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Why Does My Shoulder Hurt?

Shoulder pain is one of the most common ailments treated by physical therapists.  There are many potential causes of shoulder pain, but the two primary issues to consider include poor mobility and muscle imbalance.  The key to treating most common shoulder related pain is to improve your posture while focusing on thoracic mobility, shoulder position, and proper shoulder strengthening.

Poor Mobility

The most common reason for mobility issues is poor posture.  Poor thoracic mobility and tightness in the posterior capsule of the shoulder are the most common contributors to the lack of mobility which can ultimately lead to shoulder pain.

Mobility issues can occur if you adopt a chronic forward head with rounded shoulders posture.  As this position becomes more chronic, the thoracic vertebrae lose backward mobility (extension).  This happens in conjunction with shortening of the pec minor (which is located underneath the pec major) and causes the shoulders to roll forward.  The forward shoulder posture causes the humeral head (arm bone) to be positioned more forward.

This causes tightness in the posterior (back) portion of the shoulder joint which affects the natural roll and spin motion of the joint.  The alterations of the roll and spin motion combined with alterations in shoulder blade motion negatively affects the mechanics of the shoulder joint.  The alteration in mechanics is what ultimately leads to pain as the rotator cuff or biceps tendons become impinged, irritated, and painful.

This is commonly referred to as Shoulder Impingement Syndrome.  Shoulder impingement pain is often associated with pain reaching overhead, behind your back and/or out to the side.  Those who experience it may feel weaker in the affected shoulder and experience pain when sleeping on the affected side.

Perform the following stretch to address shoulder posterior capsule tightness.  Lie on the side of the affected shoulder.  Be sure to support your head with a pillow.  Your arm should be straight out from your body with your shoulder tucked under your body.  The goal is to pin your shoulder blade down with the floor.  Gently push your arm down (as shown).  You should feel a gentle stretch.  Hold for 30-60 seconds for two to three times.  Perform once or twice per day.

In case you haven’t already subscribed to my e-mail list, please take a moment to do so in order to access my FREE resources, including My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  It’s a downloadable .pdf file with my recommended stretches and exercises to address poor thoracic mobility and pec minor tightness.  These simple exercises (with complete instructions and photos) will help you to improve thoracic mobility and can be performed at home.

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Muscle Imbalance

Muscle imbalance is often an associated causative factor for shoulder pain.  In addition to mobility issues, altered strength and muscle activation patterns are also related to shoulder pain and shoulder impingement syndrome.  The reasons for muscle imbalance can vary, but are often associated with poor posture and/or cervical/neck related issues.

Two common muscles that must be strengthened in order to insure proper shoulder mechanics are the lower trapezius muscle and the supraspinatus muscle (which is one of four rotator cuff muscles).

The rotator cuff muscles are responsible for the stability of the shoulder and proper roll, glide, and spin of the ball and socket shoulder joint.

The lower trapezius muscle is responsible for proper shoulder blade timing and rotation during arm movements.  It helps in maintaining a proper upright posture.

For three easy and effective exercises to perform to improve your lower trapezius and rotator cuff muscle strength, please refer to Exercises for Lower Trapezius and Rotator Cuff Muscle Strength.

Most shoulder symptoms typically resolve when thoracic mobility and strength in the shoulder is improved.  Shoulder impingement is painful, but worse yet if left untreated.  It can lead to fraying of the rotator cuff tendons (and ultimately, a rotator cuff tear).  It’s always best to be proactive and address the causative factors early.

If you’re not improving or your symptoms worsen, consult with your medical provider to determine if other causes are contributing to the problem.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

If you’re experiencing shoulder pain, do you think either poor mobility or a muscle imbalance is causing it?  How can you improve your thoracic mobility and strength in your shoulder?  Please share 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!

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Why You Keep Hurting Your Back

Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and the western world.  In fact, an estimated $50 billion dollars or more is spent annually on back pain related issues.  Nearly 80% of the U.S. population is affected by LBP at one time or another.  So why are we all hurting our backs?  Why does the pain seem to always reoccur?

2 Reasons Why Low Back Pain tends to Reoccur:

  1. The original risk factor(s) or precipitating actions that caused the initial low back pain (LBP) were never addressed.
  2. The inner core stabilizing muscles were never properly rehabilitated.  This makes the spine vulnerable to re-injury.

Just imagine if you had a significant knee injury which required surgery.  The injured leg would be weak and require specific exercises to help it to rehabilitate.  In most cases, the muscles of the injured leg would be obviously smaller due to muscle atrophy.  This same atrophy happens deep within the muscles of the lumbar region (particularly, the muscles known as the multifidus shown below).MultifidusMuscles

These muscles are responsible for spinal stabilization and to prevent shearing between vertebrae to vertebrae.  Just like the muscles in the thigh (in the knee example above), these muscles will shrink and atrophy when injured.  The problem is that you cannot see or feel them easily, so most of us never know that the spine’s ability to stabilize during activity is compromised.  This is a critical factor as to why reoccurring LBP is so prevalent.

