Posted on Wednesday, November 19, 2014

Q & A: Should I Exercise if I’m Sick?

Q. I had a sinus infection this past week. I have felt really guilty about not exercising. Should I exercise if I’m sick? –Josh

A. Thanks for the question, Josh, and I hope you’re feeling better! Feeling ill is never a fun experience, but it happens to all of us. Cold and flu season starts as the weather begins to turn. I’ll first address the reasons why we tend to experience more illnesses during this time of year, and then I’ll offer guidelines to determine if exercising while sick is the best choice for you.

Why do I tend to get sick during the winter?

Decreased sun exposure as there are fewer daylight hours. With less sun exposure, the body isn’t able to produce the same amount of vitamin D as it did during the summer months. Vitamin D is a powerful antioxidant that helps prevent illness. Consider supplementing with vitamin D during the winter months.
Decreased ultraviolet radiation from the sun allows viruses and bacteria to live longer on surfaces. Consider frequently cleaning your cell phone, keyboards, door knobs, and remote controls to avoid exposure. Wash your hands frequently and teach your children proper hygiene.
Dry conditions lead to dried out mucous membranes. The colder temperatures tend to be the driest times during the year. Drier conditions can lead to dried out mucous membranes which exposes and damages them. Then the mucous membranes can’t optimally function as a physical barrier to virus or bacteria exposure. Consider using a humidifier in your home during the winter months.
As children head back to school and more people spend time indoors, the close quartered contact allows for easy transmission of illness. In the U.S.A., the winter months include major holidays, which mean more shopping and gathering together. You may be exposed to many people who are ill. Once again, wash your hands frequently and teach your children proper hygiene.

Should I exercise if I’m sick?

A small amount of activity or exercise can actually boost the immune system, but a heavy amount can actually lower your immune system in the short run. Follow these guidelines to determine if exercising while sick is the best choice for you:

How sick are you? Determine the severity of your illness. If you have a fever or may be contagious, it’s your responsibility to not spread the illness. Stay away from others. If you have an upper respiratory illness, I recommend that you don’t perform any heavy cardiovascular exercise as you run the risk of driving the illness further down into the lungs.
Listen to your body. How are you feeling? If you’re just a little under the weather, light activity might actually help you. If you’re too tired to get out of bed, listen to your body and rest. You need to support your immune system in every way you can. Don’t feel guilty about not exercising! A missed work out will not completely derail your training program. Remember, quality over quantity.
Take the time to cross train. An illness is an excellent time to perform light cross training. Take a break from your regular exercise routine with active rest. Take a few walks or perform yoga at home. Focus on your problem areas. When I’m not feeling well, I concentrate on performing back strengthening exercises. Is your knee, low back, or shoulder bothering you? Now may be a good time to start a rehabilitation program. Please refer to the following posts to get started: 7 Tips to Get Rid of Knee Pain, How to Safely Self-Treat Low Back Pain, and How Should I Treat Shoulder Pain and Impingement?
Don’t expose others just so you can get your work out in! If you are coughing, sneezing, or have a fever, you’re likely contagious. Please don’t spread it around! If you insist upon exercising, then exercise in your home or outside. Be mindful of others and always clean the exercise equipment at the gym after working out.
Stay hydrated. Regardless of illness, it’s important to stay hydrated. Colder air can be very dry and can lead to dehydration. Prevent illness during the winter months by drinking extra fluids.

Did you know that as you get older, you tend to experience fewer colds? Your immune system is more geared to fight the cold after many years of practice. You can more easily recognize those who are sick and stay clear. You make wiser choices such as frequent hand washing and less sharing of personal items and food. (Teach your children how to prevent spreading germs as well.) Unfortunately, we can’t avoid getting sick every time. When you are sick, use the guidelines noted above to determine if exercising is the best choice for you. Thanks for your question, Josh!

Do you exercise if you’re sick? Can you offer any tips on how to quickly recover from an illness? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer: The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.

Posted on Wednesday, November 5, 2014

Q & A: 7 Tips to Get Rid of Knee Pain

Q. Over the last month or so, I have had a pain in the back of my knee. My knee feels really stiff when I sit cross-legged or try to squat. What should I do? –Sam

A. Great question, Sam! The symptoms you are describing sound like the pain may be coming from your meniscus. The meniscus is the cushion found between the two major leg bones, the femur and the tibia. It is made of a cartilaginous substance. Many times, the meniscal cartilage can be torn. It would be similar to getting a hang nail near your cuticle. A tear occurs when the cartilage rises up and causes pain, a feeling of knee instability, and/or locking up of the knee. Other times, the cartilage can become frayed like an old rope. This fraying can cause pain and stiffness, particularly pain behind the knee in an area known as the popliteal space.

The good news is that most meniscal related injuries don’t require surgery. Research suggests that the proper physical therapy program can be superior to surgical intervention with long term outcomes. There are times when surgery will be indicated, but physical therapy is typically indicated as an initial course of action. (Particularly, when there are no episodes of knee locking occurring.)

The following 7 tips will help you to rehabilitate your knee. If symptoms worsen, then additional assessment and follow up is likely needed. I would anticipate an improvement of your symptoms in a few of weeks or less when initiating this program. (Depending on the severity, it could take longer for a full recovery.) If the pain continues, please seek additional assistance from a qualified physical therapist or physician.

1. Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated. Then work on moving into a deep squat position multiple times as part of the warm up. You may need to hang onto a beam or a pole to take some pressure off of your knee as you move in and out of the squat.

2. If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise. This would also be true for a lunge position or step up. Modify any exercise as you need to, and don’t compromise technique to complete an exercise. Poor technique will only increase your risk of injury elsewhere.

3. Work on strengthening. The primary goal of a strengthening program is to work on quadriceps and glut medius (hip abduction) strengthening. Weight lifting is an appropriate choice, but you may have to initially limit your range of motion (ROM). Most of my clients begin on a non-weight bearing program, then progress to partial weight bearing, and eventually, full weight bearing. The more severe the symptoms, the longer it will take for an individual to progress to more difficult exercises.

