The body is a complex, miraculous structure, which makes having an injury sometimes more complex than you would think. I often have patients come in complaining of shoulder pain, butthe area that’s truly bothering them is their neck, with pain travelling from the neck down to the shoulder. If you look at pictures of the anatomy of this region, it would be easy to see how the two are interconnected. Many of the neck muscles connect to the shoulder blades, collar bone, and shoulder; therefore, a tightness or weakness in one of these muscles would affect both the neck and shoulder.
The same can be said about the elbow and wrist, the regions of the spine, the back and the hip, the hip and knee, and the knee and ankle.
It’s important if you have an injury, that the exercises you do to help recover from it address these muscles that cross multiple joints. This is why it is beneficial to perform a comprehensive stretching and strengthening program in order to target all of the potential areas affected (and prevent these injuries from happening in the first place).

This can be accomplished with the guidance of a physical therapist, exercise physiologist, or personal trainer. In some instances, group classes such as yoga, pilates, and Tai Chi can also be effective for balancing out any flexibility and strength deficits. Some people may work independently on stretching and strengthening, gaining knowldege from books and various online resources (Wellness Professionals – Joint Pain and Arthritis Relief) If you decide to rehabilitate yourself from a minor injury, always be mindful of what you’re feeling in your body. If an exercise causes you pain, it’s your body’s way of letting you know something isn’t right, and you should modify or eliminate the exercise. If you don’t see improvement on your own after 7-10 days, it is highly recommended that you seek the care of a health care provider.
(And always seek immediate care if you experience severe pain, altered sensation, incontinence, inability to ambulate, or other unusual symptoms.)

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.)

With awareness and effort, great improvements can be made in terms of an individual’s posture and body mechanics. Inevitably, poor postural habits will creep into your everyday life at some point. For example, while typing now, I feel myself having to straighten up in my chair and stretch to reverse my slouched posture. It feels better to stretch and undo the stress on the spine. A key to decreasing postural strain is to frequently change your position or activity. The shorter period of time spent performing the same task, the less likely your muscles will fatigue, and the less chance you have for injury. Try to change your position at least every half-hour and take stretch breaks. If you easily lose track of time, you may find it helpful to set an alarm to remind you to change your position.

There are two postural exercises I recommend. The purpose of these stretches is to undo, or reverse the tendency for the spine to be slouched. I recommend you perform these once or twice daily. If you have a job that requires you to be in any one position for long periods of time, it is recommended you perform these exercises several times throughout the workday.

Wall Posture Exercise

Stand with your head, shoulders and back against a wall with your feet shoulders width apart, about 12 inches from the wall. Bring your arms out to your sides with your palms facing away from the wall. Do a pelvic tilt to press the lower back into the wall. Press your thoracic spine and shoulders against the wall without letting your lower back move away from the wall. Next, press the back of your head back into the wall, without tilting your chin up or down. You should feel a stretch along the entire spine if you do this correctly. Hold the stretch for15-20 seconds, and repeat 3 times.

Once this exercise gets easier, raise your arms higher overhead to challenge yourself. You can also bring your feet closer to the wall. The wall posture exercise not only stretches the postural muscles, it also strengthens them as you try to maintain the position.

Chin Tuck

The chin tuck exercise helps to reverse the tendency most people have to allow the head jut forward. The goal is to bring the head back into alignment over the spine, so the ears line up over the shoulders. It is best to practice this exercise in front of a mirror to assure that your form is correct. Stand with your spine straight. Pull your head straight back, without tilting your chin up or down, and try to make a double chin. Your jaw should remain relaxed. You will feel the muscles along the back of the neck stretching. Hold the chin tuck for 3-5 seconds and relax to the start position. Repeat 10 times. The chin tuck is an easy exercise to do at stop lights or when stopped in traffic (never when driving), as many people tend to sit slouched and tense up when dealing with the stress of their commute. The chin tuck will help improve posture and decrease muscle tension.