Low back pain is a serious and debilitating condition.  It will either most certainly affect you or someone close to you.  The good news is that you don’t have to be a statistic!  You don’t have to live in fear of your next episode of LBP.  First, you need to address the likely causes that lead to the initial episode of low back pain, and be mindful of your risk factors.  Please refer to 12 Risk Factors for Low Back Pain.

Next, by implementing the proper exercises for prevention and rehabilitation, you can live pain free, train pain free, and live the life you want without fear of reoccurring low back pain!  Treating Low Back Pain (LBP) during Exercise and Athletics is designed for individuals of all levels from weekend warriors to soccer moms to elite athletes.  These principles can help you live the pain free life that you desire!

Treating Low Back Pain during Exercise and Athletics

product-cover-lbp

In this complete self-treatment package, Treating Low Back Pain (LBP) during Exercise and Athletics, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

LEARN MORE

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Why Low Back Pain almost always Reoccurs

I had waited all year for the City of Trees half marathon.  My goal (as always) was to post a PR (personal record) for the event.  Since it was a fairly flat course, I figured it would be a good opportunity to run fast (at least, fast for me).  As part of my training protocol, I was squatting two days per week and working on general leg strength and cross training (practicing yoga) one day per week.

Group of people running.

My back had been sore off and on for almost five years.  Medical professionals didn’t offer me any specific reasons as to why.  Neither chiropractic nor physical therapy seemed to help much, so I just ignored it.  But not this day!

I had just completed my second work set of squatting at the gym.  At the time, I wasn’t experiencing any notable back pain.  I was on my second repetition and on my third set when my low back gave way.  The weight came down and hit the rack safety rails!  My back hurt, but worse, it felt unstable.  I decided to leave the gym in shame.  I picked up the weights I was using, but the pain began to worsen.

By the time I drove home, I could barely get out of my truck.  I decided I was tough, so I took some ibuprofen and still went to work.  By the time I made it to the office (about 10 minutes), I was in real trouble.  I walked around for a while, and I took some Tylenol before I decided to go home.  I got in my truck, but by then the pain was so bad that I couldn’t push in the clutch or hardly use the brakes.  I really don’t know how I make it home that morning, but I needed help from my wife to get out of my truck.

LowBackPainIt only got worse from there.  I went to lie on my bed.  Again, another bad plan!  An hour later when I needed to urinate, I realized I couldn’t even get out of bed!  The pain was worse than anything I had ever experienced.  After much struggle and help from my dad (who was called in to help), I was able to get upright, only to break out in a cold sweat, start shaking, and nearly pass out from the pain.  Still having to urinate, I experienced one of the more humbling things I have ever done.  I had to ask for help from my wife to urinate into a plastic bottle because I couldn’t get out of bed.

Long story short, I went to a doctor who diagnosed me with low back pain (LBP) from a lumbar strain and prescribed pain medication and a steroid pack.  After many more days of pain, I was finally upright again.

A month later, I was ready to start back into my training, but frankly, I was nervous!  My back felt weak, and I had no idea how much was too much.  The worst part of it all:  I’m a physical therapist!  Shouldn’t I known what to do?  It sure didn’t feel like it at the time.

The medication did mostly relieve the pain, but I had a chronically sore back that felt weak and unstable.  I was performing physical therapy exercises and stretches.  I was even using heat and electrical muscle stimulation (EMS).

My treatment wasn’t helping me that much.  At least, not to the point that I felt I could get resume my training for my upcoming half marathon.  All I wanted to do was to get back to training, but I was too scared to!

This experience started me down a path of study that changed my life.  I realized how incompetent I had been as a physical therapist who treated others experiencing severe low back pain.  I had new appreciation for those patients who wanted to get back to their sport and activity.  I also realized that my prior physical therapy interventions were not preparing people to get back to sport nor most high level activities.

What do you do when you’re past the worst of the pain and want to resume training, but you don’t feel physically, mentally or emotionally ready?  Your insurance money may be used up.  The pain may have dissipated, but you’re still not sure how to progress through the next steps.  What if it happens again?  Can I train as hard as before?  Am I really better?  I have lost so many days of training, should I even compete in my event?

Often after a severe case of low back pain, you may be too scared to train like you did prior to the injury, and it turns out you should be!  At least until you understand why low back pain almost always reoccurs and what you can do to prevent it. 