To initiate a physical therapy program, please refer to Meniscus Rehab Exercises. This exercise guide is designed to address the muscles that I find are weakest in most individuals. The exercises are listed from easiest to most challenging and are designed to primarily improve quadriceps and hip strengthening. Start with exercises like a straight leg raise (possibly with an ankle weight) and bridging (either one or both legs). Wall squats holding for time also works well. A Thera-Band Exercise Band can be tied around the thighs above your knees to make your hips more engaged.

Weight training exercises (with machine weights or free weights) should be geared toward general leg strengthening and may include: squats; leg press; hip abduction machine; step ups; dead lifts; and straight leg dead lifts. If further instruction is needed, search YouTube to watch the proper technique for a specific exercise.

The speed at which exercise is performed while in group exercise classes is typically too fast for an individual who is properly and safely exercising his/her knee during a rehab and recovery phase. You can still participate in group exercise classes or CrossFit WODs (Work out of the Day), but your specific knee program should be separate from any group structured activity. You need time to insure proper technique.

4. Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing range of motion (ROM).

5. Improve your Range of Motion (ROM). The goal of the rehabilitation program is to regain full pain free ROM. This can be accomplished many ways. Perform heel slides by lying on your back and sliding your heel toward your buttocks. Consider using a pole to assist in performing deeps squats. Hang onto a pole or a door frame, and bring your heel toward your buttocks as you perform a quadriceps stretch. These exercises can be performed within a mild to moderate amount of discomfort in order to regain full pain free ROM. If you experience muscle tightness and soreness, I recommend using a foam roller to assist with any myofascial symptoms. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.

6. Drink more water. Cartilage tends to have a poor blood supply. The more water you drink, the more hydrated your body becomes. This can help the body to deliver much needed hydration and nutrients to the meniscus.

7. Add a joint supplement. CapraFlex is my preferred supplement for meniscal related injuries. I have recommended this supplement for years as my clients have had successful outcomes with use. I have taken it to help prevent injury as I entered a particularly intense period of training as I prepared for a marathon. It has also assisted in recovery from my many injuries. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I recommend that you try it for 30 days to see if it improves your knee pain. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

Thank you, Sam, for your question. I hope these 7 tips will help you to rehabilitate your knee and recover quickly! If the pain continues, please seek additional assistance from a qualified physical therapist or physician.

Which treatments for knee pain are the most effective for you? Please share any recommendations that you may have by leaving your comments below.

Posted on Wednesday, October 29, 2014

Q & A: Vertigo – Causes & Treatment

Q. Hi, Ben! Yesterday I had another experience with vertigo. I visited a doctor last year, and we are using a nasal spray to help make my Eustachian tubes more pliable to help pressurize when I go skiing. I thought it was to help alleviate my vertigo issue as well. This seems to happen a couple times a year, and it’s very debilitating. The last two times, I’ve done the Epley maneuver, and I’ve been able to go about my day within six hours versus the normal all day in bed affair. I’m not sure if it’s the factor that is helping. I’m wondering if there is something else I can do to prevent this occurrence. –Amy

A. Thanks, Amy, for your question! Vertigo is often a term used to describe many different sensations including the feeling of being dizzy, nauseous, swimmy, or lightheaded. Vertigo is a false sensation that your surroundings are moving or spinning. It can be horribly debilitating and can last from seconds to minutes to days. Although there are many potential causes of vertigo, three of the most common forms include:

Benign paroxysmal positional vertigo (BPPV) – BPPV can occur for many reasons. The condition is characterized by its sudden onset. This occurs when the tiny crystals that are present in your inner ear get loose and float around in the fluid in your inner ear without becoming reabsorbed correctly. In my clinical experience, I have seen this occur many times after a fall or bump on the head or from tossing and turning while sleeping. Most cases are idiopathic–meaning from an unknown cause.
Vestibular neuronitis – Vestibular neuronitis may be described as acute, sustained dysfunction of the peripheral vestibular system with nausea, vomiting, and vertigo. This disorder is characterized by a sudden severe attack of vertigo, caused by inflammation of the nerve to the semicircular canals (part of the vestibular system, which helps control balance). Although it’s not entirely clear, vestibular neuronitis is likely caused by a virus. Hearing is usually not affected.
Meniere’s disease – Meniere’s disease is a disorder of the inner ear that not only causes vertigo, but it’s also associated with intermittent bouts of hearing loss. This chronic condition can include permanent hearing loss; ringing in the ear (tinnitus); and fullness and pressure in the ear. This disease is most commonly diagnosed in people in the 40s to 50s age range.

When first experiencing symptoms of dizziness, it’s always wise to check with your medical doctor. If you’re suffering from vertigo, I recommend that you at least try the Epley maneuver that Amy mentioned above. It’s very simple to perform and can produce immediate results. Many YouTube videos demonstrate how to correctly perform the Epley maneuver. I recommend the following: Epley Maneuver to Treat BPPV Vertigo and Epley Maneuver: How to Perform.

If the Epley maneuver doesn’t eliminate your symptoms, then additional medical consultation will likely be needed. Your medical professional may administer the Dix-Hallpike, the associated test to be performed prior to the Epley maneuver, to determine if BPPV is present and potentially treatable.

Amy, it sounds like the Epley maneuver has been somewhat beneficial in reducing the time it takes you to feel functional again. If you’re experiencing vertigo on a regular basis, you may consider other potential causes or aggravating factors which may lead to your episodes. If you don’t have a definitive diagnosis for the cause of the vertigo or dizziness symptoms, consider the following:

