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Get Gardening: Physical Therapy Tips

By Dr. Julie Hawthorne Adamski

Gardening is great for the mind, body, and soul. Gardening is exercise so treat gardening as a sport. Sports have a pre-season and an in-season. Pre-season is when you condition and train for the sport. If the start of garden season is May, then pre-season is March, and that is when you want to train to get ready for the May gardening season. Pre-season exercise for gardening is important so you can enjoy the fruits of your labor with fewer aches and pains from the seasonal activity.

During the garden season, warm-up and stretch during gardening. As we get older, we need more warm-up time. Consider a 5-10 minute walk before going to your tool shed and gathering your tools. During that warm-up walk, you can add dynamic stretching and perform static stretching between pulling weeds.

You may not be able to garden like you used to. Downsize the square foot of your garden or change to pots and raised beds. Continue to garden but accept it may look different from when you were 30 years old.

Consistency is key to not getting overwhelmed during garden season. There are 7 days in a week, spread out the gardening load. Make a plan and time yourself. 30 minutes a day of gardening is a great way to stay ahead and not to overdo it in 1 day. People get injured or inflamed when they are fatigued. Prevent injury and exhaustion by planning and spreading out the workload by performing 30 minutes daily vs 4 hours in one day.

Think smarter. Use long-handled tools, the wheelbarrow, or a tractor to make it easier on your body so you don't need to lift as much, bend over, or squat as long.

Change positions frequently. The best position for weeding is a change of position. You can kneel, stoop, bend at the waist, 1/2 kneel, sit on the ground, get on all fours, or even lay down. The key is to not stay in one position too long and listen to your body. When you change positions, that is a great time to perform a stretch.

Take breaks. If you have been standing while gardening, go grab a seat. If you have been sitting, take a small walking break. During the break, drink some water, juice, or electrolyte drink to replenish your body if you sweat a lot.

Cool down. When you are finished gardening for the day, take a stroll and look at your accomplishments and plan for tomorrow's gardening activities. Sit and stretch in the shade for a few minutes and make your to-do list. Try to cool down before you hop into a recliner for a snooze.

Gardening is great. Prepare like a sport and you will be physically ready for garden season. Think smarter to prevent aches and pains thru consistency, planning, change of positions, and taking breaks. Have fun playing in the garden!

Dr. Julie Hawthorne Adamski is a licensed physical therapist and the owner of Energy Physical Therapy LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and wellbeing of residents. Information in these tips is intended for educational use only. You should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Cane Use. Which Hand and Why?

By Dr. Julie Hawthorne Adamski

Do you put the cane in the left or the right hand? What if you have 1 painful hip on one side and a bad knee on the opposite side of the body? What should you do regarding cane placement when there is only 1 railing on the steps? Best answer, ask your physical therapist.

A cane can give you an increase in support or balance. A cane may enable a person to walk further with less pain, increase stability, and may allow an individual to walk on a surface they typically avoid, such as grass. Ascending or descending stairs or a curb with a cane is very helpful. Especially on the steps where a walker cannot go.

Which hand?

If you cannot access a physical therapist for whatever reason, here are 2 points to consider determining hand placement for the cane.

Determine your most painful and debilitating lower extremity part. Put the cane on the OPPOSITE side. If the right leg is the "worst," put the cane on the "good" left side. Prioritize if you have more than one "bad" part.
Find the railing on the steps. If 1 rail, the rail trumps hand position because the railing is more stable than a cane. If you are going up the steps, and the rail is on the right but your cane is normally on the right, switch the cane temporarily to your left hand.

Why do I place the cane on the "good" side?

Placing the cane on the “good” side vs. the “bad” side distributes your weight and pressure over a greater surface area. The greater surface area provides more support and balance.

When you walk with a cane, the cane swings with your arm in a reciprocal motion to your leg. For example, when your left foot strikes the ground, your right arm/cane swings forward at the same time to help you balance. The contact point of the cane on the "good"/right side, positioning of left heel strike/"bad side", and right foot push-off is how you measure the surface area.

Walking with a cane may take some practice. If you need help walking with a cane or other assistive device, a physical therapist can help.

Three Stretches for Lumbar Spinal Stenosis

July/August

By Dr. Julie Hawthorne Adamski

Did you get diagnosed with lumbar spinal stenosis? Don't fret. Spinal stenosis is more common than you think, and movement and exercise are good for you.

Stenosis means narrowing. Lumbar is your low back. Stenosis occurs naturally and slowly with aging and is related to osteoarthritis. The narrowing occurs in the spaces within your spine that hold the spinal cord or nerve roots. To speak simply, lumbar spine stenosis is a fancy term for arthritis in your low back.

If they have diagnosed you with spinal stenosis, your FIRST intervention should NOT be surgery. Your clinical picture, how your present with symptoms and complaints should determine your treatment with the aid of imaging. Imaging alone should not determine treatment.

Most people with spinal stenosis never need surgery and manage symptoms with conservative care such as physical therapy and a home exercise program. Conservative care does not have any negative side effects when compared to surgical treatments (Zaina et al.).

