Exercise & Vitamin D3 Save Your Noggin!

As a huge Tennessee Lady Volunteer fan, I am very affected and heartbroken by the recent diagnosis of Alzheimer’s Disease at the age of 59 years old in my favorite basketball coach, Pat Summitt.  While some people may have genetic influences that predispose them to this awful disease, lifestyle has been shown to play a huge role in helping prevent decline in cognition (knowledge) as they age with exercise and taking vitamin D3.  As people age, they normally see a decline in cognition and other bodily processes. New research shows that lifestyle factors have a huge influence on protecting that noggin of yours. Evidence supports that you can reduce your risk for dementia and Alzheimer’s by eating right, exercising, staying socially and mentally active, and reducing stress in your life.  You may even be able to reverse the deterioration of your cognition caused by aging by leading a healthier lifestyle. The main topics I am going to touch on today are exercise and vitamin D3 supplementation and their effects on cognition and prevention of disease. 

Physical exercise has been shown to reduce your risk of developing Alzheimer’s disease by up to 50 percent, according to the Alzheimer’s Research and Prevention Foundation (1).  As discussed in my last post about caffeine and exercise, regular exercise also helps reduce stress, improve mood and energy and can even improve memory! How awesome is that?! If you’re pretty sedentary, you don’t have to go crazy about exercise and start jogging, because you will probably injure yourself.  Start slow by adding daily activities that make you move more, such as taking the stairs instead of the elevator, parking farther away from the store and walking, or even taking daily walks outside around your neighborhood.  Even shopping can be seen as exercise….yup, you got it; you’re walking and burning calories.  Nothing like a little retail therapy ladies, right?? It’s easier when you have a partner in crime too, so grab a friend or significant other and take a walk together every night to help ensure you stick to your routine. 

You’re probably wondering why exercise helps improve your brain’s functioning.  Here are some reasons:

1.       Aerobic exercise increases the amount of oxygen in the bloodstream that goes to the brain.  This increased flow of blood (and oxygen) helps to create new blood vessels in the brain where its responsibility is to create/store memories.

2.       Exercise increases the amount of chemicals in the body (dopamine and norepinephrine) that are responsible for helping the brain with attention, memory, and learning.

3.       Exercise increases brain derived neurotrophic factor (BDNF), which is a protein involved in creation of new cells in the brain.  It also helps the brain in resisting damage and degeneration that occurs with aging.

So there you have it folks, exercise is not only good for your body, but it’s good for your brain! You only get one, so you better preserve it while you can.  Another way of doing so is by taking a vitamin D3 supplement.  Vitamin D3 is the form of vitamin D that your skin synthesizes from sunlight and is useful in disease prevention.  Many people will argue that they are in the sun enough and get the daily amount that way (if you don’t live in Wisconsin in the winter! Ha!), however, research shows that 41 percent of men and 53 percent of women in the United States have low vitamin D levels.  Those that have increased pigment in their skin are at higher risk of low levels, as it can take up to 5 times more sunshine for African Americans to get the same vitamin D response as someone with lighter skin pigment.  Not only is vitamin D important in maintaining brain health, it also has been shown to help prevent the following:

·         Cancer

·         Heart disease

·         Stroke

·         Colds

·         Muscle conditions & Osteoporosis

·         Depression

·         Autoimmune diseases

As with any supplement, it is important to talk to your doctor before you start taking one.  This is due to possible interactions with other medications and your body’s ability to metabolize the supplement.  Supplements are not required to be approved by the Food & Drug Administration (FDA), so it is important you ask a health professional about them before use.  The recommended dosage of vitamin D3 has been raised to about 1000-2000 IU/day to ensure prevention of the above diseases; however, research varies and continues to be done and it depends on the person’s body and how they metabolize the nutrient. 

In conclusion, lifestyle factors can help reduce the risk of Alzheimer’s and dementia by up to 50 percent; however, some people may still be at higher risk for the disease secondary to genetic factors.  Regular exercise is beneficial to your cognition by helping improve function of the brain, attention, and memory.  Vitamin D3 has also been shown to reduce the risk of dementia and several conditions/diseases when taken daily at a higher dosage.  So it’s time to start exercising and taking some vitamin D3 to help ensure a longer-lasting healthy brain. 

Resources:

1.       http://www.helpguide.org/elder/alzheimers_prevention_slowing_down_treatment.htm

2.       http://www.aurorahealthcare.org/yourhealth/wellness/whitcomb/default.aspx

3.       Exercise & Cognition: Can Exercise Make You Smarter Tri-fold by Katie Kowalski, DPT

Caffeine or Exercise??? That is the Question!