The most common treatment strategies for low back pain are too general for most active individuals, weekend warriors, sport enthusiasts, CrossFitters, weightlifters, and runners.  I have spent the past 11 years researching, studying, and refining best practices for treating LBP.  I have combined research with known anatomical and physiological principles in order to develop very specific strategies for LBP prevention among active individuals.  I have designed a complete guide and system to help you to prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.

Treating Low Back Pain during Exercise and Athletics

product-cover-lbp

In this complete self-treatment package, Treating Low Back Pain (LBP) during Exercise and Athletics, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

BUY NOW

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Why Exercise can Reduce Your Risk of Falling

There are many aspects that should be addressed as part of a thorough fall prevention program. None of them should be to limit mobility except in only the most extreme scenarios.  A thorough exercise program is a critical first step in reducing falls.  The American College of Sports Medicine (ACSM)’s Exercise and the Older Adult and The Office of Disease Prevention and Health Promotion’s Physical Activity Guidelines both state the need for all adults (and especially, older adults) to remain active in order to reduce the risk of falling.

Senior couple in the gym

A thorough exercise program should address the following four basic areas of fitness and mobility: balance; strength; cardiovascular (aerobic conditioning); and flexibility. Before starting a new exercise program, it’s best to consult with your physician to resolve any potential medication issues and be certain that you are healthy enough for exercise.

Balance

Visual System

This is the relationship of the head and eyes to your surroundings. Most people are very dependent on their eyesight for balance. Eyesight is easily impaired in dark or dimly lit environments. It tends to decrease with age due to medical conditions, such as glaucoma or macular degeneration.

Vestibular System

Our vestibular system is part of our inner ear. It provides us with information on head acceleration and gravity. It also works closely with our brains to process information on the head’s position in its environment. It helps us produce reflexes which affect our sense of equilibrium and our eyes’ ability to hold a gaze on a desired target.

Somatosensory / Proprioceptive System

The integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system is the somatosensory system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This also includes our ability to distinguish between hot and cold.

Proprioception, which is part of the somatosensory system, is a fancy word describing our brain’s ability to know where we are located in space. For example, if we close our eyes and lift our arms overhead, we know where our arms are located.

A common problem affecting the somatosensory system is neuropathy. One very common form of neuropathy is from diabetes. Neuropathy is when the nerve cells (typically in the extremities like hands and feet) will die. This may be due to poor blood supply, trauma, infection, disease, or even side effects from medication. The death of the nerve is the “neuropathy” which presents initially when a person may feel cramping, shooting or burning pain. Ultimately, it affects the person’s ability to feel sensations which causes numbness. Having numb feet makes it very difficult to balance!

For more information on balance, please refer to Q & A: How Do I Improve Balance? (Part I).

Strength

Strength training is ideally performed two or more days a week and includes a rest day in between sessions. The focus should be on a slow regular progression of weight bearing exercises which are designed to improve posterior chain strength. This includes the back extensors, buttocks, and hamstring muscles. The focus should also be on the calves and quadriceps muscles. Each plan must be designed for you as the individual.

The overload principle states that a greater than normal stress or load on the body is required for training adaptation to take place. The one exercise that should be addressed in some form or another is the squat. This basic movement insures that you can move from a sitting to standing position.

In short, the squat works just about every muscle in the trunk down toward the legs. These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something. The squat is a critical exercise to maintain mobility and function as we age.

Cardiovascular (Aerobic Conditioning)

Aerobic conditioning is ideally performed for a total of 150 minutes per week. It should be performed in at least ten minute intervals at a moderate intensity.

High Intensity Training (HIT) or High Intensity Interval Training (HIIT) may also be implemented into a cardiovascular training program. The research on the effectiveness of HIT continues to grow. Even more impressive are the findings that HIT can be safely performed at any age and with almost every medical condition.  It’s now even being implemented in many progressive Cardiopulmonary Rehabilitation Programs, where people are recovering from all kinds of cardiac and pulmonary disorders such as COPD, heart attacks, and heart valve replacements.

Perform your cardio activity in short bursts (ranging from 30-60 seconds at a time) followed by a one to two minute recovery. The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high. You should be breathing heavy.  Accommodations can be made for almost any type of medical condition.  For example, HIT may be performed while using a stationary bicycle, an upper body only bicycle, a rowing machine or in the pool.  You can also walk uphill at a quick pace, then stop and rest.  The point is to get your heart rate up, and then bring it back down for a full recovery prior to repeating.

Walking should also be implemented into a daily cardiovascular program. Ideally, your walking program will be separate from your specific 150 minutes of cardiovascular exercise per week.

Flexibility

Stretching is ideally performed 10-15 minutes for five days per week. An excellent time to work on a flexibility program is after a workout.  Static stretching is an excellent method to maintain flexibility, and it’s ideal to perform during a cool down.

