Tag Archives: physical therapy

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

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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

What comes after the PSA (Prostate-Specific Antigen)? The next steps

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I had a conversation with Dr. Harold Frazier ( http://www.gwdocs.com/physicians/hal-frazier ) the other day about some alternative testing when Prostate Cancer is suspect. This would be the next step after the initial screening with the PSA if it shows an elevated level. In the past, a biopsy would be the next step. This however can pose a number of risks to the patient, infection, bleeding, and just being plain unpleasant.

We talked first about a blood test that I had heard about from the Cleveland Clinic called the 4Kscore test. This one combines four prostate-specific results with clinical information into an algorithm that calculates the individual’s risk for aggressive prostate cancer. It has good clinical confirmation behind it.

He also talked about another test that was not a blood test, but a urine test called SelectMDX. It measures the mRNA levels of two biomarkers and helps determine if the possibility of a more aggressive form of cancer is likely and if a biopsy is therefore warranted. Good news if you don’t want to go through another blood draw!

The downside is the expense of the test and the possibility that insurance may not cover the tests. The upside is that there are more options to help detect prostate cancer and the options are simpler and more effective than ever before.

As with all methods of prostate screening, a good dialogue with your doctor, your risk factors, and age should always be taken into consideration before proceeding.

By: Patrick Wenning, PT

Photo Credit: https://pixabay.com/en/what-s-next-yellow-sticker-note-1462747/

New Prostate Screening Recommendations 2018: Rethinking the use of the Prostate-Specific Antigen (PSA) test

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Men need to be proactive about their health. Cardiovascular fitness and blood pressure screening are often part of the regular check ups with their primary care physician. In the last few years, Prostate Cancer screening is becoming part of this proactive approach.

There has been some controversy over the past few years about when and how to screen for prostate cancer. What age do I start? What type of tests are there? Am I more at risk? Do I have to have an “uncomfortable” manual exam?

In the past, there were concerns about “over diagnosing”, “false positive” tests, and unnecessarily scaring men about the threat of prostate cancer; and as a result, the PSA (Prostate-specific antigen)-based test was not part of the proactive strategy. But there are now newer guidelines for men to follow about the PSA-based test to help men determine their risk factor.

The US Preventative Service Task Force (Independent volunteer experts in evidence based and preventative medicine who work to make recommendations about prevention.) https://www.uspreventiveservicestaskforce.org/ have set forth the following guidelines for use of the PSA by men:

Men age 55-69: individual decision on Prostate-specific antigen (PSA) based screening test. Need to discuss potential benefits and harms with their clinician.
Men age 70 – older: No PSA-based screening.
African American Men: Unable to make a recommendation.
Men with family history: Unable to make a recommendation.

There is a similar point of view now from the Prostate Cancer Foundation https://www.pcf.org/ on when to begin screening and if the test is appropriate for you:

40 ➣ If family history
45 ➣ If African American
50 ➣ If no history and not African American
55-69 ➣ Discuss with your Doctor
Over 70 ➣ Not recommended

Often, Men start thinking about how their health is changing somewhere in their early 50s. This is when prostate cancer screening should be considered. Something simple to keep in mind when considering those long term health choices.

By: Patrick Wenning, PT

Photo Credit: https://www.freepik.com/free-vector/person-completing-a-test_1064134.htm

Meditation Retreat: Part 2

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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

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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

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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

Nicole Anzia of Neat Nik

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Nicole Anzia launched her organizing company, NeatNik in 2007. Ever since, she’s used her innate organizing ability and entrepreneurial spirit to help clients all over DC area simplify their lives. She believes that when people feel in control of their surroundings, they are better able to reach personal and professional goals — and they can spend more time doing the things they love. Nicole also writes a monthly organizing column for The Washington Post. Nicole lives in Washington DC with her husband and two daughters.

Spring-cleaning means different things to different people. For some people, this time of year is a chance to de-clutter surfaces, straighten up the home office and clean out their closet. To others, this is a chance to do some serious deep cleaning – windows, appliances, furniture and rugs. There is no right or wrong way to spring clean your house – do what needs to be done and feels right to you.