Cervical (Neck) Dysfunction or Derangements – Skeletal muscle spasms or cervical vertebral dysfunctions associated with the upper neck, particularly along the C2/C3 (upper cervical) region, can cause dizziness symptoms.
Dehydration – Dehydration can result from excessive alcohol, caffeine use, poor fluid intake, and other medications, including diuretic use.
Electrolyte Imbalances – Any type of electrolyte imbalance that affects the normal sodium, potassium, and calcium levels of the body can cause dizziness related symptoms.
Hypoglycemia – Low blood sugar is usually associated with diabetes, but anyone can experience the symptoms (which include dizziness and lightheadedness) as well as gait ataxia, slurred speech, or declining cognitive function.
Medication Side Effects – Dizziness is a potential side effect of many commonly used over-the-counter and prescription medications. Even if you have been taking a particular medication for a long time, you can still develop a side effect. Please consult with your medical physician and/or pharmacist if you suspect a medication issue.
Migraine Headaches – This type of headache can also be associated with vertigo and dizziness.
Orthostatic Hypotension – This condition occurs when your blood pressure doesn’t regulate fast enough upon standing or sitting up, and it’s associated with dizziness. Please see your medical physician for treatment.
Other Medical Conditions – Stroke, known as a cerebral vascular accident (CVA); Transient Ischemic Attack (TIA); Multiple Sclerosis; and Cerebellar Hemorrhages (brain tumors) can all cause associated vertigo or dizziness symptoms. You should be screened as necessary by your physician.
Recent Trauma – Any trauma that affects the head or neck area could lead to vertigo. If you experience symptoms after an associated trauma, please seek competent medical advice.
Sinus Infections – Sinus infections can cause excessive pressure to build up in the ear canal. This includes symptoms of the common cold and allergies as well. Any fluid buildup in the ear canals (whether or not associated with an infection or Eustachian tube related issues) can lead to dizziness symptoms.
Tooth Infections – Tooth or gum infections can affect the sinus canals in both the head and face area and can lead to dizziness symptoms.
Vertebro-basilar Insufficiency – When the vertebral artery (a critical artery to supply blood to the brain) isn’t supplying adequate amounts of blood, dizziness or a lightheaded feeling can occur. This insufficiency can be due to atherosclerosis, plaque buildup in the arteries which causes hardening and narrowing. This should be diagnosed and addressed by your physician.

Although this list of potential causes or aggravating factors isn’t conclusive, it demonstrates how complex it can be to treat dizziness and vertigo. The good news is that most of the time, the symptoms resolve rather quickly. In cases of BPPV (when the proper treatment technique is performed), the resolution of symptoms can be almost immediate. If your symptoms persist and can’t be definitely attributed to a particular diagnosis, then I strongly suggest that you seek a specialist who treats dizziness and vestibular related issues.

Thanks, Amy, for the question, and I hope you find relief from your vertigo episodes. It’s best to continually challenge your vestibular system by remaining active, and in particular, moving your head more. For more information on dizziness and vertigo, please refer to How Do I Improve Balance? (Part I), and also consider trying the Vestibular Ocular Reflex (VOR) exercise described in How Do I Improve Balance? (Part II).

Do you know which factors might trigger your vertigo? Have you discovered a way to successfully treat your vertigo? Additional discussion can help others to manage his/her vertigo. Please leave your comments below.

Posted on Wednesday, October 8, 2014

Q & A: Can CrossFit Cause Elbow Pain?

Q. A lot of CrossFitters, including myself, seem to have tendinitis of the elbow or other achy elbow issues. Do you know why that is? What exercises are we doing to cause it? What therapy would you recommend to help the pain? I appreciate you and love this blog that you are doing! I always look forward to reading it! -Stephanie

A. Thanks, Stephanie, for the great question! I have worked with quite a few CrossFitters who have experienced elbow pain. I have treated people new to the sport and those who participate at a high level. Elbow pain can be debilitating by limiting your ability to exercise and perform daily tasks. I will address potential causes and how to alleviate elbow pain associated with exercise. (Note: You don’t have to be a CrossFitter to benefit from this information.)

Possible reasons for developing elbow pain include:

Poor grip strength.
Muscle imbalances between wrist flexion and extension strength.
Improper lifting technique (which is the primary problem for the newer participant).
The progression of training is too quick (which again tends to be an issue for the newer participant).
Mobility related issues in the wrist, shoulder, or thoracic spine. (Poor mobility can affect both those who are new to the sport as well as CrossFit veterans.)
Excessive mobility or hypermobility may also be an issue. It tends to be more common in females than in males and is usually associated with the shoulders or elbows.

Poor technique is a frequent complaint in regard to safely performing CrossFit. Many people believe that there isn’t enough emphasis placed on proper lifting technique or specific CrossFit exercise techniques (particularly with the new participant). Some complain that the emphasis is on speed, not form, during WODs (Workout of the Day). This may be true in some Boxes (gyms/clubs), and it’s a valid concern.

Please be honest with yourself when you start a new activity. This is especially important if you’re starting very high intensity activities with very specific movements which require a high degree of skill to perform such as CrossFit. Beginners to CrossFit should spend the necessary time to learn the proper technique. With any new activity, there is always a learning curve. It’s the responsibility of the coach and the client to insure proper form.

The power clean is an example of a common movement in CrossFit and Olympic Weightlifting. This exercise can cause elbow pain when performed incorrectly. One reason for elbow pain to develop during this movement is that the bar is reversed curled. It causes excessive strain on the wrist extensor muscles instead of the participant exploding the bar upward, and then dipping underneath. There shouldn’t be a reverse curl movement to this lift. I witness it fairly often as a common mistake. If you’re experiencing aches and pain in your elbow or elsewhere, please see your coach or athletic trainer to insure that your lifting technique is correct.

Poor wrist, shoulder, or thoracic mobility is also commonly related to elbow pain associated with exercise. If the wrist cannot extend properly, it not only causes wrist pain, but excessive stretching of the forearm muscles and strain on the elbows (possibly leading to pain).

Poor shoulder or thoracic spine mobility can also cause excessive strain on the elbow. Consider exercises like the overhead lift or pull ups. If the shoulder cannot fully flex or the thoracic cannot fully extend (allowing proper shoulder flexion), then the elbows will absorb more of the load. The lack of shoulder or thoracic mobility also affects proper alignment of the upper extremity during the movement. Over time and with multiple repetitions, this overloading can cause pain and injury to the elbow.

Whenever one part of the body doesn’t have adequate mobility, another part will do more to allow for the movement to take place. When an exercise is performed at a high speed, high relative weight, or high repetitions, a lack of mobility can make you more susceptible to pain and injury.

Excessive mobility can have a similar effect. For example, if you’re performing an overhead lift, but your shoulders flex past 180 degrees, then the bar is too far behind your head. This causes excessive force to be placed on the shoulders and elbows. Again, this can lead to injury and pain when performed at a high speed, high relative weight, or high repetitions.