Tai Chi is an excellent form of exercise that positively affects your flexibility, strength, and stability while stimulating the somatosensory system. Yoga, like Tai Chi, also addresses many of these same areas.

Foam rolling is also an excellent method to improve flexibility. Individuals taking blood thinning medications or with blood clotting disorders should consult his/her physician prior to using a foam roller for mobilization.

For more information on flexibility, please refer to How to Maintain Healthy Joint Motion.

Each exercise program should be tailored to the individual. A physical therapist can help you design and implement an exercise program.  Physical therapists can also help you address the risk factors listed in What You can do to Prevent Falls.

The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Which area of fitness and mobility (balance, strength, cardiovascular, and flexibility) could you specifically improve on in order to reduce your risk of falling? 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.

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3 Strategies to Start Right Now to Improve Health Span

You have likely heard about the life span revolution in the media. Many feel we are on the cusp of significantly advancing the length a person can live.  When in fact, the actual average number of years a person is expected to live has been stable or slightly decreasing.  This is entirely due to poor nutrition, lack of physical activity, and environmental factors.  Although the promise of a long life is appealing, one must ask an important question: Is a long life really what you want if there is no quality? Increasing the number of years that you live is not as important as increasing the way you can live those added years.  Spending an extra 5 or 25 years alive, but ill, is a curse not a blessing.

Today’s pharmaceutical giants, who fund much of this research, don’t want you to feel well during this time. Their intentions are likely not altruistic.  Imagine a longer lived population that is chronically ill.  Sounds like a lucrative opportunity, doesn’t it?

Now the good news! There are very simple and scientifically proven techniques that will allow you to improve your health span AND life span.  Health span refers to the period of time during one’s life that you are generally healthy and free from disease.

Physical factors that address health span include strength, balance, flexibility, and endurance. All of these factors affect your mobility during your life.  These same factors all contribute to your body’s physical resiliency.  Maintaining your mobility is critical for all body functions and is fundamental in avoiding chronic illness.

Elderly couple walking through the park hand in hand

3 Strategies to Start Right Now to Improve Health Span:

Weight Training

Weight training (in particular, barbell training) is a critical component in physical resiliency. Lifting appropriately heavy weights is applicable for almost everyone regardless of age and/or present health status. Weight training has positive benefits on: muscle strength; bone density; cardiovascular performance; neurologic performance and adaptability; mental and cognitive function; and proper hormonal regulation.

Barbell training is the most effective method due the progressive load on the skeletal system and the muscle pull which is exerted on the bone. It fights off frailty! It increases your body’s margin for error when illness or injury occurs. With proper guidance and the right exercise prescription/dosage, nearly everyone can improve in strength and benefit from weight training. To quote Mark Rippetoe, “Stronger people are harder to kill than weak people and more useful in general.”

Resistance training (other than through barbell training) can also be beneficial. An example of resistance training would be any type of pushing or pulling exercise that exerts a force on the muscle, which causes it to work harder than it would normally.  The key to all training is that the system must be properly overloaded to produce the desired effect.  Too little and you will not receive a positive benefit.  Too much and you risk injury.  This overload principle must guide all exercise routines if there is to be actual success and benefit from the program.  Although any properly dosed/prescribed form of resistive exercise would be beneficial, the most effective exercises either activate large muscle groups and/or load the skeletal system.  Examples include squats, lunges, and dead lifts.

High Intensity Training (HIT)

High Intensity Training (HIT) or High Intensity Interval Training (HIIT) involves performing short bursts (ranging from 30-60 seconds at a time) of activity followed by a 1-2 minute recovery. The 30-60 seconds should be at a high intensity, meaning that your rate of perceived exertion (RPE) is high and you’re breathing heavy.

The research involving HIT is ever evolving. Thus far, it appears that HIT may provide superior health benefits when compared to almost any other type of exercise. It has significant positive effects on hormone regulation, particularly Human Growth Hormone (HGH). It regulates insulin sensitivity and increases cardiovascular function (VO2 Max). It not only boosts metabolism, but it leads to greater fat loss than traditional forms of exercise.

There is ongoing research on its effects on all forms of chronic disease and illness, including Alzheimer’s disease, dementia, and cardiovascular disease. Preliminary evidence shows that HIT (when performed correctly) leads to superior benefits in much shorter bouts of exercise.

Walking after Meals

Diabetes and metabolic syndrome are major contributors to cardiovascular disease and most neurologic disorders, such as dementia. Heart disease remains the number one killer in men and women today. Regulation of blood sugar and insulin levels is such a critical aspect of being healthy in today’s sedentary, high fructose corn syrup filled lifestyle. Proper blood sugar and insulin regulation should be a primary concern of anyone desiring to live a long healthy life.

