs like Percocet.  According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though “there has not been an overall change in the amount of pain that Americans report.”

In some situations, dosed appropriately, prescription opioids are an appropriate part of medical treatment.  However, opioid risks include depression, overdose, and addiction, plus withdrawal symptoms when stopping use.  And people addicted to prescription opioids are 40 times more likely to become addicted to heroin.   As of 2014, the CDC estimates that 52 people die each day in the United States as a result of prescription opioid overdose.

In addition, Americans are creatively saving and sharing prescription opioids at alarming rates. These saved and/or shared drugs are now getting in the hands of our children.  Our children are not traditionally popping pills but masking the drugs in various ways.  Drug-laced lollipops are the latest in the drug culture.  This has been reported by high school students in our area. The lollipops are apparently laced with strong levels of painkillers.  This new drug delivery method should raise concern and awareness about the dangers of prescription opioids. Consumers and prescribers are encouraged to choose safer alternatives to prescription opioids.

The Centers for Disease Control and Prevention (CDC) is urging health care providers to reduce the use of opioids in favor of safe alternatives like physical therapy.

Don’t just mask the pain. Treat it.

Choose physical therapy to manage your pain without the risks and side effects of opioids.

 

Written by: Reshma Rathod, PT

Bone Up (get the facts) on Bones

Most of us know very little about our bones- they are hidden and not painful until we break one!

So let’s start with some anatomical facts and bone up (get the facts) on bones:

  • At birth we have 300 immature bones; some of these join up; adults have 206 bones.
  • The human hand has 27 bones; the face has 14.
  • The longest bone in the body is the femur (thigh bone) which is about 1/4 of your height.
  • Did you know that humans and giraffes have the same number of bones in their necks?

During our lifetime, our bones are in a continual cycle of breaking down and rebuilding. Bone strength represents the integration of bone density and bone quality. Most women will reach their 90% of their bone mass by the age of 18 and their peak bone mass by the age of 30 which emphasizes the importance of bone growth in childhood and adolescence through active and healthy lifestyles. As we age, and especially with hormonal changes associated post-menopause, the living bone tissue reabsorbs at a higher rate than rebuilding.

Bone thinning is classified as osteopenia or osteoporosis. Osteopenia, the less severe of bone weakening, is defined as having between -1 and -2.5 standard deviation of bone mineral density. Osteoporosis, the more severe of bone weakening, is diagnosed as having bone mineral density greater than -2.5 from the standard deviation. The stronger bones we have, the less likely we will fracture in a traumatic incident.

Physical activity can modify bone strength. When gravitation or muscle pull produces strain on the skeleton that is greater than optimal strain, bone formation occurs. In conjunction to other types of interventions, bone loss can be slowed and sometimes reversed. The improvements from exercise are likely from increased bone density and lessened endocrotial bone loss, not an increase in bone size. Women who engaged in a combination of exercise types had an average 3.2% less bone loss at the spine and 1.03% less bone loss at the hip than those who did not exercise.

Consider the following to protect your bones:

  • Assessment of footwear and/or orthotics and adjustments if necessary.
  • Review food intake with a doctor/nutritionist to check if you have the essentials for strong bones.
  • Assessment of the load, type and intensity of your exercise program.
  • Medical check-up to rule out other potential causes (like thyroid disease or medications that may cause bone loss).
  • Don’t smoke and keep alcohol and caffeine intake to a minimum (these substances may lower bone density).

 

Written by: Reshma Rathod, PT