Brooklyn Physical Therapy News- Evolve NY
How Can Physical Therapy Help with Pain and Discomfort Caused by Scoliosis?
Have you struggled with finding the right treatment plan for your scoliosis? At Evolve Physical Therapy in NYC, we want to see you find relief from any discomfort caused by your condition…
Evolve NYC Physical Therapy Scoliosis Treatment
Have you struggled with finding the right treatment plan for your scoliosis? At Evolve, we want to see you find relief from any discomfort caused by your condition. If you or someone that you care about are looking for innovative physical therapy treatment methods that can help alleviate your pain, you’ve come to the right place.
Schedule a Consultation!
Call- 1-718-258-3300
What is Scoliosis?
In simple terms, scoliosis is a condition that causes your spine to move to the side and turn. When viewing your spine on an x-ray, it may appear to have an “s” or a “c” shape. Scoliosis is a medical condition that is often detected during a physical examination and cannot be prevented. However, there are many fantastic physical therapy treatments and plans that can assist in increasing your function and mobility.
Common Symptoms of Scoliosis
While scoliosis can sometimes be pain free for some individuals, for others that is simply not the case. Below are some of the many ways that this condition may cause you irritation or discomfort.
Scoliosis can alter your alignment and posture
Pain can occur with certain movements or activities
You may notice that you have an uneven hip or waist line
Pain can occur in the following areas: spine, shoulders, pelvis, and hips
Your shoulders may appear to be uneven
Combat Scoliosis Pain with Advanced Physical Therapy Treatment Options
There is a wide variety of options out there for treating your scoliosis. Some of these would include: surgery, bracing, and physical therapy. However, a physical therapist can provide an individualized physical therapy treatment plan at any time during the many phases of your Scoliosis. We can complete a full evaluation to access how the condition is affecting your body, your overall range of motion, and any other limitations that may be present.
Here are just a few of the innovative approaches that we implement with physical therapy for the treatment of scoliosis:
The Schroth Method:
This ingenious method will directly access spinal movement and muscle tightness that is caused by scoliosis. Each exercise will be tailored to benefit the unique spinal curvature of each patient. The goal of these types of exercises is to help alleviate pain and stop the curve progression of your spine and make scoliosis more manageable.
Strength Training:
At Evolve, we use strength training exercises to help build the muscles surrounding your spine back up. This type of training will be completely customized to fit the needs of your specific condition.
Range of Motion Exercises:
We can also develop and implement a plan consisting of simple range of motion exercises to help prevent, or treat any limitations caused by your scoliosis.
Manual Therapy:
Our team of dedicated physical therapists in NYC can also manually help you restore motion to joints and affected tissue. By using our hands to direct you, we can help you retain any movement patterns that you may have lost. Manual therapy has been proven to also reduce pain in those damaged tissues.
The types of treatment listed above are just some of the many options out there for reducing pain or tightness caused by scoliosis. At Evolve, we understand that each body is different. We will evaluate your individual condition to form the right treatment plan for you.
Alternative Treatment Methods for Scoliosis
If you are suffering from scoliosis it may be recommended that a brace be worn in order to prevent your condition from worsening. Wearing a brace can limit the progression of spinal curves. If your scoliosis is severe, your health professionals may even recommend considering spinal surgery or fusion to lessen the curve of your spine.
Are you suffering from pain or dysfunction caused by scoliosis?
Here at Evolve, we provide the most up to date treatments and techniques for treating pain and discomfort caused by scoliosis. Our dedicated team of therapists will work with you to implement a custom physical therapy plan to help you start seeing results, and improve your mobility. We will provide expert treatment and advice for you during any phase of your scoliosis condition.
Click here for more information about physical therapy for Scoliosis
Contact us today today to start creating your customized healing plan.
Call- 1-718-258-3300
Directly schedule an appointment through our contact form and fast track the entire process! https://www.evolveny.com/contact
About Evolve NY Physical Therapy-
NYC's Premier Holistic Physical Therapy Clinics-
There’s physical therapy, there’s training, and then there’s EVOLVE.
We use the science of bio-mechanics merged with fitness to help our patients get better and stay better!
Schedule a Consultation Today!
Call- 1-718-258-3300
NBC Nightly News Covers Rock Steady Boxing at Evolve NY Physical Therapy
Evolve NY Hosts Rocksteady Parkinsons Boxing, Tapped for NBC Nightly News TV Section; Set to Air Oct. 20, 2018 6:30p.m.
Evolve NY Hosts Rocksteady Parkinsons Boxing, Tapped for NBC Nightly News TV Section; Set to Air Oct. 20, 2018 6:30p.m.
Dynamic Physical Therapy Network in NYC, EvolveNY, Adds Special Boxing Training Program for People Living With Parkinson's Disease; Receives Recognition in form of section on NBC Nightly News Oct 20th, 2018 at approximately 6:30-6:45 pm.
Evolve NY Physical Therapy has had Certified Physical Therapists in NYC treating patients with conditions such as Parkinson’s Disease for over 25 years. As such, Evolve Physical Therapy has proudly partnered with Rock Steady Boxing at the beginning of 2018 to provide a one of a kind exercise program based on the training regiment of professional boxers at their Brooklyn, NY location that is specifically aimed at treating people suffering from Parkinson’s Disease.
What is Rock Steady Boxing?
Rock Steady Boxing (RSB) is a unique exercise program that adapts pro boxing techniques for people with Parkinson’s disease and has helped thousands of people across the country regain strength, mobility and hope.
Lock in Your Position at Evolve NY’s Rock Steady Boxing Class Today!
Call: 1-718-258-3300
What is Parkinson’s Disease?
Parkinson's disease (PD) is a long-term degenerative disorder of the central nervous system that mainly affects the movement. Common symptoms include tremors, rigid movements, slurred speech, and slowing of movement that can make a simple task like getting out of chair frustratingly time-consuming.
The statistics from the Parkinson’s Foundation are staggering:
Nearly one million will be living with Parkinson's disease (PD) in the U.S. by 2020, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig's disease (or Amyotrophic Lateral Sclerosis)
Approximately 60,000 Americans are diagnosed with PD each year.
More than 10 million people worldwide are living with PD.
The incidence of Parkinson’s disease increases with age, but an estimated four percent of people with PD are diagnosed before age 50.
Men are 1.5 times more likely to have Parkinson's disease than women.
Why Rock Steady Boxing at Evolve NY?
It is estimated that 1-1.5 million Americans have Parkinson’s disease, with as many as 60 thousand new cases being diagnosed each year. The Rock Steady Boxing program provides an opportunity to drastically improve physical condition, mobility, renewed hope, quality of life, and also adds the sense of community for people living with Parkinson’s disease.
NBC Nightly News will air the Evolve NY and Rock Steady Boxing Section on Saturday, October 20th at or around 6:30-6:45 p.m.
Read Evolve NY’s Major News Story- NBC Nightly News Covers
Rock Steady Boxing at Evolve NY
For more information on Evolve NY and Rock Steady Boxing Classes for People Living With Parkinson’s Disease, please visit- https://www.evolveny.com/rsb
Evolve NY Rock Steady Boxing Class Information:
Location: 3319 Avenue N Brooklyn, NY 11234
Class Times/ Rate: Tuesday / Thursdays 10:30-12:00pm or 3:00-4:00 PM
Sunday 1:00-2:00
Lock in Your Position at Evolve NY’s Rock Steady Boxing Class Today!
Call: 1-718-258-3300
About EvolveNY-
Evolve NY Physical Therapy- NYC's Premier Holistic Physical Therapy Clinics in NYC.
Proudly serving residents in Brooklyn, NY; with patients seeking high quality, personable, and professional physical therapy services from all over NYC, Manhattan, Bronx, Queens, Staten Island, Long Island.
EvolveNY- 3 Convenient Locations 1-718-258-3300
Is Active Release Therapy Right For Me?
Active release technique (ART) is a popular treatment method used to improve range of motion and flexibility and help correct soft tissue restriction. It's one of the fastest growing treatment methods in physical therapy and sports rehab practices today. Active Release Therapy provides practitioners with an effective tool to help treat muscular pain syndromes and stiffness, therefore improving athletic performance.