Walking after meals has been shown to stabilize blood sugar levels. It’s also an excellent way to boost metabolism and connect with friends and family.  Frequent walking is the most important physical activity a person can engage in.

Although there are many aspects (mental, social, financial, physical, spiritual, and emotional) to address in order to optimize your health span, it is clear that strength training, high intensity training (HIT), and walking after meals is critical in maximizing your health span and aging well.

What are some practical actions that you can take today to improve your health span? Please leave your comments below.

I would encourage you to sign up to receive each week’s blog post sent directly to your e-mail–making it even easier and more convenient! Advice will be related to physical therapy related topics; physical fitness and performance; health and nutrition; injury prevention and rehabilitation; and successful aging and elder care. I will provide useful and practical types of “how to” information, including methods to safely self-treat and manage common physical therapy related conditions. In addition, you will receive priority when submitting questions to be featured in an upcoming blog post by e-mailing contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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6 Reasons to Self-Treat and Manage Your Health

The United States spends more money by a wide margin than any other country on health care.  Our health care system is set up to keep us from dying, not thriving.  Our average life span barely makes it in the top 30 when compared to other nations.  As it stands now, the American health care system is poorly equipped to help us maximize our health span.  Health span is defined as a period of time in which a person is generally healthy and free from serious disease.

Health care costs in America continue to increase without actual positive change in our health status as consumers.  It is imperative that we take a leadership role in our own health care by continuing to be proactive.  Part of being proactive is learning how to care for and manage common non-life threatening injuries and illnesses.  The medical system is not designed to help you to maximize your health and well-being.  It is designed to prevent you from dying and to maximize profits for the corporatocracy that controls our health care system.  It is imperative that we manage our health by learning how to self-treat non-life threatening and non-emergent injuries and illnesses.

Senior woman suffering from neck pain with eyes closed in the medical office

6 Reasons Why You Should Self-Treat and Manage Your Health:

  1. Money – Health care is expensive. Many of the most common treatments and fancy diagnostic methods are not necessary. Costs are only going to rise more in the future. As this occurs, it will be even more important to be able to take care of the simple common place injuries and illnesses. It will save you a lot of time and money!
  2. Empowerment – There is nothing more important than your health. You have control of most of the aspects in your life that affect your health status. Taking care of yourself and your health needs leads to a sense of empowerment.
  3. Improved Care – If you understand how to be healthy and take care of yourself, you will be able to assist your medical practitioner in making the best decision on how to manage your care. Remember, it is your body and your health. Being your own advocate will insure that you receive quality care.
  4. Quicker Recovery Time – Often by taking out the middle man, you can help to increase the speed of recovery. You can address the condition and help your body to initiate the healing response to insure a faster recovery.
  5. Emergency Situations – You never know when an emergency, such as a motor vehicle accident or inclement weather, may occur. You may experience an injury or illness during a camping trip when resources are a far distance away. In the event of an emergency situation, you will be knowledgeable and equipped to take care of yourself and your loved ones. (If necessary, please seek appropriate medical assistance as soon as possible.)
  6. Healthy Living – Take the time to focus on your health. Often, small changes in your diet, activity level, and relationships can make a big difference. You can take control of your health and your life! For more healthy living tips, please refer to My Top 10 Anti- Aging Tips and How to Age Successfully.

Taking a passive role in your health is not a wise choice in America’s current health care environment.  Only you are responsible for your health.  My goal is to have a positive impact on the lives of others and on the health care system in general.  I desire to accomplish this by providing useful and practical types of “how to” information. With the cost of healthcare on the rise, I desire to help proactive adults of all ages to understand how to safely self-treat and manage common physical therapy related conditions in a timely manner so they can reach their optimal health.

To accomplish this goal, I need to hear from YOU!  What are your pains?  What injuries are you suffering from?  Please submit your questions to contact@thePhysicalTherapyAdvisor.com.  I look forward to answering your health related questions!  You CAN achieve optimal health!

Get started now by checking out the Resource Guide!  The specific exercise section is full of rehabilitation exercises ranging from low back pain to knee pain.  These .pdf files include photos and detailed descriptions to help you get started.  This list of resources also includes books, products, resources, supplements, topical agents, videos, and web sites that I personally use and recommend to my family, friends, clients, and patients (for use in the clinical setting).

Also, 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.

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Q & A: Why Am I Dizzy Upon Standing?

Q.  Almost every time I stand up, I feel dizzy. It seems to be worse if I am lying down before standing up.  Should I be concerned?  –Jill

A.  Great question, Jill! We have all likely experienced the sensation of dizziness upon standing at one time or another.  You are likely experiencing a sensation known as orthostatic hypotension (also known as postural hypotension).  Orthostatic hypotension (OH) is defined by a drop in blood pressure that is greater than 20 mm of mercury during contraction of the heart muscles (systole, the top blood pressure number) and more than 10 mm of mercury during the expansion of the heart muscles (diastole, the bottom blood pressure number).