When I was in college I had my fair share of running injuries…mostly because I didn’t stretch enough. I developed Achilles tendinitis, which is an inflammation of the Achilles tendon, the thick, fibrous tendon that travels from the calf muscles along the back of the ankle.

When the Achilles becomes inflamed, there is less space within the connective tissue sheath that surrounds it. It can feel squishy, or even like it gets stuck as you try to flex and point the foot, due to adhesions that develop. These prevent the tendon from gliding smoothly. The pain can be mild or severe, and is worse during the push off phase of walking or running, or any time you point the foot and toes downward.

Often, there is associated weakness in the Achilles and possibly weakness in the anterior muscles of the shin, with tightness in the calf and Achilles. Both stretching and contracting of the calf muscles may reproduce pain.

Managing this type of injury requires frequent icing to reduce inflammation. Rest is also key. High impact activities, particularly any sports that involve running or jumping should be avoided. Cross friction massage is also very beneficial to improve circulation and reduce adhesions and promote optimal alignment of collagen fibers. It may be that flat feet or high arches contributed to the problem, and orthotics may be helpful in restoring better alignment to the foot and ankle. There are also braces and night splints available for more severe cases that allow the calf muscle to rest and have a gentle sustained stretch. Frequent active stretching of the gastracnemius and soleus, the 2 muscles that form the Achilles tendon, is also essential.

Seeking treatment early will help prevent a chronic inflammation from developing. Physical therapy can be very helpful in correcting any muscles imbalances, retraining the joint receptors, and helping to reduce inflammation with various modalities (such as ultrasound, iontophoresis, and electric stimulation). A PT can also help develop a sports specific rehab program to help get you back to your sport safely and as quickly as possible, teaching you ways to avoid the same condition in the future.

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.

Growing up I loved the Wizard of Oz. The combination of the music, costumes, and the absurdness of it was really so entertaining. In my work, I often think of the poor Tin Man, who was so stiff and constantly needed to oil his joints to keep mobile. That’s really not too far off from our bodies in a way. We have special lubricating fluid in our joints that helps the joints move smoothly.

The joints in the body bend and straighten, but they also glide in multiple directions. For example, the knee bends and straightens, but as it bends, the tibia (shin bone) glides backwards on the femur (thigh bone). And at the same time, the knee cap glides down. There’s a lot of complexity to that really, and if any part of the bending or gliding is limited, pain can occur.

I’m going to stay with the knee as an example because it’s an easier joint to explain. If you sit with your legs straight out in front of you and relax your thigh muscles, you can use your hands to gently wiggle your kneecap up and down and side to side. If the joint capsule (which is essentially like saran wrap around the joint) here becomes tight due to a new or old injury, a disease process, or disuse, knee dysfunction could occur. In addition, tight muscles can restrict the kneecap’s ability to glide. For example, a tight IT Band will tend to pull the knee cap out to the side, decreasing it’s ability to glide inward and altering the resting and functional alignment of the kneecap. This can cause wearing on the underside of the kneecap which would inflame the joint. Injuries to the knee such as chondromalacia patella, IT Band syndrome, patella dislocation, and patella tenndinitis can all be related to a disruption in the gliding mechanism of the kneecap.

So sometimes when you stretch on your own and don’t see an improvement in flexibility, it may be because the joint isn’t gliding correctly and that is what is limiting your motion and progress. The only way to restore normal flexibility in that case is by mobilizing the joint and stretching the joint capsule. This could be done by a chiropractor or physical therapist. There are also self mobilization straps and wedges you can be instructed to use for mobilizing the neck and back. It’s important to maintain the flexibility of both muscles and joints in order to keep from getting stiff and creaky like my friend the Tin Man.

This is the time of year when many of my patients express frustration at not being ableto enjoy gardening because of pain or an injury. Personally, I look forward to making changes to my perennial garden and planning our vegetable and herb garden each spring. And though I’m careful and try to be safe, there are evenings where I find myself sore from a day’s worth of digging and planting.