Active release technique (ART) is a popular treatment method used to improve range of motion and flexibility and help correct soft tissue restriction. It's one of the fastest growing treatment methods in physical therapy and sports rehab practices today. Active Release Therapy provides practitioners with an effective tool to help treat muscular pain syndromes and stiffness, therefore improving athletic performance. Elite athletes around the world understand the benefits of regular ART sessions and oftentimes rely on them to help combat the day-to-day aches and pains associated with the repetitive stresses of sport. It can also be a solid treatment option for the average joe who enjoys physical activity but suffers from feelings of tightness and pain associated with exercise.
Where to Find Certified Active Release Technique Providers?
The medical providers who typically achieve certification in ART treatment are chiropractors, physical therapists, physicians and massage therapists. Finding a practitioner who uses ART as part of their toolbox is as simple as searching “active release therapy near me” or “active release technique Brooklyn, NY” via google. Here you will find a list of the certified practitioners in your area and where to find them.
How do I know if I can benefit from Active Release Therapy?
Some of the signs that you may benefit from ART treatment include stiffness in the elbow, neck, hands, knees, ankles, shoulders, or lower/mid back. You may also be a good candidate for this type of treatment if you experience difficulty performing exercises, have painful or swollen joints, demonstrate limited range of motion, or have the sensation of tight muscles. Many musculoskeletal disorders can be improved with the use of ART therapy. It would be beneficial to schedule a consultation with your nearest physical therapist to find out if you are a good candidate for this treatment.
How Does Active Release Therapy Work?
The aim of ART treatment is to “break up” or loosen thickened scar tissue that forms adhesions to the surrounding soft tissue. It can also be used to help prevent scar tissue formation. Thickened scars and soft tissue adhesions limit joint range of motion causing muscular tension and pain. The physiological purpose of these adhesions is to stabilize an injured body region by generating stiffness in the surrounding tissues. The problem here is that immobilization is usually not the right way to approach the soft tissue injury as it may lead to an increase in pressure on the joint itself. As a result, nerves may become trapped between layers of restricted muscle, fascia, and skin. This tension usually leads to pain and loss of muscle function/performance. ART therapy uses mobilization techniques to reverse this process and help improve mobility. The treatment itself is not typically a pleasurable experience, however most people are able to overlook this because of the relief they tend to feel afterwards.
What Are the Benefits of Active Release Therapy?
There are many potential benefits of receiving ART treatment including increased flexibility, improved range of motion optimal muscle function, and reduced pain levels.
Increased Flexibility/Range of Motion – This is accomplished by producing relaxation of the muscles and reducing any adhesions that may be found. This is especially beneficial for people who sit at a desk all day at work and feel resultant discomfort or for people who are very active during their work day and experience symptoms of muscle overactivity. Improving flexibility and range of motion will lead to improved athletic performance and decreased pain/discomfort while performing activities of daily living.
Improvements in chronic pain – Chronic pain is considered one of the main sources of dysfunction in older adults and well as people in their 20’s and 30’s. Although significant variation exists among specific diagnoses, one of the main hallmarks of chronic pain is inflammation, which can be soothed using ART techniques.
Performance enhancement– ART promotes quicker muscle recovery, thus decreasing soreness and the rest time required between training sessions or competition. For this reason, It is one of the most popular recovery tools utilized by elite athletes today. It improves blood flow to working muscles and injury sites which will help decrease pain and speed up the healing process. Enhancing your range of motion will also allow you to to move more freely and through a more natural trajectory at the joints involved.
Injury Prevention- ART helps restore normal muscle function and decreases strain on joints, which may help prevent injury during physical activity and normal daily tasks like bending down and lifting. Many athletes utilize this treatment to help upkeep their bodies during the season and prepare it for the upcoming season. By preventing the laying down of scar tissue, we are preventing adhesion formation and therefore
What sets ART apart from other soft tissue treatments?
ART is an aggressive soft tissue modality that utilizes a combination of manual pressure/massage with active movement from the patient. This combination of therapies is effective in treating soft tissue adhesions, myofascial trigger points, and joint pain. People who receive ART treatment report significant improvements in stiffness, flexibility, pain, tenderness, recovery, and performance as compared to massage on its own.
What can I expect out of Active Release Therapy?
Since ART is a very precise form of treatment, it can sometimes feel painful or overly aggressive. It's important to be thoroughly examined by your physician or physical therapist before you begin this type of treatment to ensure that you are a good candidate. Some people may experience significant improvements after just one ART session, but everyone’s body will respond differently to the onset of this treatment. Experiencing mild pain and soreness after a treatment session is normal in the beginning, however your body will eventually adapt to this pressure as time goes on. If you are feeling severe pain during treatment, please let your healthcare practitioner know, however moderate discomfort is normal. Please note that healthcare providers who utilize ART treatment should be certified in the use of active release techniques.
For more information on active release therapy, please visit: https://www.evolveny.com/active-release-therapy/
What is BPPV and How Can PT Help it?
What is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is a disorder of the vestibular system in the inner ear. This system is responsible for coordinating head and eye movements and plays a large role in balance. Dysfunction occurs when calcium carbonate crystals break loose and fall from their original resting position in the utricle (see photo below) into one of the semicircular canals, which typically sense movements of the head. Once this occurs, the brain receives a signal that the head is moving, even though this is not the case.
By Nick Mazzone PT, DPT, CSCS
What is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is a disorder of the vestibular system in the inner ear. This system is responsible for coordinating head and eye movements and plays a large role in balance. Dysfunction occurs when calcium carbonate crystals break loose and fall from their original resting position in the utricle (see photo below) into one of the semicircular canals, which typically sense movements of the head. Once this occurs, the brain receives a signal that the head is moving, even though this is not the case. This false signal causes uncoordinated movements of the eyes when the head is moved into a specific position (depending on which canal the crystals lands in). This leads to the sensation that the room is spinning around you, which is known as vertigo. In BPPV, the symptoms typically go away within 30 seconds or so.
What causes BPPV?
In more than half of all BPPV cases, the exact cause is unknown (AKA idiopathic). Head trauma, infections, and issues with blood flow are some of the known causes of the condition. Sometimes something as simple as a sinus infection can cause symptoms of vertigo due to congestion in the middle ear, which may place pressure on the structures of the inner ear causing dysfunction.
How do we treat BPPV?
Physical therapists are trained to treat the symptoms of vertigo by using positional maneuvers that are aimed at returning the dislodged calcium carbonate crystals to their original resting position. The most common intervention used to treat BPPV is known as the Epley maneuver. This technique consists of passive movement of the patient’s head into multiple provocative positions. This maneuver will cause your symptoms, so be ready to feel the vertigo come on. Once the symptoms subside in that particular position, it is said that the crystals have moved on to a different portion of the canals. The head is then repositioned to catch up with the new position of the crystal. At the end of the technique, the crystals should return to their original position in the utricle. Patients are typically symptom free after 1-2 sessions when the Epley is performed. Your physician or physical therapist will explain to you that you should not drive after this treatment and should plan ahead to secure yourself a ride home. You may also be given a home exercise program to help take care of any remaining symptoms.
Click here to find out more information about vestibular physical therapy, or call
Check out this video that shows an alternative exercise for treating BPPV that can be performed at home. It is particularly helpful for those who have periodically recurring symptoms and would like to expand their treatment options.
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources
Main photo retrieved from http://www.acceleratedhealthcentre.com/concussion
Photo of Epley maneuver retrieved from https://www.healthdiseases.org/epley-maneuver/
Photo of inner ear congestion retrieved from http://www.greathillsent.com/blog/date/2013-12-01.html
Photo of anatomy of the outer, middle, and inner ear retrieved from https://www.medcor.com/anatomy-of-the-ear/
Photo of vestibular organs retrieved from https://virginiavisiontherapycenter.com/signs-and-causes-of-vestibular-dysfunction/
Vestibular Rehabilitation for BPPV (n.d.). Retrieved from https://wwspt.com/pt-treatments/vestibular-rehabilitation/benign-paroxysmal-positional-vertigo/
What is Hip Impingement and How Can PT Help?
What is hip impingement?
Femoracetabular impingement (FAI) is a condition in which bone spurs grow on the joint surfaces of the hip. These bone spurs eventually lead to irritation of the structures at the hip, which may lead to soft tissue damage such as labrum tears and potentially arthritis.