Suddenly standing up can cause blood to pool in the blood vessels of the body and legs.  For a short period of time, a decreased supply of blood is carried back to the heart to be pumped to the brain.  This results in a sudden drop in blood pressure which causes a feeling of dizziness.

Business people with stress and worries in office

Unless you’re experiencing severe symptoms or losing consciousness (blacking out), OH is typically not a concern and can happen to anyone.  In my clinical experience, I have treated highly active adults and athletes as well as the elderly for OH.  The concern is greater for the elderly as it may be a sign of additional cardiac related illness such as congestive heart failure (CHF).  OH can increase the risk of falling which is already an issue for many elder adults.

The following conditions may increase the likelihood of developing OH:

  • A low blood volume from dehydration can cause OH, fatigue, and weakness. Be sure to adequately re-hydrate after activity. Soda and other processed drinks do not optimally hydrate your body. Water is best. Other options include coconut water, caffeine-free tea, and consuming fruits and vegetables.
  • Postprandial hypotension is a sudden drop in blood pressure after eating. The body shunts blood to the stomach and digestive system to aid in the digestion and transport of nutrients out of the gut. This can lead to low blood volume in other parts of the body and could cause OH. Eating small, low-carbohydrate meals may help to reduce symptoms.
  • When I am in a high volume cardiovascular training cycle, I tend to experience low blood pressure. Average blood pressure (BP) should be around 110/70 mm mercury. My blood pressure will be close to 100/60 mm mercury when I struggle with OH. To eliminate this problem, I increase my salt intake. Sherpa Pink Gourmet Himalayan Salt is my preferred type of salt to use. The extra sodium retains more fluid in my system which keeps my blood pressure up while providing important trace vitamins and minerals.
  • Bradycardia (slow heart rate) can increase your risk of OH. A slow heart rate is generally considered a healthy side effect of being cardiovascularly fit. A heart rate less than 60 beats per minute (bpm) is considered low. This is a common finding in well trained athletes as they range between 40-60 bpm. Other more serious heart conditions, such as heart valve related issues and CHF, can be associated with bradycardia. OH is also common post cardiac surgery or heart attack. If your heart rate is low or you’re experiencing cardiac issues, please consult with your physician.
  • Diabetes, thyroid dysfunction, and adrenal insufficiency as well as other hormone (endocrine) related issues can cause OH.
  • Many illnesses affecting the nervous system (spinal paralysis, Parkinson’s disease, and some forms of dementia) can cause OH related symptoms.
  • Many medications have side effects that can result in OH symptoms. If you develop symptoms of OH, address your medications with your medical physician or pharmacist.

Treatment options for OH include:

  • Compression. Lower extremity compression serves to help prevent blood from pooling in the lower extremities and can aid the venous return system. With compression, the heart doesn’t work as hard to pump blood to and from your toes. You can utilize a common ACE wrap, but I highly recommend that you purchase a mild over the counter compression sock (at least thigh high) such as Jobst Relief Therapeutic Thigh High Stockings. Do not apply any compression too tightly that it causes numbness or tingling in the legs, feet, or toes. In cases of spinal paralysis, an abdominal corset (binder) may be necessary to maintain a normal blood pressure.
  • Stand up slowly. If you’re suffering from OH, take your time when you first sit up after lying down or after you first stand up. Moving slowly will decrease your risk of injury (should you fall) while feeling dizzy.
  • Perform a cardiac warm up to get the blood in your legs moving prior to standing and performing an activity or exercise. Begin with tapping your toe 15 times on each foot. Then perform a seated knee extension by moving your leg straight out 15 times on each leg. Next, remain sitting, but march in place 15 times on each leg. Once you have completed this routine, stand up slowly (if you don’t feel dizzy) and proceed with your activity. Be sure to pause briefly to insure that you’re not experiencing dizziness as a delayed response of a few seconds is typical.

In most cases, OH is a common and benign condition.  It can affect anyone for many different reasons.  In most cases, dizziness can be easily treated with hydration and possibly a small increase in salt intake.  Elder adults should take care if they are experiencing dizziness.  Seek medical advice to determine if dizziness is a symptom of a more serious condition.  If the condition worsens or you lose consciousness, please consult with your medical physician as OH is just one of many forms of dizziness.

Thank you, Jill, for your question.  I hope these treatment options for OH will not only help you to determine the cause of your dizziness, but that they also decrease the frequency of your symptoms.  For additional information on dizziness, please refer to Q & A: Vertigo – Causes & Treatment and Q & A: How Do I Improve Balance? (Part I).

