Swimming season is upon us, and it really is a great way to tone, strengthen, and improve cardiovascular fitness. Swimming uses all the muscles of the extremities and trunk and provides a comprehensive no-impact form of exercise that is safe and gentle on the joints. For those who are proficient swimmers at the crawl, breast, side, and back strokes, simply varying strokes can provide a great total body workout.

People with arthritis, osteoporosis, and back, knee, hip, ankle, and foot pain can achieve relief from swimming. Even if you don’t know how to swim, you can benefit from short sessions in the pool. If you are unsure where to begin, talk with your doctor about the possibility of participating in aquatic therapy where you can learn exercises specific to your condition. Here are some exercises I used with my aqua therapy patients that may also be helpful:

1. Water walking: walking in the shallow end at a good pace can help to strengthen the legs but in a very low impact situation, thereby reducing strain on the joints.
2. Kick board assisted kicking: Holding the kick board very close to the body for support, practice straight leg and bent knee kicking. This can be done on you belly and on the back in order to train the muscles on all sides of the legs.
3. Deep water leg bicycling on a noodle: straddle one of those inexpensive pool noodles (or 2 or 3 if you need more buoyancy) and pedal your legs as if you were on a bicycle.
4. Arm strengthening with water resistance: one of the great things about water exercise is that you can adjust the resistance by pushing or pulling in the water. You can perform bicep curls, chest press, arm rowing, and rotator cuff strengthening by moving the arms in the specific direction. The faster you move the arms, the greater the resistance.
5. Heel and toe raises: Standing in waist deep water, raise up on the tip toes and back on the heels. This works on balance and is a great exercise for anyone recovering from ankle injuries since the buoyancy of the water makes it easier to achieve your full range of motion.
6. Back float pelvic tilts: Using a kick board or noodles to help you stay afloat, perform gentle pelvic tilts to loosen your back and strengthen your abs. It feels great to do as you’re floating around.
7. Core strengthening with the kick board: Stand in waist deep water with your knees bent and push and pull a kick board forward and backwards. The resistance created by the water tends to make your body sway or tip. Use your core muscles to hold the body as still as possible while doing this exercise.
8. Plyometrics: jumping jacks and jumping up and down in the water help to retrain joint and muscle stretch receptors, but in a safer environment since the water’s buoyancy reduces your weight and overall impact on the joints. (This should only be done in later phases of rehab.)

Although often considered a safe form of exercise for any injury, there are certain conditions that can be aggravated by swimming. Rotator cuff injuries, for example, may be aggravated by overhead strokes. Low back pain caused by hyperextension and abdominal weakness may be worsened by swimming on the belly if the back overarches. It’s important to be aware of any discomfort as you swim. If you feel pain in the water, it’s likely doing more harm than good.

So get out your suit and head to the pool to cool off and get some beneficial exercise for your body. (Be sure to never swim alone and always follow pool safety guidelines to prevent any injuries.)

Parenthood is an amazing, life-altering experience for both first-time and veteran parents. The job of caring for infants and toddlers is mentally and physically demanding. Mothers and fathers spend countless hours holding their baby, carrying him in his car seat (you know how heavy and awkward that can be), and bending over changing diapers. These tasks require strength and stamina and can result in aches and pains for mom and dad if they’re not careful.

Common injuries, such as neck, back, shoulder, or wrist pain can result from the repetitive lifting, bending, and carrying of young children.
Regular exercise is one of the best ways to help prevent these injuries.
The better your endurance, strength, and flexibility, the less likely you are to develop pain.

If you don’t generally exercise, walking is often a nice way to start.
Hand and ankle weights, an exercise ball, and a jump rope are also excellent investments for the home that allow mom and dad to do basic strength and toning exercises when the kids are sleeping or playing. In addition, running outdoors, working out at a gym, or joining a group exercise class will help improve overall fitness. If alone time is sparse, you could always experiment with family fitness.

With the help of some kid-friendly gear, it can be fun for the whole family to exercise together. Strap baby into a backpack and take a hike, or exercise with kids in tow in a jogging stroller or child bicycle seat around the neighborhood. After all, what could be better motivation than a two year old yelling “Faster, faster!”?

Mommy and baby Yoga and Pilates classes and videos are gaining popularity and are a great way to tone stomach muscles and improve flexibility (and there’s no reason Daddy can’t join in). On a rainy day, parents can join their toddler in dancing along to their favorite music or video. It may feel a little silly, but exercise benefits the body, and children enjoy this quality time. Exercising not only keeps the body fit and pain free, but also helps parents model a healthy lifestyle that children can embrace from an early age.