The two types of FAI are cam lesions and pincer lesions. Cam lesions develop on the head of the femur, therefore affecting the shape of the bone. Pincer lesions form on the pelvic surface of the hip joint. There are also situations in which both of these types of lesions are present…
By Nick Mazzone PT, DPT, CSCS
What is hip impingement?
Femoracetabular impingement (FAI) is a condition in which bone spurs grow on the joint surfaces of the hip. These bone spurs eventually lead to irritation of the structures at the hip, which may lead to soft tissue damage such as labrum tears and potentially arthritis.
The two types of FAI are cam lesions and pincer lesions. Cam lesions develop on the head of the femur, therefore affecting the shape of the bone. Pincer lesions form on the pelvic surface of the hip joint. There are also situations in which both of these types of lesions are present.
What causes FAI?
Cam and pincer lesions may form due to abnormal development of the hip joint during childhood. They may also develop after prolonged pressure on the front of the hip joint over time due to asymmetries in muscle strength among the prime movers of the hip (for example, overactive hip flexors and underactive glutes).
What can be done to improve FAI?
It is imperative that we address the strength deficits present in this situation. If you have weak gluteus maximus muscles and your hip flexors are overactive, you would expect the hip joint to be sitting in a suboptimal position during functional tasks. In this scenario, you would see the femur sitting in front of its optimal position in the socket. For this reason, you want to strengthen the gluteus maximus muscles in order to realign the hip joint and prevent excessive pressure on the structures in front of the hip. Sometimes it is indicated to stretch the hip flexors, but that should be dependent on the physical therapist’s evaluation. Just because a muscle is overactive and tense does not mean it is short of length. It is also important that we strengthen the lower abdominal muscles to help stabilize the pelvis. This should help decrease the tension in the hip flexor muscles which may have been acting as a pelvic stabilizer (thus leading to overactivity).
How can PT help?
Your physical therapist will develop a specific treatment plan according to the findings of the clinical exam. While two people may both be diagnosed with hip impingement, they may present in completely different ways and with different impairments to address. For this reason, it is important to be evaluated and treated with a plan specific to you and not a general exercise plan. Your specific treatment plan is aimed at helping you return to your prior level of physical activity without pain.
Click here for more information about hip physical therapy in Brooklyn, or
Check out this video that shows three simple exercises you can do to help improve your symptoms from hip impingement:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com
Resources
Femoroacetabular Impingement - OrthoInfo - AAOS. (n.d.). Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement
Main photo retrieved from https://reverehealth.com/live-better/what-is-hip-impingement/
Photo of bridging exercise retrieved from http://www.womenshealthmag.co.uk/fitness/find-a-workout/4456/how-to-do-glute-bridges/
Photo of cam and pincer lesions retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement
Photo of muscle asymmetries retrieved from http://www.racquetfit.com/articles/Coaching/controlling_your_posture_and_the_serve
Photo of plank exercise retrieved from https://www.waysandhow.com/good-reasons-plank-daily-6-benefits-planks-exercise/
Photo of runner retrieved from http://lisabaylis.com/2017/07/15/running-for-wellness/
Thoracic Mobility: Why is it Important?
What is the thoracic spine?
The thoracic spine is the middle portion of the spinal column that connects the neck to the lower back region. It consists of 12 separate segments that serve as connections for the ribs, which protect many vital organs including the heart and lungs.
By Nick Mazzone PT, DPT, CSCS
What is the thoracic spine?
The thoracic spine is the middle portion of the spinal column that connects the neck to the lower back region. It consists of 12 separate segments that serve as connections for the ribs, which protect many vital organs including the heart and lungs.
Why is mobility here so important?
It is vital that you have adequate mobility in this region because of the interdependent relationship it has with the cervical and lumbar spine. If you do not have enough motion in the mid back, the nervous system depends more heavily on the upper and lower spine to make up for that motion. This lack of thoracic mobility can then be a contributor to neck pain or low back pain.
Overhead mobility
We need adequate thoracic mobility in order to move our shoulder joints into their natural end ranges of motion. If we do not have enough mobility here, more strain is then placed on the glenohumeral joint (shoulder ball-and-socket joint). In this case, we usually see a compensatory increase in motion at the shoulder joint that may lead to increased pressure or strain on the soft tissue in this region. This may increase the chance of injury over time. It is also important to note that we need enough thoracic mobility when we perform overhead presses at the gym. If we cannot keep our thoracic spine extended to neutral (straight spine; not hunched over), we would have to compensate by extending the lumbar spine (bending low back in backward direction). This could lead to increased pressure on the discs of the lumbar region, especially when we load the exercise with too much weight.
Breathing and rib expansion
We just discussed how each thoracic segment is a connection point for the ribs. This means that adequate thoracic mobility is essential for normal expansion of the ribcage while we breathe. When we take a large inhalation, the thoracic spine extends (segment rotates backwards). This allows the ribs to create more space for the lungs to expand. When we exhale, the thoracic spine flexes in order to return to its resting position (flexion would be rotating forward). If we cannot extend the thoracic spine adequately, it limits the amount of air that can fill the lungs. This is important for regulation of the parasympathetic nervous system as well as the cardiovascular system.
Relationship to legs and lumbar spine during squat
You need normal thoracic extension in order to properly perform loaded lower body movements such as the squat. If you are starting to pick up on the theme of interdependence, you are on the right track here. When you perform a squat with resistance from a barbell at the gym, you are resting the bar on your shoulders. When you do not have adequate thoracic mobility, your center of mass shifts forward. This alters the biomechanics of the entire exercise form the floor to the head and neck. This makes it harder to keep your heels down and keep your buttocks back, which ensures that the load is properly handled by the hips and spine. The lumbar spine would then have to compensate by overextending itself, forcing it to handle more of the load than it normally would have to.
Check out this video that shows 3 simple exercises you can perform to help improve thoracic mobility:
Click here for more information about physical therapy for mid back pain
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources:
Main photo retrieved from https://www.t-nation.com/training/tip-improve-thoracic-spine-mobility
Photo of ribs and vital organs retrieved from https://www.britannica.com/science/thoracic-cavity
Photo of neck and low back pain retrieved from http://posturedirect.com/17-exercises-to-improve-your-thoracic-spine/
Photo of overhead mobility retrieved from https://fitnesspainfree.com/the-correct-way-to-mobilize-your-thoracic-spine-with-a-foam-roller/
Photo of squat and thoracic spine position retrieved from https://www.ensomovementculture.com/blog-1/movement-training-for-sports-people-mobility/18/4/2017
Photo of rib expansion during breathing retrieved from https://newgradphysicaltherapy.com/role-breathing-physical-therapy/
What Are Cervicogenic Headaches and How Can PT Help?
What are cervicogenic headaches?
A cervicogenic headache is caused by dysfunction in the neck, whether it be from stiff joints in the upper cervical spine or from tension in the muscles near the base of the skull. Pain from this type of headache is typically felt around the skull, temple regions, and eye sockets…
By Nicholas Mazzone, PT, DPT, CSCS
What are cervicogenic headaches?
A cervicogenic headache is caused by dysfunction in the neck, whether it be from stiff joints in the upper cervical spine or from tension in the muscles near the base of the skull. Pain from this type of headache is typically felt around the skull, temple regions, and eye sockets. The origin of this condition can be traumatic, as in a whiplash injury from a motor vehicle accident, or it could be due to prolonged abnormal load on the joints and muscles of the neck (getactivephysio.com.au).
What would be a non-traumatic cause of these types of headaches?
The most common non-traumatic cause of cervicogenic headaches is excessive, prolonged load on the joints and muscles of the neck. This is common in people who sit at a desk for most of their day at work. This occurs because the person winds up in a slumped posture in their spine, which eventually leads to what is known as “forward head posture”. This posture leads to increased tension in the muscles at the base of the skull as well as increased pressure on the first three segments of the cervical spine. Over time, this poor sitting posture can cause cervicogenic headaches. Adjusting one’s desk setup to ensure prevention of this situation can be as simple moving the keyboard closer to you. If the keyboard is placed too far away, you will have to slump forward to reach it, which will lead us to the forward head posture discussed above in order to ensure that you can see what is on your screen. Check out the picture below to get a better idea of what your desk setup should look like.
