Brooklyn Physical Therapy News- Evolve NY

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Jay C 11/16/22 Jay C 11/16/22

What Technology Are Physical Therapists Using Today?

New Physical Therapy Technologies- IAPT. Advancements in PT Technology… While individually prescribed exercise programs are often the bread and butter of a physical therapy plan of care, there is no denying that technological advances in physical therapy tools have a place in the clinic also. If it’s been a while since you’ve been to physical therapy you might be wondering what new technology exists to target tissue mobility, reduce pain, and improve the effectiveness of strengthening programs…

New PT Technologies- IAPT

AdvanceMENTS in PT Technology…

While individually prescribed exercise programs are often the bread and butter of a physical therapy plan of care, there is no denying that technological advances in physical therapy tools have a place in the clinic also. If it’s been a while since you’ve been to physical therapy you might be wondering what new technology exists to target tissue mobility, reduce pain, and improve the effectiveness of strengthening programs. This article will introduce you to some new pieces of equipment you might find at your next PT visit.

Myofascial Decompression (MFD): Myofascial decompression is a negative pressure soft tissue mobilization technique based on the traditional cupping method. During this treatment cups are placed on a particular area of the body and a special tool is used to create suction within the cup. Unlike other forms of soft tissue work in which the skin, fascial layers, and muscles are compressed, for example during foam rolling, these instruments actually pull the skin, muscle, and fascial layers up into the cup creating space and temporarily altering blood flow to the area. When placed strategically and paired with active movement, MFD can alter the mechanical and fluid properties of fascial layers, increase blood flow to the area and allow the fascial layers to glide and slide on one another more easily. Given that pain and movement receptors are often found in the deeper layers of the fascia this treatment can help improve tissue mobility, reduce pain, and improve neuromuscular control and biomechanics.

Percussive Massage Guns: Massage guns are becoming common in many physical therapy clinics. These tools provide a percussive vibration from a single, interchangeable, head at the end of the handheld “gun.” They typically have different settings and the intensity can be adjusted as needed. When used before or after intense exercise it can help reduce delayed onset muscle soreness (Imtiyaz et al., 2014) and when used before it can provide short-term increases in muscle length. It also may increase blood flow to an area and reduce inflammation which can have pain relieving benefits. One benefit to this tool is that it is portable and many people feel a benefit after its use.

Blood Flow Restriction Training Method: This technique consists of applying a pneumatic tourniquet cuff to the proximal portion of a limb to partially restrict venous outflow from the areas below it. This technique causes blood to pool in the capillary beds and has been shown in many studies to increase muscle strength and size while exercising at loads less than would be typically required to induce strength gains. It has also been shown to have positive effects on bone mineral density and tendon stiffness. It is often used in patients who are recovering from surgeries such as an ACL or tendon repair in which weight bearing and load tolerance is low but they need to regain strength. As you can imagine, if done incorrectly, injury can occur, so this is not something to try at home but should be applied by a PT trained in this particular modality.

Neuromuscular Electrical Stimulation (NMES): In the body, muscles are activated through nerve signals originating in the brain and spinal cord. If there has been an injury to the brain or spinal cord the descending motor signals to the muscles are impaired and sometimes nearly absent resulting in weakness and poor motor control of the muscles affected. This can result from an injury to the central nervous system such as a stroke, spinal cord injury, or Multiple Sclerosis, for example. NMES consists of a machine that sends an electrical signal to a muscle through a pair of electrodes placed over the muscle. NMES can help restore some of the brain- and spinal cord-muscle connectivity as a patient actively tries to move their muscle while the external signal causes a muscle contraction. In the past, these machines were mainly for use in the clinic but advances in technology have allowed for the production of at-home units that can be prescribed by your physical therapist and are relatively low-cost. This technology has also been incorporated into several different types of wearable technology to help with things like foot drop or grasp and release.

THE NEW PHYSICAL THERAPY FRONTIER

While the role of physical therapists as movement and injury rehabilitation experts will remain, new advances in technology will undoubtedly help us to be more effective practitioners. Every year new research is being done on technology to help you move better and feel better and while time and repeated use will determine which of these technologies deserves to remain in the physical therapist’s toolbox for the long run, for now we are excited about what is to come!

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Jay C 11/13/22 Jay C 11/13/22

Get Back on the Ice with Physical Therapy for Hockey Players

Physical Therapy for Hockey Players- In the last thirty years the sport of ice hockey has seen a sizable increase in participation at all levels of the sport. From youth hockey to the professional level, more players on the ice means more potential for injury. Whether it’s a nagging discomfort you’ve been noticing for a while or a sudden injury that’s just occurred, finding a physical therapist familiar with the demands of ice hockey is important.

Physical Therapy for Hockey Players

In the last thirty years the sport of ice hockey has seen a sizable increase in participation at all levels of the sport. From youth hockey to the professional level, more players on the ice means more potential for injury. Whether it’s a nagging discomfort you’ve been noticing for a while or a sudden injury that’s just occurred, finding a physical therapist familiar with the demands of ice hockey is important. This article will discuss common injuries in hockey and how physical therapy can address these injuries to help you get back out onto the ice.

COMMON INJURIES IN ICE HOCKEY

If you’ve ever played ice hockey or enjoy spectating, you will notice that ice hockey differs from other sports in a few ways. Hockey is a collision sport and requires quick changes in direction and movement in all planes but unlike other contact sports, it is played on a frictionless surface while players balance on a very narrow contact surface (the blade).

Depending on the position you play you may spend more of your time skating backwards than forwards while some positions perform more crossover skating. Goaltenders may spend a period of time relatively still then be required to make quick movements that require large ranges of motion and flexibility. Furthermore, stickhandling the puck requires good hand eye coordination, strength, and proprioception (Wolfinger, Christopher and Davenport, Todd, 2016).

A review of hockey injuries in highschool and collegiate men’s and women’s hockey found that injuries were most common to the head/face, shoulder/clavicle, and hip/thigh/upper leg. Injury type ranged from concussion (most common), ligament sprains, muscle/tendon injuries and contusions (Lynall et al., 2018). Body checking accounts for a high percentage of injuries.

Depending on the type and severity of injury, loss of practice and play time can be a real concern. Having a proper rehabilitation plan and perhaps just as important, a comprehensive prehabilitation program, can help limit time spent recovering off the ice and reduce the likelihood of injuries overall.

WHAT DOES PHYSICAL THERAPY FOR HOCKEY LOOK LIKE?

Prehabilitation: Prehabilitation refers to participation in therapy based movements and exercises in order to avoid injury, decrease pain or to prepare for surgery. In the context of hockey, prehabilitation is intended to prepare the body for the physical demands of the sport to improve injury resilience and maximize the ability to recover from injury. Below are some of the components of prehabilitation for hockey players:

Flexibility: Hockey requires quick changes in direction and the ability to push off the skates quickly. Having adequate flexibility throughout the lower body and trunk will allow for improved mechanics while skating and more reach while tending the goal. It also decreases the likelihood of sustaining a muscle strain which can occur when the muscle is stretched beyond its level of flexibility.

Endurance: Muscle and cognitive fatigue can lower reaction times and decrease stability and protection around joints. Having the stamina to maintain proper form, biomechanics, speed, and agility through all four periods of a game can decrease one’s risk for injury and make playing the game more enjoyable.

Stability: Having sufficient shoulder, pelvic, and core stability not only makes one more resistant to being thrown off balance with a body check, but it allows for more powerful transfer of energy through the body. The ability to powerfully shoot the puck and transfer energy from the skates through the rest of the body to accelerate and decelerate is related in part to muscles contracting in a coordinated fashion to stabilize the bones and joints.

Strength: Full body strengthening is important to maximize power output and speed and to increase injury resilience during practice and competition. It is important to include shoulder strengthening exercises as shoulder and clavicle injuries are common in hockey.

Power: Skating powerfully, being able to reach across the crease as the puck comes flying at you, and driving the puck across the ice into the net requires the ability to generate large amounts of force quickly, also known as power.

Injury Rehabilitation: Despite great preparation, injuries can still occur and applying the right rehabilitation techniques is vital to ensuring full recovery of the injury, minimizing time spent off the ice, and reducing the likelihood of reinjury. Let’s take a look at how physical therapy can address some of the more common hockey injuries.

Concussion: Concussion is considered a functional brain injury. Its effects can not be seen in a CT Scan or an MRI but we know from more advanced imaging that it affects the brain’s ability to function which leads to the signs and symptoms we see after a concussion. Concussion is a serious condition and failure to allow full recovery before returning to full play can put one at risk for serious brain injury if they sustain another blow to the head.

Although most players will recover from a concussion within a couple of weeks, consulting with a physical therapist is important to both recognize signs of postconcussion syndrome, in which recovery is delayed, and also to guide the player through active recovery. A concussion does not necessarily require total rest but understanding what activities to limit and when to begin resuming activity is essential. If issues with dizziness, headaches, poor tolerance to higher intensity exercise, imbalance, or gaze stabilization persist, vestibular physical therapy can help a hockey player improve these symptoms.

Muscle strains: When a muscle is strained, you will typically experience pain in that specific muscle when it is contracted strongly or stretched. If the strain is moderate in severity you may also notice some localized stiffness, tenderness, and swelling in the area. You may also observe that the muscle feels weaker than usual. Finally, if it is severe and the muscle belly has separated from the tendon or all the fibers have torn, the range of motion of the joints at either end of the muscle may be either significantly reduced because of guarding or excessive because the torn muscle is no longer limiting it.

Recovery from a muscle strain depends on the severity but physical therapy can guide you through that process. Your physical therapist can advise you on how to manage pain and inflammation and protect the newly injured muscle while still performing exercise with uninjured body parts to limit overall deconditioning. Next you will be guided through a program of gradually strengthening and restoring flexibility to the muscle and then performing hockey-specific exercises to prepare the muscle for the demands of return to play.

Femoroacetabular Impingement (FAI): This condition in which there is bony overgrowth on the femoral head (ball) or acetabulum (socket) of the hip joint can lead to pain and pinching in the groin. It is most common in goaltenders who spend a lot of time in the “butterfly position” moving in and out of hip internal rotation and flexion which typically trigger symptoms of pain with this condition. When mild, this condition can often be treated conservatively with physical therapy but if a surgical approach is warranted then physical therapy will be needed after surgery to rehabilitate the hip and recover strength, mobility, and stability for return to play.

Ligament sprains: When a joint is moved beyond its normal range of motion it stresses and stretches the inelastic fibers of the ligaments surrounding it and can cause tearing (sprains). Because the primary function of ligaments is to provide passive stabilization to the area, loss of stability can range from mild to severe with a ligament sprain. Ligament injuries can occur in any joint but are common in the ankle, knee, shoulder and wrist. Your physical therapist can assess the joint to determine which ligaments are involved.

They will advise you on how to protect the ligament in the earliest phase to reduce pain and inflammation and protect healing tissues. In later phases of rehab you will focus on improving strength in the muscles that add stability to the joint and on motor control and proprioception to help protect the joint from future injury. When ready, your PT can advise you on how to begin hockey-specific drills and exercises to ease back into full participation.

CHOOSE PHYSICAL THERAPY

More time spent on the ice makes you a better hockey player and if hockey is what you love, then staying injury free is a priority. While you can’t prevent all injuries, physical therapy can help you identify the areas that make you more susceptible to injury so you can begin addressing them now. If you do find yourself injured, the physical therapists at Evolve will get you started right away on the road to recovery so you can get back on the ice.

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics-

There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

Multiple Locations!

https://EvolveNY.com

Jay C 11/3/22 Jay C 11/3/22

How to Prepare for ACL Surgery with Prehab Physical Therapy

Prepare for ACL Reconstruction with Physical Therapy- Much research has been done to try and determine what preoperative factors are associated with better long-term outcomes for those undergoing ACL reconstruction. Some factors like age and sex cannot be modified with a preoperative rehab program. Other factors, however, such as knee range of motion, quadriceps strength, and level of activity prior to surgery (measured by the Tegner Activity Scale) are associated with positive indicators at one to two years post-surgery and beyond.

How to Prepare for ACL Surgery w/ Prehab

Did You Know Pre-ACL Reconstruction Rehab Leads to Better Outcomes?

Prepare for ACL Reconstruction with Prehab Physical Therapy-

Many people ascribe to the notion that the best way to address an injury is to rest. While this is true in certain cases, like when healing a bone fracture, in many other cases complete rest can lead to muscle atrophy and delay return to full function.

A torn ACL is an injury that defies this notion as well and though activities will most definitely need to be modified due to the pain, swelling, and instability that arise from an acutely torn ACL, a carefully prescribed rehabilitation program prior to ACL reconstruction surgery may lead to better long term outcomes (Melick et al., 2016).

In this article we will talk about what components may be included in an ACL reconstruction preoperative program.

WHAT PREOPERATIVE FACTORS SHOULD I TARGET?

Much research has been done to try and determine what preoperative factors are associated with better long-term outcomes for those undergoing ACL reconstruction. Some factors like age and sex cannot be modified with a preoperative ACL program. Other factors, however, such as knee range of motion, quadriceps strength, and level of activity prior to surgery (measured by the Tegner Activity Scale) are associated with positive indicators at one to two years post-surgery and beyond.

Decrease swelling and restore range of motion: The primary goal of early preoperative management for ACL injury is decreasing swelling (joint effusion) and restoring full passive and active knee range of motion. Regaining knee extension and flexion range of motion is an important goal before ACL reconstruction surgery. Trouble regaining full knee range of motion is one of the more common complications of ACL reconstruction surgery and failing to achieve full range of motion in the preoperative phase is a risk factor for this complication (Quelard et al., 2010).

