Category Archives: Pain Management

Ehlers-Danlos Syndrome EDS

The human body is a complex landscape, and that landscape is made up of countless, invisible connections. Without those connections––whether they’re neurological (like synapses in your brain), vascular (part of your veins or arteries), or musculoskeletal (think joints and ligaments)––we would be a collection of different parts, rather than a single, unified body.

Ehlers Danlos Syndrome, or EDS for short, is one of these disorders. It occupies a strange intersection, and it can be described as “rare but not uncommon” as far as genetic diseases go. It is misunderstood both within and without the medical field, and this is partly because it is both incurable and difficult to diagnose.

So, what exactly is EDS? How is it managed, and how do you know if you ought to seek a possible diagnosis?

In honor of national EDS day (January 31), and our partners at The Fem Word and Restore Motion are here to inform, educate, and explore the little-known world of Ehlers Danlos Syndrome and its many faces.

Bent Out of Shape––The What, Why, & Who of EDS and hEDS

Ehlers-Danlos Syndrome is part of a group of disorders known as the hypermobility spectrum disorders. To describe these disorders in layman’s terms, imagine you’re looking at a picket fence. Continue reading →

The Tennis Warm-Up

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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

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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

Manual Therapy Treatment for Concussions

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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

Is this Backpack Too Large?

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What to look for in a Backpack:

Wide, padded shoulder straps distribute the weight over a larger area around the shoulders. This avoids that “cutting into the shoulders” feeling.
Chest and waist straps also help distribute the load of the pack. Use of a chest strap (and/or waist strap) decreases load that would completely weigh on the shoulders if it were not used.
Padded back cushions the load as it rests on the back. Some backpacks feature no padding directly over the spine – This is favorable because it creates a comfortable “cut out” for the spine bones. It decreases load contact directly over the “spinous processes” of the bones.
Multiple compartments even out the load and are preferable to one large cavernous compartment. It makes retrieving items easier as they don’t all fall into one single “pit” of the pack.

Consider the size of the backpack wearer—the overall length of the backpack should not go below the waist of the wearer. Appropriately sizing the shoulder straps to distribute weight evenly over both shoulders and using the chest or waist strap can help the pack sit at the waist of the wearer.

Wear the pack with both shoulder straps not just one strap over one shoulder—Really! Wearing the pack on one side contributes to neck, shoulder and hip strain in addition to back pain.

Avoid filling the pack too full. It is too full if the wearer has to lean forward to bear the weight. This can contribute to bad posture and back pain. Full packs can cause havoc when the wearer turns and unknowingly knocks into people or priceless artwork.

Rolling packs have their advantages and disadvantages as well:

Some school lockers aren’t big enough to accommodate the rolling packs.
Need to be carried over stairs or rough terrain.
May be a trip hazard.

When using a rolling pack remember to switch arms frequently and to engage core/abdominal muscles to balance the strain on the body.

Written by: Miriam Graham, PT

Pilates and Your Game

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PILATES AND YOUR GAME
The Pilates principles of core stabilization address posture, breathing, muscle performance and motor control. Pilates sessions break down faulty movement patterns, and enable the practitioner to work on new movement strategies. Pilates can be integrated into any rehab phase, from the most acute to advanced sport-specific training.

Q: What is Pilates and how do you say it?
A: Pilates (pronounced Pi-La-Tees) in named after Joseph Pilates who first devised the exercise program during the Second World War. Pilates is a form of exercise that concentrates on the “core” or trunk area, including the stomach and low back, promoting strength and flexibility in a controlled manner. People who do Pilates often describe themselves as getting “longer and leaner”.

Q: I have some friends who do Pilates mat classes and others who do it on equipment. Is there a difference?
A: Pilates can be done on a mat or the floor, but it can also utilize equipment called reformers that resemble a table with different springs and attachments that alter resistance. There are many different pieces of equipment that are now being used in a Pilates program.

Q: Is it better to take classes or do private lessons?
A: Pilates is a very specific form of exercise, and it is best taught on an individual basis initially. Progressing into small group classes can then be done. Of greatest importance is learning from a highly-qualified Pilates instructor.

Q: Would doing Pilates regularly improve my sports performance?
A: Many people think that powerful tennis strokes come from the arms and shoulders. This is untrue. The power comes from proper weight transfer and rotation of the trunk and hips region. A strong “core” will certainly help the tennis game, and Pilates is an excellent form of exercise for the core region. Pilates can also be made “sport specific” by doing arm and leg movements whilst keeping the trunk stable. In fact, many of the top professional players are now incorporating Pilates into their fitness program to improve their game.

Q: Will I become more flexible and be able to move better?
A: Quite possibly, and in addition to strengthening, Pilates also increases flexibility and will improve any sporting performance. It will even carry over to your golf game!

Q: I have a chronic back problem, is Pilates a good idea?
A: Pilates can be extremely effective for back pain patients. We have seen tremendous results with our caseload of patients, and it is a low impact form of exercise that can be undertaken by people with many different physical conditions. If you already suffer from an ailment, make sure that your Pilates instructor understands the condition and teaches you appropriately.

Written by: Reshma Rathod
Picture from: www.premapilatesbarre.com