How can PT help?
Your physical therapist will create a program for you that includes manual therapy, therapeutic exercise, postural training, and stability training. Your program will also include education on how to adjust your desk setup or information on how to alter your current lifestyle in order to help your condition. Manual joint mobilization of the upper cervical spine, soft tissue mobilization of tense muscle tissue, and manual stretching of the region will help soothe the muscles and decrease pressure in the neck region. You will also be given specific exercises to target the muscles that are weak as well as the muscles that need to be lengthened. While heating modalities can feel good, they should not be the main intervention used in the treatment of cervicogenic headaches.
Check out this video that demonstrates 3 simple exercises that can help with your cervicogenic headaches:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources:
Cervicogenic Headaches. (2016, March 09). Retrieved from http://www.getactivephysio.com.au/cervicogenic-headaches/
Desk posture photo retrieved from https://sinicropispine.com/tips-improve-posture/
Main photo retrieved from http://yoffielife.com/sweat-dictionary/cervicogenic-headaches/
Manual therapy photo retrieved from https://learnmuscles.com/blog/2017/11/10/treat-spinal-joint-dysfunction-manual-therapy/
Whiplash photo retrieved from https://www.bouldercentre.com/news/whiplash-diagnosis-and-treatment
A cervicogenic headache is caused by dysfunction in the neck, whether it be from stiff joints in the upper cervical spine or from tension in the muscles near the base of the skull. Pain from this type of headache is typically felt around the skull, temple regions, and eye sockets. The origin of this condition can be traumatic, as in a whiplash injury from a motor vehicle accident, or it could be due to prolonged abnormal load on the joints and muscles of the neck (getactivephysio.com.au).
ACL Tears: Do They Always Require Surgery?
What is the ACL?
The anterior cruciate ligament (ACL) is a crucial stabilizing structure at the knee joint. When intact, it will prevent the lower leg (tibia) from moving forward on the thigh bone (femur). The ACL is commonly torn in athletes and may require surgical intervention in order to repair it. This structure does not heal on its own mainly due to its poor blood supply and twisted structure of collagen fibers. This twisted structure leads to frayed ends and therefore, cannot heal without assistance (surgery in this case)…
By Nick Mazzone PT, DPT, CSCS
What is the ACL?
The anterior cruciate ligament (ACL) is a crucial stabilizing structure at the knee joint. When intact, it will prevent the lower leg (tibia) from moving forward on the thigh bone (femur). The ACL is commonly torn in athletes and may require surgical intervention in order to repair it. This structure does not heal on its own mainly due to its poor blood supply and twisted structure of collagen fibers. This twisted structure leads to frayed ends and therefore, cannot heal without assistance (surgery in this case).
How does someone typically tear their ACL?
ACL tears typically occur while the foot is planted and the femur twists over the tibia (or vice versa). Sometimes this happens because an athlete’s footwear gets caught on a grass surface, for instance. An ACL tear may also occur when an athlete lands on a straight knee on a hard surface such as a basketball court.
Can surgery be avoided?
Surgery is not necessary in all cases of an ACL tear. It would be highly suggested that an athlete who plans on returning to that same level of function receive surgical treatment to ensure that they return to their sport at the same level they were at before they got injured. For a person who tore their ACL but does not plan to partake in athletics or any activities that would require high level stability of the knee, a thorough and specific rehab program can help them return to their normal activities.
What might a non-surgical ACL rehab protocol consist of?
In the early stages, it is important to address the swelling and help strengthen the muscles around the knee in a gentle way in order to help normalize muscle activation patterns (acute swelling tends to turn these muscles off!). Once these issues have improved, we can move on to more functional exercises. A program aimed at rehabilitating someone after a torn ACL must address the limitation in the knee that is now missing one of its major stabilizing structures. While we no longer have the static stability that the ACL was providing to the knee, we can absolutely improve its dynamic stability by targeting the muscles around the knee joint. It is important to ensure that we are strengthening the hamstrings since they will act to prevent the forward movement of the tibia on the femur (which is one of the main functions of the ACL!). We must also ensure that we are challenging the stability of the knee in functional positions. This will teach the muscles around the knee joint to act together to keep the knee joint stable (co-contraction).
Check out this video that shows 3 simple exercises to help normalize the knee after a torn ACL that did not require surgery:
Click here for more information about physical therapy for ACL injuries or call 1-718-258-3300
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources:
Main Photo retrieved from http://www.stack.com/a/a-new-type-of-acl-surgery-could-have-athletes-back-on-the-field-faster-than-ever
Photo of ACL tear retrieved from https://www.reddit.com/r/nba/comments/2ws4zu/science_and_the_nba_digging_in_to_the_anatomy_of/
Photo of twisting of knee retrieved from https://www.parisischool.com/acl-what-why-and-how/
Photo of ACL repair retrieved from https://www.mocnyc.com/acl-reconstruction/
Photo of squat on bosu ball retrieved from http://www.ctialatest.org/lab/lab-equipment-diagram
What is Achilles Tendinitis and How Can Physical Therapy Help It?
What is Achilles tendinitis?
The Achilles tendon is the thick band that connects the rear calf muscles to the heel. Achilles tendinitis is considered an overuse injury and may be caused by a sudden increase in physical activity and is commonly seen in the running population. Some risk factors for the development of this condition may be improperly fitting footwear, a stiff ankle and foot, weakness of the muscles that act on this region, and over-pronation of the foot during walking or running.
By Nick Mazzone PT, DPT, CSCS
What is Achilles tendinitis?
The Achilles tendon is the thick band that connects the rear calf muscles to the heel. Achilles tendinitis is considered an overuse injury and may be caused by a sudden increase in physical activity and is commonly seen in the running population. Some risk factors for the development of this condition may be improperly fitting footwear, a stiff ankle and foot, weakness of the muscles that act on this region, and over-pronation of the foot during walking or running. If left untreated, this condition can lead to degenerative changes in the makeup of the tendon itself, which will further exacerbate the symptoms. At this point, the condition would be considered a tendinosis.
What should be done in the early stages of this condition?
In the early stages of the condition it may be wise to combine active rest with techniques that help decrease swelling. This would mean refraining from running, long distance walking, or any other higher intensity activity that may have led to this issue in the first place. The active part of this equation would include gentle strengthening and range of motion exercises for the region to help improve blood flow for healing and address some of the issues that may have contributed to the condition in the first place. It is important to elevate the leg above chest level so that gravity can assist in decreasing swelling. If desired, ice can be used in combination with these methods as well.
What can PT do for me in later stages of this condition?
Once the acute stages of the condition have passed, it is important to restore normal function of the muscles in this region. Your physical therapist will prescribe a specific program based on your flexibility and strength assessments. Foot posture and stability will also be addressed after screening is completed. Stretching of the Achilles tendon is important; however, it is more important that we gradually reintroduce normal activities to the foot and ankle. Progressive loading of the Achilles tendon combined with eccentric exercise is the gold standard method for healing this condition.
What does progressive loading and eccentric exercise mean?
Progressive loading of the Achilles tendon simply means that we will be using specific exercises to gradually increase the amount of pressure that the Achilles tendon is under. For example, early exercises may include an activity performed with a resistance band while the foot is off the ground and later stage exercises may include activities on one leg.
Eccentric exercise simply means that we are strengthening the muscle’s ability to contract while it moves from a shortened position to a lengthened position. Most functional activities require eccentric strength. An example of an eccentric-focused exercise would be standing on your toes and then slowly lowering the heel to the ground. The eccentric portion of the exercise is the part where you focus on slowly lowering the heel to the ground (muscle is lengthening).
Check out this video that shows an example of a program that utilizes eccentric activity with progressive loading of the Achilles tendon:
For more information about foot physical therapy or ankle physical therapy, or call: 1-718-258-3300
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources:
Main photo (green background) retrieved from http://www.achillestendonitis.co.uk/
Photo of anatomy of Achilles region retrieved from https://www.researchgate.net/figure/The-anatomy-of-the-Achilles-tendon-and-the-suralis-muscle_fig1_262230849
Photo of “RICE” retrieved from https://www.quora.com/How-do-I-heal-my-Achilles-tendon
Photo of foot posture retrieved from http://okanaganpeakperformance.com/knee-solution-seminar-recap
Photo of heel raise retrieved from https://fitness.stackexchange.com/questions/14976/is-this-a-good-at-home-exercise-routine-for-a-beginner
How Can Physical Therapy Help My Sciatica?