Since swelling in and around the joint capsule impairs range of motion and can inhibit muscle activation, reducing swelling should be one of the first goals of an ACL surgery prep program. Here are a few methods for managing swelling:

Apply ice to the area for 15 minutes, 3-4 times a day
Elevate the leg above the level of the heart throughout the day
Apply compression with a bandage or compression sleeve
Modify weight bearing as needed to limit an inflammatory response

Start a progressive exercise program: Goals in this second phase of early post-injury rehab for an ACL tear include maximizing muscle strength, specifically quadriceps muscle strength, and neuromuscular control. Having at least 90% return of quadriceps strength compared to the opposite side is important leading into ACL reconstruction but undergoing additional therapy to address impairments in neuromuscular control of the knee and all the joints of the leg can improve functional outcomes two years after surgery (Failla et al., 2016). Once you’ve attained a “quiet knee” without joint effusion, with full range of motion, and the ability to hop on one leg, progressing toward heavy resistance training and even plyometric exercises has been found to be safe with a low incidence of adverse events and can have benefits that extend years beyond ACL reconstruction (Filbay, S. and Grindem, H., 2019).

It is important to consult with a physical therapist who can prescribe and progress a program that is specific to you. Trying to do this on your own may lead to failure to achieve and sustain a “quiet knee” but also may lead to underdosing of beneficial exercises. Let's take a look at examples of exercises that might be included in a 5-6 week preoperative protocol. Please note that these exercises are not necessarily ordered as a progression.

Quad sets: performed in sitting with the injured leg extended in front of you, try and lift your heel as you press the back of your knee into a towel. When possible, try to sustain a contraction of the quadriceps muscle for six seconds. This exercise is great to establish motor control and volitional contraction of the quadriceps muscle.

Straight leg raise: lying on your back, with the injured knee straight, raise the leg up off the table without letting the knee bend then slowly lower it back to the table.

Squats: Starting with body weight, use a mirror as feedback to maintain equal weight through both legs. Progressions of this exercise include adding weight and performing as a single leg squat or single leg sit to stand.

Knee extension: Initially you may perform this exercise seated in a chair and extending the injured knee to raise the lower leg against gravity. As you gain strength you may progress to adding ankle weights or using a resistance machine.

Single leg balance: Stand on one leg while trying to maintain a level pelvis. Aim to increase the time you can hold this position and vary the surface to a softer or more compliant surface for added challenge.

Perturbation training: these dynamic exercises help to improve the stability of the knee. Most likely starting as a double leg activity and progressing to a single leg activity, perturbation training involves withstanding challenges to balance and postural control in multiple planes of movement. They may be performed on a variety of unstable surfaces.

While an ACL injury can feel overwhelming and the recovery may seem daunting, a good preoperative rehabilitation program can set you up for better success. Let physical therapy guide you through this process and create an individualized ACL reconstruction preparation program just for you so that you can go into surgery with the comfort of knowing you have done everything you can to have the best surgical outcome possible. The physical therapists at Evolve are ready to help even day one after an injury because the road to recovery from an ACL tear begins right away.

Don’t Wait Until After ACL Reconstruction to Begin Your Rehab! Click here to find out more information about ACL physical therapy and our specialized prehab physical therapy programs.

About EvolveNY-

Multiple Brooklyn Physical Therapy Clinic Locations!

https://EvolveNY.com

Jay C 10/21/22 Jay C 10/21/22

5 Best Exercises to Prepare for Basketball Season

Get Ready for Basketball Season with These 5 Workouts: 5 Principles for Offseason Basketball Training-When you’ve finished the last game of the season you might be thinking it’s time to take a few months off but if you are looking to improve your performance during the next competitive season then this is the time to get to work. Focusing on basketball-specific training principles during the off-season will allow you to maximize performance and minimize injury risk when it’s game time again.

Get Ready for Basketball Season with These 5 Workouts

5 Principles for Offseason Basketball Training

When you’ve finished the last game of the season you might be thinking it’s time to take a few months off but if you are looking to improve your performance during the next competitive season then this is the time to get to work. Focusing on basketball-specific training principles during the off-season will allow you to maximize performance and minimize injury risk when it’s game time again.

Basketball is considered a contact sport and it involves sprinting, jumping, landing, withstanding contact from other players, and pivoting quickly. If you want to improve your performance on the court you need to incorporate training elements that enhance your ability to perform each of these skills and prepare the body’s tissues to withstand the high forces associated with training and competitive basketball.

During a 10 year period of seasons between 2008 and 2019, 66% of professional basketball players sustained an injury with a median three game loss as a result of the injury (Bullock et al, 2021). The most common injuries occurred at players’ ankles, followed by knees, hips/groin/thighs and ranged in severity from mild to severe. While injury rates may differ for players outside of a professional league, it stands to reason that any player is at risk for injury and maximizing injury resilience in the off-season is a wise idea.

Incorporating strength training for the legs, trunk/core, and arms is an essential part of training during this time. Exercises like deadlifts, lunges, pull ups, hamstring curls, squats and overhead press target the entire body and can help support many of the skills needed on the court. Since many of you will already be doing a full body strengthening routine this article will introduce you to five other elements of training that you can incorporate to get ready for basketball season.

FINE TUNING YOUR WORKOUT ROUTINE

Stability Matters: though strength development should always be a part of pre-season training for basketball, don’t forget to incorporate exercises that develop stability. Stability is provided by coordinated co-contraction of muscles surrounding joints. Having good stability not only reduces the risk of injury to ligaments and muscles that can happen when they are stretched beyond their normal length but it is vital for transferring power through the body to make that three pointer or land on your feet when another player contacts you during a jump. Dynamic exercises standing on one foot, for example, can improve the motor control and stability of ankle muscles to prevent ankle sprains, a common basketball injury. Core stabilization exercises like pallof presses and shoulder stability exercises like plank variations are another good place to start.

Mobility: without enough flexibility in the upper and lower body and the spine it will be difficult to translate the speed and power you developed during pre-season training into quick changes in direction, explosive jumps, and powerful shots on the court. Off-season is the perfect time to start working on your flexibility. Static and dynamic muscle stretches and joint/muscle mobility exercises that target the hips, groin, knees, ankles and shoulders can reduce injury and improve performance.

Stiffen up those tendons: while it may sound counterintuitive, stiffness in the tendons that attach a muscle to the bone is actually a good thing. Stiff tendons are more resilient against injury. They are also capable of stretching further during a muscle contraction, storing the elastic energy and then recoiling strongly to produce more powerful movements. Stiffer achilles tendons, for example, are often seen in faster runners.

Many of us focus on concentric exercises in our workouts wherein a muscle is shortening against a load, for example, a bicep curl. Research shows, however, that eccentric and isometric exercises are much more effective at developing tendon stiffness. Eccentric exercises, also sometimes called “negatives”, consist of a muscle lengthening against a load. An example would be slowly or “eccentrically” lowering into a squat then standing up quickly. An 8-12 week eccentric training program for the calf muscles, for example, can significantly improve achilles tendon stiffness which may result in higher jumps and fewer tendon injuries (Geremia et al., 2018). Similarly longer duration isometric contractions of a muscle, in which the muscle contracts against a load but doesn’t change length, can also improve muscle strength and tendon stiffness (Kubo et al., 2006; Kubo et al., 2017).

Power training: If all you were required to do on the court was lift or push something heavy then strength training might be all you needed. Basketball players, though, need to accelerate or decelerate very quickly as they jump and land, change directions, and shoot a ball. This is where speed and power training become important. Power lifts at >80% of one rep max, plyometrics, and sprints are great ways to develop explosive speed. Incorporating the upper body into this type of training is important so you can catch, pass, and shoot the ball with power and control. This type of training is hugely beneficial to prepare for basketball season but needs to be incorporated carefully as it can be easy to injure oneself if done incorrectly. Your coach or trainer can help you build a program for speed and power that meets your current fitness levels to improve your play and decrease your risk for injury.

Basketball specific drills: being strong, fast, and powerful will certainly help during a basketball game but if this was all that was needed to be a great player then just about any Olympic athlete should be able to earn a spot on a professional basketball team. The reason strength, speed, and power don't automatically make a player great is that training for any sport requires specificity. If you want to be good at basketball you need to be practicing skills and drills that are specifically used during a basketball game. Training for soccer, for example, might help you get fit but it won’t make you a better basketball player. In the off season pick 3 or 4 of your favorite basketball drills for shooting, passing, and footwork and incorporate these into your training to hone your neuromuscular control.

Now that we see how offseason prep in the training room is important to prepare for basketball season, we should also acknowledge that the offseason is the perfect time to rehab any injuries or irritations. If you are currently injured or have noticed a pain or irritation that develops as training and practices ramp up, now is the time to schedule an appointment with the physical therapists at Evolve so they can help you recover and build resilience ahead of basketball season.

Click here for more information about physical therapy for basketball players

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics-

There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

Multiple Locations!

https://EvolveNY.com

Jay C 10/19/22 Jay C 10/19/22

Physical Therapy for Gamers and Workaholics

Hit Pause on Pain from Gaming and Computer Work- In the modern world of technology many of us find ourselves sitting for much of the day looking at computers or screens. You might sit in a desk chair for the better part of eight hours doing work on your computer and then hop onto the couch and wind down for a few hours playing video or computer games…

Physical Therapy for Gamers and Workaholics

Hit Pause on Pain from Gaming and Computer Work

In the modern world of technology many of us find ourselves sitting for much of the day looking at computers or screens. You might sit in a desk chair for the better part of eight hours doing work on your computer and then hop onto the couch and wind down for a few hours playing video or computer games. If you are one of the many people who spend a majority of their day sitting in front of a computer, phone, or television, you are probably familiar with how your body feels after sitting in one position for a long time. In this article we are going to examine some of the more common physical symptoms and conditions that gamers and workaholics experience and how physical therapy can help you find relief during your workday and while you game.

Neck pain/stiffness/fatigue: Neck pain, neck muscle stiffness, or neck muscle fatigue can happen when you are working on a computer or gaming all day. A few causes are likely to blame. First, after staring at a screen for a while we often begin to experience eye strain or fatigue. Many of us will tend to stretch our heads forward to bring our eyes closer to the screen and this “forward head posture” can lead to neck pain or stiffness. Depending on how your workstation or gaming system is set up you may find yourself spending prolonged periods of time with your head turned to one side to look at papers or your computer or looking up at a raised TV screen. These prolonged postures can also cause neck pain or stiffness. In worst cases symptoms may radiate down into the arms or hands as the nerves exiting the spine are compressed.

Headaches: There are many potential causes of headaches but for those working at a desk most of the day or spending long hours in the gaming chair both eye strain and cervicogenic (originating from the neck) headaches are common. Eye strain occurs after spending a prolonged time looking at a screen. As you contract your eye muscles harder to maintain focus a headache can develop. Similarly those with neck pain or neck muscle stiffness may experience cervicogenic headaches. These headaches are typically one-sided and can feel like a dull ache in the neck, head or face.They can worsen with movements of the neck or pressing on the tender neck muscles.

Carpal Tunnel: Carpal tunnel syndrome refers to a group of symptoms that are caused by pressure on the median nerve as it passes through the carpal tunnel of the wrist. The carpal tunnel is a narrow passageway on the palm side of the wrist created by a ligament called the transverse carpal ligament that crosses from left to right between several wrist bones. Symptoms of carpal tunnel include numbness, tingling, or burning in your palm, thumb, index or middle fingers or weakness in the hands. You may wake up with these symptoms and they will often recur when you have been using your hands for a while.

“Gamer’s thumb” (De Quervain’s Tenosynovitis): pain and inflammation in the tendons that run from the wrist to the thumb are characteristic of this condition. This condition is caused by repeated wrist or hand movements and is sometimes called “mother’s thumb” because it is common in parents who are holding infants for long periods of time. More recently the term “gamer’s thumb” has also been used to refer to this condition in persons experiencing these symptoms after lengthy sessions of using gaming controls.

Back Pain: If you’ve ever had to sit for a long period of time you have likely noticed that it can be tough on your back. Unsupportive chairs, tight muscles, and the tendency to remain in one position for too long are likely contributors. Feelings of stiffness in your spine are common after spending a lengthy period of time in one position. You may experience an ache on one side of your spine or tightness on one or both sides. In some cases sharp, burning, or aching pain may radiate down into the legs.

HOW CAN PHYSICAL THERAPY HELP?

If you find yourself in pain or discomfort frequently while working or gaming, it’s time to do something about it. Physical therapy is a great choice to address the underlying causes of your symptoms, improve them, and prevent them from returning. Here is what you can expect from physical therapy for these conditions:

Subjective Assessment: In order to treat your symptoms your physical therapist will need to understand more about your symptoms. They may ask you some of the following questions:

How long have you been experiencing these symptoms?
Where on your body are you feeling pain/discomfort/tightness?
How long can you work or game before your symptoms start?
What can you do now to alleviate the symptoms?
How often do you change positions or take a break while you are working or gaming?
What does your work/gaming setup look like?

Physical Exam: The physical exam will allow your physical therapist to assess your body systems, for example, your joints and muscles, and assess how you move. During this portion of the appointment they will be looking at your muscle strength, muscle length, joint mobility, movements that cause pain, neuromuscular control, and posture.