Some typical signs and symptoms of lumbar spinal stenosis are:

Increase in pain when walking or standing
Relief with sitting
Increase in pain or numbness in low back or legs with backward bending/extension
Relief with bending forward/flexion

There are many exercises and stretches for the management of lumbar stenosis. For example, biking, rowing, or a walking program with flexion exercises embedded in the program. Many benefit from a strength training program. Here are three stretches that can help manage pain and keep people moving:

1. Seated Hamstring Stretch. Sit towards the front of a chair with one leg extended straight and the other leg bent with a foot firmly on the ground. Lean until you feel a stretch, or medium pull, at the back of your straight leg.

2. Seated Forward Fold in a chair. Sit towards the front of a chair, spread feet apart. Bend forward with a rounded back and reach toward the ground.

3. Childs Pose. Get on hands and knees on the floor. Spread knees a little more than shoulder-width. Sit back on heels. Keep back rounded. You can keep your arms in front of you or tuck your arms beside your legs.

Hold stretches 30 seconds to a minute. You want to feel a light to medium pull and no numbness or tingles. Never stretch to pain.

Movement and activity are great for the management of lumbar spine stenosis. Physical therapy can give you an individualized tailored plan with the correct dosage of exercise to manage stenosis. Give Energy Physical Therapy a call, keep moving, and avoid surgery.

Zaina, F., Tomkins-Lane, C., Carragee, E., & Negrini, S. (2016). Surgical vs. non-surgical treatment for lumbar spinal stenosis. The Cochrane database of systematic reviews, 2016(1), CD010264. https://doi.org/10.1002/14651858.CD010264.pub2

Sleep Hygiene Tips

May/June

By Dr. Julie Hawthorne Adamski

Sleep. For some individuals, sleep can be as easy as laying your head on the pillow. For others, sleep is elusive.

Sleep is important for mental and physical restoration. Recovery, memory, and mood are all affected by sleep. Sleep is a very important part of your physical therapy journey and can affect outcomes. If you do not get enough sleep when injured or healing, it can negatively affect your healing rate and mood.

Sleep hygiene, or healthy sleep habits, are behavioral tools that can treat insomnia. Improve your sleep by regularly implementing these sleep hygiene strategies in your schedule.

Wake up at the same time every morning. Set an alarm.
Exercise daily or as prescribed. Any exercise will do. One of my favorite types of exercise is a nature walk, which helps increase the parasympathetic nervous system and decreases the sympathetic nervous system. A nature walk will nourish the part of the nervous system that calms you down and starves the part that is fight or flight.
Get outside in the daytime for sun exposure. This will help regulate melatonin and cortisol.
Naps are fantastic. During your recovery process, I encourage and recommend naps. Limit them to 30 minutes well before dinner. Set an alarm.
Location, location, location. Nap at the same spot you want to sleep at night to condition your brain for sleep. Think about Pavlov’s dogs and conditioning. Did you set an alarm?
No caffeine 4 hours before bed.
Make your bedroom like a quiet cave. Cool and dark.
Try background noise such as a fan. White or pink noise in the background, used via a sound machine or found on the internet, can be helpful.
Bedtime routine, bedtime routine, bedtime routine. First, have a set bedtime. Then implement a routine an hour before the scheduled time. Turn off electronics. That means social media, phone, tablet, computer, and TV. Try listening to music, an audiobook, or read a physical book. You can also try to make a cup of chamomile tea, take a warm shower, get into your favorite pajamas, and dim the lights.
If you can’t fall asleep within 30 minutes, leave the bedroom. Do not turn on electronics. Try to read, clean, or listen to music.

How many of these sleep hygiene tips do you already perform? How many tips do you perform consistently? If sleep is evasive to you, add one tip at a time. Sleep improves restoration, memory, mood, mental and physical recovery. Having healthy sleep hygiene aids in healing and will improve your physical therapy journey.

3 Shoulder Stretches for Mobility

March/April

By Dr. Julie Hawthorne Adamski

Shoulder mobility can be measured by how high you reach overhead, out to the side, and behind your back. Mobility of the shoulder is important for overhead reach, to help tuck in your shirt, and doing your hair. Here are my favorite shoulder stretches to help with upper extremity mobility.

1. Posterior Capsule Stretch. Grab above your elbow and pull your involved arm across your body. You can feel the stretch between the back of the shoulder to the outside of the shoulder.

2. Internal Rotation Stretch. Use a belt, dog leash, or towel. The goal is to first pull your hand to the middle of the spine and then up the spine. Put the involved hand behind your back and use the other hand to assist via the belt. You should feel the stretch in the front of the shoulder.

3. Doorway Pect Stretch. Stand in a doorframe and place forearms on the frame. Feel the stretch in front of your shoulder and chest. Can perform at multiple angles on the doorframe. Hold the stretch at 90 degrees and then approximately 15-25 degrees greater or less than 90 degrees. To make this stretch easier or less aggressive, perform one arm at a time vs. both arms at once. To make this more aggressive, lean forward, use both arms, and use the higher angle.