What is Sciatica?
Sciatica is one of the most common symptoms associated with lower back pain. It refers to the sensation of burning pain that tends to radiate from the buttock down the leg. The distance the pain travels is typically correlated to the extent of the irritation effecting the nerves. The name “sciatica” comes from the sciatic nerve, which is one of the largest nerves in the body…
By Nick Mazzone, PT, DPT, CSCS
What is Sciatica?
Sciatica is one of the most common symptoms associated with lower back pain. It refers to the sensation of burning pain that tends to radiate from the buttock down the leg. The distance the pain travels is typically correlated to the extent of the irritation effecting the nerves. The name “sciatica” comes from the sciatic nerve, which is one of the largest nerves in the body. The spinal nerves that become irritated are typically those that eventually come together to form the sciatic nerve (from spinal level L4 to S3). Sciatica is not a permanent condition and does not typically require surgical intervention.
What causes sciatica?
These symptoms are typically caused by excess pressure on a nerve after it exits the lumbar spine (lower spine). This pressure can come from a herniated disc, arthritis in the lumbar region, and other conditions in which the space that the spinal nerve travels becomes compressed or shrinks.
How can physical therapy help improve this condition?
This condition is relieved by decompressing the region in which these spinal nerves travel. This can be achieved through a specific mobility and strengthening program that includes postural education and awareness training. These specific exercises will depend on the location at which the nerve is being irritated. Generally speaking, in order to decrease pressure in the lumbar region of the spine, you must be mobile in not only the lumbar spine but the thoracic region (mid back) and hips. This will help take pressure off the low back by allowing a more even distribution of movement. Think about it this way: If you are lacking proper mobility in your thoracic spine, your lumbar spine will have to make up for this lack of mobility. This can lead to increased stress and strain in this area. The same idea works for the hips.
Postural training is important in helping to decrease pain and inflammation in the low back. The pelvis and lower spine are anatomically connected (the lower spine actually sits in the pelvis), and therefore movement between the two will be interrelated. The position of the pelvis will dictate the posture in our lumbar spine during all activities (including at rest!). Depending on where the nerve irritation is occurring, this positioning of the pelvis will either increase or decrease pressure on the nerve. If the irritation is occurring at the point where the nerve exits the spinal canal (at the nerve root), extension of the lumbar spine should help alleviate the pressure by “opening” the region where the spinal nerves exit, while flexion of the lumbar spine may increase pressure due to “closing” of the region. Refer to the picture above for a visual of this phenomenon. “Lordosis” is known as lumbar spine extension, while “flat” spine refers to a flexed spine. The picture below demonstrates these movements.
Click here to find out more information about physical therapy for sciatica or call 1-718-258-3300
Check out this video that demonstrates a simple mobility exercise for the sciatic nerve to help alleviate your symptoms of sciatica:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources:
Main photo of sciatica pain in leg retrieved from https://www.magnilife.com/blog/5-effective-ways-for-dealing-with-sciatica-pain/
Photo of irritated nerve retrieved from http://arizonapaintreatmentcenters.com/from-dr-craig-peterson-mva-sciatica
Photo of lumbar flexion and extension retrieved from https://b-reddy.org/making-pull-ups-and-burpees-more-shoulder-and-lower-back-friendly/
Photo of pelvis position and lumbar spine retrieved from https://body-motion.co.uk/injuries/postural-pain/improve-your-sitting-posture/
What is Tennis Elbow and How Can Physical Therapy Help?
What does tennis elbow mean?
“Tennis elbow” is the nickname given to a condition known to the medical community as lateral epicondylitis (also seen ending in -osis or -algia). This name describes the region from which the pain originates on the outside of the elbow…
By Nick Mazzone, PT, DPT, CSCS
What does tennis elbow mean?
“Tennis elbow” is the nickname given to a condition known to the medical community as lateral epicondylitis (also seen ending in -osis or -algia). This name describes the region from which the pain originates on the outside of the elbow. The lateral epicondyle is the part of the upper arm bone that serves as the origin for all of the muscles that extend the wrist.
What causes tennis elbow?
Tennis elbow is considered an overuse injury. It typically occurs after repetitive stress to the involved region over time, however one traumatic incident such as a fall or work accident may also cause inflammation in this region. Tennis elbow got its name because it is a common overuse injury seen in those who play the sport. Tennis players tend to hold a tight grip on their racquets while producing powerful forces with their wrist extensor muscles. In certain cases, this may be a recipe for inflammation. Another common population that tends to get tennis elbow is the office worker. Being in a position of wrist extension while typing for prolonged periods may cause repetitive stress to the outside of the elbow.
Here is an example of what your posture should look like while in front of your computer:
How Will Physical Therapy help me?
Your physical therapist will design a specific treatment plan tailored to your needs based on your background and activity level. The program will consist of soft tissue mobilization to assist in the healing process, stretching/mobility training, functional strengthening of eccentrics (the muscle’s ability to control movement from wrist extension to wrist flexion) and grip strengthening, training of ergonomics and posture, and education on how to prevent the condition from reoccurring.
Your specific program will depend on how you acquired the condition in the first place. An office worker will be trained to alter their desk setup in order to decrease the stress on the wrist extensors. A tennis player may be prompted to consider changing the thickness of their racquet handle or the tightness of the strings. Both of these variables may help contribute to the repetitive stress that occurs during the sport since more force production is necessary to produce the desired effect when these conditions are not optimal.
This picture shows one way to stretch the wrist extensor muscles.
Click here to find out more information about physical therapy for tennis elbow
Check out this video for 3 simple exercises to help with your tennis elbow:
About-
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources
Main photo retrieved from https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987
Photo of bones of arm retrieved from http://cruxcrush.com/2014/06/26/climber-problems-elbow-injury/
Picture of wrist and finger extension retrieved from http://www.militarydisabilitymadeeasy.com/images/handmuscles/
Picture of ideal desk posture retrieved from xhttps://www.microsoft.com/accessories/en-us/support/ergonomic-comfort
Photo of wrist extensor stretch retrieved from https://www.therapeuticassociates.com/athletic-performance/golf/stretching-for-golfers/
What is Assisted Stretching and How can it help me?
What is Assisted Stretching?
Assisted Stretching is a hands-on method of stretching in which a person is gently supported through a series of stretches by a trained practitioner. Assisted Stretching is more effective than stretching by yourself because the practitioner stabilizes your joints in positions that allow you both to isolate and stretch one muscle at a time while expanding your fullest range of motion.
Nick Macaluso
Stretching is kind of like flossing... everyone knows they should be doing it, but who really does it? It’s one of those things that we’re all going to start making into a habit tomorrow, but somehow tomorrow never comes. To our credit though, when we get that cramp in our thigh, or piece of spinach in between our teeth, we know exactly what we need to do. But how do we identify the exact muscles that tend to cramp or spasm, and prevent it from happening? How can we isolate and stretch the muscles we hold the most tension in to prevent and alleviate pain? How can we most effectively just enhance our mobility for a higher quality of life? The answer, Assisted Stretching.
What is Assisted Stretching?
Assisted Stretching is a hands-on method of stretching in which a person is gently supported through a series of stretches by a trained practitioner. Assisted Stretching is more effective than stretching by yourself because the practitioner stabilizes your joints in positions that allow you both to isolate and stretch one muscle at a time while expanding your fullest range of motion. The benefit to being able to isolate and stretch individual muscles is to give both you and the practitioner a better understanding of where exactly your body may be out of alignment. Perhaps your low-back pain is just a result of tight hamstrings, or your sciatica is just a result of tight glutes. Both of which can be relieved from general stretching, but without the assistance of a trained practitioner, it is nearly impossible to isolate the exact muscle and relieve its tension.
Why is Assisted Stretching so productive?
Aside from being able to realign your body by isolating the muscles being stretched, Assisted Stretching is an opportunity for you to relax and repair your body and mind while still using your time constructively. Many of us after long days or weeks want nothing more than a massage to take the tension out of our backs, necks, shoulders, or hips, but aside from the relaxation, what is the massage doing to prevent that tension from returning? Most of the time, tension builds in areas of our bodies that are either overactive or misaligned due to habitual poor posture. While massages are great, if you’d rather spend your time relaxing AND simultaneously preventing the tension from returning, Assisted Stretching is for you.