Treatment Interventions: treatment may include hands-on techniques such as joint or soft tissue mobilization to improve overall mobility and reduce pain. Your therapist may apply modalities such as heat, ice, ultrasound or electrical stimulation to manage inflammation and pain. You will also be given exercises to do both in therapy and at home such as stretching, strengthening, and neuromuscular control exercises to both reduce your immediate symptoms and give you long term relief

Education: modifications to the equipment you use, how the equipment and tools are set up and how you utilize them can play a big role in triggering or relieving symptoms. Education on a more ergonomic work or gaming space, the importance of changing positions throughout the day and how to integrate exercises like stretching into your daily routine can be a game changer for these types of conditions and injuries.

Since many of you will not be able to give up working or want to give up gaming as a solution to your symptoms, it’s time to look for other answers. The physical therapists at Evolve are here to provide you with long term solutions for your pain and discomfort so you can get back to doing the things that matter most! Give us a call today to schedule a consultation! Call: 1-718-258-3300

About EvolveNY-

Multiple Brooklyn Physical Therapy Clinic Locations!

https://EvolveNY.com

Jay C 10/12/22 Jay C 10/12/22

Work Out? How A PT Can Enhance Your Training

Whether you love running or biking, olympic weight lifting or crossfit, yoga or hiking, at some point in time you may start thinking about how you can enhance your performance in these activities…

How Physical Therapy Can Take Your Workout to the Next Level-

There is no denying that exercise and working out produce a long list of benefits for your physical and emotional well-being. Reducing risk factors for developing chronic diseases, preventing injury, improving brain health, strengthening bones and muscles, managing your weight, improving ability to do functional activities, reducing stress, anxiety and depression are only a few of the benefits you will receive by participating in regular physical activity.

Whether you love running or biking, olympic weight lifting or crossfit, yoga or hiking, at some point in time you may start thinking about how you can enhance your performance in these activities. Most of us think about personal trainers or coaches as the primary resource for learning how to optimize your performance and progress in your ability but today we are going to talk about how physical therapists can play an important role in enhancing your training.

WHAT MAKES A PT QUALIFIED TO HELP YOU IN THIS AREA?

Physical therapists help people live healthy and active lives. The American Physical Therapy Association defines physical therapists as movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education. Many people think about physical therapists as professionals who help people recover from injury, which is certainly true, but physical therapists also work with people who just want to become healthier, perform their sport or activities better, and prevent injuries before they happen.

While some seasoned physical therapists may have a bachelor’s degree in physical therapy, the majority of practicing physical therapists have a master’s or doctorate level education in movement and exercise. They go through rigorous education on anatomy, physiology, and biomechanics to understand how the body should work. They also undergo extensive education on exercise physiology, disease, injury, and dysfunction of the body as a platform on which they build their skills as rehabilitation professionals who work to restore optimal movement and prevent recurring injury.

While other exercise professionals and coaches have a great depth of knowledge in exercise principles and training for different sports, a physical therapist has a great depth of knowledge in exercise principles and training specifically for you, as an individual whose body may have capabilities and injuries that necessitate a more individualized training plan.

IS A PHYSICAL THERAPIST THE RIGHT RESOURCE FOR ME?

If you’ve been reading this article and wondering if a physical therapist is the right resource to help you enhance your training keep reading below to see if you fit into one of these categories.

I have an injury or am experiencing pain/discomfort: No matter the type of workout you are engaged in you may find yourself experiencing pain or discomfort during or after you exercise. There are many potential causes to injury, pain, or discomfort during a workout but without understanding the cause it’s hard to fix the problem. A physical therapist can help you with this in many ways:

They will perform physical assessments and special tests to examine the area of pain or discomfort to better understand it’s origin.

They will perform physical assessments of related areas and movement analyses of your specific workout components to see if deficiencies in strength, flexibility, stability, or motor control may be causing extra stress and strain on the area of pain or discomfort.

They will create a treatment plan to help rehabilitate the injury or reduce pain and discomfort while staying active and getting stronger and more injury-proof.

They can advise you on how to modify either temporarily or permanently the workouts and exercises you love to increase your ability to perform them pain and injury-free.

They will educate you on how to self-monitor your own positions and performance during your workouts so you will feel confident in your ability to return to full activity after discharge from physical therapy while limiting the chance for re-injury.

I want to start training more, differently or at a higher intensity or become more competitive but I don’t want to injure myself: You have been working out for some time but are ready to take it to the next level. This may mean entering races or competitions, lifting heavier weights, trying new compound moves, or going longer distances. Whenever you increase any component of training such as time, speed, or intensity, you may experience an increased risk for injury if your body is not prepared to handle the new load. Here are several ways consulting a physical therapist with special knowledge in your sport or workout can help:

PT’s are movement experts and a PT with extensive knowledge in your sport or workout will understand what optimal movement or mechanics look like for each component of your workout.

Since they know what is needed to enhance your performance of a particular skill they will next examine your body and your movement performance to see how your strength, flexibility, power, agility, etc. line up with the demands of the skill.

If areas of deficiency are noted in your performance then your PT can create a plan to fix them.

They can also advise you in proper warm up and cool down routines as well as any cross-training that would both reduce your injury risk and improve your performance on your favorite workout.

I have a history of disease, surgery, or injury and I could use some guidance on how to safely enhance my training and workouts: As long as you have been cleared to exercise by your physician, finding ways for you to workout more or differently is something PT’s love to do. Because physical therapists have a strong background in injury, disease, and differential diagnosis they are specially positioned to help those who may be unsure or intimidated by working out, get more comfortable.

A PT will get a thorough medical and surgical history and work with your doctors to understand if there are any precautions or contraindications for exercise.

They will find out what kind of exercise and workouts excite you and what concerns you have about starting or progressing these workouts.

They can teach you safe and effective modifications to activities when needed to help you perform your workouts safely and effectively.

They can monitor things like heart rate, blood pressure, or oxygen saturation while you exercise to keep you safe and help you monitor your body’s response to the workout.

They can provide you with a program of exercises and activities to supplement your favorite workouts to manage pain or discomfort and reduce injury risk.

So as you can see, physical therapists can help you optimize and enhance your workouts whether you are fighting off an injury or wanting to prevent one. With a unique combination of knowledge in disease, injury, and movement dysfunction with expertise in movement and exercise PTs want to help you take your workout to the next level.

Click here for more information about sports physical therapy for athletes

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics-

There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

Multiple Brooklyn Locations!

Jay C 9/29/22 Jay C 9/29/22

Different Types Of Arthritis Explained

The Many Faces of Arthritis; What Kind of Arthritis Do You Have? Did you know that there are over 100 types of arthritis and related conditions? In fact, the Arthritis Foundation lists arthritis as the leading cause of disability among Americans. People of all ages may be affected by this condition to varying degrees, even children, and while its effects may be merely an annoyance to some, to others it can interfere greatly with everyday tasks.

The Many Faces of Arthritis; What Kind of Arthritis Do You Have?

Did you know that there are over 100 types of arthritis and related conditions? In fact, the Arthritis Foundation lists arthritis as the leading cause of disability among Americans. People of all ages may be affected by this condition to varying degrees, even children, and while its effects may be merely an annoyance to some, to others it can interfere greatly with everyday tasks. As arthritis progresses, simple things like getting out of bed, opening a tight jar, or going up stairs can become more difficult.

So what is arthritis? The term arthritis is actually an umbrella term for conditions involving inflammation and pain in the joints. This article will introduce you to the different categories of arthritis and some of the more common types of arthritis.

WHAT’S IN A NAME–CLASSIFYING ARTHRITIS

All arthritic conditions can be typically classified as degenerative, inflammatory/autoimmune, infectious or metabolic. While each of these affects the joints, their underlying physiologic mechanisms differ. Let’s take a closer look at each category:

Degenerative arthritis: Degenerative arthritis is more commonly known as osteoarthritis (OA) and is the most common type of arthritis. This condition refers to the wear and tear of the cartilage that cushions the ends of the bone. It can happen in any joint but is more common in joints like the hips, knees, spine, and hands. OA typically develops slowly and may worsen over time. It can be diagnosed via an x-ray to evaluate the integrity of the joint surfaces but the presence of OA does not necessarily mean you will be symptomatic.

Symptoms of OA include joint pain during or after movement and stiffness that often worsens after a period of inactivity. You may feel tenderness when applying pressure over the joint and notice swelling in the soft tissue nearby. Flexibility or range of motion of the joint may also decrease. You may even feel a grating sensation or hear popping or cracking in the joint when you move it though even healthy joints can make noise sometimes.

Inflammatory (autoimmune) arthritis: Much less common than OA, inflammatory arthritis is typically caused by an auto-immune response in which the body begins to attack its own joints. These conditions are usually managed in part with medications to modulate the immune response. Unlike the gradual wear and tear mechanism of OA, this type of inflammation can quickly affect the cartilage and surrounding tissues causing morning stiffness that lasts more than an hour, joint pain, swelling, tenderness and warmth.

The pain and discomfort felt in this type of arthritis is often multifactorial. Sources of pain may include:

Erosion of the bone beneath the cartilage

Inflammation of the synovial lining of the joints which releases chemicals that irritate nearby nerves

Fluid buildup inside the joint can cause pressure, stiffness, and irritation

Muscle weakness can put more stress on the joints and the inflammation may damage the ligaments that support the joint

The fusion of joints (most often in the spine) can happen in certain types of inflammatory arthritis

Chronic pain and long standing pain can become what is called centralized after which the body’s perception of pain can become heightened

Some of the more common types of inflammatory arthritis include the following:

Rheumatoid arthritis: small bones of the hands and feet are most commonly affected. More common in women than men and onset is often between 30 and 50 years of age. It is the most common type of autoimmune arthritis.

Psoriatic arthritis: Occurs in people who have psoriasis of the skin. Most often occurs years after skin symptoms present but sometimes can occur beforehand. Can affect any joint and range from mild to severe. Like psoriasis it may have active periods and periods of remission.

Systemic Lupus Erythematosus (SLE): This autoimmune condition can be life threatening. Not only does the inflammation cause joint damage but it can cause damage to many of the other organs such as the skin, kidneys, lungs and brain and affect blood vessels.

Ankylosing spondylitis: Inflammation targets the joints and ligaments of the spine leading to stiffness and sometimes over time fusion of the vertebrae and sacrum. Back pain and stiffness may be mild and episodic or severe and chronic. This type of arthritis can affect areas outside of the spine as well such as the hips, ribs, shoulder, feet, and ankles.

Infectious (septic) arthritis: this type of arthritis is caused by infection-causing germs entering a joint space. These germs may enter the body through a wound, a surgery, or an injection and may travel a ways before settling into one (or rarely two) joint. The onset is usually rapid and damage can be severe and permanent if not addressed quickly. Bacteria are the most common cause of septic arthritis and the bacteria Staphylococcus Aureus is the most common perpetrator. Viruses and fungi can also cause septic arthritis.

Unlike other types of arthritis the onset is typically very quick and pain is accompanied by swelling, warmth, redness, fever and chills. The knee is most commonly affected but hips, ankles, and wrists may also be affected. Treatment of this condition typically requires antibiotics, antivirals or antifungals and often fluid needs to be drained from the affected joint.

Metabolic Arthritis: Imbalances in the metabolism of the body can lead to arthritis. The primary example of metabolic arthritis is gout. Gout is also considered to be an inflammatory arthritis but since it is not caused by an autoimmune response it was not included in the list above.

Gout is a complex form of arthritis characterized by sudden, severe bouts of joint swelling, pain, warmth, redness, and tenderness. Accumulation of needle-like urate crystals in the joint causes the inflammation and pain characteristic of gout. Gout attacks are most common in the joint at the base of the big toe but can actually occur in any joint. Ankles, knees, fingers, wrists and elbows may be affected by gout as well. An attack of gout typically occurs suddenly but recurrent bouts can cause lasting joint damage.

WHAT TO DO ABOUT ARTHRITIS?

As you can see, there are many types of arthritis and the treatment of arthritis will vary based on its cause. For example, the treatment for an autoimmune mediated arthritis will differ from the treatment for an arthritis caused by an acute infection or even from gradual wear and tear. One thing we do know is that physical activity and physical therapy can be effective tools in managing the symptoms of arthritis and improving mobility and function. If you’d like to know more about how physical therapy can help your arthritis symptoms, schedule an evaluation with a therapist at Evolve and we will be happy to share more about our treatment approach.

Click here for moe information about physical therapy for arthritis

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Four Convenient Physical Therapy Clinics Throughout Brooklyn!

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Jay C 9/22/22 Jay C 9/22/22

Best Sleeping Positions to Combat Back, Neck, Foot, and Elbow Pain

Is Pain Keeping You Up at Night? Did you know that the average person who lives to be seventy-nine years old will spend the equivalent of seven years of their life trying to fall asleep and twenty-six years of their life sleeping? There is a reason we sleep so much. Sleep plays a vital role in maintaining health and functioning at an optimal level.

Is Pain Keeping You Up at Night?

Did you know that the average person who lives to be seventy-nine years old will spend the equivalent of seven years of their life trying to fall asleep and twenty-six years of their life sleeping? There is a reason we sleep so much. Sleep plays a vital role in maintaining health and functioning at an optimal level. Scientists from the Division of Sleep Medicine at Harvard Medical School have found that insufficient sleep is associated with a number of diseases and health problems and impairs perception, judgment, and safety.

Pain and discomfort are important causes of lost sleep and if you have been struggling to find a comfortable position for sleeping, then this article is for you. Read on to learn about tips and tricks to modify your sleeping situation to reduce pain and discomfort and catch some extra Zs.

WHY DO I HURT MORE AT NIGHT?