Hold stretches 30 seconds to a minute. You want to feel a light to medium pull in your shoulder and no numbness or tingles. Never stretch to pain.

Try these 3 stretches to increase your shoulder mobility. You can perform these stretches throughout the day. Stretching after a warm shower, daily walk, or workout is an ideal time.

Overcome Lockdown Inactivity: Tips

January

By Dr. Julie Hawthorne Adamski

Quarantine and lockdowns are tools used to combat COVID-19. To stop the spread of COVID-19 over 100 countries implemented lockdown and quarantine strategies. However, there are known side effects of lockdown and quarantine. According to Fuzeki et al., “social, psychological, health and economic consequences must also be considered” (Fuzeki, 2020).

Physical inactivity and deconditioning, or getting out of shape, are side effects of quarantine and lockdowns. In under two weeks, you can see physiological deconditioning.

Studies show in simple step reductions, that metabolic changes occur such as an increase in abdominal fat, negative effects of glucose and insulin metabolism, decrease in muscle mass, and an increase in an inflammatory response (Fuzeki, 2020).

That simply means a decrease in activity can poorly affect your sugars and diabetes, blood pressure and heart rate, low back pain and joint pain in a very short time frame.

The good news is that you can reverse those effects with exercise. The bad news is that older and chronically ill individuals are more affected than younger individuals in that recovery is slower and sometimes incomplete (Fuzeki, 2020).

Physical Activity And Step Count

Make a positive impact on your health. Use your fitness tracker to find your pre-pandemic activity level and steps/day and compare them to your current levels. Set realistic goals of getting back to your normal levels by slowly progressing over weeks. A generic goal for seniors is 6,000 steps/day.

If you do not know your steps/day, make an honest assessment of your typical activity levels. For example, are you missing steps by:

Getting groceries delivered vs. going to the grocery store
No exercise class vs. exercising at TRAAC or local gym
Shopping online vs. shopping in person
Working from home vs. working at the office

All these little steps add up throughout the day and make a big impact on health.

Tips On Regaining Steps/Day And Risk Level

Do a self-assessment and weigh your risk level of COVID, your health history, living arrangements, and goals in life. Use these tips whether you are in lockdown, quarantine (not during acute illness), and level of risk. When you are ready to get back to pre-pandemic activity, you can be physically ready.

Low level of risk: take a walk in a grocery store, small business, or mall to get exercise in disguise during early hours or workweek.

High level of risk: walk in your home, set up a route, and see how many laps you can take within 6 minutes. Compare your number of laps over weeks, using the same 6 minute time, and see if you are healthier.

All risk levels would benefit from walking outside in a neighborhood, on a trail, or use the stairs repeatedly to increase your cardiovascular system.

If you are out of shape, walk 2-5 minutes after each meal. If you are in better shape, increase duration, intensity, and utilize interval training. Progress with a plan and chart on a calendar. Increases in daily step average should progress over weeks, not days to avoid injury.

Strength And Balance Program

Combine your daily step progression with the addition of a strength and balance program to combat deconditioning. Perform a strength and balance program 2-3 days per week, non-consecutive days. Target both the upper and lower body, such as squats, lunges, and wall push-ups. Bodyweight exercises are great for high school athletes up to senior citizens. Start light and progress slowly to decrease injury.

Low level of risk: go to the gym or TRAAC if open. Use resistance with machines, free weights, or body weight.

High Level of risk: Online classes or your own strength and balance program in your home.

Increase your daily step count to pre-pandemic levels and implement a strength and balance program to counter and reverse the negative physiological effects of lockdown and quarantine. If you already feel deconditioned from the pandemic, and require more help than these tips, call Energy Physical Therapy. Traditional Medicare covers Energy Physical Therapy for outpatient physical therapy. Energy PT is 1 on 1 in the privacy of your own home vs. in a crowded clinic to give you personalized and safer care.

Fuzeki, E. G. (2020). Physical activity during COVID-19 induced lockdown: recommendations. Journal of Occupational Medicine and Toxicology, 15:25.

Measure Your Fall Risk

November/December

By Dr. Julie Hawthorne Adamski

Physical therapists use many tests and observations to determine fall risk. Timed Up and Go(TUG) is one simple tool to determine fall risk.

The TUG may be self administered but typically performed by a healthcare professional. Here's how to do it yourself.

Measure 10 feet away from the base of a standard chair and place a piece of tape on floor.

You can use any assistive device you normally use such as a cane or rolling walker. Be consistent with device if you compare your score.

Start seated in chair. Stand up from chair. Walk 10 feet to the tape on floor. Turn around and walk back to chair. Sit down.

Time yourself from the moment you leave your chair to the moment you sit down again. The timer starts immediately, even if it takes you multiple attempts to get out of the chair.

The TUG cutoff scores can range from 8 sec to 15 seconds. TUG scores are useful in healthcare to look for fall risk, Parkinson's, post-op orthopedic, vestibular, or other issues.