Stretching is one of those things that people spend their lifetime studying and writing about because of its incredible complexity and near infinite amount of benefits. But instead of wasting your time with all that, experience the hype for yourself by scheduling a 20 minute Assisted Stretching session with Nick Macaluso at Evolve Physical Therapy. Sessions run in 20 minute increments and can last anywhere from 20 minutes to 2 hours depending on how long you would like to be stretched. While this service is open to the public, all active patients of Evolve must first speak to their therapist to ensure an Assisted Stretch is right for them.
For more information or any questions, give us a call at 718-258-3300 or contact us today!
How Can Physical Therapy Help My Plantar Fasciitis?
What is the plantar fascia?
The plantar fascia is a thick band of connective tissue that runs from the lower surface of the heel to the beginning of the toes. This fibrous band of tissue is placed under tension during walking and other activities in which you place weight onto the feet. This tension creates support and stabilization of the arch of foot, which will help stabilize the entire lower extremity during these types of activities…
By Nick Mazzone, PT, DPT, CSCS
What is the plantar fascia?
The plantar fascia is a thick band of connective tissue that runs from the lower surface of the heel to the beginning of the toes. This fibrous band of tissue is placed under tension during walking and other activities in which you place weight onto the feet. This tension creates support and stabilization of the arch of foot, which will help stabilize the entire lower extremity during these types of activities.
What causes this structure to become inflamed?
While the exact mechanisms behind the causes of plantar fasciitis are not completely understood, the condition has been correlated with some mechanical issues at the foot and ankle. One of the more common impairments associated with this condition is inadequate dorsiflexion of the foot. Dorsiflexion is the movement performed when the top surface of the foot comes closer to the front of the leg.
Another impairment that is commonly associated with plantar fasciitis is weakness of the posterior tibialis muscle. This muscle helps to increase arch height during activities in which weight is placed on the feet.
This condition can also be considered an overuse injury. For instance, a running athlete may progress their running program too quickly without allowing their body to adapt. This can cause inflammation and pain in the plantar fascia.
What can PT do to help?
Your physical therapist will create a specific foot physical therapy treatment plan tailored to your needs and impairments. Most commonly, the treatment will consist of mobility drills and functional stabilization techniques to help support the arch of the foot. These exercises are more effective when performed with weight on the legs in a standing position, as this is more closely related to the way in which these structures actually function in the real world. Your program may start more conservatively depending on your pain and activity tolerance.
The ultimate goal of the treatment is to progressively load these structures so that they become adapted to increased stress. This will ensure that the plantar fascia can handle the demands placed on it during our daily endeavors, whatever they may be. In some cases, a physical therapist will recommend orthotics to help provide support to the arch of the foot.
Click here for more information about physical therapy for plantar fasciitis
Check out this video depicting 3 simple exercises that can be performed to help improve your plantar fasciitis:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources:
Picture of painful foot retrieved from https://www.tcpaindoctor.com/can-prp-help-treat-plantar-fasciitis/
Picture of plantar fascia function during weight bearing retrieved from https://painphysiotherapist.com/2016/05/25/plantar-fascia-rupture/
Picture depicting dorsiflexion of ankle retrieved from http://www.militarydisabilitymadeeasy.com/
Picture of posterior tibialis retrieved from https://www.fixpodiatry.com.au/podiatry-conditions/tibialis-posterior-tendinopathy/
Picture of collapsed arch retrieved from https://www.epainassist.com/sports-injuries/foot-and-heel-injuries/flat-feet-or-pes-planus-or-fallen-arches
Photo of orthotic placement retrieved from https://bestwalkingfeet.com/good-shoes-for-flat-feet/insoles-and-inserts/
Wheeless' Textbook of Orthopaedics. (n.d.). Retrieved from http://www.wheelessonline.com/ortho/Plantar_fascia
What is the Rotator Cuff and What Does It Do?
What is the rotator cuff?
The rotator cuff is the name given to the group of 4 muscles that originate from different positions on the shoulder blade and connect to the humerus (upper arm). These muscles all work together to ensure stability of the shoulder joint during movement (dynamic stability). When isolated, each of these muscles acts on the humerus and moves the shoulder joint in different directions…
By Nick Mazzone, PT, DPT, CSCS
What is the rotator cuff?
The rotator cuff is the name given to the group of 4 muscles that originate from different positions on the shoulder blade and connect to the humerus (upper arm). These muscles all work together to ensure stability of the shoulder joint during movement (dynamic stability). When isolated, each of these muscles acts on the humerus and moves the shoulder joint in different directions. These muscles are named supraspinatus, infraspinatus, teres minor, and subscapularis.
Why do we need this dynamic stability?
As we move the arm, these rotator cuff muscles will contract together to help keep the humerus centered nicely inside the cup of the shoulder joint (think ball and socket). If there is an asymmetry in strength among these muscles, the positioning of the shoulder inside the socket may be altered while you move your arm. Over time, this can cause irritation of other tendons, ligaments, and bone in the shoulder region. Some of the common diagnoses associated with rotator cuff muscle weakness are shoulder impingement syndrome and non-traumatic rotator cuff tears.
What happens if the rotator cuff is torn?
The most commonly torn rotator cuff muscle is the supraspinatus. People with supraspinatus tears typically have trouble elevating the arm and may exhibit a compensatory shrugging of the shoulder in order to assist in raising the arm.
If a partial tear is present, the muscle and tendon have the ability to heal without surgical intervention. In order for proper healing to occur, we must provide an ideal environment for the muscle and tendon to recover. This would include intervention aimed at decompressing the region where the muscle attaches to the humerus, which would be achieved through range of motion exercise and strengthening of all 4 rotator cuff muscles to help produce more efficient movement of the shoulder (to put it briefly).
If a complete tear is present, there are two options that one may follow. The non-surgical route would include strengthening other muscles around the shoulder joint that will help to compensate and act as a substitute for the torn rotator cuff muscle. Fortunately, the shoulder joint was designed to be able to withstand this type of injury and with the right rehab protocol, may return to normal functioning. In cases where this method does not help, surgical intervention is typically indicated. After surgery, patients will be sent to a physical therapist in order to help them return to their prior level of functioning.
What does physical therapy typically consist of for rotator cuff injuries?
The plan of care will consist of manual stretching and soft tissue mobilization of tense muscles, specific strength and stability exercise to improve the function of the shoulder, range of motion exercises to help normalize joint movement, and movement re-education to ensure pain-free use of the arm.
Click here to find out more information about physical therapy for rotator cuff injuries
Check out this brief video for 3 exercises that will strengthen the rotator cuff muscles:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Resources
Photo depicting widespread shoulder pain (top photo) retrieved from https://www.myanthemhealth.com/blog/shoulder-paincould-it-be-my-rotator-cuff
Photo depicting different muscles of the rotator cuff retrieved from https://www.slideshare.net/prkhuman/shoulder-impingement-syndrome-24685952
Photo depicting a rotator cuff tear retrieved from https://www.vivehealth.com/blogs/resources/rotator-cuff-tear
Photo depicting the compensatory shoulder shrug during shoulder elevation retrieved from https://healtheappointments.com/chapter-16-the-musculoskeletal-system-essays/5/
How Can PT Help My Carpal Tunnel Syndrome?
What is carpal tunnel syndrome?
The carpal tunnel is the space formed by the bones of the wrist and hand that allows passage of the median nerve along with tendons of muscles that move the joints of the hand. This space is typically about an inch wide, however it can be made narrower in the presence of irritation and swelling of any of these structures.
By Nick Mazzone PT, DPT, CSCS
What is carpal tunnel syndrome?
The carpal tunnel is the space formed by the bones of the wrist and hand that allows passage of the median nerve along with tendons of muscles that move the joints of the hand. This space is typically about an inch wide, however it can be made narrower in the presence of irritation and swelling of any of these structures. Narrowing of this passageway can lead to pressure on the median nerve, which may lead to symptoms such as tingling, burning, weakness, and pain in the hand and fingers.
How do I know it is carpal tunnel syndrome?