On my spring-cleaning/to-do list this month
1) Take things out of my kitchen drawers and cabinets and wipe out the insides. And I’m only going to put back the items I need and use.

2) Wipe out the insides of the garbage and recycling cans in my kitchen.

3) Remove things from my vanity’s cabinets and drawers, wipe out the inside and re-organize the contents.

4) Remove everything from the floor of our coat closet, clean the floor, and throw away or donate any shoes or boots that no longer fit or have not been worn in the past 6 months.

5) Clear off my desk and wipe the surface clean. Cull papers and file papers from the past 3 months.

6) Wash my pillows, pillow covers, and mattress cover.

7) Wash throw blankets and have furniture and area rugs deep cleaned.

8) Wipe down baseboards and doors.

9) Throw away old and expired food from my pantry. Wipe off shelves and make a list of what needs to be re-stocked.

10) Discard all old newspapers and catalogues. Remove myself from the mailing lists of at least 5 company’s catalogues.

The change of seasons is a perfect time to clean and organize your home. It’s an opportunity to get things in order and head into the warm spring and summer months feeling in control and refreshed.

Frozen Treat Fruit Smoothie

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Nighttime snacking can be a difficult habit to quell. If you crave ice cream, Dr. Annina Burns of Oxford Nutrition Health, says you may be lacking magnesium. Magnesium helps with muscle relaxation and sleep. Many people are deficient in magnesium because of ongoing chronic stress. Dairy is one source of this vital mineral. If something frozen and tasty is your passion and you can tolerate dairy, try this frozen treat instead of ice cream.

Ingredients

1 C Full-fat Greek Yogurt
1C Whole milk
1 scoop vanilla protein powder (I use Whole Foods brand Whey protein powder)
½ teaspoon vanilla extract
Cinnamon to taste
2 cups frozen berries

You will need a blender that can blend frozen fruit into an appealing consistency and paper cups to freeze ~¾ cup individual servings.

Directions
Pour milk and scoop yogurt into blender. Add protein powder, vanilla extract and cinnamon. Blend for a minute until combined and smooth. Add frozen berries to the blended liquid and pulse blender to break up the frozen berries. Continue to blend mixture until all the berries have been liquefied into a uniform mixture. This may take up to 4 minutes depending on the strength of your blender. Pour ~¾ cup smoothie mixture into paper cup for individual servings. Place the smoothie cups in the freezer. When firm, place them in a bag to protect their flavor. To enjoy, allow the smoothie to sit at room temperature to soften for a few minutes. If you can’t wait, partially defrost it in the microwave on high for 25 seconds.

Click here for a printer friendly copy.

Written by: Miriam Graham, PT, DPT, MBA

RM Hosts DMV Pelvic Floor Study Group

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Restore Motion hosted the DMV Pelvic Health Study Group Saturday, January 27th. There were over 23 attendees from DC, Maryland, VA and WV! Our guest presenter was Dr. Rachel Rubin a urologist who specializes in sexual health. We were thankful for the chance to discuss scholarly articles and challenging patient care issues with Dr. Rubin.

One sensitive topic discussed was the general outrage about the sexual abuse by USA Gymnastics Team physician, Larry Nassar . His actions put legitimate treatment of the pelvic floor in questionable light for the general public. (See link to article below by a pelvic floor PT and doctor of Physical Therapy.)

This determined group of therapists and physician want to speak out for the necessity of pelvic health and sexual health education for all ages. We also enjoyed catching up with and meeting our colleagues and friends. Always good to put a name with a face!

We plan hold more events that bring our network of colleagues closer together to help our patients. It often takes a team of practitioners to heal pelvic dysfunction and sexual trauma. Physicians (urologists, gynecologists, colorectal, gastroenterologists), physical therapists, mental health therapists, nutritionists and sex therapists refer to each other to promote each patient’s healing and well being.

Written by: Miriam Graham, PT, DPT, MBA

Nassar’s Atrocities Stigmatize A Legitimate Medical Treatment article by Lori Mize, PT, DPT