Both nervous system-related and orthopedic causes of pain may seem worse at night. There are a few possible reasons for this. First, as your body prepares to transition into sleep, hormone levels shift. Reduction in the anti-inflammatory hormone Cortisol may actually cause a heightened sense of pain at night. Additionally, if you’ve been struggling to get enough quality sleep, the impact of repeated insufficient sleep can also increase your perception of pain. Couple this with the lack of distractors present as you climb under the covers and you may find your pain at the center of your attention.

One other cause of sleep loss or night pain that needs to be addressed, however, is how you are positioned while you sleep. Sometimes the way our bodies are positioned as we fall asleep or throughout the night can cause increased stress and strain on painful areas. So while we can’t change the natural rhythm of our hormone cycles or the fact that we have less to distract our minds when it is time to go to sleep, we can often make changes to our sleeping positions that will reduce pain and discomfort and allow us to sleep better through the night.

Below we will address some positioning strategies to relieve pain from different areas of the body. Some of these suggestions require simply changing the way you lie while others suggest the addition of different types of pillows or bedding to relieve discomfort.

Back Pain-

The trick to relieving back pain is often improving alignment of the spinal column. Some people find their pain increases if their spine is flexed or extended too much and so sleep positioning should aim to stay out of painful ranges of motion.

Side Sleeping: If you are a side sleeper try drawing your knees up slightly toward your chest and placing a pillow between your legs so your thighs are parallel.

Back Sleeping: Depending on the firmness of your mattress, sleeping on your back can sometimes be uncomfortable. Try placing a pillow or wedge (sloping down away from you) under your knees so your hips and knees are gently bent. You can also use a small pillow roll or rolled up towel under the small of your back for extra support. If you have a bed that adjusts behind the knees, use the controls to elevate the mattress behind the knees to imitate the use of a wedge.

Stomach Sleeping: Stomach sleeping tends to be hard on the back but if this is your favorite position you can take a pillow and place it under your lower stomach and hip bones to reduce the arch in your lower back.

Neck Pain-

Having proper support and alignment of the head and neck while sleeping can improve sleeping-related neck pain. Oftentimes a trial of different pillows is needed but one key aspect is to ensure the head is fully supported and the neck is well-aligned with the rest of the spine. Back and side sleeping is best as sleeping on the stomach requires the neck to be fully rotated to the side and can be irritating to the neck.

Side Sleeping: In this position you want the head and neck to be aligned with the rest of the spine. A flatter pillow that is thick enough so your head is in line with but not lifted higher than your back is important.

Back Sleeping: Because the back of the skull extends beyond the curve of the neck, a pillow that has a thicker area at the front to fill in the space behind the neck and a smaller, flatter area for the rest of the skull is often helpful to reduce pain. These are sometimes called cervical or neck pillows and can be purchased at many stores. If you think you may benefit from one of these you can experiment at home by rolling up a towel and sliding it into the pillow case just at the front of the pillow to simulate the contour of a neck pillow.

Elbow Pain-

If you are experiencing elbow pain at night there are a few things you can do to make waking up with pain less likely

Don’t sleep on the affected elbow: this might seem obvious, but if you are a side sleeper, try and sleep on the opposite side and use a pillow in front of you to rest your upper arm and forearm on to reduce stress on the elbow

Try and avoid sleeping with arms overhead or under the pillow

If you like to sleep on your back you can place a small pillow under the back of the upper arm and elbow to elevate it so that it aligns with the rest of the trunk.

An elbow that is warm may be less likely to stiffen overnight so using a neoprene sleeve over the elbow while you sleep may help.

Foot Pain-

Sleeping positions for foot pain will vary depending on where you have pain and what is causing it:

Change your blanket: a heavy blanket or one that is tucked tightly under the end of the mattress will push down on your toes and foot. To combat this use only a light blanket or no blanket on the feet themselves and use warm socks to keep your feet warm

Elevate your feet: If foot swelling or inflammation are an issue for you, use a wedge under your legs that slopes upward away from you to elevate the feet

Pillow between the legs: If your feet or ankles pressing together is uncomfortable or if the side of your foot hurts, try and lie on your opposite side and place a pillow between your knees, lower legs, and feet to reduce the pressure

If pain is keeping you up at night then give these suggestions a try. If you find yourself needing more individualized suggestions to help you sleep comfortably at night then the physical therapists here at Evolve are ready to help. Give us a call to schedule an initial evaluation and mention your painful sleep so they can address not only your sleep issues but help get to the root of the problem so you can sleep comfortably through the night and feel great during the day.

Click here for more information about our physical therapy services

About EvolveNY-

Multiple Locations!

https://EvolveNY.com

Jay C 9/16/22 Jay C 9/16/22

Have you checked out your neck curvature lately?

It’s Time to Check Your Neck Curvature- Let’s face it, we all find ourselves slumping throughout the day while working at the computer, watching TV, or standing at our jobs for a long time. Occasionally we recognize we have abandoned good posture completely and will quickly stretch our necks and backs and try to sit or stand up taller.

It’s Time to Check Your Neck Curvature

Let’s face it, we all find ourselves slumping throughout the day while working at the computer, watching TV, or standing at our jobs for a long time. Occasionally we recognize we have abandoned good posture completely and will quickly stretch our necks and backs and try to sit or stand up taller. Maintaining good posture requires a lot of attention and awareness and over time the unconscious habit of rounding our upper back and pushing our heads forward can transform from a temporary loss of spinal alignment to a more permanent change in our posture. In this article we will examine how changes in the normal curvature of the neck can lead to symptoms of pain, discomfort and difficulty gazing forward and what we can do about it.

LET’S GET A BETTER UNDERSTANDING OF THE ALIGNMENT OF THE NECK AND SPINE

If you look at a model of a typical, healthy spine from the back or front it appears to be a straight column of vertebrae (spinal bones) stacked on top of one another. When you view the spine from the side, however, you will see that the spine is actually curved in several places. In the neck the spine curves toward the front creating a small arch or “lordosis” in the neck. It then switches directions and a gentle backwards curve or “kyphosis” can be seen in the thoracic spine followed by another reversal and lordosis in the lumbar spine. Even the sacrum and coccyx are slightly curved. This alignment of the spine allows for all of the movement we expect from the spine, proper shock absorption capabilities, and good alignment from the head to the feet.

Because the body is one continuous system connected by muscles, ligaments, fascia, and connective tissue, a change in one part of the body often results in a compensatory change in another. The curvature of the neck may change in response to chronic postural habits or in response to changes in the curvature of the upper back or even due to changes in function or alignment of the lower body. Since the neck vertebrae protect and provide an exit for the nerves that supply the muscles and skin of the arms and hands, changes in neck curvature can sometimes have significant effects both locally and more distantly. Nerves can be compressed leading to radiating symptoms into the arms and muscles can be over lengthened or overworked causing tightness, pain, fatigue, or headaches.

HOW DO I KNOW IF MY SPINAL CURVATURE IS ALIGNED?

If you are wondering if your neck curvature has changed over time, there is an easy way to check but it's helpful if you have someone to help. First, stand tall with your arms resting at your sides. Using your phone or a camera, have someone take a photo of you from the side. First take a look at the shape of your neck between your ear and your shoulder. Is it curved slightly toward the front or does it look flattened? Is the ear aligned over the shoulder, the hip, knee and ankle like it should be in a body with good alignment or is your ear positioned further forward than your shoulder?

MY NECK CURVATURE SEEMS FLATTENED, WHAT SHOULD I DO?

If you notice that your ear has moved in front of your shoulder or that your neck no longer seems to have that typical lordotic curve, you may be wondering what you should do. Classically, the loss of curvature in the neck was always considered problematic and worthy of correction but recent research suggests we need to assess people on a case by case basis. A recent review of studies that compiled x-rays of individuals without any neck, back or radiating pain symptoms found that there was a larger range of curvature among asymptomatic necks than recently realized. Some necks were more flattened and others were more lordotic but in this case none had pain (Virk, et al, 2020). So when deciding whether to seek care, here are a few things that would suggest you may benefit from treatment to address your neck curvature:

You are having neck pain or upper back pain

You are experiencing neck or upper back tightness or fatigue

You are experiencing headaches– typically one sided, exacerbated with head or neck movements or with pressure applied to neck musculature or the base of the skull

You are having trouble maintaining a forward gaze and find yourself looking down at the ground

You are experiencing radiating pain, numbness, tingling, or weakness in the arms or hands.

HOW CAN NECK CURVATURE BE IMPROVED?

If changes in your neck curvature are causing pain or dysfunction or impacting your daily activities then physical therapy can help. Your physical therapist will assess your entire spine and may locate areas of the body outside of the neck such as the upper back or hips that may be contributing to your change in neck curvature. Here are examples of what you might expect during a physical therapy treatment to address this problem:

Manual Therapy: Your therapist may apply various soft tissue mobilization techniques to the muscle and fascia around the neck to reduce tension and improve the health and mobility of the tissues. They may also perform mobilization techniques to the neck joints themselves to restore normal movement between the seven vertebrae of the neck. If indicated, these same techniques may be applied to the upper back or related areas of the body.

Modalities: To manage pain and reduce radiating symptoms your therapist may recommend the use of cervical traction to gently stretch and decompress the spinal segments in the neck or other modalities like electrical stimulation to manage pain symptoms.

Stretching: Both passive stretching performed by your therapist and self-stretching performed by you can help optimize the length of muscles that may have become shortened as a result of the changes in your neck curvature. If other areas of the body are also involved you may be instructed in other back, chest, hip or lower body stretches as well.

Strengthening: Strengthening exercises targeting the muscles that help support the neck and upper back in good alignment are important to treat this condition. Exercises such as chin tucks and scapular stabilization are examples of common exercises to improve neck alignment and curvature.

If you’re ready to tackle symptoms caused by your neck curvature, it’s time to call the local physical therapists at Evolve PT. The skilled physical therapists at Evolve can assess your neck curvature and over all movement patterns and biomechanics and create a treatment plan to improve your symptoms and reduce the likelihood they will progress or return.

Click here to find out more information about physical therapy for neck pain

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4 Convenient Physical Therapy Clinic Locations in Brooklyn!

1-718-258-3300

https://EvolveNY.com

Jay C 8/25/22 Jay C 8/25/22

The Truth Behind the Hot and Cold Compress Debate

The Truth Behind the Hot and Cold Compress Debate- The Low Down on the Heat vs Ice Debate: Heat or Ice? Which Should I Apply to an Injury? When it comes to pain relief most of us are familiar with using heat or ice. Sprain and ankle? Apply an ice pack. Back sore from doing yard work all day? Lie on the heating pack. While you may have heard clear cut instructions on when to use heat and when to use ice, the real answers actually lie a bit more in the gray area. To gain some clarity on this topic…

The Low Down on the Heat vs Ice Debate

Heat or Ice? Which Should I Apply to an Injury?

When it comes to pain relief most of us are familiar with using heat or ice. Sprain and ankle? Apply an ice pack. Back sore from doing yard work all day? Lie on the heating pack. While you may have heard clear cut instructions on when to use heat and when to use ice, the real answers actually lie a bit more in the gray area. To gain some clarity on this topic, keep reading as we sort through the heat versus cold therapy debate. In this article when we reference heat we are talking about superficial heat which includes things such as hot packs or heating pads while cold therapy typically refers to ice packs.

WHAT EFFECT DO HEAT AND ICE HAVE ON THE BODY

It seems appropriate to kick off this inquiry with a deeper look at the physiological effect that hot and cold have when applied to the body. Afterall, the reason we apply these modalities in the first place is because we hope they will have a healing impact on the body.

When an injury occurs, tissue damage and inflammation typically follows. Pain, tenderness to palpation, sometimes bruising and difficulty moving or bearing weight through the injured body part can result. On a molecular level recovery from an injury involves tissue destruction, repair and then remodeling of connective tissue, muscle tissue, and blood vessels.

When ice or cold therapy is applied to an injured tissue, the cooling effect reduces swelling and slows the arrival of inflammatory mediators. It is also thought to reduce tissue metabolism and secondary tissue damage while also having an anesthetic effect that reduces pain (Swenson et al.,1996, Malanga et al., 2014). Heat or thermotherapy warms the skin and underlying tissues and has a vasodilating effect which brings more blood to the area and may promote healing by bringing more nutrients and oxygen to the injured area. It also has a pain-mediating effect and increases the elasticity of connective tissue (Malanga et al., 2014).

WHAT DOES THE EVIDENCE TELL US?

While we understand the physiological mechanisms of applying heat and ice, many of the recommendations we have about when to use each modality are based on anecdotal evidence. In 2015 Petrofsky et al. specifically examined the use of heat and ice to manage post-exercise muscle soreness and damage. They found that cold therapy immediately or 24 hours after exercise was more beneficial in reducing soreness than heat but wasn’t better than heat to mediate muscle damage. In 2014 Malanga et al., did a literature review of a large number of individual studies and reviews evaluating the effectiveness of heat and ice to treat acute musculoskeletal injuries and delayed onset muscle soreness. Their review found that many of the studies were of poor quality and found conflicting evidence in some cases. They concluded, however, that ice was more effective to treat acute injury with inflammation and heat for muscular pain and soreness and joint pain and stiffness.

As you can see the research is still somewhat unclear about the benefits of using heat versus ice in some scenarios. Typically individuals with joint pain and stiffness such as those with osteoarthritis prefer to use heat to manage their symptoms. If you have sustained an acute injury, especially if there is inflammation, using heat would not be recommended as it can worsen the inflammation. For muscle soreness after exercise or activity the literature is mixed and it's probably effective to use either modality based on your preference or experience in the past.