There may be small differences in normative times due to variables such as age, gender, and cognition.

For high fall risk, use >13.5 seconds for a cutoff time. That means if your score was over 13.5 seconds, such as 17 seconds, you are at high risk for falls. If you are less than 13.5 seconds, you are a low risk for falls for that particular test.

If you find you are a high fall risk, try physical therapy to reduce your risk of falls. It's easy to get a prescription for physical therapy. Call your doctor and let them know you are a high fall risk and want to work on your balance.

Ryan, S. (2013, Novemeber 06). Shirley Ryan AbilityLab. Retrieved from sralab.org: www.sralab.org/rehabilitaton-measures/timed-and-go#older-adults-and-geriatric-care

Dr. Julie Hawthorne Adamski is a licensed physical therapist and the owner of Energy Physical Therapy LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of local residents. Information in these tips are intended for educational use only. You should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Knee Arthritis, Muscle Weakness, and Functional Limitations

September/October

By Dr. Julie Hawthorne Adamski

Knee osteoarthritis(OA) is the leading cause of disability and complaints among my older adult patients. Knee OA is associated with pain at the knee joint, stiffness, and weakness. Knee OA is typically diagnosed with plain films(x-ray) and shows loss of hyaline cartilage at the joint.

Muscle impairments and weakness in the legs are the primary cause of functional loss and limitations. Therefore, knee OA is not just about the knee joint and hyaline cartilage but also the health of the surrounding musculature (Alnahdi, 2012).

Muscle weakness, with the affected knee OA, is most pronounced in the quadriceps (front of thighs)but also seen in the contralateral (non-affected) knee. Folks with knee osteoarthritis are also weaker in hamstrings(back of thighs) and hip muscles compared to healthy peers (Alnahdi, 2012). It is important to strengthen and treat both legs at multiple joints, not just the knee with OA.

Quadriceps muscle strength has been shown to be a determinate of performance of function. Quadriceps weakness affects functional ability to go up or down steps, get off the floor, and sit to stand from a chair. Most of my patients find it especially hard to control the descent into a chair and descent of steps which are great goals for physical therapy.

Hamstring weakness is also a predictor of stair climbing, walking, and picking an object off the floor. When treating knee OA, it is important to look at all muscles of the knee and hip.

There is more to knee osteoarthritis than hyaline cartilage and straight muscle strength. Loss of strength in the quad can lead to atrophy and muscle inhibition. Muscle inhibition is the loss of voluntary control of the quad when you want that muscle to perform. The muscle is getting distorted or no neurological input and can lead to muscular shutdown and improper work by that muscle group. For example, when you plop into a chair because you cannot perform a purposeful, controlled, and smooth descent into the chair.

The good news is that exercise is the most powerful intervention to address muscle loss whether it's from knee OA or other issues. Strength training and aerobic exercise can help pain associated with knee OA and help improve function. Exercise is a conservative treatment with little to no contraindications unlike some invasive treatments. Gains in muscle strength at knees and hips may reduce the progression of OA (Alnahdi, 2012).

When treating and preventing knee osteoarthritis, address the affected knee with OA and the opposite leg. Be sure to include hips, quads, and hamstrings muscle groups in your exercise and strength training program. Make sure your physical therapy and exercise programs address muscle strength deficits, motor control, and inhibition. Involve an aerobic fitness program that addresses individual functional deficits such as walking distance. Address specific limitations that are causing you problems and attack them individually and globally with a comprehensive treatment program.

To achieve long-term outcomes, adherence to a program is crucial. If you need assistance with treating and preventing knee OA and/or with compliance, a physical therapist can help.

Alnahdi, A. Z.-M. (2012). Muscle Impairments in Patients with Knee Osteoarthritis. Sports Health , 4(4), 284-292.

Tennis Elbow

July/August

By Dr. Julie Hawthorne Adamski

Have you been sewing masks and have a lingering pain in your forearm? Do you have pain in your elbow with gripping? Do chores like weeding the garden, computer work, or other fine motor work bother your elbow? Is it painful in your elbow to extend your arm out straight? You may have signs and symptoms of tennis elbow. And NO, you do not need to play tennis to have tennis elbow. A majority of people diagnosed with tennis elbow have never played tennis in their life.

Tennis elbow, or lateral epicondylitis, is an inflammatory condition or tendinopathy of the extensor tendons in your forearm and elbow. Those that have experienced tennis elbow know that this condition can be very irritating and often reoccurs in the same arm or other arm.

Physical therapy can help with your elbow pain and loss of function. Your physical therapist can help you with:

Resolving the inflammation
Education on body mechanics and behavior
Stretching the whole upper extremity and neck muscles
Strengthening the whole upper extremity using eccentric and concentric exercises such as the Theraband Flexbar
Manual therapy such as transverse friction massage or instrument assisted massage
Bracing

Physical therapists look not just at the elbow but the whole chain from neck to fingertips. You want to get to the cause of the problem and not just treat the symptoms. A physical therapist can determine if the problem is actually from the elbow or if the elbow pain is really coming from the neck; and treat accordingly.