Top 7 Recommendations to alleviate Elbow Pain associated with Exercise:

Work on your Grip Strength. Practice bar hangs for time. Carry barbell plates (one in each hand) to challenge the grip strength. Don’t just work on wrist flexion or gripping exercises, but also work on wrist extension to improve grip strength and decrease your risk of lateral elbow pain. Use an exercise band (as shown below) to perform 2-3 sets of 20 repetitions. Extend the wrist up, and then slowly back down toward the floor. Be sure to move very slowly during the eccentric/muscle lengthening position (when your hand returns to the floor).
Identify the Offending Movement. If you’re experiencing elbow pain, try to identify which specific movement aggravates the elbow. Once you identify the movement, work with your coach or athletic trainer to insure proper lifting technique.
Work on your Mobility. CrossFit is not just about metabolic conditioning or strength training. You need to develop all aspects of your fitness, and this includes your flexibility. Work on upper body mobility by focusing on shoulder and thoracic mobility as well as lower body and spinal mobility. A free resource for shoulder and thoracic mobility is My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain which you can automatically download when you subscribe to my e-mail list. You will receive each week’s blog post sent directly to your e-mail making it even easier and more convenient!
Warm Up. Prior to activity, be sure to perform a cardiovascular warm up to insure that the muscles are ready to stretch and perform high level activities. Perform a dynamic warm up by taking the associated muscle (or muscles) needed for the workout through the anticipated and needed range of motion (ROM) in a quick and brisk manner. A foam roller can also be utilized as part of your warm up. For more instruction, please refer to Foam Rolling for Rehabilitation and Does Foam Rolling Help or Hurt Performance?
Static Stretch and Self-Mobilization Post Work Out. Continue to work on the immobile areas through static stretching and/or self-mobilization. Again, a foam roller can also assist. If you prefer a very comprehensive guide for improving mobility, I recommend Kelly Starrett’s Becoming a Supple Leopard.
Be Proactive. Once you start to feel pain, be aggressive with your management and self-treatment. I like to use either a tennis ball or roll PVC pipe over the forearm area, which can be an effective treatment for lateral epicondylitis (“tennis elbow”). For more ideas on how to self-mobilize, please refer to My Top 3 Household Items for Self Mobilization.
Contact your Physical Therapist. If the pain persists, seek additional help. Don’t let the pain linger. The longer it’s left untreated, the more potential for harm and damage which potentially could lead to a longer recovery. The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Elbow pain can be debilitating by limiting your ability to exercise and perform daily tasks. Be proactive in your care and management. Most importantly, don’t let the pain linger. You can find more tips and strategies on managing pain and injury by simply using the search function (located on the upper right-hand sidebar).

What specifically causes your elbow pain? Which treatments have you found to be the most effective? Additional discussion can help others to manage his/her pain. Please leave your comments below.

Posted on Wednesday, September 17, 2014

Q & A: The #1 Way to Extend Your Life Span

Q. Can you comment on the whole concept of stand-up desks? I know that sitting is the new smoking. Is it just a matter of standing at my desk (with everything elevated)? Or is there more to it than that? What exactly is it about standing with minimal other movement that is so much healthier than sitting? –Erin

A. Thank you, Erin, for the excellent question! Stand-up desks have become increasingly more popular during the last several years. The latest research indicates that sitting for more than two hours at a time can significantly lessen your life span. The real headline should be: Even if you are a regular exerciser, sitting for more than two hours a day will still lower your life span. The take home message is that frequent movement throughout the entire day is critical for health. A stand-up desk could be beneficial if you follow these simple guidelines:

Do not stand still. Standing still for long periods of time is as equally hard on the body (particularly in the lower lumbar, knees, ankles, and feet) as sitting. It can cause negative effects in the joints as well as cause circulation issues. Use a foot stool and frequently shift your weight and stand in different positions. Modify your position at least every five minutes.
Do not stand on a hard surface. Standing on a hard surface all day is not natural. Our native environment is full of softer surfaces such as dirt, sand, bark, and grass. Rarely would someone stand on a large section of concrete or granite without moving. Instead, I recommend standing on a rubber mat similar to the one a grocery store cashier may utilize in order to take the strain off of the low back and the joints of the lower extremities.
Get a treadmill desk. Walking all day long isn’t practical. An excellent way to keep moving (without excessive strain or fatigue) would be to have a treadmill on which you could slowly walk on as you work for several hours per day. The treadmill desk would allow you to keep moving and maintain a higher metabolic rate without excessive strain (as long as it is kept at a slow pace).

Do not stand all day. Standing all day isn’t any better than sitting all day. The key to optimize your health is frequent moving. A desk that can be adjusted to sit or stand would be ideal. If you can combine it with a treadmill desk, then you would have the ultimate work station. When sitting at a desk, I recommend using a large Thera-Band exercise ball. The exercise ball provides you with the benefit of more movement while you work on your postural and core muscle development.
Go barefoot. We spend so much of our day in shoes that our feet forget what it is like to be unsupported and to actually feel the ground, which helps with balance to support our bodies. I recommend standing barefoot when possible and appropriate. If lower extremity swelling is an issue for you, then you may need an over-the-counter compression sock. Vitalsox Graduated Compression Socks can help you manage the swelling in your feet and can help prevent conditions such as spider veins or varicose veins.

When standing or sitting, pay close attention to your posture. Slouching while sitting or standing can cause pain and eventually, dysfunction. My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain, full of photos and exercise instructions, can help you maintain good posture in sitting or standing.

What are your experiences in dealing with stand-up desks or treadmill desks? Are you intrigued to try one? Feel free to leave your comments below.

Posted on Wednesday, September 10, 2014

Q & A: Exercises Beneficial in Managing Rheumatoid Arthritis

Q. I have rheumatoid arthritis in my hands, wrists, and elbows. What type of exercise can I do to keep my upper body strength? –Gloria

A. Thanks for your question, Gloria, as it presents an opportunity to discuss a very devastating disease, Rheumatoid Arthritis (RA). Your willingness and desire to maintain your upper body strength despite the disease is an encouragement to others who may be suffering as well.