WHAT ABOUT USING ICE ON ACUTE INJURIES?

As mentioned above, it’s probably not wise to apply heat to an acute injury as the vasodilative effect can worsen inflammation. More recently, however, researchers and rehab professionals have been questioning whether using ice to stop the inflammatory process in an acute injury is actually helpful or harmful (Zi-Ru Wang and Guo-Xin Ni, 2021). The RICE approach to acute injury (Rest, Ice, Compression, Elevation) has been standard practice for quite some time but has recently come into question for quite a few reasons. The conventional wisdom of using ice immediately after injury is one of these reasons as we consider whether inflammation after acute injury is the big bad wolf we always made it out to be.

The inflammatory response actually serves an important role in injury recovery. Inflammation is the process of flooding the injured area with fluids containing white blood and other cells whose jobs it is to destroy bacteria and eat up dead and dying cells. This step is needed before tissue repair can begin. So if we think about inflammation as the first step to injury repair then it stands to reason that we should think twice about interfering with this process as it actually delays recovery.

For now we need more high quality studies to fully understand how and when cold therapy should be used with acute injuries. When injuries are severe and swelling is a limiting factor for recovery then ice or cold therapy is still likely a smart option to get control of inflammation so rehabilitation can progress. If the injury is mild or moderate, shortening the duration or frequency of applying ice may be something you want to consider so the body’s natural healing process can proceed.

BOTH ICE AND HEAT SHOULD BE USED WITH CAUTION

While the aim of both heat and cold therapy is to heal injured or painful tissues, when used incorrectly both of these modalities can cause injury. Here are some precautions and contraindications for each therapy (Seidel et al., 2021, Malanga et al., 2014). These lists are not exhaustive so you should always check with your doctor if you are unsure if these treatments are safe for you:

Cold Therapy

Frostbite, skin burns and neuropathy of superficial nerves can occur if ice or cold therapy is applied for too long

It should be used with caution in those with hypertension, mental or cognitive impairment, or decreased sensation

It should not be used in those with cold hypersensitivity, cold intolerance, Raynaud’s disease or over areas of vascular compromise or open wounds,

It can cause short term changes in joint position sense, muscle strength and neuromuscular control post-cooling

Heat Therapy

When used incorrectly and without proper protection heat therapy can cause skin burns or ulcerations

It is contraindicated in those with peripheral vascular disease, bleeding disorders, local malignancy, acute inflammation or trauma, edema, infection, open wounds, over large scars, those with impaired sensation (neuropathy) or impaired ability to communicate/cognitive impairments

It should be used with caution in those with diabetes and multiple sclerosis

THERE IS MORE WORK TO BE DONE

While there is still more work for scientists and researchers to do to settle the debate between heat and ice once and for all we hope you found some clarity after reading this article. Using heat and ice to manage pain or inflammation can be helpful in the early stages of injury recovery or exacerbation but don’t forget that active recovery is one of the best tools to promote healing and the physical therapists at Evolve are here to walk you through that process.

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Multiple Locations!

https://EvolveNY.com

Jay C 8/17/22 Jay C 8/17/22

5 Best Exercises to Prep for Football Season

5 Best Exercises to Prep for Football Season- If you want an edge this coming football season then preparation needs to begin well before tryouts. While you work to get your mental game on point, incorporating these five exercise principles into your weekly workouts will help you get game ready…

Prepare for Football Season with These Five Types of Exercise

If you want an edge this coming football season then preparation needs to begin well before tryouts. While you work to get your mental game on point, incorporating these five exercise principles into your weekly workouts will help you get game ready. The goal of preseason conditioning should be to prepare your body for the physical demands of both practices and games so that you can help lead your team to victory and stay off the injured list (Fullagar HHK, McCunn R, Murray A, 2017).

A good trainer will help you periodize and structure your offseason and preseason workouts but a well-rounded training program should incorporate these five elements :

Strength training: Offseason is the time to focus on strength development and muscle hypertrophy. Compound movements like deadlift, front squat, side lunges, and isolated strength training like lat pulldowns or bicep curls when performed in sets of 8-12 at 40-80% of your one rep max with a 2-3 minutes break between sets will help increase muscle hypertrophy. Your coach or trainer may recommend you focus more on certain muscle groups depending on the position you play on the field but two to three training sessions per week during the offseason can help increase your strength.

Speed and power: If all you were required to do on the field was lift or push something heavy then strength training might be all you needed. Football players, though, need to accelerate or decelerate a great deal of force at quick speeds. This is where speed and power training become important. Power lifts at >80% of one rep max, plyometrics, and sprints are great ways to develop explosive speed. This type of training is hugely beneficial to prepare for football season but needs to be incorporated carefully as it can be easy to injure oneself if not done correctly. Your coach or trainer can help you build a program for speed and power that meets your current fitness levels to improve your play and decrease your risk for injury.

Agility: Since football is a multiplayer game you need to be able to react quickly to the actions of both your teammates and your opponents. The ability to make whole-body changes in speed or direction in response to a stimulus is called agility. You can have all the strength and power in the world but if you can’t harness that energy to make a quick change in speed or direction you will be at a disadvantage during a game. Ladder drills and cone drills like zig zag and four corners are examples of agility drills. These drills focus on quick feet with deceleration and acceleration as well as changes in direction–forward run, side shuffle and backpedal.

Flexibility: We’ve already looked at how agility is imperative to both a good offense and a good defense but without enough flexibility in the upper and lower body and the spine it will be difficult to translate the speed and power you developed during pre-season training into quick changes in direction and fast passes on the field. Off-season is the perfect time to start working on your flexibility. Static and dynamic muscle stretches and joint mobility exercises that target the groin or adductor muscles, and the hip flexors, for example can help a player play low and generate power from these positions.

Spend time at the beginning of each workout developing flexibility throughout your hips, knees, ankle and spine and follow it up with strength and stability exercises so that you learn to control your body and develop power within these new ranges.

Aerobic Conditioning: while quick bouts of sprinting, backpedaling and cutting that challenge the anaerobic system are common during a football game, the typical rest time between plays and during advertising-, injury-, and tactical-timeouts averages between 25 and 40s (Fullagar HHK, McCunn R, Murray A, 2017) which may not be long enough to bring your heart rate and breathing rate down to resting levels. This places a high demand on the cardiorespiratory system and if you have been neglecting aerobic conditioning you may find yourself still trying to recover your breathing as the next play starts.

Aerobic conditioning involves sustained exercise at 60-80% of your heart rate max. This could mean running, rowing, swimming, jumping rope, or riding a bike, for example. If you have been training pretty consistently using the calculation below will give you a pretty good estimate of your max heart rate:

220 - your age = max heart rate (MHR)

To estimate your aerobic training zone you can calculate the equivalent heart rate for 60% and 80% of your heart rate max and use those numbers to monitor your heart rate during workouts. If you haven’t been doing aerobic conditioning or if it’s especially hot out you may notice you have to go slower or at a lower intensity than expected initially. If you perform consistent aerobic training you will notice you can train faster and harder while maintaining your heart rate in the aerobic zone and you should notice a change in your recovery and endurance in the later parts of a game.

EXACTLY WHICH EXERCISES ARE BEST FOR ME?

Now that we’ve discussed the exercise principles that should be incorporated into a well-rounded offseason football training program you may still be wondering exactly which exercises are right for you. This article is focusing more on the principles of a training program than the specific exercises because a high quality training program will be individualized both to your needs as an individual player and to the demands of the position you play on the team. The kicker, the linebacker, and the quarterback have different skills and strengths they need to develop and working with your trainer and coach to target these skills in your workout will help you become a better player.

Now that we see how offseason prep in the training room is important to prepare for football season, we should also acknowledge that offseason is the perfect time to rehab any injuries or irritations. If you are currently injured or have noticed a pain or irritation that develops as training and practices ramp up, now is the time to schedule an appointment with the physical therapists at Evolve so they can help you recover and build resilience ahead of football season.

Click here to find out more information about sports physical therapy for football players

About EvolveNY-

4 Brooklyn Locations!

Offices in Marine Park, Park Slope, Mill Basin, and Our New HQ in Gravesend!

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Jay C 8/12/22 Jay C 8/12/22

Big Toe Pain?

Why is My Big Toe Hurting? Mild discomfort in the big toe may be easy enough to shrug off for a while but if it persists, or gets worse, big toe pain cannot be ignored. If you have been experiencing pain in your big toe you may be wondering what the cause might be and how you can improve your symptoms. Well read on, sufferers of big toe pain, and we will explore some of the underlying causes of big toe pain and when to seek care from a physical therapist or doctor…

Why is My Big Toe Hurting?

Mild discomfort in the big toe may be easy enough to shrug off for a while but if it persists, or gets worse, big toe pain cannot be ignored. If you have been experiencing pain in your big toe you may be wondering what the cause might be and how you can improve your symptoms. Well read on, sufferers of big toe pain, and we will explore some of the underlying causes of big toe pain and when to seek care from a physical therapist or doctor.

WHAT’S THE BIG DEAL WITH THE BIG TOE?

Turns out the big toe really is a big deal. The big toe, also known as the hallux, is made up of two smaller phalanx bones. You may be interested to know that each of the other four toes actually has three phalanx bones. Between the two phalanx bones lies the interphalangeal joint that allows bending of the middle of the big toe. Just behind that is another important joint called the metatarsophalangeal (MTP) joint that connects the proximal phalanx bone of the big toe to the first long bone of the foot. This joint allows the big toe to flex and extend as you walk.

If you’ve ever injured your big toe you will immediately recognize how your walking or running gait changes as you try to minimize pressure through the big toe. This is because the big toe plays an important role in propulsion of the body forward and in shock absorption as the foot hits the ground and travels underneath the body. Somewhere between 40-60% of your bodyweight is translated through the first MTP joint which means the bones, joints, tendons, and ligaments of the big toe need to be very resilient. In order to walk normally without some degree of compensation, your big toe must be able to extend (bend backwards) 45 to 60 degrees as you push off your foot to initiate a step forward. On the bottom of the foot, just behind the big toe lie two small pea-shaped sesamoid bones that act as a pulley system for tendons and as a lever when the toe pushes off.

Because the big toe has a lot of work to do each time you take a step, stand on your tiptoes, or jump up to shoot a free throw, even small changes in the strength, flexibility, and integrity of any part of the big toe can change the way you move. Now that we better understand the anatomy and function of the big toe, let’s look at some common causes of big toe pain.

WHY DOES MY BIG TOE HURT?

Big toe pain can have a number of causes. Understanding the cause of your toe pain will help guide you toward appropriate solutions.

Turf Toe: Turf toe is the common name for a sprain of the MTP joint of the first toe. This is often a sports-related injury that occurs when the toe is hyperextended past its normal range of motion. Pain around the big toe may be constant or only noticed when you press on it or try to put weight on it. The joint may feel stiff and range of motion may be limited. Alternatively the joint may feel like it is popping out of place. Finally, swelling or bruising around the big toe that extends up into the foot may occur. Injury to the ligaments and soft tissue around the MTP joint is typically the cause of the symptoms. In rare cases surgery may be required to treat severe turf toe.

Gout: Gout is a complex form of arthritis characterized by sudden, severe bouts of joint swelling, pain, warmth, redness, and tenderness. Accumulation of needle-like urate crystals in the joint causes the inflammation and pain characteristic of gout. It can occur at any joint in the body but most often occurs in the big toe. An attack of gout typically occurs suddenly. You may wake in the middle of the night with pain, heat, and redness in a joint so severe that even the bedsheet touching the area is unbearable. Untreated gout can lead to joint erosion and prolonged pain.

Sesamoiditis: Inflammation of the tendons that travel along the bottom of the foot can cause inflammation of the sesamoid bones behind the big toe. Because the big toe is a primary shock absorber for the foot, these bones are subject to repeated forces that can trigger inflammation. Running, dancing, and walking in high heels may trigger this condition.

Osteoarthritis or Hallux Rigidus: Osteoarthritis of the big toe is often called Hallux Rigidus. Degradation of the cartilage lining the joint surfaces in the big toe can cause progressive stiffening and pain with pushing off of the toe.

Bunion: A bunion (hallux valgus) is a bony bump that develops on the inside of the foot at the base of the big toe. Oftentimes the big toe is no longer straight but instead deviates toward the other toes. Inflammation and swelling can occur in the area of the bunion and that area of the foot can become stiff and painful. Discomfort during walking or running and difficulty with the fit of shoes can occur over time.

HOW DO I KNOW IF I NEED TO SEE A DOCTOR OR PHYSICAL THERAPIST?

Depending on where you live and the type of insurance you have, you may be required to see your physician and obtain a referral before seeing a physical therapist. In some states you can seek primary care from a physical therapist directly. Physical therapists are able to screen for the underlying causes of big toe pain but may refer you back to your doctor if they feel your injury requires imaging or further assessment before initiating treatment. If you are experiencing big toe pain and unsure if you need to seek the care of a medical professional these guidelines may help you decide:

The toe is red and warm: Redness and warmth typically indicate an inflammatory process that needs medical attention. Infection and gout are two possible causes of redness and warmth in the big toe. These conditions need to be assessed by a physician or podiatrist because antibiotics or other medication may be necessary.