Have you ever experienced OH symptoms?  Which treatments for dizziness are the most effective for you?  Please share any recommendations that you may have by leaving 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.

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Why You Should Practice Tai Chi

When was the last time you saw an American elder person perform a full squat or be able to move up and down from the ground?  Now ask that same question about an elder person in China or India.  The answer is much different.  We notice some interesting differences in how people age when we study other cultures around the world.  Many societies have fewer infirmed and immobile elders than does America.  Elders in many of the Mid East and Eastern cultures tend to function at a much higher level.  Lifetime participation in activities, such as Tai Chi and yoga, is one reason for this difference in healthy aging.

Fitness group doing tai chi in park on a sunny day

Aging healthfully and successfully involves integrating the body, mind, and spirit.  Few activities and exercises simultaneously address all three aspects of a person’s life.  Tai Chi and yoga are two forms of exercise that have an effect on all three aspects.

Tai Chi, also known as Tai Chi Chuan (TCC), is a soft form of martial arts that originated in China hundreds of years ago. Its basic movements allow for full body strengthening and balance. A focus on relaxed breathing and mental attention helps to achieve balance between body, mind, and spirit. It doesn’t require special equipment–only a small space indoor or preferably outdoor to perform. Research on Tai Chi supports many wonderful medical benefits. The major outcome of regular practice is reduced frailty.

12 Reasons Why You Should Practice Tai Chi:

  1. Increase your lower extremity and core strength.
  2. Improve your lower body and upper body arm control.
  3. Improve your balance and postural stability.
  4. Improve your flexibility.
  5. Reduce your body fat.
  6. Reduce your number of falls.
  7. Utilize your practice as part of a cardiovascular rehabilitation program for prevention and/or post surgically.
  8. To produce higher peak oxygen uptake during exercise and reduce your blood pressure.
  9. Safe and beneficial exercise if you have diseases such as rheumatoid arthritis (RA), osteoarthritis (OA), and multiple sclerosis (MS).
  10. Benefits your immune system and aids in hormone regulation.
  11. Improves your bone mineral density. Regular Tai Chi exercise can help to treat osteoporosis and osteopenia (the loss of bone density and associated with fractures of bones in the elderly).
  12. Improves your mood and reduces stress, tension, depression, anger, fatigue, confusion, and anxiety.

No wonder why Chinese doctors utilize Tai Chi to treat hypertension, stress, depression, mental strain, chronic indigestion, insomnia, and arthritis!

Tai Chi offers a wonderful method to maintain your mobility and health as you age.  With people living longer, the focus should be on health span versus life span.  Older adults participating in Tai Chi exercise report a sense of improved well-being, increased alertness, relaxation, an improved mental outlook, and greater confidence.

I strongly recommend finding a local Tai Chi class to participate in with a group. Active engagement in your community is a critical part of successful aging as well maintaining meaningful relationships with others.  If you are unable to locate a group or Tai Chi instructor, then utilize the free resources available on YouTube.  Daily Tai Chi, a free instructional video, will teach you how to perform the basic Tai Chi movements.  Tai Chi for Beginners discusses the origins of Tai Chi and offers a sample lesson.

America is heading into a generational change as the baby boomers move into their elder years.  For a more thorough discussion on successful aging, please refer to How to Age Successfully.  For an excellent read on America’s aging population and how it will re-shape our expectations, check out Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old.

Do you participate in Tai Chi?  What benefits have you experienced?  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!

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7 Reasons Why the Squat is Fundamental to Life

If you were born and raised in an industrialized nation (like the U.S.A.), then squatting was probably something you did as a child.  As soon as you became school age, you rarely squatted again.  In other countries around the world, squatting is a normal part of daily life.  In countries such as India and in many Asian countries, it is common to see very aged individuals who are still perfectly capable and comfortable in a full squatting position.  When was the last time you saw a 75 year old man in a full squat?  (A full squat will vary from person to person, but typically your hips are well below your knees and your thighs are past a parallel position.)

Here are 7 reasons why we should continue squatting as a lifelong pursuit:

1. Maintain Lower Extremity Strength: The squat activates nearly all of the muscles in the lower leg. It is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates the calves, the stabilizing muscles in the ankles, the quadriceps, as well as the core (the abdominals and lumbar extensor muscles). In short, the squat works just about every muscle in the trunk down toward the legs. These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something.

2. Maintain Lower Extremity Range of Motion (ROM): Moving into a full squat position takes quite a bit of flexibility. Most children have no problem squatting. As we age, we tend to become less flexible which is primarily due to non-use. Physiologically, muscles, tendons, and ligaments lose some elasticity and can become stiff. The squat requires good hip mobility, knee mobility, lumbar and pelvic mobility as well as ankle mobility. It requires adequate muscle length and joint range of motion in all of the major joints of the lower leg and all of the major muscles of the lower limb.