Once it is determined the elbow pain is indeed lateral epicondylitis and not other issues, one of the many treatments I like to use is the Theraband Flexibar. The Theraband Flexbar looks like a 1 foot long licorice stick. You use it by strengthening the muscles in your forearm eccentrically.

Hold the bottom of the flexbar vertically in the arm that is injured. Injured elbow is at 90 degrees.
Reach across with the other hand, palm facing outward, to the top of the bar
Then the injured arm holds still while the uninjured top arm twists the bar
Maintain the twist, then turn the bar from vertical to horizontal, while extending the injured elbow
Then with the injured arm only, slowly undo the twist

You can perform this exercise for 2 set of 10 repetitions. If you have difficulty performing this exercise and/or need more assistance, call Energy Physical Therapy today for an evaluation.

Are You Stiff After Sitting for Long Periods of Time?

May/June

By Dr. Julie Hawthorne Adamski

Are you Stiff After Sitting for Long Periods of Time?

If you drive to Virginia or Florida, would you plan for stretch breaks? Yes, you would. It takes approximately 3 hours to drive to Washington, DC, and nearly 13 hours to get to the Florida state line. Most travelers would plan for quite a few breaks (especially the women).

Yet, people tell me they binge watch Netflix or the news for hours or read an entire novel without getting up and moving. Or they sit working at their desks staring at their computers for 5 hours or longer. That's a lot of sitting at one time.

Thankfully, your body will let you know that it does not like all this stillness. You may feel stiffness or pain in your back, hips, or knees when you finally stand up. But you can listen to your body and change that! Perform these 3 activities daily to manage or eliminate pain associated with the poor habit of sitting for too long:

Move Frequently
Counter Flexed Posture
Exercise Regularly and Consistently

Move Frequently

I advise if you are well, move every hour. If you are dealing with orthopedic issues, move even more frequently but less intense. About every 30 minutes.

I like to think in work hours when addressing movement to help you manage daily activity. In your average day, look at an 8-hour span and spread out your steps or activities. You want movement throughout the whole day, not just when you go to gym or supermarket. Exercising for one hour than sitting 10 hours straight doesn't quite cut it.

Use technology to get an unbiased picture of your movement. Step counters and fitness trackers are everywhere. Some are complex and some very basic. Some fitness trackers vibrate or beep to let you know if you have been sitting for longer than an hour. A good movement goal could be 250 steps/hour for 8 hours in a day. If you minimally do this, that equals 2,000 steps per day.

Most older adults can shoot for 6,000 total steps per day. Start by getting a baseline of your current steps per day. That's important. Then take your average number of steps and slowly increase your steps over a few weeks or months depending on your fitness level. I tend to see setbacks when folks try to progress their steps/day too quickly. Slow and steady tends to be successful. But most importantly, move throughout your day to prevent and manage stiffness in your back, hips and knees.

Counter Flexed Posture

If you are sitting (flexed activity) then stand. If you are standing or walking (extension activity), then sit. Here are 3 exercises that I use to counter the flexed posture of sitting:

Hip Flexion Stretch: Start in a kneeling position. Gently lunge forward with your hips. You are looking for a stretch in the front of the hip in which the knee is on the ground, not in your back. Can be performed standing if you have difficulty getting on ground.
Doorway Pect Stretch: In a doorway, place both forearms on doorframe, keep your shoulder blades down and back, elbows and shoulders at 90 degrees (like a bike signal for turning right). You can also do this laying down on your back with shoulders and elbows bent at 90 degrees. You want to feel this in your pects and thoracic spine. That's your chest and mid back.
Chin Tuck and Chin Nod: Stand with the back of your head against a wall. Bring your chin straight back to wall. The motion looks like you are getting a double chin. For the chin nod, use the same position, but nod your chin up and down, like saying yes, while maintaining your head against the wall. You should feel it in the back of your head/neck.

I like to hold stretches for about 30 seconds. For the chin tuck and chin nod, I just look for active range of motion and hold for a slight pause. The stretch is designed to be felt in a designated location. Never stretch to pain. Never increase numbness or tingling.

Exercise Regularly and Consistently

The Centers for Disease Control and Prevention recommend 150 minutes of moderate activity a week, like brisk walking (cdc.gov, 2020). If you can walk 30 minutes Monday thru Friday, you meet that goal. Most Americans do not. If you cannot walk 30 minutes straight, then walk 10 minutes at breakfast, lunch, and dinner. Individuals that have chronic health conditions like stenosis may not be able to walk 30 minutes or 10 minutes, but most can walk 5 minutes. Just get your steps in increments and your health will still improve despite your chronic health issues.

The CDC also recommends at least 2 days a week of strength training. That can be done with body weight, machines, bands, or free weights or even cans of soup. You do not have to join a gym to get a strength workout. Some folks with chronic illness such as arthritis, may have difficulty knowing how to start a strength training workout. A physical therapist can manage your strength training or generally help If you have difficulty moving with unmanaged pain, difficulty with stretching and changing your posture, or performing exercise safely.