Rheumatoid Arthritis (RA) is one of 171 different types of arthritis. RA is most commonly diagnosed in women, with nearly three out of four cases involving women. Over 46 million people in the United States alone suffer from one form of arthritis or another, and this number is climbing rapidly. The most commonly recognized forms of arthritis are osteoarthritis and RA. Osteoarthritis is most commonly associated with “wear and tear” syndromes (degeneration of the joint from excessive use or injury). RA (known as an inflammatory arthritis) is an autoimmune disease in which the immune system works against normal body cells by attacking the joint surfaces and eventually, even the body organs. As the condition progresses, joint surfaces become severely damaged–leading to deformities and dysfunction.

A person with RA should always be medically managed by a specialist in the disease. Symptoms are typically quite severe and not only cause pain and deformities, but also excessive fatigue and loss of appetite. RA can be found in only one joint or area, but it’s usually associated with many areas in combination, typically in a symmetrical pattern. Eventually, it can affect the entire body including the internal organs.

In addition, it is important that you and your loved ones learn as much about the disease as possible. There must be a multifactorial approach to managing the disease. Consider the following:

Medical/Physician Management – This may include pharmacological management or surgical intervention, including total joint replacement.
Nutritional Management – Eat foods which promote a low inflammatory diet, including a diet high in Omega-3 fatty acids and other natural herbs (like garlic and turmeric) which can naturally lower inflammation.
Weight Management – It is important to manage your weight effectively. Excessive body weight can cause additional “wear and tear” (particularly on the lower extremities joints) and can worsen any damage caused by RA. Also, excessive weight can worsen RA symptoms or even cause osteoarthritis. If possible, you don’t want more than one form of arthritis if it can be avoided.
Activity Modification – As the disease progresses, it is important to understand how your body is functioning and then learn how to adapt to manage the disease. Unfortunately, certain activities and how you perform them will need to be modified or avoided. Learn to pace yourself and take more frequent rest breaks. Adequate night time sleep is also critical. Depending on the joints affected, learning to limit the use and strain on the joint is important. For example, if your knee is affected, then repeatedly going up and down stairs could cause a strain. You may choose to eliminate or minimize the frequency of that particular activity. Repetitive joint motion and in particular, repetitive joint loading and hyper loading, should be avoided and/or minimized. Learning to use adaptive devices to limit the strain placed on the body during activities will also be helpful.
Modalities – This is a broad category, but in general the application of heat, cold, or over-the-counter topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help manage pain and stiffness. Gentle massage and TENS (Transcutaneous Electrical Nerve Stimulation, a form of electrical stimulation) may also be beneficial.
Splints – Many times, custom or over-the-counter splints (particularly for the upper extremities) can be utilized to provide support and comfort to joints which are in pain and/or suffering from deformity.

Now that you have a clear understanding of RA and options available to manage the disease, I will specifically address Gloria’s question regarding exercise for the upper extremity and exercise in general. Although the research for exercise for individuals with RA is far from complete, it indicates that a regular exercise and range-of-motion (ROM) program is a critical component to proper management of the disease. (Make sure you are adequately rested before performing any exercise program.) General guidelines for exercise include:

Strength Training – Strength training is encouraged, and the exercise program should be established by a professional who is familiar with managing RA. Excessive shearing forces and rotational forces and/or exercises should be avoided. Joints with severe involvement should be exercised with caution and an emphasis should be placed on ROM versus actual loading of the joint. All exercises should be performed in a slow and controlled environment within the available ROM. Maintaining muscle mass through strength training is critical and should be performed only one to two times per week to minimize any risk of over stressing the joint.
Endurance Training – Endurance training is critical for general health and should be included as part of a comprehensive exercise program for individuals with RA. Avoid cardiovascular exercise (running, jogging, skipping, jump roping, etc.) which produces high impact forces. Instead, focus on less impact activities such as bicycling, rowing, or water aerobics.
Flexibility Training – Flexibility training is important for everyone as part of a healthy lifestyle, but it’s critical for those with RA. A person should take every joint through a full ROM at least once a day. I highly encourage a regular two to three times a week flexibility program in addition to a daily ROM program. Appropriate options include: yoga, Pilates, Tai Chi, water aerobics, or a self-stretching routine. The program should be performed in a slow and very controlled manner by taking care to never overstretch a joint or to move too quickly.
Aquatic Therapy – Many find that performing a regular exercise program in an aquatic environment can satisfy most exercise needs, including flexibility and strength. Water can also be very useful in pain control and help with relaxation. Exercising in a reduced gravity environment like the pool limits the compression forces on the bones. Additional weight training or body weight exercise should still be performed to insure adequate bone density as one ages.

To specifically answer Gloria’s question on the upper extremities, I would encourage her to daily perform an upper extremity stretching routine which takes all of the upper extremity joints through at least one full ROM. Be sure to take several rest breaks during the day to perform stretching and ROM exercises. Strengthening exercises for the shoulders, elbows, wrists, and fingers would also be beneficial. Be sure to work the finger extensors (opening the hand) and not just the flexors (squeezing). Finger Putty is a great product which enables you to perform a variety of hand and finger exercises. I would also encourage an emphasis on posture and upper back stretching as demonstrated in My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. Gloria, I hope you find this information to be helpful as you manage your RA. Please let me know if you have additional questions.

I would love to hear from more of you! What are your experiences dealing with rheumatoid arthritis? Have you or a loved one been dealing with this condition? What has worked or not worked for you? Additional discussion can help others to manage a very difficult disease. Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on Wednesday, July 9, 2014

Q & A: How to Prevent My Mom From Falling Out of Bed

QMy mom has fallen out of bed several times recently. She doesn’t know why or what happens, only that she just ends up on the floor. She also has minor dementia, and she needs help when walking. What can I do to help? -Kelly

A. Thanks for your question, Kelly! Falling out of bed may sound like an unusual experience to hear about an older person. It’s often thought of as an issue for young children, but surprisingly and unfortunately, falling out of bed is an issue for older adults as well.