If despite your best efforts you develop pain, don’t ignore it. Aches and pains should be addressed promptly to prevent a chronic condition from developing. Your primary care doctor can evaluate you and prescribe the appropriate treatment, which could include medication, exercise, physical therapy, chiropractic care, massage therapy, or acupuncture.
Your health is essential to you, your children, and your family’s well-being, so make yourself a priority. You deserve it!

An often overlooked muscle group when it comes to stabilization exercises for the pelvis and low back are the pelvic floor muscles (the levator ani and coccygeus). This is a group of muscles that connect from the front of the pubic bone to the tailbone. They create a hammock between the legs and assist in stabilizing the pelvis as well as supporting the abdominal organs, particularly the bladder and bowels.

Weakness in the pelvic floor muscles can contribute to back pain, sacroiliac joint pain, pubic symphysis pain, as well as incontinence (leakage of urine) when you cough or sneeze. Dysfunction in the pelvic floor muscles can be due to trauma, as a result of childbirth, or due to poor posture with associated muscle imbalances.

To exercise the pelvic floor muscles, try to envision pulling the muscles of the saddle area up and in towards your abdominal cavity. You should not feel your buttocks, thighs, or abdominals tightening as you do this. One of the simplest ways to learn to contract the pelvic floor is to stop the flow of urine while you are on the toilet. You can try this technique to verify which muscles to isolate, but avoid doing this often, as it can cause urinary tract infections.

This type of pelvic floor contraction is also known as Kegel exercises. Though it can be difficult to learn how to isolate these muscles, they are an important component of a lumbosacral rehabilitation program. (They’re also very important to do throughout pregnancy and immediately following birth in order to prevent and manage incontinence.) If you are not certain that you are performing these with the correct technique, discuss it with your health care provider or physical therapist.

It seems there are always new products, gimmicks, exercise plans, and support groups that claim to offer the most effective, latest and greatest forms of weight loss. I see it on TV, in magazines, newspapers, and I even received a marketing piece in the mail the other day claiming to be the solution to my weight loss problem (which I incidentally don’t have).

I’m starting to hear and see a lot of the same about back pain. On the radio today they were promoting the newest “controversial” cure for back pain that is supposed to be highlighted on the 11pm news (I hope I stay awake long enough to see it). There are a slew of new products from braces, supports, pillows, and supplements. Not to mention, many, often contradicting types of exercise programs. Even the physical therapy treatments range from very aggressive, to passive and gentle. So how do you know where to start or what to invest in?

I wish there was an easy answer…and if there is, I unfortunately don’t have it. I don’t think there is a magic answer to back pain and for many reasons. Here goes:

1. Every body is different and will respond differently to each product and treatment available.

2. Mental /emotional pain and stress will often contribute to physical pain and if not addressed, the individual may not experience relief from a given remedy.

3. Motivation and commitment make a huge difference. If you are supposed to wear a brace for a certain number of hours a day but don’t, the results may not be as implied. Or if an exercise program takes an hour and you only find 15 minutes, you’re not going to get results.

4. It’s often difficult for me to bring up the topic with patients who are overweight, but finding a weight management program is often needed to find relief from back pain. As hard as it is to lose weight, it is so important to make lifestyle changes that include healthy, mindful eating and exercise.

5. The spine is complex structurally, with so many joints, ligaments, muscles, discs, and nerve, that there is lots of room for things to go wrong. Any imbalance can create pain and result in muscle spasm that can lead to weakness and loss of motion over even a short period of time.

6. If there was a magic answer, there wouldn’t be so many resources, products, and treatments available.

I encourage people to tackle back pain quickly to prevent a chronic problem from developing. If one treatment isn’t successful and you are consistently following through with whatever components were recommended (you have to be honest with yourself here), then discuss alternative approaches with your current provider or seek out complementary treatments. Evaluate your lifestyle and overall physical and mental well-being to see what other directions you may need to follow for treatment. Keep an open mind and open lines of communication between all of your providers so you can achieve the best outcome possible.

And who knows, maybe the 11 o’clock news tonight will have a miraculous break through treatment new to all of us that will put an end to back pain forever.

The knee is a common site for osteoarthritis and various other joint and soft tissue injuries. If you have intermittent aching in your knees, the first thing I would recommend (if I wasn’t able to see you to look at it) is to start to work on strengthening and stretching the quadriceps.

The quadriceps are a group of 4 muscles that run along the front of the thigh and over the knee cap. When they contract, the knee straightens and the knee cap glides up towards the hip. Strong quadriceps help to improve the stability of the knee joint, encourage proper function of the knee, and allow us to easily walk, go up and down stairs, and stand up and down.