Last week a man came into my clinic and tried to advertise sales for “5 Hour Energy”.  He wanted to sell it in my clinic.  As a huge advocate for exercise, I firmly disagreed with the idea of selling an energy drink in my PT clinic.  So many people are turning to caffeine products to get their daily dose of energy, instead of realizing that this effect is only temporary and can cause health problems or even addiction to caffeine.  Caffeine is highly addictive and can cause withdrawal symptoms, leading to increased use of the product and ultimately leading to a downward cycle for dependence on more and more caffeine for that energy kick.  What people don’t realize is that exercise, adequate sleep, and a healthy diet have been shown to give you long-lasting energy that energy drinks can’t provide and they’re a much healthier option for you.  Don’t get me wrong, I love a good cup of coffee or a can of soda, but I know that they are only temporarily providing me relief for fatigue.  Today I am going to discuss the differences between caffeine and exercise for daily energy.

Caffeine is useful for short-term boosts of energy.  Most energy drinks contain a large amount of sugar and other substances that can lead to weight-gain and unhealthy side effects such as:

·         Nervousness

·         Increased heart rate

·         Increased blood pressure

·         Irritability

·         Decreased ability to sleep

·         Anxiousness

Foods and drinks with caffeine and a large amount of sugar may provide that short-term kick that you need; however, they can actually cause you to be more fatigued later, leading to increased use of caffeine for more of a boost.  They may also be loaded with vitamin B which will make you think they are healthy; however, fish and vegetables have plenty of B vitamins to jump start your energy, instead of the increased load of sugar and other empty calories your body doesn’t need from these energy drinks. 

Exercise has been shown to have awesome physiological benefits on the body, including reduction of fatigue.  Below is a list of positive effects brought to you by regular exercise:

·         Decreased blood pressure

·         Improved cholesterol and fat levels

·         Decreased resting heart rate

·         Maintained flexibility of arteries

·         Improved mood and energy level

·         Stress relief

·         Decreased pain (if pain is caused my disuse of muscles and joints that stiffen)

Now if you go ahead and compare the effects of caffeine and exercise on your body, you will see that they are complete opposites.  You can clearly see that exercise is the healthier option here. 

Most people will argue that they are too busy to exercise and I will argue right back with my favorite quote from a sports ad, “Someone busier than you is running right now.”  It’s true…most people can find time in their busy lives to exercise, but most often they don’t want to fit it in their schedules.  They feel they are too tired or stressed, but if you have learned something above, you will see that these things can be reduced with a regular exercise program! Yayyyy!  Stress is a huge contributor to fatigue in our society. We are overworked, undernourished or overnourished with poor food choices, and lack proper sleep and exercise routines.  Most people want that quick fix and don’t want to fix the underlying framework behind why you’re fatigued in the first place.  If you take a rubberband and wrap it around your finger as tight as you can, it’s pretty painful right? Well hmmm, we could numb it with a shot right??? Well that would only be temporary. Ok, well let’s kill the pain with pain killers….and again, the rubberband is still there and you’re masking the main problem. Well let’s just take it off of our finger! BINGO! That’s the answer. We have to fix the underlying cause and in this case, that's with regular exercise, a healthy diet, and improved sleep patterns. Now some people may have fatigue for other medical reasons, other than poor diet, lack of exercise, and stress.  These people that suffer from chronic fatigue and don’t find relief with change in their diet, improving sleep patterns, or regular exercise should seek a qualified physician for further medical investigation. 

So what are you gonna choose to do next? I guess that’s the main question.  If you decide that exercise is for you, the American College of Sports Medicine (ASCM) provides guidelines for exercise and its benefits.  Below is a list of these guidelines from their website:

Cardiorespiratory Exercise

·         Adults should get at least 150 minutes of moderate-intensity exercise per week.

·         Exercise recommendations can be met through 30-60 minutes of moderate-intensity exercise (five days per week) or 20-60 minutes of vigorous-intensity exercise (three days per week).

·         One continuous session and multiple shorter sessions (of at least 10 minutes) are both acceptable to accumulate desired amount of daily exercise.

·         Gradual progression of exercise time, frequency and intensity is recommended for best adherence and least injury risk.

·         People unable to meet these minimums can still benefit from some activity.

Resistance Exercise

·         Adults should train each major muscle group two or three days each week using a variety of exercises and equipment.

·         Very light or light intensity is best for older persons or previously sedentary adults starting exercise.

·         Two to four sets of each exercise will help adults improve strength and power.

·         For each exercise, 8-12 repetitions improve strength and power, 10-15 repetitions improve strength in middle-age and older persons starting exercise, and 15-20 repetitions improve muscular endurance.

·         Adults should wait at least 48 hours between resistance training sessions.

Flexibility Exercise

·         Adults should do flexibility exercises at least two or three days each week to improve range of motion.

·         Each stretch should be held for 10-30 seconds to the point of tightness or slight discomfort.

·         Repeat each stretch two to four times, accumulating 60 seconds per stretch.