Falling is the number one cause for fracture in the elderly. Many times, a fracture will lead to a cascading decline in mobility and function. Finding methods to limit falling, without restraining or inhibiting important functional mobility, is critical.

The following are reasons why a person may fall out of bed:

Changes in mobility, such as a recent surgery or stroke.
Illness: Many illnesses can cause weakness which makes getting in or out of the bed difficult.
A person has a new bed which is higher or lower than it was previously.
A person has new bed coverings which are slicker than the previous bedding.
New night time clothing which are slicker than the old clothing.
New night time clothing which clings to the bedding and causes increased difficulty with movement on or off the bed.
New Sleeping Environment: Sleeping on a new bed, on the different side of the bed, different lighting, or changes in nearby furniture.
Recent medication changes which have affected how deeply a person is sleeping or causes grogginess upon waking.
Incontinence: If a person has the urge to use the bathroom or needs to rush to the bathroom to prevent an accident, then the risk of falling out of bed increases.
Sundowners: Many older adults with dementia will suffer from a condition known as sundowners in which fatigue causes increasing confusion at the end of the day.
Eyesight Related Issues: New corrective wear which isn’t fitting or working properly, such as a new pair of bifocals when the person didn’t wear them previously. Maybe worsening eyesight from conditions such as glaucoma, macular degeneration, or cataracts.
Benin Paroxysmal Positional Vertigo (BPPV)
Poor environmental lighting.

One simple trick to prevent a person from falling out of bed (without restraining them or using bed rails) is to use a simple water noodle. Just place the water noodle along the inside of the mattress pad or sheet. (For those with young children, this tip may also be particularly useful if you are transitioning a young child into a bed without railings for the first time.)

Sometimes as a person ages or becomes more confused or frail, we want to discourage them from getting in or out of bed without assistance. This may be an appropriate time to utilize the “water noodle technique” (as I call it). The idea is to simply provide a minor barrier (a reminder) of where the edge of the bed is located and that the person shouldn’t be attempting to get out of bed without calling for assistance.

For some, this minor barrier is all that is needed to actually physically limit his/her ability to get in and out of bed without assistance. This serves as a temporary solution while the person is recovering from or modifying the underlying reason why he/she is at elevated risk of falling out of bed.

The water noodle also provides a subtle physiological barrier. When the body is moving, it subconsciously feels the barrier and tends to not proceed any further in that direction. I have witnessed the water noodle technique work repeatedly in homes (with both adults and children) and nursing homes with great success.

Kelly also mentions that her mother is having difficulty with dementia and walking. Unless the mother’s dementia is so severe (like she is actually losing her ability to walk or she can’t follow any time of direction), she may be a good candidate for physical therapy treatment. Depending on the situation, she may benefit by going to an outpatient facility for physical therapy or she may qualify for home health physical therapy. I strongly encourage you to seek a physical therapist who is an expert with gait (walking) and balance physical therapy or who had experience in geriatric related physical therapy care. You can search for specific providers here: American Physical Therapy Association (APTA)

In addition, Kelly, you may be interested in reviewing my prior posts on balance related issues, How Do I Improve Balance? (Part I) and How Do I Improve Balance? Part II. Good luck, and thank you for your question.

Join our growing community on Facebook by liking The Physical Therapy Advisor! If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

Posted on Wednesday, June 25, 2014

Q & A: How Should I Treat Shoulder Pain and Impingement?

Q I suspect I have a left rotator cuff tear. I have severe pain especially when I move my arm outwards. It feels like a knife stabbing my left deltoid area with spasms. There is no swelling or bruising. The area is tender to touch. I have trouble lying on my left side at night due to discomfort. If I don’t move my arm, there is no pain. Ibuprofen is not effective. I have been applying ice. I haven’t seen my MD yet. When I raise my arm when I perform range of motion (ROM), I hear a cracking sound. It has been six weeks. Please advise, Dr. Ben! -Linda

A. Thanks for your question, Linda! Unfortunately, this is a fairly common scenario. Shoulder pain can be one of worst most intense pains a person can experience. It can be completely debilitating–rendering an arm almost useless in some cases. The shoulder is vital for any movement of the arm which includes the hand. It can even affect a person’s ability to utilize a computer mouse.

Linda doesn’t mention any specific causative factor which is common in these cases. She also mentions pain at night and pain with movement. Another very common symptom is where she describes the stabbing pain in the deltoid. The pain is almost always located down the arm into the deltoid area. Typically, it is located at the insertion point of the deltoid muscle. It can migrate even further to the elbow or hand.

In a situation like Linda’s, the source of the pain is rarely the deltoid and almost always the rotator cuff. The rotator cuff tends to “refer pain” into this region. Referred pain is a common phenomenon which occurs when the pain is being caused in one area of the body, but the pain is felt somewhere else. (An example of referred pain would be left arm pain or jaw pain which is present during a heart attack.)

Linda states that the pain is present when she raises her arm. This implies that she still has the ability to raise her arm, which tends to (but not always) rule out a full rotator cuff tear. Typically with a full tear, the person loses the ability to raise his/her arm. The level of pain on a full tear will vary depending on how acute or recent the tear.

To accurately diagnose Linda’s condition, I encourage her to seek treatment from her medical physician or physical therapist. Based on her reported symptoms, she is likely experiencing either a partial rotator cuff tear or shoulder impingement. Shoulder impingement can lead to an actual rotator cuff tear if it remains untreated. The key to treatment (with either a partial rotator cuff tear or an impingement) is to first address the pain and inflammation. Then the mechanical cause or causes which led to the injury must be addressed.

My Top Tips & Recommendations to Treat Shoulder Pain & Impingement include:

Reduce the Inflammation:

Use ice on the affected area (not directly on the skin) for 20 minutes per hour. Watch the skin carefully. If it looks white or blue and is non-blanching, then discontinue the use of ice. It is possible to frost bite your skin.
Rest the affected area. Stop or reduce any activities which tend to aggravate the area. This is typically overhead activities or repetitive activities.
When sleeping, try not to lie on the affected side. Hug a small pillow for comfort. This also promotes optimal blood flow to the shoulder area.
Try Mt. Capra CapraFlex. Mt. Capra, an organic goat farm in eastern Washington State, offers superior quality products primarily utilizing goat based products. Capra Flex is the best bone and joint supplement I have found. It is a blend of natural herbs and spices along with glucosamine and chondroitin. The herbal and spice formulation is designed to naturally decrease inflammation and support healing. I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level. I personally use it, and in my practice, it has helped clients recover faster and prevent injury. It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.