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3. Maintain Bone Density: Squatting activates the major muscles of the lower limb and trunk. The pull of the muscle against the bone stimulates the bone to grow and improve its density. Squatting is also a weight-bearing exercise meaning it is against gravity. If you add any type of resistance, then that load to the bone once again stimulates bone growth. Squatting is a fundamental movement to prevent osteoporosis.

4. Maintain Balance: Squatting activates the lower leg muscles. Adequate lower leg and trunk strength is a critical component to balance. It also activates the somatosensory system. This 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. (Please refer to How Do I Improve Balance? (Part I) and How Do I Improve Balance? Part II.)

5. Aids in Digestion: Many people in “civilized nations” might not know this little known fact, but incidences of constipation have increased since the advent of the toilet. This is because people are no longer squatting in the woods, over a hole, or some form of plumbing. The body’s colon has three major parts: the ascending, transvers, and descending colon. When you are in a full squat, the thighs put pressure on the ascending and descending colon, which stimulates the smooth muscles to move (this is known as peristalsis). When in the full squat position, the rectum (which is a short, muscular tube which forms the lowest portion of the large intestine and connects it to the anus) is allowed to straighten and unkink. Feces collects in the rectum until pressure on the rectal walls causes nerve impulses to pass to the brain. The brain sends messages to the voluntary muscles in the anus to relax, which permits expulsion. If you are experiencing constipation, take a walk and then spend time relaxing in a full squat position.

6. Prevents Osteoarthritis: There are many potential causes, like trauma or infection, for osteoarthritis. Trauma can be from a one-time accident or due to accumulated trauma or over-use syndrome. Just as common as over-use causing osteoarthritis is under-use. A joint cannot remain healthy if it does not move through its full available range of motion (ROM) on a regular basis. If you never move into a full squat, then you likely never take your knees or hips through their full ROM. According to osteoarthritis statistics, countries in which people still rest and spend extended time in a full squat have the lowest incidences of osteoarthritis. Squatting does not cause arthritis; it actually protects the body from it.

7. Fundamental to All Mobility: Maintaining your ability to squat, and (more importantly), come up from a squat is vital. Your ability to do so is critical to your ability to function independently. In my experience of working with seniors, there are two main reasons why a person will need additional care and support: 1. The person can no longer safely get from point A to point B (this usually involves walking). 2. The person is no longer able to stand up from a sitting position. This means he/she cannot get up and down from a chair, a toilet, or even the bed. If you cannot perform these activities safely and independently, then you will need additional care. Typically, it is a major sign of failing health when an aged and infirmed person loses the ability to care for him or her due to weakness and other factors. (This statement is not directed at someone who has suffered a spinal cord injury or has some form of paralysis which affects his/her ability to utilize lower extremities.) The squat is a critical exercise to maintain mobility and function as we age.

Squatting is one of the first abilities we develop as a child, and it needs to be one of the last ones we lose as we age.  Your ability to perform a squat is fundamental to how you are able to function throughout your life.  Keep squatting!

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

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Taping for Posterior Tibialis Tendon Dysfunction (PTTD)

Pain along the inside (medial) portion of your ankle is often due to Posterior Tibialis Tendon Dysfunction (PTTD), also known as posterior tibial tendon syndrome or tibialis posterior syndrome, and it can be very difficult to treat.

The posterior tibialis muscle is a particularly important muscle in runners as it is used in plantar flexing the ankle (pointing the ankle/toes downward) and inverting the ankle (rolling it inward).  More importantly, its role is to support the arch of the foot. Injury to this muscle is common in runners as well as those who play sports involving high foot impact such as basketball. It can be associated with a fall or can generally develop overtime depending on your risk factors and the strain your foot has taken. (Please refer to 9 Tips to Self-Treat Posterior Tibialis Pain.)

In this video, I demonstrate a taping technique for supporting the arch and the bottom of the foot for those suffering from PTTD. (I recommend using KT TAPE.)

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PTTD most commonly starts out as an over use injury. Although more common in runners and those who are involved in high impact sports, this condition can affect anyone. If the condition is left untreated, the end result is usually a falling of the arch which causes adult acquired flatfoot. When this condition is caught early, it can be self-treated. Once the arch has fallen, surgery would most likely be indicated.

If you’re interested in more thorough guide along with other videos on how to self-treat lower extremity injuries and pain like PTTD, check out the Resilient Runner Program. This is the perfect guide to help you take control of your health and fitness as well as self-manage common aches, pains, and injuries. Even if you’re not a runner, this program is appropriate for those who love to stay active and want to enjoy a healthy lifestyle.

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