Pain is severe and you are unable to put pressure through the toe: if you are experiencing severe pain that prevents you from bearing any weight through your big toe you should not ignore these symptoms. If you are able to recall a traumatic event such as dropping something on your toe or stubbing your toe you may be dealing with a fracture of the phalanges or first metatarsal. If the symptoms occur suddenly for instance after hyperextending the big toe, or are accompanied by visible bruising and swelling you should be evaluated by a medical professional and imaging may be required to assess the extent of the injury

Pain occurs with activity and eases with rest: In the absence of bruising, severe pain, and inability to put pressure on the big toe, pain that worsens when you are active but eases once you rest may indicate a more chronic condition. Sesamoiditis, osteoarthritis, and bunions are conditions that may present this way. If you choose to see a physical therapist first they can help determine if a trip to a physician is needed.

No matter how it started, if big toe pain is interfering with your ability to walk, run, and do your daily activities it is time to investigate the cause. Physical therapy can be very helpful in alleviating the symptoms of big toe pain for many of these conditions and the physical therapists at Evolve can help you better understand the origin of your symptoms, create a program to treat them, and help prevent their recurrence in the future

Click here for more information about physical therapy for legs, foot physical therapy or physical therapy for Gout.

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Jay C 8/10/22 Jay C 8/10/22

Foot Cramps?

Ready to Kiss Foot Cramps Goodbye? Most of us are familiar with that moment of panicked recognition when a sudden tightening of a muscle becomes a full-blown muscle cramp. The pain is enough to jolt most of us out of our beds or chairs in a desperate attempt to stretch the muscle and alleviate the cramp.

Ready to Kiss Foot Cramps Goodbye?

Most of us are familiar with that moment of panicked recognition when a sudden tightening of a muscle becomes a full-blown muscle cramp. The pain is enough to jolt most of us out of our beds or chairs in a desperate attempt to stretch the muscle and alleviate the cramp. Sometimes cramping occurs during exercise, other times it wakes us up from a peaceful sleep. For those of you experiencing foot cramps you might be wondering why it’s happening and what you can do about it.

WHAT IS HAPPENING DURING A MUSCLE CRAMP?

Practical Neurology reports the “conventional definition of a muscle cramp is a painful contraction of a muscle or muscle group, relieved by contraction of antagonist muscles.” It is induced by a hyperexcitable and involuntary sustained muscle contraction. It is usually localized to a single muscle group, a single muscle, or a few muscle fibers and can last from a few seconds to a few minutes. Often palpating the cramping muscle(s) will reveal a “knot”. Soreness can persist following the cessation of the muscle cramp even into the next day.

Myogenic, “originating in muscle tissue,” causes of cramping as outlined above and below need to be distinguished from neurogenic, “originating from the nerve” causes of cramping which are not discussed in this article. Neurogenic causes of cramping originate from dysfunction or injury in either the central or peripheral nerves. Examples of neurogenic origins of cramping include spasticity, dystonia, tetany, and myotonia.

WHAT CAN CAUSE FOOT CRAMPS?

Myogenic foot muscle cramps are thought to have several causes. According to Harvard Health, exercise habits, diet, and medical conditions can all contribute to muscle cramps. Poor blood flow in the lower leg and foot muscles caused by narrowing of the arteries (called atherosclerosis) can predispose one to foot cramps or lower leg cramps. In some cases acute narrowing of the arteries caused by cold temperature on a foot that has snuck out from under the bed covers can cause sudden cramping.

Diets low in magnesium or potassium can lead to a deficiency in these minerals and may interfere with a muscle’s ability to relax properly. Because high levels of magnesium or potassium can have significant side effects including causing cardiac abnormalities, it is important to consult with your physician before supplementing with either magnesium or potassium. Dehydration is another condition that may explain cramping so drinking enough water, especially if you have been exercising in hot weather, is important.

Exercising without properly warming up or cooling down may also increase the likelihood of developing foot cramps. Newer clinical research also suggests muscle strength, flexibility, and foot biomechanics may play a role in developing foot cramps which we will explore further in the next section.

PHYSICAL THERAPISTS TACKLE FOOT CRAMPS

If you have optimized your hydration levels, learned to rest appropriately between bouts of exercise, and blood mineral levels are in the normal range but are still experiencing either nocturnal or exercise-related foot cramps, physical therapy may be able to help.

Warming up muscles properly prior to exercise may be helpful in decreasing foot cramps. Your physical therapist can teach you proper warm-up exercises for the feet and ankles to help prepare the foot muscles for the demands of the upcoming exercise and activity. Dynamic stretches which involve tightening and relaxation of the muscles as they move the joints through their range of motion are a great way to warm up. Walking on your toes, walking on your heels, and actively rolling your ankles through their full range of motion are some examples of dynamic warm ups for the foot muscles.

Static foot and ankle stretching prior to exercise, where a muscle is lengthened and held in this position for a long period of time, has been the subject of much debate over the years as research has suggested it may increase the risk of injury before strength and power-related activity. For recreational athletes, short duration static stretches (<60s) are likely safe when integrated within a dynamic warm up routine but should be applied with caution by high performance athletes prior to intense strength and power activities (Chaabene et al., 2019). Your PT can personalize a static and dynamic warm up for your feet depending on the type of sport or exercise you are doing. Static stretching before bed, however, may reduce the incidence of nighttime foot cramps.

McKay et al. (2021) explored the relationship between nighttime and exercise-induced cramps with several factors. Their research found a correlation between overall decreased body flexibility and increased incidence of nocturnal cramping. They also found that those with decreased toe flexor strength and fallen arches were more likely to experience foot cramps during exercise. Finally, those who passed the toe flexor strength assessments and were able to walk their age and gender-predicted distance or greater on the Six Minute Walk Test were less likely to have either type of muscle cramp.

These findings suggest that a program of proper foot strength and mobility training and overall lower extremity muscle strength, power, flexibility and endurance exercises may decrease the likelihood of both night-time and exercise-induced foot cramps. A case report submitted to the International Journal of Physical Therapy in 2019 (Addison Williams Andrews & Richard Pine) outlined a physical therapy program consisting of addressing soft tissue extensibility, joint mobility, muscle strength and lower limb biomechanics. In this case the subject was experiencing bilateral lower limb muscle cramping lasting several minutes three to four times per night. This multifaceted approach helped to decrease the frequency of cramping to one episode a week on average lasting less than a minute.

AN INDIVIDUALIZED PROGRAM IS BEST

Now that we have reviewed some of the causes of foot cramps and some of the solutions, it’s time to get started treating your foot cramps. When you schedule an appointment at Evolve PT your physical therapist can assess your foot and lower body structure, strength, and flexibility and identify which factors may be contributing to your foot cramps. If you are ready to take your exercise and activity to the next level or sleep through the night without foot cramps, let our therapists create a program just for you so you can kiss those cramps goodbye.

Click here to find out more information about physical therapy for feet

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Multiple Locations!

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Jay C 7/31/22 Jay C 7/31/22

Fighting the Effects of Cancer with Physical Therapy

What to Know About Oncology Physical Therapy- While the reality of facing a cancer diagnosis can be daunting, modern medicine has advanced greatly in the area of medical treatments and cures for cancer. Surgery, chemotherapy, radiation, stem cell transplants, and hormone therapies are targeted to destroy cancer cells, but in the process of restoring health these treatments can cause mild to severe physical impairments. The development of specialty oncologic physical therapy has meant, however, that these physical impairments can be managed and addressed during and after cancer treatment.

What to Know About Oncology Physical Therapy

While the reality of facing a cancer diagnosis can be daunting, modern medicine has advanced greatly in the area of medical treatments and cures for cancer. Surgery, chemotherapy, radiation, stem cell transplants, and hormone therapies are targeted to destroy cancer cells, but in the process of restoring health these treatments can cause mild to severe physical impairments. The development of specialty oncologic physical therapy has meant, however, that these physical impairments can be managed and addressed during and after cancer treatment. This article will outline the role that oncology physical therapy has in restoring physical health and quality of life for those undergoing or who have undergone treatment for cancer.

WHAT PHYSICAL SIDE EFFECTS CAN RESULT FROM CANCER TREATMENT?

Before we discuss the types of physical therapy treatments that are available to survivors of cancer, let’s take a look at some of the physical side effects that can result from cancer and its treatments:

Lymphedema: swelling caused by accumulation of lymphatic fluid in an area of the body. This can result from a cancerous tumor blocking the flow of fluid or from surgical removal of lymph nodes.

Cancer-related fatigue: defined by the National Comprehensive Cancer Network (NCCN) as a “distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.” It affects 70-80% of cancer survivors of all stages of disease and recovery.

Balance impairments: those undergoing current or previous cancer treatment are at higher risk for falls due to factors such as increased levels of fatigue, chemotherapy-induced nervous system changes, and muscle weakness.

Chemotherapy-Induced Peripheral Neuropathy: some chemotherapy drugs can damage the peripheral nerves that relay sensory and motor information. Muscle weakness, numbness and uncomfortable or painful sensations in arms or legs may develop.

Muscle weakness, muscle atrophy and loss of stamina: this impairment has many possible causes including cancer-related fatigue, chemo-induced neuropathy, medication side effects, side effects of the cancer itself, and increased sedentary behaviors.

Radiation Fibrosis: The scarring fibrosis of tissues in an area treated with radiation can occur immediately or years after radiation therapy, though it does not always develop. Tissue shortening and skin tightening, weakening of bones, contracture or atrophy of muscles and lymphedema can occur.

Pain: pain can occur as a side effect of the cancer, the treatments used to treat the cancer and as a result of changes in physical activity or mobility.

HOW CAN PHYSICAL THERAPY ADDRESS THESE CONCERNS?

Oncology physical therapy can help with many of the symptoms listed above. Your physical therapist will be able to monitor your vitals and your response to therapy as you go along. It is important to note that certain types of treatments such as ultrasound, soft tissue mobilization, deep heat, or electrical stimulation may not be appropriate over areas of tumor growth or healing tissues. Also, for those with lymphedema or who are at risk for lymphedema, it is important to speak with your physical therapist and physician about what treatments are safe and appropriate for you. While a physical therapy program will always be individualized to meet your specific needs, here are some of the ways oncology physical therapists may treat your symptoms:

Manual Therapy: Hands on techniques such as soft tissue mobilization, scar mobilization, or joint mobilization may be used to improve the movement and mobility of muscles, skin, and joints

Strengthening: Strength training can help improve muscle weakness and atrophy to assist you in performing your day to day activities

Flexibility: Restoring flexibility through stretching or mobility exercises can help with pain management and improving your ability to perform functional tasks

Balance training: Balance training is essential in reducing the elevated risk for falls in survivors of cancer.

Endurance training: Regular aerobic exercise is important to combat cancer and cancer treatment related conditions. Your PT can prescribe you a progressive aerobic and muscular endurance training program. You may ride a stationary bike or walk on a treadmill, for example, for progressively longer periods as your stamina improves.

Gait training: If restoring walking ability is part of your treatment plan your PT can train you on appropriate assistive devices and work with you to improve the safety, quality, and endurance of walking.

Patient Education: Education is always an important part of oncology physical therapy. Education may include information on pacing and energy conservation, on incorporating exercise at home, on mindfulness and stress management techniques, on home modifications, and on equipment and assistive devices.

IS EXERCISE SAFE FOR ME?

Before beginning an exercise program it is always important that you speak with your oncologist and any other physicians caring for you. If your cancer or cancer treatments have affected your bones, heart, or lungs, for example, your doctors may encourage or restrict certain types of exercise to keep you safe and healthy.

Research has shown over and over again that engaging in regular physical activity can reduce your likelihood of developing many types of cancer. More important for this topic, however, is that research has also shown that regular physical activity can help prevent and treat many cancer health related outcomes such as fatigue, anxiety, reduced function, and quality of life. For survivors of cancer who are not currently participating in a regular exercise program and for whom unsupervised exercise may be unsafe, a referral to outpatient physical therapy is highly recommended.

The physical therapist will perform a thorough evaluation of your current strength, balance, endurance, sensation, flexibility, and mobility. They will also interview you about any concurrent medical conditions or past surgeries. Your physical therapist will also be able to communicate with your doctors regarding any restrictions or precautions you may have for specific types of movement or exercise and present them with any questions or concerns that may arise throughout your plan of care.

YOU GET THE WHOLE PACKAGE

Oncology physical therapy focuses on a whole-person approach to better health and quality of life for survivors of cancer. While cancer may have been an unexpected detour in your life’s path, physical therapy will create an individualized program to address any physical impairments you have and to empower you to move better and exercise more so that you can participate in and enjoy life to the fullest. Call Evolve PT today and learn how we can support you on this journey to better health and better function.

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Jay C 7/29/22 Jay C 7/29/22

Like to Run? Get a Gait Analysis!

Like to Run? Get a Gait Analysis! Run From Injuries with a Running Gait Analysis- Running is a great way to stay healthy, manage stress, explore new areas, and spend time with friends. With a good pair of running shoes you can be out the door or on the treadmill enjoying your run in seconds…

Run From Injuries with a Running Gait Analysis

Running is a great way to stay healthy, manage stress, explore new areas, and spend time with friends. With a good pair of running shoes you can be out the door or on the treadmill enjoying your run in seconds. Whether you are beginning to run for the first time, lacing up for track season, or training for your first marathon, a running gait analysis can be a great tool to assess your running form in order to treat and prevent running-related injuries and help you run more efficiently.

WHY DOES RUNNING FORM MATTER?

Running is an orchestration of muscles, tendons, joints, and fascia throughout the entire body. From the swing in your arms and the rotation of your trunk to the length of your step and mechanics of your foot, a lot of moving parts are involved. Over time, scientists and researchers have analyzed the running form and mechanics of many runners and gathered data about their strength, flexibility, and motor control. By also gathering information about each runner’s speed and endurance and history of injury, a picture of ideal running form began to evolve. Noticing correlations between certain ways of moving the legs, arms, and trunk and the incidence of injury or likelihood of winning a race has informed much of what modern day physical therapists know about running efficiency and injury prevention.