·         Static, dynamic, ballistic and PNF stretches are all effective.

·         Flexibility exercise is most effective when the muscle is warm. Try light aerobic activity or a hot bath to warm the muscles before stretching.

Neuromotor Exercise

·         Neuromotor exercise (sometimes called “functional fitness training”) is recommended for two or three days per week.

·         Exercises should involve motor skills (balance, agility, coordination and gait), proprioceptive exercise training and multifaceted activities (tai ji and yoga) to improve physical function and prevent falls in older adults.

·         20-30 minutes per day is appropriate for neuromotor exercise.

It is important to fit these things into your workout routine to improve your overall health and well-being.  Going for a walk during a lunch hour is a huge start to jumpstart energy in the middle of the day to fight that post-lunch fatigue.  Movement is power. Join a yoga class to reduce stress and improve flexibility and mindfulness.  If you need that extra kick in the butt to get moving, get a personal trainer.  Visit http://igo-fitness.com/ and check out their awesome training and yoga classes.  You can still have caffeine in your life, but just remember the risks vs. the benefits.  Is that short-term wakefulness worth it overall or would you rather exercise and eat healthier to not only boost energy, but also improve overall health? That’s your ultimate decision. 

References:

http://www.livestrong.com/article/465128-the-effects-on-exercise-on-energy-levels/

http://www.greatist.com/fitness/new-acsm-exercise-guidelines/

http://igo-fitness.blogspot.com/2011/09/568-hour-energy-and-worx.html#!/2011/09/568-hour-energy-and-worx.html

http://www.mayoclinic.com/health/caffeine/NU00600

My Knee Hurts...So Why Are You Looking At My Hip???

Are you struggling with knee pain? If so, you may have gone on Google and searched treatments for knee pain and found a bunch of websites that advertise injections and other temporary pain relief solutions.  I have discussed pain in past posts and again I will tell you that pain is your body giving you the “check engine” light. You have pain for a reason and shouldn’t ignore it or mask it with medication or injections.  Injections, medications, and other modalities used to relieve pain can and should be used in conjunction with other forms of treatment to help relieve pain and reduce the body’s natural inflammatory response; however, you should not rely solely on them to help make your issue go away completely. Searching the internet, you may have also came across people discussing hip strength related to reducing knee pain.  Today, I am going to discuss the diagnosis of plain old “knee pain” that I get from referring physicians and the importance of looking at the whole picture, especially hip strength. 

Knee pain can be caused by several different factors, such as trauma, acute injury, the aging process, or onset of new activities.  Knee pain is not always the result of trauma.  Most of my patients with knee pain have it for years and they have no idea how it started, while others recently started running or exercising and their body did not tolerate it too well because they progressed themselves too fast.  If you have gone to physical therapy in the past, they may have tried to give you exercises to strengthen your hips and butt and you may have looked at them like they were crazy because your pain was in your knee.  The truth is that everything is connected when your foot hits the ground and your hips are key supporters of your knee.  Your quadriceps and hamstrings help control your knee in the plane of movement that causes your knee to flex (bend) and extend (straighten).  These muscles do not tend to help much with rotation as your foot hits the ground and this is where your butt comes in handy! Your gluteus medius (as shown below) helps stabilize your knee and prevents it from rotating too much as you take each step.  It does this by stabilizing your pelvis and core, to prevent it from placing the joints below, such as your knee and ankle, in a detrimental position. 

Reference

This detrimental position I am referring to is called dynamic valgus (shown below), or the knee moving inward with squatting, jumping, walking, transferring from standing to sitting in a chair, running, or other daily activities.  It is important to note that some people have a natural valgus at both knees, and may be subject to further wear and tear at the knee joint with increased activity levels.  The strength of your hips/glutes and the way your foot hits the ground plays a huge role in the way your entire leg absorbs impact.  If you have weak glutes, your knee joint may be absorbing more impact when your foot strikes the ground instead of your hips, which may cause pain and increased chance for joint damage.  Another thing to keep in mind is that you may also need different shoes or orthotics (shoe inserts) to help stabilize your foot as it hits the ground.  If your arch drops when you squat or walk, you may be told that you “pronate”.  This also places your knee at greater risk for injury and should be analyzed further. 

Reference

There are so many factors that can contribute to knee pain, so proper analysis is recommended.  As a physical therapist, I take a look at the whole picture and find what is causing your knee pain.  I assess strength, range of motion, flexibility, and dynamic movement.  I also give suggestions for proper footwear and orthotics, as well as assess running mechanics if my patients run frequently.  My main goal is educating the patient to help fix the problem and prevent it from reoccurring in the future.  If your knee pain is caused by trauma, I assess the integrity of ligaments, muscles, and tendons around the area and refer to a physician for imaging, such as x-rays or MRIs, if my findings warrant further investigation.  I use modalities such as ultrasound, electrical stimulation, and ice/heat to help reduce inflammation and pain in the area to aid healing.  I recommend a combination of knee and hip strengthening exercises to my patients to help them improve their mechanics as they move.  Usually, with a combination of modalities for pain, flexibility and strengthening exercises, my patients are pain free within a few weeks.  (Please note that healing time varies by the person, lifestyle, age, and anatomy) If you want your knee pain further evaluated today, give us a call. It’s never too late to get back to the activities you love most!