The back, neck, knees, and shoulders are often taxed with the various motions and positions assumed while tending to a garden. Kneeling, for example can be hard put a lot of pressure on the knee joint and bursa. Squatting repeatedly or for sustained periods can be aggravating to the knees, low back, pelvis, and hips. Raking, weed pulling, and digging require the neck and shoudlers to do a lot of work. So what’s a gardener to do?

I always promote the use of proper body mechanics, however I am realistic too. It’s often difficult to keep the joints in neutral alignment whn working in the garden. In situations where the body is under stress or working in a less than ideal alignment, the following tips may help prevent soreness and injury:

1. Vary your position every 5-10 minutes. Alternate between half kneeling on one knee, kneeling on both knees, and squatting when working low to the ground. It’s also a good idea to vary between standing and squatting to minimize the likelihood of strain to the joints and overuse type injuries.
2. Stretch often. Every 10-15 minutes, do a few simple stretches. Since a lot of positions I find myself in when gardening involve bending forward, I try to do stretches where I bend backward. Placing the hands on the lower back and gently arching back while standing is a nice way to stretch the front of the body. You can also do various stretches for the neck, chest, hip, and hamstring. This gives the muscles a well deserved break, allows better circulation to reach the tissues, and helps restore symmetry and balance to the body.
3. Don’t overdo it. (This is where I often go wrong.) I sometimes get on such a roll and can be in the garden for hours working. Try to limit the length of time you spend to perhaps one hour, maybe more or less, each day.
4. Sit back and enjoy. Allow yourself time to relax and take in the sights and sounds in your garden, even if you aren’t finished.

I was talking with a nurse the other day and she said to me, “You’ll appreciate this…my husband just ruptured his Achilles Tendon.” The look of dread on her face was apparent, and she went on to share with me that he had ruptured his other one only a few years before. They knew exactly what lie ahead.

The Achilles tendon is the thick, long band of tendon that runs vertically along the back of your ankle. It’s where tendons of the calf muscles (gastracnemius and soleus) come together, and it functions when you push your foot down. Actions like pushing off to run, jumping, and other high impact sports all require the Achilles tendon to be strong and pliable.

A more common injury in men, Achilles tendon ruptures are often seen in weekend warriors, though can also occur in seasoned athletes. When a person experiences a complete rupture of the Achilles, he may hear or feel a snap or pop, but with complete ruptures there usually isn’t a lot of pain since the nerve endings are no longer intact. The tendon may then ball up, like a roller shade would retract up, and a lump can be seen and felt in the calf. This type of injury requires surgery to reconnect the Achilles tendon in order to regain a normal walking pattern and daily function.

Following surgery, the rehabilitation course is a long, extensive process. For the first month or more, weight bearing is restricted and a walking cast is required. Physical therapy often begins with gentle non-weight bearing range of motion exercises to start getting the calf and Achilles used to movement again. This is in addition to modalities such as ultrasound, heat, and soft tissue mobilization and scar massage which help to increase circulation to the tissues, promote healing, and help reduce scar tissue and adhesions.

Over the next month, usually the walking cast is still required for all weight bearing in order to protect the Achilles, but additional stretches and strengthening are begun. The boot cast may be taken off (depending on the individual surgeon and case) during therapy sessions at this point. Eventually, and it can seem like forever with this injury, you’re told the walking cast can be removed and walking without it attempted. People are often surprised at how unable to walk they are, since the calf hasn’t had to work to push the foot off the ground. Many have to re-learn how to walk in a more normal fashion without a limp.

It is now that weight bearing strengthening and balance retraining begin for most individuals. Rising up on the tiptoes, using a balance board to shift weight, and progressing to other uneven surfaces, balancing on one leg, and more dynamic stretching of the Achilles are performed.

Return to sports and hobbies can take up to a couple of months more if running or jumping are required. (Maybe a good time to focus on your golf swing?) It is so important to gently warm-up and stretch before, during, and after play, to keep the Achilles soft, flexible, and less susceptible to re-injury.

Just don’t forget to stretch both sides!

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.

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.