Symptoms from carpal tunnel syndrome such as numbness and tingling typically present themselves at the thumb, index finger, middle finger, and half of the ring finger. This is because sensation to these areas is supplied by the median nerve. If the median nerve is being compressed, these areas may become numb or painful. You may also find weakness of the muscles that move the thumb, first two fingers, and wrist. The picture below shows what the hand may look like when a person with long-standing carpal tunnel syndrome attempts to make a fist. It is known as the “Hand of Benediction Sign”.
What is the traditional treatment for carpal tunnel?
Typically, people suffering with the symptoms of carpal tunnel syndrome receive anti-inflammatory medications or are suggested to have surgery. This surgery involves a “release” of the transverse carpal ligament, meaning that the surgeon cuts this ligament to help decrease pressure on the tunnel and, therefore, the median nerve. The issue is that this does not always solve the problem. If the tendons are still inflamed and swollen, we may still be feeling these symptoms after the post-surgical healing process is complete. For this reason, physical therapy should be a patient’s first option. Many people find that PT alone helps them return to normal, pain-free functioning during daily tasks.
How do we improve these symptoms in PT?
The symptoms from carpal tunnel syndrome can be resolved by decreasing pressure on the median nerve at the level of the wrist and hand. This can be accomplished by improving flexibility of the muscles and connective tissues at the wrist and hand, especially those on the front of the forearm. Your physical therapist will perform mobilization and stretching techniques, postural training and education, nerve gliding techniques, and soft tissue mobilization. Once the tissues are of proper flexibility, we must ensure that the muscles surrounding the hand and wrist are strong to help stabilize the joints. A home exercise program with specific exercises to help your condition will also be prescribed.
Check out the video below for a demonstration on how to perform median nerve gliding to help alleviate symptoms of carpal tunnel syndrome:
Click here to find out more information about physical therapy for carpal tunnel syndrome
Resources:
Our knowledge of orthopedics. Your best health. (n.d.). Retrieved April 05, 2018, from https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/
“Hand of Benediction” photo retrieved from http://slideplayer.com/slide/9418409/
Photo depicting carpal tunnel release surgery retrieved from http://www.korshjafarniamd.com/treatment/minimally-invasive/endoscopic-carpal-tunnel-release.php
Photo depicting median nerve compression retrieved from http://nursinglink.monster.com/training/articles/814-carpal-tunnel-syndrome
Photo used at top of page depicting painful wrist retrieved from http://www.pipmchealth.com/conditions/carpal-tunnel-syndrome/
“Tips for preventing and treating carpal tunnel syndrome”photo retrieved from https://www.mispinerelief.com/blog/carpal-tunnel-treatment-and-preventing-for-carpal-tunnel-syndrome/
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
How Can PT Help My Spinal Stenosis?
What is Spinal Stenosis?
Spinal stenosis is one of the most commonly diagnosed conditions that affects the lumbar spine (lower back). It is common for people with stenosis to feel tightness and pain that radiates from the low back and buttocks down into both legs.
It is estimated that only about 5% of people with spinal disorders actually require surgery (Eidelson, 2018). So, what are the other 95% of people expected to do? This is where physical therapy comes into play. There are many methods your PT will use in order to help address the issue causing your pain and discomfort.
By Nick Mazzone, PT, DPT, CSCS
Spinal stenosis is one of the most commonly diagnosed conditions that affects the lumbar spine (lower back). It is common for people with stenosis to feel tightness and pain that radiates from the low back and buttocks down into both legs.
It is estimated that only about 5% of people with spinal disorders actually require surgery (Eidelson, 2018). So, what are the other 95% of people expected to do? This is where physical therapy comes into play. There are many methods your PT will use in order to help address the issue causing your pain and discomfort. This includes but is not limited to therapeutic exercise, soft tissue mobilization, manual stretching of the hips and spine, and postural re-education.
What is spinal stenosis of the lumbar region?
As you can see from the picture above, stenosis of the spine involves a narrowing of the canal in which the spinal cord sits. This leads to increased pressure on the spinal cord as well as the nerves that branch from it. This is the reason why people feel pain in the buttocks and legs; the region of pain stems from a specific section of the spinal cord that is under pressure. For this reason, two people with the same condition will present with different symptoms.
How can physical therapy help with this problem?
The treatment plan will be specifically tailored to each patient with stenosis. The main objective is to help decompress the spinal cord and its nerve branches by using techniques that create more space in the spinal canal. Bending backward, also known as extension of the lumbar spine, will decrease the space in the spinal canal due to the way the joints of the spine are oriented. This may increase pain and symptoms in a person with spinal stenosis. For this reason, the treatment plan will be focused on utilizing and improving spinal flexion, more commonly known as bending forward. This will help to widen the canal and decompress the inflamed structures, effectively providing relief of symptoms.
A comprehensive treatment plan will help you find positions of maximal comfort and give you more drug-free and surgery-free options for taking care of your lumbar spine and preventing pain in the future.
Please check out this brief video that provides 3 simple exercises to help decrease symptoms due to lumbar spinal stenosis, or click here to find out more information about physical therapy for spinal stenosis.
Resources
Eidelson, S. G., & An, H. S. (February 2018). Spinal Stenosis Center | Lumbar, Cervical, Symptoms, Exercise, Surgery. Retrieved March 18, 2018, from https://www.spineuniverse.com/conditions/spinal-stenosis
Picture of person with low back pain retrieved from http://www.omegapainclinic.com/spinal-stenosis-pain-treatment-utah
Pictures of stenosis in lumbar region retrieved from https://www.spineuniverse.com/conditions/spinal-stenosis
Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.
What Does Foam Rolling Do for Me?
Foam Rolling has become one of the more popular health and fitness topics over the past few years or so. These tools can be found in many different shapes, sizes, and colors with varying textures and firmness to fit everybody’s apparent need. If you google this, you will find claims that foam rolling can help you improve range of motion, muscle strength and performance, and decrease pain…
By Nick Mazzone, PT, DPT, CSCS
Foam Rolling has become one of the more popular health and fitness topics over the past few years or so. These tools can be found in many different shapes, sizes, and colors with varying textures and firmness to fit everybody’s apparent need. If you google this, you will find claims that foam rolling can help you improve range of motion, muscle strength and performance, and decrease pain. It is also often used as part of a warm-up and cool-down within an exercise program.
Who do I believe?
Well, unfortunately there are very few studies on foam rolling and its effects on our muscles and connective tissues. The following bullet points can be used as a summary of the current body of research on this topic:
Positive Effects of Using a Foam Roller
· Increased blood flow
· Increased tissue temperature
· Better short-term improvements in range of motion versus static or dynamic stretching
· Decreased sensation of pain
What Foam Rolling Will NOT do for You
· Increase strength or power output
· Give lasting improvements in range of motion when used as a stand-alone treatment
· Lead to complete resolution of pain/symptoms when used as a stand-alone treatment
Let’s Discuss these findings…
As you can see, there are some benefits to using a foam roller, however I feel it is important that we clear up some of the common misconceptions on the topic…
Many people who use a foam roller use it in isolation as a method of improving their mobility. I understand why people want this to be true; foam rolling is much easier and less strenuous than stretching. Unfortunately, you will not receive lasting effects from foam rolling alone. While foam rolling will only provide temporary improvements in range of motion, we can take advantage of this temporary improvement by proceeding to perform static or dynamic stretching. With consistency, this can help to improve range of motion on a more permanent basis (although more studies are needed on this topic).
There is also no evidence that foam rolling increases strength or explosiveness during your workout, however one may argue that by utilizing a foam roller you are increasing blood flow to the area, and therefore, helping to facilitate contraction of specific muscles during exercise.
Foam Rolling may also help decrease pain by working to desensitize the area through repetitive stimulation and can help promote tissue healing by improving local blood flow.
How do you suggest I use the foam roller in my daily life?
· In conjunction with a stretching program for improving range of motion
· As part of a warmup routine, especially for activities that have high mobility requirements
· As an alternative to pain killers for temporary pain relief
· As a method of soothing sore, painful muscles after a physically demanding workout
Check out this video for a brief introduction on how to use a foam roller:
For more information or any questions, give us a call at 718-258-3300 or contact us today!