608-222-2325

Runners Beware: IT Band Syndrome Can Haunt You

The weather is changing and avid runners are anxious to get off of those treadmills and begin running outside as the snow and ice begin to melt.  As people begin to train for races or start running for pleasure, they may not be aware of training principles and proper progression of distance and time of runs. Being unaware of properly progressing your runs or exercise routine can cause injury.  Even if you have been running a certain mileage for awhile, your body may not be strong enough to handle it if you are not performing a regular strengthening regimen.  Once your muscles get fatigued, your body can begin to compensate for tired muscles and cause your body mechanics to change eventually giving rise to injury.  Several injuries can occur, however, today I will specifically be discussing the ugly Iliotibial (IT) band syndrome that causes runners to have excruciating hip and knee pain. 

Reference Page 

As displayed above, the long white band of tissue on the outside of your leg is your IT band.  IT band syndrome is caused when your IT band, the band of tissue that attaches from your ilium (outer pelvic bone) to the outside of your tibia (shin bone) and patella (knee cap), becomes taut and can cause lateral tracking of your patella or friction (rubbing) on the top or end of your femur (thigh bone).  This can cause diffuse pain and tenderness in the hip region or the outside of your knee.  If irritated severely enough, you may feel like your knee is "locking" when trying to bend or extend your knee or you may feel like your hip is "popping" or "snapping".  This whole phenomenon can be caused by muscle strength and flexibility imbalances, as well as with fatigue during prolonged running causing faulty mechanics that lead to injury. 

If this sounds like something you're experiencing, there are some home remedies you can try.

1.  First and foremost, ice and rest are ways to help relieve immediate pain. Icing for 10-15 minutes every couple of hours can help relieve inflammation. Also, if you are able to take ibuprofen, it is best to take that with food for a few days as directed by the bottle to help reduce inflammation further.  If unable to take ibuprofen, other pain relievers can help with reduction of symptoms.

2. One of the best things to do for this injury is using a foam roller to massage the IT band to help stretch out and loosen up the tissue.  Let me warn you that this is painful and most people aren't fans of this exercise, however, I promise that it gives good results.  If you or your gym do not have a foam roll you can purchase one for a reasonable price at Amazon.com, or it is ok to use a tennis ball, coffee can, basketball, PVC pipe, or other object that is somewhat dense and able to roll along your leg.  The harder the object is, the more massage you will get, however, it can be pretty painful if you start with a very dense object like a PVC pipe or coffee can.

*Start with the foam roll positioned under your hip on the painful side (as pictured above) and begin to slowly move your body upward so the foam roller rolls down the side of your leg towards your knee.  You can use your other foot and arms to help you move along the roller. 

*Once you have reached the outside of your knee (as pictured above), you can begin rolling back towards your hip.  You will repeat this slowly 10-15 times.  It is wise to perform this on both legs so that you can keep both IT bands from becoming tight.

3.  Strengthening of the gluteus medius (hip abductor) and gluteus maximus (buttocks) muscles is highly recommended for people with IT band syndrome.  If these muscles are weak or fatigue during running, it can cause your pelvis to be unstable with running and cause your knee to rotate inward when your foot hits the ground.  This inward rotation of the knee can cause not only your IT band to get stretched and irritated with every step, but can also cause further knee and foot injury.  Below are some great exercises you can perform to strengthen your glutes!

*Side Stepping with Band: If you have a theraband (elastic band) that you can tie around your ankles, this exercise is great to work the gluteus medius.  You will perform a slight knee bend, keeping your butt back and preventing your knees from going over your toes, while you step sideways across the room with the band. It is important to make sure your knees do not rotate inward with each step and that you keep your toes facing forward.  This should be performed with 15-20 steps in each direction once a day. 

*Sidelying Leg Lift: This exercise can be performed anywhere and is great to activate the gluteus medius. Lay on your side with your bottom leg slightly bent.  Keep the top leg straight and lift it straight up and down, making sure that the leg does not come forward at all.  To get good gluteus medius activation, it is recommended that you keep your leg slightly extended while you lift it.  Perform a couple sets of 20 repetitions once a day on each side.  If you have ankle weights, you can add one to three pounds to progress this exercise. 