Your body will thank you for if you remember to perform these 3 activities every day. Get up and get moving!

cdc.gov. (2020, March 18). Retrieved March 18, 2020, from https://www.cdc.gov/physicalactivity/basics/age-chart.html:

Tudor-Locke, C. Y. (2008). Revisting "How Many Steps are Enough?". American College of Sports Medicine , S537-S543.

Managing Inflammation and Promoting Recovery with Nutrition

March/April

By Dr. Julie Hawthorne Adamski

Did you know that inflammation is a normal part of healing? Muscle damage from an injury or exercise naturally occurs to help muscles heal, recover, and adapt to strenuous activities in the future. Inflammation is part of getting stronger because it helps with muscle hypertrophy.

Not all pain or discomfort is pathological or bad. When you have a good workout or perform an activity that you have not done in awhile, you may experience muscle soreness. You just got stronger. Don't confuse this feeling with injury because they are different.

We do know that chronic inflammation can be a problem. Obesity, diabetes, and other health conditions, poor nutrition, poor sleep habits, and high stress can affect your immune and healing rate.

What does that mean to you? You want to manage and facilitate healing in both acute/post-exercise and chronic inflammation. You don't always have to reach for the NSAIDs (Aleve, Advil etc.) for inflammation or pain. You can manage inflammation by placing a bigger emphasis on recovery and fighting inflammation with these nutritional tips:

Fill half of your plate with fruits and vegetables, especially those high in polyphenols and anti-oxidants. Great examples of anti-inflammatory polyphenolic fruit and vegetables are tart cherries, berries, beets, grapes, and pomegranate. Smoothies are a great way to increase your anti-inflammatory diet.
Eat cold water fish twice a week for Omega-3 fatty acid. Examples are salmon, albacore tuna, halibut, and cod. If you hate fish, look for a supplement.
Use olive oil not corn oil. Easy swap when cooking.
Limit or avoid simple sugars. Some good desserts are fruit based, without added sugar and with granola or oatmeal on top.
Fried food should be limited or avoided. If you want to have fried food, it’s better to cook it yourself at home with olive oil or an air fryer. Avoid fast food with re-used corn oil.
Use spices both for anti-oxidant and flavor. Turmeric, ginger, basil, and rosemary are examples. Consider taking a turmeric-curcumin supplement.
Add protein, whey proteins, or branch chain amino acids to prevent muscle protein breakdown. These proteins are helpful in injury recovery and rehabilitation. Found in cow's milk and cheese, meat (use grass fed vs corn feed) or eat pork chops, chicken, or fish. Some folks supplement with protein products.

Making these healthier changes to your diet, along with getting adequate sleep, can help you manage your inflammation and promote recovery with nutrition.

When was the Last Time you Shoveled Snow?

January/February

By Dr. Julie Hawthorne Adamski

If it was over a year ago, your body may be a little rusty from performing that activity. Your muscles will feel sore from a strenuous activity that hasn't been performed in a long time. Just think how your body feels, when you skip the gym for a week from vacation and then go back to your workout. You get sore. If you combine the stress of frigid cold temperatures, which make your heart and lungs work harder, and the strain of not shoveling in a year, that can explain why the first snow shoveling is so tough for everyone. You probably hear stories of low back pain, neck pain, and shoulder pain and the visits to the emergency room for heart attacks from that first snow fall. So how can we be smarter and avoid pain and the ER?

Pace yourself. Take planned breaks often, even if you feel great. Remember, you haven't used your muscles in this way in a year!
Push the snow. Minimize the lifting.
Move smaller loads of snow in a few more trips vs. larger loads.
Bend your knees. Use your big leg muscles. You will be more energy efficient with your bigger muscles than your smaller arm muscles.
Keep your back straight. Do this while bending your knees. This is athletic work!
Move your feet. Do NOT twist.
Walk it out. When you take your planned breaks from shoveling, walk it out to counter the forward shoveling motion. You may also benefit from standing backward bends with hands on your hips or standing quadriceps stretching.
Listen to your body. Your body will tell you if you need more breaks or longer breaks than the already planned breaks.

Avoid the pain and the ER by heading these snow shoveling tips. A physical therapist can give you specialized tips individualized to you. And with in-home outpatient services offered by Energy Physical Therapy, you can get treatment without leaving the comfort of your home.

Energy Physical Therapy will be at the TRAAC(TriCounty Active Adult Center) on Moser Road Sept. 20th for their Annual Health Fair performing FREE balance screens. Come join me and grab some popcorn while you are there! 10am-1pm

Take a Step Back: Backwards Walking

Aug/Sept 2019

By Dr. Julie Hawthorne Adamski

According to my teenage son, you never walk backwards. That's when I asked him to open the front door for me. As he took a step back to allow the door to swing open, he said "ohhh." As we walked over to the kitchen table, he then proceeded to tell me he doesn't have to walk backwards any other time. I asked him to take a seat. As he was positioning himself, he took a step back to get closer to the chair. He said "ohhh." I asked him if he wanted to go play tennis, he just laughed and said," I get it Mom."