Resources:
Su, H., Chang, N., Wu, W., Guo, L., & Chu, I. (2017). Acute Effects of Foam Rolling, Static Stretching, and Dynamic Stretching During Warm-ups on Muscular Flexibility and Strength in Young Adults. Journal of Sport Rehabilitation,26(6), 469-477. doi:10.1123/jsr.2016-0102
Cartoon depicting man foam rolling retrieved from https://www.gq.com/story/foam-roller-tips
Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.
How Do I Warmup Prior to Lifting Weights?
The warmup phase is easily one of the most forgotten components of an exercise program these days. Would you intentionally leave it out if I told you that it could lead to increased performance and results during your workout?
By Nick Mazzone, PT, DPT, CSCS
The warmup phase is easily one of the most forgotten components of an exercise program these days. Would you intentionally leave it out if I told you that it could lead to increased performance and results during your workout?
Traditionally, people have used static stretching (long holds in a position that lengthens a muscle) before workouts to help decrease their risk of injury, however there is no evidence that this is the case. Static stretching before exercise has actually been shown to decrease maximal force production, jump height, and sprint speed while increasing reaction time and impairing balance (Perrier et. al).
Rather than static, long holds in the lengthened position of a muscle, dynamic movement involves actively moving through a joint’s range of motion without holding at the end point. A study by Perrier et. al found that dynamic movement including skipping, shuffling, and calisthenics of increasing intensity that were chosen based on the movements that would be performed during training led to improved athletic performance versus static stretching and no stretching at all.
Dynamic movements that mimic the exercises you will be performing help to prepare the central nervous system for physical activity. By activating specific muscles prior to exercising, we are facilitating proper muscle activation patterns and therefore, “priming” the nervous system.
Suggestions for a proper warmup routine
· 15-20 minutes of dynamic movement
· Must make an effort to mimic the activities that will be performed in the exercise program
· Must include enough intensity to elevate heart rate
· Should not approach more than 30% of your maximal effort to prevent muscle fatigue
Example of warmup routine prior to squatting or deadlifting
· Bridging with a resistance band 3 sets of 15-20 reps
· Marching with a resistance band 3 sets of 15-20 reps
· Body weight squatting with a resistance band 3 sets of 15-20 reps
· Lateral Band Stepping with resistance band 3 sets of 10 steps in each direction
Example of warmup routine prior to overhead pressing or bench pressing
· Banded shoulder external rotation with retraction 3 sets of 12-15 reps
· Wall Angels 3 sets of 10-15 reps
· Overhead Arm Raise at Wall 3 sets of 10-15 reps
· Banded Wall Climbs 3 sets of 8-12 reps
For a preview of upper and lower body warmup routines, check out these videos:
For more information or any questions, give us a call at 718-258-3300 or contact us today!
Click here for more information about sports physical therapy and how a personalized physical therapy program may just be your best bet…
Resources
Perrier, E. T., Pavol, M. J., & Hoffman, M. A. (2011). The Acute Effects of a Warm-Up Including Static or Dynamic Stretching on Countermovement Jump Height, Reaction Time, and Flexibility. Journal of Strength and Conditioning Research,25(7), 1925-1931. doi:10.1519/jsc.0b013e3181e73959
Warmup picture retrieved from https://www.hosmerchiropractic.com/blog/7-ultimate-dynamic-stretching-exercises/
Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.
How Can Physical Therapy Help My Arthritis?
What is Osteoarthritis?
Osteoarthritis is a major cause of chronic pain and disability in our society today. People with arthritis typically report deep, aching pain in the joints affected as well as stiffness and inability to get up and get right out of bed in the morning. The most common treatments for this painful condition include cortisone injections aimed at decreasing inflammation, over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs), and knee replacement surgery once the condition significantly worsens…
By Nick Mazzone, PT, DPT, CSCS
What is Osteoarthritis?
Osteoarthritis is a major cause of chronic pain and disability in our society today. People with arthritis typically report deep, aching pain in the joints affected as well as stiffness and inability to get up and get right out of bed in the morning. The most common treatments for this painful condition include cortisone injections aimed at decreasing inflammation, over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs), and knee replacement surgery once the condition significantly worsens.
What is going on in my joints that causes this pain?
Osteoarthritis is a degenerative condition that leads to wearing away of the outer layers of cartilage and bone as you can see in the image above. This causes an inflammatory process to be induced by the body which leads to swelling, increased sensitivity to touch and pressure, and pain. On an X-ray, you will see decreased space between the bones and potentially bone spurs, which the body lays down in response to excess pressure in the area. This inflammatory condition typically leads to inactivity, which then leads to decreased range of motion along with muscle weakness.
What will physical therapy accomplish?
The hallmarks of arthritis include joint stiffness, swelling, muscular weakness, and pain. In physical therapy, your therapist will prescribe specific exercises that will help improve range of motion, and therefore, stiffness, as well as exercises for strengthening the surrounding muscle groups. These exercises will also act to help decrease the central nervous system’s hypersensitivity to pressure and touch, which will allow you to perform your daily tasks with much greater ease. Your therapist will also work on improving your patterns of movement in order to ensure that you are decreasing the pressure on your arthritic joints and using the most efficient pattern available to your body. There are also modalities and other methods used that will help to decrease the amount of swelling in the joint, which then leads to decreased pain.
Great. Stronger muscles, improved range of motion. How exactly is this helping my condition?
Good question. I would like to start by saying that there is currently no way to reverse the arthritic condition. That being said, I would like you to consider this example. Think about a stiff and swollen knee joint. When a person bends their knee, the stiffness in the muscles and fibers of the joint force the bones to glide along a smaller surface area. This will eventually lead to more breakdown of the cartilage and outer layers of bone, which means progression of the osteoarthritis. Now imagine we have a knee joint that has been sufficiently stretched and has less swelling. These bones glide in a smoother manner across a larger surface area (due to less range of motion restrictions). Now that the force can be spread evenly across the bony surfaces, there is a much less chance of increasing breakdown of the cartilage and bone.
Strengthening the muscles helps to ensure that while walking or performing other functional daily tasks, the joint is kept in a position that ensures proper alignment and efficiency of muscle function. This formula along with a prescribed home exercise program will prevent progression of the condition and assist in avoiding knee replacement surgery.
Check out this brief video which shows how to utilize a “hip-first pattern” to help offset pressure on the knee joint when bending down and squatting.
For more information or any questions, give us a call at 718-258-3300 or contact us today!
or click here to find out more about physical therapy for arthritis
Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.
Anterior Hip Pain and How to Manage It
What is Anterior Hip Pain and what are it's causes?
Anterior hip pain is most often caused by a strain in the hip flexor muscles which are located at the front of the hip. A strain, which is a injury to a muscle or tendon, causes a painful sensation to the hip which heavily contributes while walking, running or squatting. These strains are common with overtraining, strength imbalances, poor technique, inflexibility and forceful contractions such as kicking and sprinting.
How does the hip work?
The hip is a ball-and-socket joint that comprises the top of the thigh. The femur, which is your thigh bone, sits into the acetabulum, which is the socket that allows it to remain both stable and mobile, and to allow for movement without dislocation.
What is Anterior Hip Pain and what are it's causes?
Anterior hip pain is most often caused by a strain in the hip flexor muscles which are located at the front of the hip. A strain, which is a injury to a muscle or tendon, causes a painful sensation to the hip which heavily contributes while walking, running or squatting. These strains are common with overtraining, strength imbalances, poor technique, inflexibility and forceful contractions such as kicking and sprinting. The most common and impactful of these is overtraining which includes insufficient rest and difficult training sessions. Consistent overtraining sessions will result in micro trauma which accumulate and result in a possible hip flexor strain or tendonitis.
Myofascial Release of the Anterior Hip
In this video, Chris Desiderio, DPT will explain how to release some tension that may be in the front of the hip in order to help the hip flexors function optimally.
Posterior Mobilization
In this video, Chris will demonstrate a mobilization of the hip in a posterior direction to help release the front of the joint capsule.
Standing External Rotations
In this video, Chris will demonstrate a standing external rotation, which can help strengthen the gluteus medius to prevent anterior hip pain.
Click here to find out more information about hip physical therapy in Brooklyn or give Evolve Physical Therapy in Brooklyn a call today! 1-718-258-3300