*Singe Leg Bridge: The single leg bridge is a great way to isolate your glutes.  Bend one knee in towards your chest (or you can hold it out straight with your knee extended) and bend the other knee up and keep your foot on the ground.  Keep your stomach muscles nice and tight while slowly lifting your butt off of the ground and back down.  Be sure that your pelvis remains level the entire time. Peform a couple sets of 10-15 repetitions on each leg once a day.  ***Please note that this exercise is advanced and may be too difficult for some people.  If this is the case, start by keeping both feet on the ground and lifting the butt up with both legs, instead of one.***

*Body-Weight Squat (with or without theraband): Another great glute strengthening exercise is the body-weight squat.  This exercise, if done correctly, should not cause pain.  If it does cause knee pain, please do not perform it or contact a physical therapist or personal trainer for advice.  Start with your feet shoulder width apart and your toes facing forward.  Slowly squat down, keeping your butt backwards and your knees in line with your feet.  The key thing to remember with squats is that your knees should not go inward or over your toes.  You can stick your arms out in front of you or hold onto a sturdy object for balance if needed.  If you have a theraband, you can place it around your knees for added gluteus medius activation.  The band will want to pull your knees inward and you must resist it in order to keep them in good alignment.  Perform a couple of sets of 15-20 repetitions once a day.

It is important to note that the strengthening exercises should not cause pain.  You may feel a slight burning or achy sensation in the muscles when the muscle is working during the exercise, however, this is normal and should not be a sharp pain.  Also, with any new exercise routine, it is normal to have muscle soreness up to 24-72 hours after exercise.  To help with reducing this soreness, it is best to keep moving around, stretch, and drink a lot of water to help flush the muscular tissues. 

I suggest trying these exercises to help relieve your pain and take a break from running until your pain subsides. You can perform other non-painful aerobic activity in the meantime. If your pain does not relieve itself within a few weeks, it is best to seek help from a physical therapist.  If you do not feel comfortable trying these exercises without the advice of a professional, feel free to seek help right away.  Physical therapists can provide pain and inflammation relieving strategies such as ultrasound, electrical stimulation, and iontophoresis, as well as help mobilize the soft tissue with manual therapy and massage techniques and give further education on stretching and strengthening exercises you can perform to decrease and get rid of your symptoms.  We can also take a look at your feet and suggest types of shoes you should be wearing, assess your running technique and provide any helpful hints on improving your form to decrease likelihood of further or future injury, and give ideas on things to avoid or how to progress your training regimen. 

If you think you have IT band syndrome or if you just want your running form or shoewear assessed professionally, please give us a call today!

608-222-2325



The Importance of Collaborative Medicine and Patience

Too many times I have heard patients complain that their doctors and physical therapists gave up on them after only trying one or two things to fix them. Unfortunately, our healthcare system makes doctors so busy that they rarely have much time to actually listen to their patients and spend time with them anymore, leading to missed diagnoses and continued pain. Sadly the country’s healthcare system has turned to drugs to help mask the pain, while leaving the patient with the problem that still remains. We see all these commercials on television for drugs to take for everything and all of a sudden we are convinced that all of our problems will fade away with a “miracle drug”.  The United States is one of the only countries that legalized advertisement of pharmaceuticals on television.  We may find temporary relief with these “miracle drugs”, but if we don’t treat the issue that’s causing it, there’s only so much that drugs will do to stop the pain. The best form of treatment that I will discuss later in this blog is a collaboration between health care providers with a mixture of medications needed for pain and inflammation reduction that coincide with physical therapy treatments to rid the pain and it’s causative factors completely. 

As a patient and physical therapist, I have experienced the realities of our disaster of a healthcare system.  As a patient, I was at the dentist and had to get a crown, which can be very painful.  After I was done with the appointment, they gave me a prescription for a high dosage of Vicodin, an addictive narcotic, which was completely unnecessary.  I also went to the doctor for a strep test because my throat was in severe pain and he offered me a prescription for Hydrocodone and pushed me to take it.  I was shocked at how easily available these narcotics are to people.  It’s like they hand them out like candy because people want a quick fix or way to mask the pain.   As a physical therapist working in Racine, WI, I actually had a patient call to tell me that her doctor told her she was getting too old for physical therapy and to just take pain pills to ease her pain.  This patient constantly complained that she was in pain and it was almost as if she didn’t have the patience to get better so she wanted an instant fix.  Now if you understand research on aging, you would know that nobody is “too old” to gain muscle and ease pain by getting stronger and increasing flexibility.  It may take longer to get the results secondary to the aging process; however, it is possible to still achieve good results.    I continue to be shocked at how much we turn to the pharmaceutical company these days.  It is truly sad how much advertisements sway our beliefs and how much we depend on medications to get us through the day.    