Address the Mechanical Causes:

A slouched posture with a forward head and rounded shoulders can be associated with this condition. Try to keep a good postural alignment with your shoulders under your ears and the shoulder blades set in a back and down position. This is particularly important when performing any activity while using the shoulder.
Improve thoracic (upper back) mobility. The more mobility your upper back has, the less likely your shoulder will impinge when moving. Your upper back, shoulder blade, and arm must work together when moving. Tightness in the upper back will throw this system off.
Be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. By subscribing to my e-mail list, you will automatically gain access to this FREE resource. Download the .pdf file, which is full of photos and exercise instructions, to get started!

Strengthen the Rotator Cuff:

The rotator cuff is a critical component to shoulder mobility. It is made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates and slides properly in the socket, which is made up of the scapula. The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform. When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone–leading to impingement or eventually fraying and tearing.
Here are my recommended Rotator Cuff Exercises using an exercise band.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover. My tips and recommendations are the first steps for treating and preventing shoulder impingement and pain. Many different causative factors can lead to these conditions. In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.

If your symptoms continue to worsen or you don’t improve, I highly recommend that you seek further medical treatment. Many times, a person will require medical intervention, which could include anti-inflammatory medications either orally or through an injection. A person may also need hands-on treatment from a qualified physical therapist to address other mobility issues in the shoulder, thoracic or cervical regions which are causing or contributing to the pain. Sometimes, surgical intervention is needed to repair a fraying tendon or an acromion which is hooked and causing the impingement.

Good luck, Linda! I hope you find the information to be helpful and provide some relief from the pain you’re experiencing. If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

Posted on Wednesday, June 4, 2014

Q & A: How to Optimize my Child’s Health & Development

Q Are there any kinds of specific mistakes we parents make with our kids in regards to their bone, joint, and muscle health? I know diet is huge, but what about general wear and tear on their bodies? Should I be purchasing good quality shoes for my 7 year old daughter (who is not involved in organized sports, but she goes to P.E. and plays outside a lot)? Should my kids have inserts in their shoes? Should I tell them to stop popping their knuckles, shoulder blades, and necks all of the time? I suppose what I’m asking you is whether or not you ever encounter injuries in adults (acute or not) which could have been prevented if they had made different choices in their younger years while their bodies were still growing. -George

A. Thanks for your question, George! This is a large topic to cover, but an important one. As a parent, I want to insure that I do everything I can to help my child live a long, rewarding, and healthy life. For the first time in history, today’s youth are expected to have lower life spans and more health problems than their parents. This is primarily due to the rise in childhood obesity and diabetes. It is projected that nearly one third of American youth will be diabetic in the coming years. Worse than that: after only five years of diabetes, a person of any age will start to experience negative, and typically non-reversible changes to his/her health, including damage to nerves and the vascular system. This problem is now at epidemic proportions for America’s youth.

As parents, we CAN make a difference! The following recommendations can help to optimize your child’s body and health without excessive wear and tear. (As for popping knuckles and other body parts, research is inconclusive about whether or not it’s harmful. Don’t encourage it, and hopefully, over time it will become less habitual.)

Encourage Daily Activity: My advice to parents is to encourage as many different kinds of activities as possible. This can be through organized sports or just for fun! Variety and fun is the key. Also, don’t have a child specialize too early. Contrary to popular culture to push kids to be professional athletes, realistically, the majority of kids will not become professional athletes someday. Let’s insure that they grow up to be healthy and fit. Our bodies need lots of different stimulus to develop. This is particularly true at a very young age, but it is also relevant even in later teen years. If your child likes soccer, great! Let your child play, but also try to encourage other movement based activities, too, such as bike riding or martial arts. For younger kids, time at the playground or just playing tag is wonderful. Think of it as cross training. We need it at an early age just like we do later in life!

Have an Off Season: Many parents pack their children’s itineraries with year round sports and activities with one sport season to the next. This never allows the body to rest and recover. Not even professional athletes can compete year round. We all need an off season to recover, rest, and cross train. Use this time to have fun! Participating in volleyball to basketball to soccer to track, without any break for recovery, is a good way to over train which will likely lead to injury. It also tends to lead to burn out, which is the last thing we want as parents. Think long term when it comes to a healthy lifestyle and activity level. Keep it fun!
Wear Appropriate Equipment: Make sure your child wears the appropriate safety equipment, particularly in sports which require head gear or helmets such as skiing, skateboarding, bike riding, and baseball. Most safety equipment offers fashionable designs. It is never worth risking injury to appear cool. Be safe!
Wear Appropriate Clothing: Some children will outgrow their clothes before they wear them out. This can especially happen in the case of shoes. Make sure their shoes appropriately fit. In general, brands do not matter as long as the shoes fit. This includes wearing the right shoe for the right sport. If the child participates in track, take him/her to a local running store to be fitted for proper running shoes. (I would not go to Walmart or another local retailer expecting a similar quality of shoe.) If your child participates in soccer or football, buy an appropriate set of shoes for the sport as improper fitting shoes can lead to injury. If your child just likes to run around and be active, but isn’t involved in any particular sport, then a well-fitting pair of general athletic shoes from a department store would likely be fine. Inserts for shoes are probably unnecessary, but please seek advice from either a physical therapist or podiatrist if your child is experiencing foot pain or you’re uncertain if he/she needs inserts.
Go Barefoot: Spending time barefoot allows the foot muscles to develop and encourages development of the nervous system as it relates to movement and balance. Make sure your child spends time barefoot, and not just indoors, but outside, too. Grass and sand are the best environments when barefoot.
Stop Sitting and Start Squatting: We push our kids to sit in chairs way too early! Not only does poor posture occur, but sitting can affect many developmental growth stages, including hip development. Encourage your kids to get out of their chairs. Squat, bend, and move! Yoga for children is great for this as well. Children often go through bony growth spurts, which leads to muscle and tendon tightness and can temporarily limit mobility. Squatting helps insure proper muscle length in the lower extremities and assists with bone development and strength. (I will be addressing the importance of squatting in an upcoming blog post.) Yoga teaches the child great motor control, strength, and mobility. It can also be a time of peaceful mobility and reflection in our hypercharge world and can be a great cross training opportunity.
Encourage Body Weight Exercises and Moderate Weightlifting: This may be controversial, but I’m not suggesting Olympic power lifting. This is an opportunity to set your child on a path of fitness and health for the long term. For a child, the goal should be to learn fundamental exercise and lifting techniques to use throughout his/her life. It is also critical for cross training, and these days, the options are limitless. Many schools offer before or after school weight lifting classes. There are CrossFit classes for kids and other exercise programs which teach body weight training (such as push-ups, pull-ups, squats, and TRX). As parents, we need to be diligent about getting our kids involved in this type of activity as they tend to play less due to cuts in physical education programs and spend less time on the playground. Lifting weights is appropriate for children of both genders when it is supervised by trained coaches, and the emphasis is on technique, not weight. The right age to start these activities will vary depending on the child’s physical and emotional development and desire to participate.
Encourage Proper Nutrition: Variety is critical. Don’t eat the same food all of the time. To optimize your child’s health, vary his/her diet by eating real food (and when possible, organic). Better yet, grow your own in a garden! If the food comes in a box or has words I can’t pronounce or my grandmother wouldn’t recognize, then I don’t eat much of it. Review this great article to see what the food Pyramid should look like! http://www.bengreenfieldfitness.com/2012/01/why-the-food-pyramid-is-wrong/