Backwards walking is more difficult than forwards walking. It requires your muscles to work in a different way which is more work on the body and cardiovascular system. You will get more tired walking backwards the same distance as you would forwards. Furthermore, it requires more concentration and motor control to perform backwards walking.

As we get older, backwards walking becomes more challenging because of the different demands backwards walking requires. There are many tests out that that identify fall risk. The 3-Meter Backwards Walk Test(3MBW) is a test that demonstrates that backwards walking can identify age related changes in mobility and balance vs forwards walking (Carter, 2017).

In the 3MBW test, you measure out 3 meters or 9 feet, 10.1 inches. Start by placing heels on starting tape. You are allowed to look behind you. Walk backwards for 3 meters and record your time. There are 3 trials to the test and you want to take the average time. When I administer this test, I walk with the individual for safety reasons.

The cutoff score is 3.5 seconds to perform walking backwards in 3 meters. If you took longer than 3.5 seconds, you may be more likely to have a fall.

How can you lessen your risk of falls? Practice with help. You may need to hold on with 2 hands and then walk backwards in a kitchen aisle or hallway. Progress once you feel safe and comfortable from 2 hands, 1 hand, to a few fingers with the ultimate goal of no hands and performing safely. Need help? Call a physical therapist.

Carter, V. J. (2017). The 3-M Backwards Walk and Retrospective Falls: Diagnostic Accuracy of a Novel Clinical Measure. Journal of Geriatric Physical Therapy , 00, 1-7.

Top 10 Reasons to get Physical Therapy

June 2019

By Dr. Julie Hawthorne Adamski

During my 18 years as a practicing physical therapist, I’ve learned that many of my patients initially viewed physical therapy as something you do only after surgery or an injury. That is, until they start working with me and discover that physical therapy offers many additional benefits. Here are 10 ways physical therapy might help you, too.

Bounce back faster. If you have recently slowed down due to pain or weakness, physical therapy can help you return you to your previous level or better. For example, if you overdid it in the garden or golf course, now have knee pain, and then altered the ascent and descent of steps to one at a time. Physical therapy can help manage your pain, restore your range of motion, and strengthen your lower body to help you go up and down the steps in a more fluid motion, in a shortened time span, and with less pain.
Balance yourself against falls. Set a goal to decrease your risk of falls by improving your balance. When you are in physical therapy, you’ll take balance tests to learn what is typical for your age group and gender. Physical therapists can tailor a balance program to your individual needs. Want to get younger? Improve your balance scores! With your therapist, you can set a goal to achieve the balance score that is set for your age group, improve your time, or improve your quality with each test. Not everyone can achieve all three components, and achieving just time or quality improvement is considered very successful.
Safely workout to get in shape. Physical therapy can be your gateway to the gym in a safe manner. Have you tried going to a gym only to quit after a few visits because it hurts? Or your doctor tells you that exercise can help a chronic health condition, but you’re not sure if you are doing more harm to your body with certain gym workouts? A physical therapist can help you start an exercise program and progress you to the gym in the safest manner, without aggravating your health conditions. The personal trainer at your gym? He or she might not have the education to help those with chronic issues and are best used by healthy individuals.
Enjoy your routine activities. Even if you have physical limitations and extensive health history, you can more fully enjoy routine activities like shopping for groceries or playing with your grandchildren without becoming exhausted or worrying about injuries. Physical therapy can improve your daily quality of life by helping you navigate life in a safe manner with less risk of falls and an improved cardiovascular system.
Manage chronic health issues. It’s no fun living with chronic conditions such as osteoarthritis, stenosis, rheumatoid arthritis, balance issues, MS, Fibromyalgia, or Parkinson’s, to name a few. While physical therapy is not magic and cannot completely take away your chronic pain forever, it can help you have more good days and less bad days, which means a lot to those with chronic health issues.
Combine with pain management. Physical therapy works great combined with pain management doctors, neurologists, and orthopedic doctors and their interventions. For example, you can use physical therapy and injections concurrently to maximize your body and its functions. The injection takes care of the inflammation but does nothing for shortened muscles or the weak and miss firing muscles. Only physical therapy does that. So, the next time you make an appointment for an injection, also schedule physical therapy.
Manage pain with fewer meds. Opioids are in the news and you are rightfully fearful of addiction. Physical therapy can help you manage your pain with less medication. While some folks will always need pain medications, no drug can replace movement. No drug can re-teach you how to walk and fix the bad habits you picked up due to pain or weakness. Physical therapists work with you and your physician to achieve your goals with as little pain medication as possible.
Physical therapy before surgery. Consider pre-habilitation with your physical therapist weeks or even months before you head to the hospital for your elective knee, hip, shoulder, or back surgery. The stronger you are prior to surgery, the better you’ll come out of surgery with regards to recovery time.
One-year-post-surgery recovery. Plan on using physical therapy the year after you have major surgery such as a total knee or total hip replacement. The health care system allows only so much physical therapy per year, but you may only get so far with your motion, strength, and motor control in a few months. Time is a factor. Even if you keep up with your home exercise program, you will be at a different level one year from your date of surgery. At that point, try PT again to perfect your walking, your motor control, your descent of steps, and return to recreational activities such as golf, tennis, or shopping for pleasure at a big mall.
Stay healthy. Visit your physical therapist for a yearly check-up, just like you do with your family doctor or dentist. Most adults over 65 years of age have some type of health history that physical therapy can help. Your body changes as you get older and your level of health and fitness changes throughout the year depending on your activity level. Are you low risk of falls compared to your peers? Is your strength, flexibility, and cardiovascular system being maintained compared to your peers or your individual level? Physical therapy can help keep you moving to maximize your health and wellness and minimize your negative outcomes.