I believe that some medications are very helpful and necessary for helping heal ailments and reducing the inflammatory process; however, we tend to depend on them too much for temporary pain relief instead of working hard to fix it completely.  The best use of medications is in collaboration with other treatments.  So many people are looking for that “quick fix” and easy way to feel better instantly.  What they don’t understand is that the quick fix they are looking for only lasts temporarily without some other form of treatment that actually is geared towards fixing the actual problem.  The patient has to put in a little work and possibly endure some pain along the way to get the best results.  Patience is the key in rehabilitation, along with trusting the therapist. If you’re willing to put in the work, it goes a long way. 

 A good physical therapist will make sure to assess the whole picture and not only treat the area that is causing pain, but understand what caused it originally and ensure that gets fixed as well.  At Monona Rehabilitation Services, I strive to find the root of the pain and treat with a “whole-body” approach, instead of just recommending ways to mask the pain and discharging them when they no longer feel pain.  If someone no longer feels pain, it doesn’t mean they still don’t have impairments that can make it return in the near future.  If I discharged them too early with remaining impairments that led to the problem at hand originally, my patients would be back again and again.  Now, as much as I would love the business, I would much rather see my patients healed than want them back in the clinic with the same issue because whatever caused it wasn’t fixed the first time.  It is a pet peeve of mine when my patients complain that past physical therapists they had gave up on them because they couldn’t figure out what was wrong within a few weeks.  Now this can happen if all the possibilities of treatment have been exhausted (there are A LOT!) and nothing seemed to work, however, it is highly unlikely that they tried everything because this will take a very long time.  To be completely honest with you, physical therapy is trial and error based on immense amounts of research.  We practice based on evidence that is strongly supported by years of research and if that doesn’t work, we try another research-supported approach.  Like I said, there are several approaches to treating patients and since every patient is different, some things won’t work on every person.  Not only is it important for the patient to have patience, but it is equally important for the therapist to be patient in order to find the best approach for each person they treat. 

 I have ranted about a lot in this blog; however, please understand I am in no way trying to bash doctors or other physical therapists.  There are some very good doctors and physical therapists out there that will take the time to listen and help you find the answer that you need.  Every therapist and doctor is different and has different approaches to treatment.  What I wanted to present to you was the sad truths of the healthcare system and the unfortunate beliefs that are created so people get that “quick fix”.  To be completely honest with you, there really is no “quick fix” that lasts.  Like I have discussed in the past, pain is your body’s natural “check engine” light that needs to be assessed.  It is a signal that your body presents to you to tell you that your tissues are in danger.  If you just mask that signal with only pain medicine, the problem will persist and only get worse over time leading you to need even more medicine to “mask” the pain.  It really is a vicious downward cycle if not treated correctly. 

If you take the patience to come to physical therapy, we can help you get rid of that pain for good and I will help ensure that it doesn’t come back.  I had a patient in her 70’s that had knee pain since 1995 when she got her knee replaced.  She came to see me a couple of months ago after dealing with the pain for so long and within a week of putting her on a regular strengthening and stretching program, she was pain-free.  It takes some work, but it’s totally worth it.  She can defend that statement and is happier than she has been in awhile.  Her family has noticed a huge difference in how she walks and even transfers in and out of a chair or the car. 

The best way to get results you want and need is a collaborative approach between doctors and physical therapists, as well as personal trainers and other healthcare workers that are necessary in the plan of care.  Working together, we can help create a unique treatment program geared towards you.  It may combine pain medications temporarily to help ease pain and reduce inflammation, but you must know there is no “quick fix”.  If your therapist or physician is unsure of what to do next, it is perfectly acceptable for them to refer you to someone else that is more specialized in the area. After all, knowing their weaknesses and limitations makes them a better healthcare worker and helps ensure you get the proper treatment you deserve.  If you’re ready to take the next step in getting rid of your pain completely with a collaborative approach and have the patience to do so, come see us today and let me help you get back to what you strive to do pain-free!

Call us at 608-222-2325

Work Place Ergonomics 101

I have had several people complain to me that they sit for a huge portion of the day for work.  As more and more desk jobs arise, I have an increase in the number of patients with neck and back pain related to sitting at work.  Along with these issues, I also hear about “Carpal Tunnel Syndrome” and so many people I know have had surgery to correct this chronic injury, however, it can come back if the main source of the problem is really stemming from the neck and sitting posture.  Other injuries associated with poor posture include, but are not limited to, elbow and wrist tendonitis, shoulder pain and impingement, disc herniations, and sciatic nerve irritation. Below I will discuss proper sitting posture, as well as suggestions for promoting this during the work day.  Also, I will let you know the benefits of seeing a physical therapist for injuries related to poor posture. 