Your child’s path toward a healthy lifestyle started before he/she was born. What mom did when the baby was still developing in the womb continues as the child ages. What we teach and demonstrate to our children is likely what they will do as they grow into adulthood. Start by modeling the behavior that you want your kids to use in order to thrive. It is never too late to implement new and healthier behaviors! The earlier we start, the better it is for the child. Encourage movement, activity, and be mindful not to project any negative body insecurities (particularly with girls). The main goal should always be health and fitness and never a focus on appearance.

Thank you, George, so much for this question! As parents, we CAN make a difference!

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.

Posted on Tuesday, May 27, 2014

Q & A: How Do I Improve Balance? (Part II)

In last week’s blog post, I answered a reader submitted question from Kay regarding worsening balance and what we can do to improve our balance. The blog post addressed five different body systems which affect balance and how they work together to insure that we have proper balance and mobility in our environments. In case you missed it or would like to review the five systems, please refer to Q & A: How Do I Improve Balance? (Part I).

This week, I will offer specific suggestions on how you may improve balance in each of the five body systems. If you require specific advice, I highly recommend that you seek advice from a physical therapist or a qualified medical doctor who is well versed in balance related disorders.

Muscle Strength and Range of Motion (ROM) – Without adequate strength, you are unable to balance. These specific exercises can help to improve balance. If your balance may be due to an issue in this area, then the next step is to narrow down as to why. To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits.

Stretch your calves. If your calves are tight, you are more likely to tip over backward as you age. It also affects your body’s normal ability to balance and recover from a loss of balance via what is known as an ankle strategy. Hold each stretch for at least 30 seconds twice on each leg.

Get stronger hips. An easy way to work on strengthening this area is to get into a quarter squat and walk sideways. Keep your toes pointed forward and go both directions. (Add an exercise band for more of a challenge.)

Improve your quadriceps and buttock muscle strength by doing sit to stands. This is exactly as it sounds. Sit down, and then stand up. If this is difficult, start with using your hands, but eventually you shouldn’t need to use them. Use a standard height chair and see how many sit to stands you can perform in 30 seconds. The CDC’s 30SecondChairStandTest .pdf file provides further instructions and norm values for your gender and age. Scoring below your norm values indicates you are at higher risk of falling.

Stand on one leg. I would recommend being near your sink in case you lose your balance. On average, you should be able to hold a single leg stance for at least 30 seconds.

Somatosensory – The somatosensory system is the integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This system will be challenged as you work through the other activities suggested. If you’re a diabetic, you must keep your blood glucose ranges within the parameters set forth by your physician in order to help minimize damage to this system. Most importantly for all of us, continue to live a healthy lifestyle.

Eyesight – My first and most obvious suggestion is to visit your ophthalmologist to make sure your eyes are healthy. If you are using corrective lenses, confirm that they are functioning effectively for your needs. You can also work on Vestibular Ocular Reflex (VOR) by performing the following exercise. Hold your thumb or colored object out in front of you and practice moving your head up and down, to the left and right, and at diagonals as you keep focused on the object. Then practice moving the object while your eyes track it in all directions. Finally, try moving the object opposite the direction you move your head while still keeping focused on the object. If you are advanced, try reading a few words while you perform these.

Vestibular – If you’re experiencing vertigo or dizziness, ask your physical therapist to screen you for Benign Paroxysmal Positional Vertigo (BPPV), which is fairly common and easy to treat. Otherwise, it’s best to continually challenge your vestibular system by remaining active, and in particular, moving your head more. Try the VOR exercises described above. Try moving your head while you stand on one foot. Moving your head, jumping, and any bouncing activity in general not only stimulate the musculoskeletal system, but also the vestibular system.

Central Nervous System – Live a healthy lifestyle and move more. The brain needs to be challenged. Think “heart healthy” because anything that keeps the vascular system healthy is also good for the brain. Also, don’t forget to drink plenty of fluids. Like other systems in the body, the brain is primarily water. Dehydration affects your balance in many ways (including the vestibular system) and also increases your risk of blood clots and strokes. Discuss with your medical practitioner any changes, new onset of dizziness, or poor balance as it can be a sign of something more severe or could be a side effect from a new or old medication.

The key to helping someone improve balance is to understand why his/her balance is worsening in the first place. Balance is affected by any one or a combination of the body systems listed above. The brain integrates the information within one’s environment. To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits. That is usually the most difficult part. If a person spends time evaluating why his/her balance has worsened, then an effective treatment program can be designed to address the issue.