When the quadriceps are tight, the degree of flexion, or bending of the knee can be restricted. Tight quadriceps also create undue stress on the kneecap and cause a compression at the knee joint. The result may be pain with activities such as stairs, squatting, running, and prolonged sitting.

Try these quariceps stretch and strengthening exercises and you may notice your knees start to ache just a little less.

When people hear I’m a physical therapist, I often get bombarded with questions about their various aches and pains. This began when I first started college at cookouts, and has continued through the years at weddings, functions, playgroups, and the sidelines at my son’s soccer games.

Though it’s great to be able to talk to people about their problems and help them figure out the best steps to take, there are of course issues with liability (I don’t think my policy covers me if I give advice at the grocery store) and being able to accurately evaluate them based upon a verbal description of their symptoms.

What I love about Wellness Professionals is the numerous exercise videos that have been provided to go along with each of the diagnoses as well as the tools to help you determine what might be going on. All of the instructions are provided in both written and video format, which makes my “job” when I’m not working so much easier. At our most recent family gathering, my brother-in-law asked me what he could do about his neck pain that causes him headaches. I was able to quickly refer him to the Wellness Professionals site and told him to look at the section on cervicogenic headaches and start trying some of those exercises. It is such a great resource to be able to refer people to, and I hope many people out there in the world of cyberspace are able to take advantage of it and start taking control of their pain or injury.

To view the exercises and see which ones are right for you, follow the above link to the home page and click on “Stretches and Exercises.” Remember, the more strength and flexibility you have, the less pain and disability you are likely to experience.

Living with the pain from arthritis can be tiring and frustrating, and its impact on your function and hobbies can really take a toll on your overall well-being. Educating yourself about the best ways to manage your condition is the first step to achieving less pain and greater freedom.

The Arthritis Foundation offers various books, videos, and publications that provide educational information about living with arthritis. Some people find it helpful to meet and talk with others also coping with arthritis in order to share experiences, vent, and gain valuable insight into ways to manage the condition. There are individual state chapters of the Arthritis Foundation that provide ways for people living with arthritis to find this support.

• In Massachusetts, for example, there is a young adult networking group designed for people between the ages of 18 and 44 to learn and share information.
• There are also groups that get together to exercise, which is one of the best ways to manage the pain of arthritis and optimize function and health.
• There are even “Joints in Motion” teams training to walk or run a marathon or half marathon to raise money for children with arthritis. Sometimes giving back to others is enough to ease some of the physical pain you experience on a daily basis.

To learn about the latest research, exercise guidelines, and find out what events and opportunities are available in your area, check out the Arthritis Foundation’s website.

Within physical therapy and among physical therapists there is a a lot of variation in treatments that can be implemented. I’ve worked in hospitals and private clinics, and I have yet to meet 2 physical therapists who would approach a patient with low back pain in exactly the same way. A lot depends on the therapists level of experience, continuing education, and clinical training.

When I graduated with my master’s 10 years ago, I could treat a patient with low back pain in a very basic way. I had done one of my clinical rotations at an outpatient clinic in rural Iowa, and I learned entry-level techniques, without a lot of emphasis on manual therapy for the spine. With my low back patients, I would do some stretching, strengthening, modalities (like ultrasound and electric stimulation), and basic soft tissue and joint mobilization. The lower back was certainly not the area I was most comfortable treating.

Then I attended a seminar where I learned muscle energy techniques, and it changed my approach to back pain (and how quickly my patients felt better). A year or so later I learned another type of joint mobilization and again my experience, approach, and effectiveness improved. I also learned myofascial release, a type of soft tissue mobilization, which added another hands on tool for me to utilize. I wonder had I not taken these particular courses, would I still dread evaluating and treating lower back pain.

I recently read an article that talked about how the approach to care for low back pain patients varies greatly. Some practitioners take a very gentle approach to working with these patients, doing aquatic exercise, gentle stretching, heat, ultrasound, and ice. Others use McKenzie exercises, which encourage a lot of back bending type exercises. Some prefer to do all spinal stabilization. Some therapists use only hands on techniques to restore alignment and muscle balance. This is in high contrast to others, such as the New England Baptist Spine Program which takes a very aggressive approach to strengthening and does not use any modalities or hands on treatment (which has very good clinical results for decreasing pain and improving function for patients with chronic back pain.).