First off, I will review sitting posture that I talked about in the last blog about body mechanics, but I will show a picture below of proper sitting mechanics while at a desk that I found from a website on Google. (http://www.fitsugar.com/Sitting-101-Desk-Ergonomics-1669975)

• Adjust your chair so your hips are resting between 90-120 degrees.  If your feet do not touch the floor, you will need to use a foot rest.  (books tend to work nicely)
• Make sure your lower back is supported promoting its natural curve as shown above.  A lumbar roll or rolled up towel will do the trick. When your low back is in good alignment, it promotes positive aligment above and below. 
• Elbows should be bent between 90-120 degrees with your arms next to the side of your body.  Wrists should be straight, so your keyboard and chair height may need to be adjusted to promote this alignment.
• Ears should be in line with your shoulders and your shoulder blades should be squeezed gently together to promote an upright posture, as discussed in last week's blog. 
• Keep objects you use the most closest to you, so you are not repetitively reaching for them and straining your arms and neck. 
• I suggest getting a headset for your phone if you answer a lot of phone calls to decrease the likelihood of injuring your neck. 
• The top of your computer screen should be at eye level so you don't have to continuosly flex your neck downward to look at it. 
• Avoid crossing your legs during the day for prolonged periods of time because this interrupts proper pelvic and back alignment and can cause injury to occur. 

These are all good suggestions on how to improve sitting posture throughout the day.  Keep in mind, however, that sitting for longer than 30 minutes is tough on your body.  Pain is felt when your body senses danger.  Everybody senses pain differently and at varying intensities, depending on your body's perception of danger.  Sensors in the body send signals to your brain telling you to do something about this pain you are having. Most office workers and people that sit for prolonged periods throughout the day may sense pain mainly because of lack of movement. Your body was made to move and in order to flush out the waste products your body creates throughout the day, you need to move to increase blood flow to your muscles and rid these waste products.  It may sound silly, but even just making a bunch of random movements in your office during the day is better than sitting completely still for hours upon end.  Every 15 minutes or so you should get up and stretch or walk around your cubicle or office.  If you feel pain, listen to your body and move around.  If you ignore it, it can result in the injuries I listed above.  Below are some gentle quick exercises you can perform to increase movement throughout the day.

• Shoulder shrugs - Move your shoulders up and down, as well is in a clockwise or counter-clockwise pattern.
• Neck stretches - Gently move your neck in all directions to help increase mobility throughout the day. (neck circles work nicely!) Tilt it to the side for 30 seconds and then to the other side to stretch the upper trapezius muscle at the top of your shoulders. 
• Shoulder blade squeezes - Gently squeeze shoulder blades down and back and tuck your chin so your head lines up with your shoulders as discussed in my first blog post about body mechanics.
• Ankle pumps - Move your ankles up and down and around in circles to increase blood flow to your legs. 

If you have pain that won't go away with movement or stretching, or have any numbness or tingling in your arms or legs, it is recommended that you seek intervention to prevent further injury from occuring.  Like I said earlier, your body is in pain because it senses danger, so think of it as a warning sign that you need to get it fixed.  If your "check engine" light in your car goes off, you get it looked at right? Otherwise you don't know what could happen...your car could break down and you could get stranded somewhere...the possibilities are endless. Think of this pain as your "check engine" light....go get it looked at and prevent what could happen in the near future! You only get one body, so you wanna be sure it lasts a long time.  Below I will list some of the benefits to coming to physical therapy for this pain that you may be experiencing.

Benefits of PT:

• We evaluate the whole picture and not only treat the issue at hand, but find what caused it and prevent it from happening again by mobilizing joints, improving flexibility and strength, and educating patients on prevention and the overall plan of care.
• We educate patients about their pain and provide a description of their injury in a way that is easy to understand.  After all, who wants to hear a bunch of big words thrown at them that they don't understand?!
• We provide modalities to relieve pain right away, such as ultrasound, electric stimulation, cervical and lumbar traction, TENS, iontophoresis, and heat/ice. We also give guidelines for icing and heating at home.
• We provide a home exercise program with stretches and strengthening exercises to help relieve pain and prevent it from coming back. 

My philosophy is treating the joints above and below the pain because the body is all connected.  Ankle pain can be coming from the low back, just like pelvic misalignment can cause increased incidence of ankle sprains.  I individualize each plan of care because everyone is different and has a different activity tolerance.  I listen to the patient and base my plan of care off of their needs and goals.  If you want to get back to the activities you want to do without pain and limitations, give us a call today and schedule an evaluation!

608-222-2325

Simple Body Mechanics for Daily Activities

Many patients I have come in with injuries secondary to faulty body mechanics while lifting, shoveling, vacuuming, and other daily tasks that can easily cause back or neck pain.  I spend several sessions reviewing body mechanics with people and they play a huge role in daily life if you want to prevent injury and pain. After all, nobody wants to be in pain. I will review some simple body mechanic facts and ideas, as well as go through certain tasks and describe the best way to go about them to prevent injury from occuring.