Because running has a low barrier to entry it is accessible to someone starting an exercise routine for the first time as much as it is to a professional athlete. While it may be easy for most anyone to start running, it is a sport whose repetitive nature can predispose someone to new injuries if the body’s mechanics are not optimal. A running gait analysis can help identify these injury risk factors before the injury develops and also pinpoint areas for treatment in someone who has already found themselves injured.

Additionally, a running gait analysis can give you a look at your running form and insight into how small changes in running mechanics may enhance speed and efficiency for those looking to improve performance.

HOW IS A RUNNING GAIT ANALYSIS PERFORMED?

A running gait analysis is typically a three part process:

Running history interview: the first step to the gait analysis is getting to know you–the runner–better. Your physical therapist may ask you questions about how long you have been running, what a typical training week or cycle looks like for you, what kind of footwear you use and what surface(s) you like to run on. It is also helpful to know if you are training for any events, what your short and long term running goals are and if you have suffered any running-related pain or injuries in the past.

Orthopedic Exam: Before your running is analyzed it is helpful to assess the strength and flexibility of the muscles, joints, and tendons related to running. Presence of weakness, laxity, or tightness can give clues as to why a runner is moving in a certain way or why they may be experiencing pain or injuries. Here are some of the things assessed during the orthopedic exam:

Strength of the muscles around the hips, knees, ankles, pelvis, and core
Flexibility of the ankle, hip, feet, and knee joints
Motor and muscle control of the joints during movements like squatting, standing on one leg, stepping down from a step

Observational Gait Analysis: While running on a treadmill your running form will be recorded so that it can be analyzed by your physical therapist. Read on to learn more about what elements of your running form can be analyzed this way.

WHAT INFORMATION IS GATHERED DURING THE GAIT ANALYSIS?

By observing a runner from the front, back, and from each side, many elements of the gait cycle can be observed:

Asymmetry in movement between the right and left sides
Where the foot lands in relation to the position of the hip, thigh, and lower leg
The position of the foot and ankle as the foot moves underneath the body
The angles between the pelvis, hip, knee, ankle, and foot throughout the stride
The position of the arms and the quality of arm swing
The rotation of the trunk
The rate of turnover: how many times your feet hit the ground during a minute
The length of your stride

WHICH CAME FIRST: THE RUNNING INJURY OR THE RUNNING FORM?

One of the great benefits to working with a movement expert such as a physical therapist is their ability to interpret all of the data gathered throughout the running analysis and use it to individualize a plan to meet your goals of injury-free, enjoyable running. As mentioned earlier, running requires the orchestration of many moving parts–parts which have been analyzed thoroughly by your PT. By combining the results of the orthopedic examination with the video running gait analysis, a clearer picture of how issues with strength, flexibility, and motor control are related to your running gait and to your pain or injury.

Since we have a good idea of the types of running movement errors that predispose someone to injury and decrease the efficiency of their running, once identified in an individual runner they can be targeted with physical therapy. A running gait analysis, therefore, is an excellent tool for anyone experiencing conditions such as runner’s knee, achilles tendinopathy, plantar fasciitis, stress fractures, hamstring injuries, or IT Band pain.

WE TAKE IT ONE STEP FURTHER

At Evolve, we would certainly like to help you with a running gait analysis but what we really love is to use the data and insights to create a customized physical therapy program for you. If you are hoping to enjoy running for now or for a lifetime, the physical therapists at Evolve are here to help you stay injury free and setting personal records for years to come.

Click here for more information about physical therapy for runners

About EvolveNY-

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Jay C 7/24/22 Jay C 7/24/22

Addressing Ankle Pain with Physical Therapy

Addressing Ankle Pain with Physical Therapy: What a Pain in the Ankle! Looking for Answers to Ankle Pain? Ankle pain, whether new or chronic, can seriously interfere with being on your feet. If sitting down all day isn’t an option, physical therapy is a great choice for identifying the cause of your ankle pain and taking steps to getting a handle on your symptoms…

What a Pain in the Ankle!

Looking for Answers to Ankle Pain?

Ankle pain, whether new or chronic, can seriously interfere with being on your feet. If sitting down all day isn’t an option, physical therapy is a great choice for identifying the cause of your ankle pain and taking steps to getting a handle on your symptoms.

LET’S EXAMINE THE ANKLE CLOSER

The ankle is a hinge joint where the primary motion is to lift and point the foot. If we look at an image of the ankle joint you will see the larger inner bone of the lower leg leg called the tibia and the thinner outer bone called the fibula articulate with a bone called the talus in the posterior part of the foot. Beneath the talus lies the calcaneus or heel bone. Many ligaments, muscles. and tendons travel between the bones of the lower leg and foot, crossing the ankle joint.

Because of the complex anatomy in the ankle area, there are many potential sources of ankle pain or discomfort. In this article we will take a look at some of the more common causes of pain and how physical therapy can treat these conditions.

COMMON CAUSES OF ANKLE PAIN

Posterior Ankle Pain

Posterior Ankle Impingement: symptoms of this condition include posterior ankle pain with forced plantarflexion (pointing of the toe or pushing off of the toe). It results from compression of the soft or bony tissue between the tibia and the calcaneus. Some people have a small extra bone in their ankle called an O’s Trigonum which can increase the compression. On occasion a large amount of force through the ankle joint can cause small fragments of bone to fracture and become compressed when the toe is pointed. Inflammation and swelling in this area leads to pain.

Achilles tendinopathy or rupture: pain felt behind the heel and up the back of the ankle may indicate an irritation of the achilles tendon, the long tendon that connects the calf muscles to the bottom of the foot. This irritation may be a result of an acute or sudden trauma or from repetitive microtrauma and can cause discomfort when walking, running, jumping, or climbing stairs. Tenderness when pressing the achilles tendon, stiffness and pain especially during first steps, and swelling in the back of the ankle are characteristic of this condition. In the case of a tendon rupture or tearing of the tendon, calf weakness, bruising, swelling, and pain result. A full rupture can typically be identified by squeezing the calf muscle with your hand and observing a lack of toe pointing indicating the connection between the calf muscle and foot has been disrupted.

Lateral Ankle Pain

Ankle sprain: rolling your ankle outward, can cause an acute ankle inversion sprain. There are three ligaments on the outside of the ankle that can be injured when stretched beyond their normal capacity. These ligaments are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). Tenderness over the involved ligament is common. Depending on the severity of the sprain you may notice bruising, swelling, stiffness, and if the sprain is severe, laxity or instability of the ankle.

Peroneal tendon injury: Two peroneal muscles run along the outer lower leg and their tendons travel behind the ankle bone (known as the lateral malleolus) and attach at the outer midfoot and beneath the foot. These muscles are tasked with stabilizing the foot and helping to prevent sprains and injuries. Symptoms of peroneal tendon injury can come on suddenly or over time and include pain or tenderness along the lateral lower leg or ankle. Warmth or swelling may be noticed in the lateral ankle and a pop may be heard with a sudden injury. Increases in activities such as running, jumping or walking, a sudden trauma to the ankle, having high arches and wearing inappropriate footwear can contribute to this type of injury

Sinus Tarsi Syndrome: this clinical syndrome is characterized by pain in the lateral foot just below the ankle in an area called the sinus tarsi. It is thought to be caused by inflammation and scar tissue formation possibly brought on by abnormal mechanics in the joint between the talus and calcaneus. Recurrent ankle sprains causing instability may be a predisposing factor.

Medial Ankle Pain

Ankle sprain: rolling the ankle inward so that the outer edge of the foot lifts up is called an eversion sprain. The primary ligament involved in this type of sprain is called the deltoid ligament, a strong, flat, triangular band composed of four separate ligaments. Tenderness over the deltoid ligament is common with this type of injury. Depending on the severity of the sprain you may notice bruising, swelling, stiffness, and if the sprain is severe, laxity or instability of the ankle.

Medial ankle stress fracture: a stress fracture refers to a weakening of one area of bone caused by repetitive breakdown of bone without sufficient rebuilding. It is considered an overuse injury and seen most commonly in track and field athletes and military recruits who walk long distances with heavy packs. In the ankle, pain and tenderness along the inner ankle bone called the medial malleolus may indicate a tibial stress fracture. Initially the pain is present during activity and will improve with rest but over time it may become more constant and be accompanied by tenderness to touch over the area and swelling or bruising.

Posterior tibial tendonitis: The tibialis posterior muscle runs along the inside of the calf muscle and its tendon travels behind the medial ankle bone and attaches under the arch of the foot. Pain or swelling along the inner ankle or arch of the foot especially with standing or walking and increased pronation or flattening of the arch are common with this condition. Overuse or sudden trauma can trigger this condition

Tarsal Tunnel Syndrome: Running parallel to the tendon of the posterior tibialis, the tarsal tunnel is a dense band of fibrous tissue that creates a tunnel through which the tibial nerve, several tendons, and the blood vessels traveling to the foot, course. Similar to carpal tunnel in the wrist, compression of the tibial nerve as it passes through the tarsal tunnel can cause burning, tingling, electrical shock pain, and numbness in the inner ankle and/or bottom of the foot

Anterior Ankle Pain

High ankle sprain: In contrast to the much more common lateral ankle sprain, the high ankle sprain involves injury to the ligaments that connect the tibia bone to the fibula bone just above the ankle. This ligamentous connection helps stabilize the ankle joint and typically has very minimal movement so a large force is needed to disrupt and injure this area. It is important to correctly diagnose this injury as it typically requires longer times to heal and can result in more chronic ankle instability than other ankle sprains.

Anterior Ankle Impingement: Ankle instability, bone spurs, and repeated stress at end range positions of squatting, jumping, or descending stairs can cause this condition that leads to pain in the anterior aspect of the ankle. A history of repeated ankle sprains may predispose one to this condition as scarred ligaments take up more room in the joint space leading to compression and inflammation.

PHYSICAL THERAPY FOR ANKLE PAIN

Identifying the cause of your pain is the first order of business when a physical therapist assesses your ankle. If your physical therapist suspects a more serious injury such as a tibial stress fracture or high grade ankle sprain they may refer you back to your doctor for imaging to determine if surgery, modifications to weight bearing, bracing, or casting are needed.

If you are being treated for an acute injury such as a tendon injury or sprain, your physical therapist will educate you on how to protect these newly healing tissues. Treatment may include compression or bracing, offloading the injured area through crutches, modalities such as ice, ultrasound or electrical stimulation to reduce pain and swelling, and activity modification.

In the case of well-healed tissues, chronic injuries like tendinopathy or ankle impingement, or a well-healed stress fracture your physical therapy program will focus not only on reducing or eliminating localized symptoms but on addressing factors that contributed to the onset of the symptoms. Often chronic injuries or pain in the ankle are caused by repeating faulty movement patterns or having an imbalance of muscle strength and length to carry out a task such as walking, running,or jumping. Optimizing muscle strength and flexibility and improving motor control and mechanics of the lower limb is important for returning to prior activities and reducing the likelihood of the injury recurring.

While some ankle injuries may require intervention by a doctor or surgeon, a physical therapist should always be a primary member of your care team. A physical therapist at Evolve can help you get on the road to recovery. Our therapists do not just treat symptoms, but we get to the root of the cause. We strive to enable our patients to live pain free, and prevent the recurrence of related issues

Click here for more information about physical therapy for your ankles!

About EvolveNY-

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Jay C 7/21/22 Jay C 7/21/22

Look out Gravesend, Evolve Physical Therapy is Coming Your Way

Evolve Physical Therapy is Growing to Gravesend! And Gravesend Makes Four: Evolve Physical Therapy Opens a New Location in Brooklyn. Check it out, Brooklyn, Evolve Physical Therapy + Sports Rehabilitation is growing! We are very excited to announce a brand new flagship location in Gravesend on Avenue U. Construction is wrapping up as we speak and we are thrilled that we will have the opportunity to serve more of our community members…

Evolve Physical Therapy is Growing to Gravesend!

And Gravesend Makes Four: Evolve Physical Therapy Opens a New Location in Brooklyn

Check it out, Brooklyn, Evolve Physical Therapy + Sports Rehabilitation is growing! We are very excited to announce a brand new flagship location in Gravesend on Avenue U. Construction is wrapping up as we speak and we are thrilled that we will have the opportunity to serve more of our community members.

Since our first location opened its doors in 2010, Evolve Physical Therapy + Sports Rehabilitation has been providing physical therapy, post-operative care and pain relief to the people of Brooklyn. After hearing so many experiences of unsuccessful physical therapy treatment we knew it was time to get to work. We have always believed that long term health and recovery is achievable through physical therapy and we set forth to build a model of care that is holistic, patient-centered and focuses on addressing the root cause of pain and injury, and the dysfunction they are causing.

If you’ve been to our Marine Park, Mill Basin, or Park Slope locations already then you know how much detail and attention we put into designing our clinic spaces. Our new Gravesend location is no exception and we can assure you this place will look good. But more importantly you will feel great after working with one of our skilled therapists who will provide you with the one on one attention that quality physical therapy care necessitates.

From pediatrics to post-surgical care, neurologic rehab to sports injury recovery, we’ve got a team member ready to get you on the road to recovery. Let us show you what high quality physical therapy care looks like when provided by a team of therapists passionate about their profession and the impact they can make on the people of New York.