I feel very strongly that each patient is unique and their experience of pain must be looked at very individually. My experience has shown that a combination of some manual therapy, stretching, strengthening, and pain management modalities (all specific to the patient’s body and needs) if necessary provides relief for most patients. If you are working with a therapist and not seeing results, it may be that a different approach to your condition may be what you need. If you notice you are only doing exercises and the therapist doesn’t do any hands on work, you may need some specific joint stretching done. If your therapist is only doing hands on work and modalities, you probably need to do exercises to maintain the changes that their hands are invoking. It’s perfectly okay and appropriate to let your PT know that you are concerned about a lack of progress. You can also ask for a second opinion. You may not feel comfortable telling your provider that you want a different PT to see you, but a good therapist should be open to at least getting a colleague’s opinion and suggestions if you aren’t improving. You can always seek treatment at a different facility as well. If you take that route, be sure to communicate with your new therapist about the specifics of prior treatment that weren’t effective so you can start in the right direction. (You will also need to talk with your insurance company as they may not pay for a second evaluation and you may have partially exhausted your benefit.)

There are many options for back pain treatment within and aside from physical therapy. The same treatment doesn’t work for everybody; if it did, there wouldn’t be anybody living with chronic pain. If you can be open to trying new things, be consistent with the requirements of the treatment (if you don’t do any of your exercises and aren’t getting better, that may be the problem), and be proactive in finding the best solution for yourself, over time you should find relief from your pain.

According to the American Academy of Orthopedic Surgeons, 90% of hip fractures occur as a result of a fall. Women are 2-3 times more likely to sustain a hip fracture, and the morbidity and mortality rates are quite high, with only 25% of people making a full recovery, and almost 25% dying within a year due to complications. There are some basic steps to take to help prevent falls and likelihood of a hip fracture. test

1. Vision is a primary factor for balance, and it is important to optimize vision for fall prevention. Get annual eye exams and ensure there is adequate lighting in your home. If you wake at night to use the bathroom, keep a night light on to reduce the risk of falling.

2. Wear proper footwear. A low heeled, supportive shoe provides stability for the foot which improves balance.

3. Use an assistive device if necessary. Although you may feel too young to use a can or walker, it is much safer to use one than to walk holding onto walls or furniture. If you need a device, be sure to use it all the time to optimize safety.

4. If you experience dizziness, talk to your doctor right away. Many medications can cause dizziness as a side effect, and it may be that you need your dosages adjusted. It can also be a result of vertigo, low blood pressure, and other equilibrium problems.

5. Perform stretches to maintain the flexibility in the calf and hip muscles. If you start to lose your balance, the first receptors to respond are in the ankles. They try to shift the weight onto the heels to adjust for balance, but tight calf muscles will make this response ineffective. The second area to respond is the hips. Maintain good flexibility of the hamstrings and hip flexors to allow for better balance.

6. Maintain as upright a posture as you can. The taller you stand, the less likely you will fall.

7. Make safety modifications within your home. Remove scatter rugs, install grab bars in the shower area, and use a shower chair if necessary to prevent slips and falls. Be sure the railings at any stairways in and outside of your home are sturdy.

If you have even one fall, discuss it with your doctor. S/he may refer you to a physical therapist who can help design a specific exercise program to help improve your balance, strength, and flexibility, and reduce your risk for fall related fractures.

The rotator cuff is a group of 4 muscles (supraspinatus, infraspinatus, subscapularis, teres minor) around the shoulder that help to stabilize the humerus (upper arm bone) and coordinate the movement of the shoulder. These muscles are responsible for keeping the bones aligned and allow full overhead motion without jamming or compression at the top of the shoulder joint.

Injuries to the rotator cuff are common. These muscles and tendons are small, often not specifically stretched or strengthened, and used every day. They are susceptible to micro tears from overuse and can also be injured due to poor posture or trauma.

Muscle imbalances within the shoulder, for example very strong deltoids, chest muscles, and biceps in the presence of weak upper back and rotator cuff muscles can result in problems with the cuff’s ability to function effectively. Using free weights or resistance bands to strengthen the rotator cuff is a very important part of a weight training program in order to ensure healthy shoulders. (There are no specific nautilus machines I’ve seen that target these muscles; however, pulley systems can be adjusted and set up to perform the correct exercises. One word of caution, the minimum weight for the pulleys is usually 10 pounds which may be too heavy to start with, particularly if you have an injury.) Performing shoulder rotation exercises can help to strengthen the cuff and help prevent injuries as well as encourage healing.

As with any other body part, maintaining good posture is important so the joint rests in the correct position. In addition, when a rotator cuff injury is suspected, I recommend people avoid overhead motion and any other activities that reproduce the pain in order to minimize the amount of inflammation within the joint.