First, I will discuss posture because it is a HUGE factor associated with daily pain and chronic injuries.  As people age, they begin to develop a forward head posture and rounded shoulders if they are unaware of their body position while sitting at a computer, school desk, standing to do the dishes, or even while eating at the dinner table. Most people begin to slouch secondary to decreased core strength and it seems "more comfortable" as we get fatigued or even lazy throughout the day. I will admit that as the day goes on, my posture begins to fail because I am tired.  Let's be real here, who doesn't get tired? That is not an excuse though because your body will pay for it later! WeThe key things to keep in mind is that your head should be directly over your shoulders...and when I say this, it means your ears should be located over your shoulders.  Next, your shoulders should be in line with your hips and then your hips in line with your ankles with equal weight on both feet.  This promotes proper posture and helps prevent neck and low back pain from occurring, especially if you are seated or standing for long periods of time during the day for work or daily tasks throughout the house.  A good thing to do is reassess your posture every 15 minutes.  It takes 10 seconds to realize where your body is in space and adjust it accordingly.  If your posture is faulty throughout your life, this leads to changes in the spine, pain, and tight chest musculature.  To put things in perspective, your head weighs about 10-13 pounds and if it is forward at all it can put up to 3x that weight (about 30 pounds) of pressure on the muscles in your neck and upper back.  Just think of all the energy your body could preserve if you had good posture! These things can be prevented with a simple assessment of your posture throughout the day.  If you already have rounded shoulders, it is important to start doing a chest stretch.  Below is a picture of a chest stretch in the corner that can also be performed in a doorway if you place your forearms on the wall or door frame and place one foot in front of the other and lean forward.  This stretch should be gentle and not painful.  Hold for 30 seconds and repeat 3 times up to 2-3 times a day to help decrease rounded shoulders. 

Another exercise that should be performed to help improve posture is sitting up tall and squeezing your shoulder blades down and back, while trying not to extend your lower back and while keeping your chin tucked in so that your ears are lined up with your shoulders.  Machines and exercises that target the middle and lower trapezius muscles, as well as the rhomboids should be used to help promote better posture.  These exercises should get you started on a healthier posture today!


The next thing I will discuss is lifting mechanics.  Many people will use faulty body mechancis to lift an object, even as light as a pencil, however, this can still result in a "bulging disc".  There are "jelly donut-like" structures between each vertebrae in the spine that help absort shock between each bone and these are called intervertebral discs.  People lose up to 3/4 of an inch in height each day as gravity pulls on these discs and drains their water content....but don't worry because you gain your height back when laying down to sleep at night! (Kinda cool, huh??) As time goes on, however, your discs do lose water content and that is why elderly people seem to "shrink" and are shorter than they used to be. Postural changes play a big role in that too....so looks like you better start early on prevention! To prevent yourself from back injury, it is important to follow these simple rules while lifting an object, no matter how heavy it is.  There are two main ways to lift up an object. (See below paragraph for pictures of both strategies) The first way is the bend at the knees with a wide base of support, keeping the object close to your body.  With this strategy, you want to be sure to keep your spine in a neutral position and tighten your abdominal muscles while using your legs to push up from the ground and lift the object.  The second strategy is the "hip hinge".  This strategy can be used if you have painful knees.  To perform this properly, you must keep your back flat and bend completely at your hips while maintaining a slight knee bend.  Again, it is always important to keep the object close to your body.  If you go to lift up a 5 pound object and hold it directly out in front of you, instead of close to your body, it will add up to 10x that weight in pressure on your spine (up to 50 pounds in this case).  Another thing to remember is not to rotate at the spine when holding or moving an object.  Instead of rotating your spine, you should rotate your entire body.  When carrying an object, you should avoid over-extending or over-bending of your low back, as well as shrugging your shoulders in order to keep pressure off of muscles that can easily be irritated.  When pushing or pulling an object, keep in mind that pushing is easier than pulling and you should keep loads close and maintain a neutral curve in your spine while tightening your core musculature.  These simple things can help save yourself from a lifetime of back injuries!

 

Strategy 1: Knee bend               Strategy 2: Hip hinge

Lastly, I will talk about shoveling! For all those people in Wisconsin, we know how this simple task can turn into a nightmare and loads of back pain and sore muscles the next day.  The key things to remember with shoveling, I have already discussed above. Simple to remember then, huh? As a reminder, the main thing is to keep the load close to you, bend at the knees, and don't rotate at your spine.  Most people, me included, have tried to shovel and when tired, we tend to want to just throw the snow by rotating to the side....this is very BAD and creates injuries and sore backs the next day.  Always rotate your entire body if you want to move the snow. Please remember these simple things next time you go out to shovel. 

Hope this was helpful! Please feel free to comment or ask questions. I treat all sorts of neck and back injuries at the clinic here in Madison, so if you need a physical therapist, see your doctor for a script today and let me help you get rid of your pain and prevent future injuries!