Follow us on social media @Evolvefit4life to get a sneak peak at our progress and be the first to know when it’s time for the official grand reveal! Click here to find out more information about our new HQ location- https://evolveny.com/locations/gravesend-physical-therapy-brooklyn

About EvolveNY-

Multiple Locations!

https://EvolveNY.com

Jay C 7/19/22 Jay C 7/19/22

Is Postpartum Physical Therapy Right for Me?

Body After Baby: How Postpartum PT Can Help- Feeling Strong and Pain-Free After Childbirth. Whether giving birth for the first time or fifth, by vaginal delivery or cesarean section, bringing that new little bundle of joy into the world can take a toll on mom’s body. It may be challenging to find time to prioritize your physical recovery from pregnancy and childbirth or to address any new aches and pains that develop as you care for your little one but doing so is an important part of what has been termed the “fourth trimester”. This fourth trimester is a concept that emphasizes the need to address lingering health concerns in postpartum women and physical therapists play an essential role during this time.

Body After Baby: How Postpartum PT Can Help

Feeling Strong and Pain-Free After Childbirth

Whether giving birth for the first time or fifth, by vaginal delivery or cesarean section, bringing that new little bundle of joy into the world can take a toll on mom’s body. It may be challenging to find time to prioritize your physical recovery from pregnancy and childbirth or to address any new aches and pains that develop as you care for your little one but doing so is an important part of what has been termed the “fourth trimester”. This fourth trimester is a concept that emphasizes the need to address lingering health concerns in postpartum women and physical therapists play an essential role during this time.

WHAT POSTNATAL CONDITIONS CAN PHYSICAL THERAPISTS TREAT?

In this section we will take a look at some of the conditions that can develop before, during, and after childbirth that when lingering, should be evaluated by a physical therapist with experience in postnatal care or pelvic health.

Ligament laxity and joint pain: Many women are familiar with the discomfort in their joints that can develop during pregnancy. Throughout pregnancy a woman’s body is changing proportions and size to accommodate the growing fetus and the onset of pregnancy-related hormones leads to increased laxity in tissues and joints. Some women may experience discomfort or pain in their legs, arms, back, neck, or pelvis as the pregnancy progresses. These hormones can persist for several months after delivery, even for a short while after breastfeeding stops.

While joint pain that occurs in response to carrying the weight of a growing fetus may disappear upon delivery, parenting an infant often includes repetitive movements that can lead to new pain or injuries.

Back pain: Can you imagine how many times in a day, an hour, or a week, you are bending down to pick up your growing baby from the bassinet, the floor, the carseat? Persisting ligament laxity, weakened core muscles, and use of poor biomechanics can lead to back pain that can interfere with your ability to care for your little one and yourself.

Wrist pain: without thinking, most of us will automatically cock our wrist to the side and stretch open our thumbs while bottle feeding a baby or supporting their head. Over time, this repetitive motion can cause inflammation to develop in the tendons of the thumb that run along the inside of the wrist. This condition, called De Quervain’s Tenosynovitis, or “mother’s thumb” can cause mild to severe pain at the base of the thumb along the inside of the wrist.

Neck Pain: Sitting in prolonged positions while breastfeeding or holding your baby while they sleep can cause neck pain to develop. Even falling asleep in uncomfortable positions or holding your baby on one side of your body more than the other can cause uncomfortable neck pain to develop.

Diastasis Rectus Abdominis: A diastasis rectus abdominus is a separation of the left and right outermost abdominal muscles known as the rectus abdominis. It most commonly occurs as a result of pregnancy. As the fetus grows, increased pressure is placed on the connective tissue between the two sides of abdominal muscles causing separation. It commonly develops during the second or third trimester and often will resolve on its own in the first few postpartum months. Sometimes, however, it will persist and can cause discomfort, feelings of weakness in the abdominals, low back, hip, or pelvic pain, and feelings of “flabbiness” in the abdominals

Pelvic Floor Dysfunction: Carrying a growing fetus and the process of giving birth vaginally can lead to postpartum pelvic floor dysfunction. Pelvic organ prolapse, pelvic pain, and incontinence are the most common conditions.

Pelvic organ prolapse occurs when the muscles and tissues of the pelvic floor that support the organs of the pelvis–the bladder, uterus, and rectum–become weakened causing the organs to descend out of position into our out of the vagina. This can happen soon after giving birth or years later. The pressure from the descended organs can sometimes be felt or seen in the vagina and women may experience uncomfortable sensations of pressure during physical activity or sex. Aside from feeling increasing pelvic pressure, urinary incontinence or problems having bowel movements can also be signs of pelvic organ prolapse.

Women can experience issues with fecal or urinary incontinence after childbirth in the absence of pelvic organ prolapse. Weakness or impairments in the muscle control of the pelvic floor may be the cause of incontinence and while you may hear other moms joking about “peeing a little” when they laugh, cough, or exercise, it is not considered a “normal” side effect of pregnancy or delivery and should be addressed by a pelvic health physical therapist.

HOW WILL POSTPARTUM PT HELP ME?

While the lack of sleep and never ending diaper changes may be out of your control for a while, living with postpartum pain, discomfort. or pelvic floor issues are not. A consultation with a physical therapist knowledgeable about pre- and postpartum conditions and treatments should be a priority within the first few months after giving birth. Here are some of the ways physical therapy can help:

Education: While you may not feel you have the time to begin new exercises right now, there are likely very simple changes and modifications you can make to the routines you already have in place that can relieve some of your symptoms. For example, if you are experiencing back, neck, or wrist/thumb pain, your physical therapist can suggest ways of lifting your baby, feeding your baby, and holding your baby that will keep them comfortable while reducing irritation and discomfort in your own body.

Pelvic floor physical therapy: if you are experiencing pelvic pain, incontinence, pelvic organ prolapse or other problems with your pelvic floor, it is important to see a specialist in pelvic health to begin to address these issues early on. To learn more about what to expect during pelvic floor physical therapy, check out this article on our site (I thought we could link to the pelvic floor PT article I wrote)

Manual therapy techniques: Hands on techniques such as joint mobilization, soft tissue mobilization and myofascial release may be applied to improve joint and tissue mobility to reduce symptoms of pain and tightness.

Strength and flexibility training: Strengthening and stretching or mobility exercises to optimize strength and flexibility can help improve conditions such as back pain and prevent their recurrence in the future. It can also be used to treat a diastasis rectus abdominis.

Modalities: The application of modalities such as ice and heat, ultrasound, or electrical stimulation may be used to address pain and inflammation.

If you are experiencing any of the conditions described in this article, don’t put off getting the help you need and deserve. Addressing postpartum concerns early will allow you to focus on the joy of raising your child and the physical therapists at Evolve are here to support you. Call us today and let postpartum physical therapy be the answer to getting your strong and resilient post-baby body.

Click here for more information on post partum physical therapy in Brooklyn

About EvolveNY-

Multiple Locations!

https://EvolveNY.com

Jay C 6/22/22 Jay C 6/22/22

Help! My Jaw is Killing Me

Should You Call the PT or the MD for Jaw Pain? If you’ve ever suffered from tightness, popping, or pain in your jaw joint known as the temporomandibular joint (TMJ), then you may be familiar with a condition called temporomandibular joint dysfunction (TMD). According to the American Academy of Family Physicians, up to 15% of adults experience TMD with peak incidence occurring between the ages of 20 and 40 years old.

TMJ PT or TMJ Doctor?

Should You Call the PT or the MD for Jaw Pain?

If you’ve ever suffered from tightness, popping, or pain in your jaw joint known as the temporomandibular joint (TMJ), then you may be familiar with a condition called temporomandibular joint dysfunction (TMD). According to the American Academy of Family Physicians, up to 15% of adults experience TMD with peak incidence occurring between the ages of 20 and 40 years old. In this article we will examine this condition further and discuss how to determine if seeing a TMJ physical therapy practitioner is appropriate or if a visit to a physician is needed.

WHAT AND WHERE IS THE TMJ?

The temporomandibular joint is located in front of the ear on each side of the face. It is the connection between the mandible or jaw bone and the temporal bone of the skull. It works a little like a hinge and a little like a ball-and-socket joint. The two joint surfaces are separated by an articular disc and surrounded by fibrocartilage. Several ligaments stretch between the skull and the jaw bone to stabilize the TMJ. Muscles of the face and neck allow you to protrude and retract your jaw and elevate and depress it to open and close the mouth.

WHAT DOES TMD FEEL LIKE?

Dysfunction of the TMJ can be caused by problems both within and outside the joint. Common symptoms include facial pain, jaw pain or soreness, jaw fatigue, earache or ringing in the ears. Additionally headache, popping of the joint, locking of the jaw, teeth sensitivity without dental issues, limited mouth motions, and changes in the way the teeth fit together can occur. Often these symptoms are more pronounced upon waking up and in the late afternoon.

WHAT IS THE CAUSE OF TMD?

The cause of TMD is often thought to be multifactorial. Biological, environmental, emotional, social, and cognitive triggers for TMD exist. The incidence is higher in persons diagnosed with other conditions such as autoimmune conditions, sleep apnea, mental illness, or fibromyalgia. TMD can be the result of arthritis in the TMJ or from displacement of the articular disc. Jaw or facial fractures and surgery of the face or jaw may lead to TMD in some persons. Also problems with teeth alignment (malocclusion) and frequent jaw clenching (bruxism) can trigger TMD. Even poor posture habits can lead to TMD if repeated frequently.

SHOULD I GO STRAIGHT TO MY PHYSICAL THERAPIST?

Many physical therapists are trained in the assessment and treatment of TMD. Physical therapy has been shown to be effective in reducing pain and restoring motion to the jaw in many cases. It also has the benefit of teaching you how to manage the symptoms on your own if it recurs in the future. In some states you can schedule an evaluation with a physical therapist without a referral from a physician. Outside of those states you will need to see your physician first for a referral.

Since physical therapy is a great option for managing your TMD, let’s take a look at some of the treatments offered by physical therapy to manage TMD symptoms:

Postural re-education: Poor posture including a forward head position and rounded shoulders can contribute to increased stress on the muscles around the jaw and on the TMJ. PT will assess for any postural abnormalities and teach you how to be aware of them and begin to correct them.

Manual Therapy to improve jaw mobility: Restoring the normal motions and mobility of the TMJ and jaw can be done through gentle hands on techniques either outside of the mouth or sometimes from inside the mouth.

Strengthening Exercises: Exercises to strengthen the muscles around the jaw and neck can be very helpful in reducing symptoms of TMD, improving jaw range of motion, and reducing the likelihood of recurrence.

Dry needling, ultrasound, electrical stimulation: Your therapist may choose to apply these modalities to manage your pain and inflammation

WHEN DO I NEED TO SEE MY DOCTOR?

If these symptoms are new to you it is always a good idea to visit your primary care physician or dentist and update them on how you are feeling. While we know that TMD is fairly common, it is not the only condition that can cause jaw pain or discomfort. Here are some other conditions that may mimic TMD but need evaluation and treatment by a physician or dentist:

Cluster headaches: one of the most painful types of headaches, a cluster headache often causes pain around or behind one eye but it can also radiate pain into the jaw.

Sinus infection: infected sinuses can cause pressure on the jaw joint causing discomfort and pain. Unlike TMD, however, sinus infections are often accompanied by congestion, facial pressure or pain, runny nose, throat irritation, fever, or tenderness over the sinuses.

Tooth Pain: Dental abscesses in a nearby tooth can cause pain to radiate into the TMJ and jaw. Sensitivity to chewing or biting, tenderness of the lymph nodes in the neck or jaw, and fever are other symptoms of a tooth abscess.

Trigeminal Neuralgia: pressure or compression on the trigeminal nerve that is responsible for sensation in the upper and lower jaw area can mimic TMD to some degree. Numbness or tingling on one side of the face, pain in front of the ear, one-sided tooth pain, and electric-like shooting pain on one side of the face or jaw is common with this condition.

Heart Attack: The most serious and emergent condition listed here, some people will experience sudden-onset jaw pain during a heart attack. If you are experiencing jaw pain along with other symptoms such as chest pressure or pain, shortness of breath, lightheadedness, cold sweats, nausea or vomiting, or a sense of impending doom, call 911 immediately.

Certain treatments may be prescribed by a physician or dentist that cannot be provided by a physical therapist to treat TMD symptoms. These may be necessary if you are experiencing severe symptoms interfering with eating or physical therapy treatments have not been successful. Here are some examples of these types of treatments:

Medications: anti-inflammatories, muscle relaxants, or low-dose tricyclic antidepressants may be prescribed for pain management

Imaging: Imaging such as X-rays, CT Scans, or MRI may be recommended if a more in depth look at the TMJ is recommended

Oral splints or mouth guards: These devices are typically worn at night to minimize teeth grinding and bruxism which may be causing increased muscle tension and jaw pain.

Surgical intervention: Various surgical options exist to address different causes of TMD. These may be recommended if conservative care has failed to successfully treat your symptoms.

Corticosteroid joint injections: used to reduce local inflammation

THERE IS HELP OUT THERE FOR YOU

After reading this article we hope you have a better understanding of how doctors, dentists, and physical therapists can treat your TMD symptoms. If you haven’t had the opportunity to try physical therapy, it is a great option to improve your symptoms and educate you on how you can manage your TMD symptoms in the future. If you have been suffering with symptoms of TMD, the physical therapists at Evolve are ready to help restore better jaw movement, provide symptom relief, and give you something to smile about.

Click here for more information about TMJ/TMD treatments or if you are in need of immediate need of physical therapy for TMJ/TMD

About EvolveNY-

Multiple Locations!