How do you get physical therapy?

You just need one thing to see a physical therapist: a prescription. In the state of PA, you need a prescription of physical therapy from your family doctor, neurologist, cardiologist, pain management doctor, or orthopedic doctor. A physician assistant or nurse practitioner can also write the prescription for physical therapy. Just ask for a prescription or "script" for PT and tell them what you want it for. You might get a handwritten script, or it may be sent electronically to a physical therapist of your choice.

How do choose where to go for physical therapy?

You have a choice for physical therapy in PA and can go anywhere your insurance allows. Even if your doctor has on-site physical therapy, you do not have to go there. To find the best fit for your needs, just ask a few questions: Will you receive 1:1 therapy or are you sharing the physical therapist with other patients? Ask how long a typical visit is and how long do you have to wait to be treated. Time of day may be important to you. Location and driving may be important. Consider outpatient physical therapy in your home if you had surgery on your legs, or shoulders which may make driving difficulty, or you are at high risk of falls and want 1:1 with the therapist. Not all physical therapy clinics and clinicians are the same. Do your homework and get what works best for your own health needs.

A Different Look at Treating and Preventing Hamstring Injuries

March 2019

By Dr. Julie Hawthorne Adamski

Attention all weekend warriors, runners, tennis or pickle ball players, and grandparents that run around with their grandkids: if you ever had a hamstring injury (muscles at the back of the thigh), you probably want to prevent it from happening again. This article may help you prevent or treat a hamstring injury.

Most hamstring injuries occur while running, and hamstring injuries are notorious to reoccur. A goal of physical therapy is to treat the present injury and return to normal activities as soon as possible. But physical therapy is also meant to prevent an injury from re-occurring.

Location of a hamstring injury can affect your return to activity. Generally, hamstring injuries near the ischial tuberosity, or closer towards the buttocks, tend to heal slower than distal injuries located further down the back of the thigh. No matter the location, the time to return to activity is lessened with the Lengthening Protocol (L-Protocol) versus a traditional method (Askling, 2014).

L-Protocol Exercises

There are three exercises in the L-Protocol that focus on lengthening during an eccentric muscle contraction. The three exercises are (Askling, 2014):

1. The Extender: twice every day, 3 sets x 12 repetitions

Lay on your back and hold the affected thigh with the hip at 90 degrees. Then slowly extend the knee and stop just prior to pain.

2. The Diver: every other day, 3 sets x 6 repetitions

Standing on your affected leg with that leg slightly bent at the knee and that hip is flexed about 90 degrees. You want to try to get your trunk parallel to the floor and extend arms as if you are diving. Your unaffected leg is off the ground; the unaffected knee is bent 90 degrees, and you want to get the unaffected hip parallel to the ground into hip extension. Progress slowly with speed and range of motion with this harder activity.

3. The Glider: every 3rd day, 3 sets x 4 repetitions

The affected leg is the stationary leg that is slightly bent. You want the weight of your body on the heel of the affected stationary leg to get the load on the hamstring. The emphasis of the weight on the heel is important. The unaffected leg is the gliding leg that moves back within a pain-free motion. You can use a stocking foot on the unaffected gliding leg and wear a sneaker on the standing affected leg. When coming back to baseline, use your arms to help bring you back to an upright position. This is the most complex exercise of the three and should be performed in a slow, steady manner starting with a small motion of the gliding leg.

Why the L Protocol?

Why is strengthening the hamstring muscle in a lengthened, or eccentric, position a good idea? The intent is to load the hamstring through the full range of motion at both the hip and knee and have the injured part of the hamstring work during that load (Askling, 2014). That is why the Extender, Diver, and Glider exercises are a good addition to your at home strengthening program.

The focus of The Extender is for range of motion and stretching. The focus of The Diver is for both stretching and adding strength and stability of the trunk and legs. The last exercise, The Glider, is mostly a strength training exercise of the hamstring in the lengthened position that uses both hip and knee movements. The three exercises build off each other which is why the dosage of exercise is set up this way (Askling, 2014).

It's important to never exercise to pain whether using the L-Protcol or any exercise routine. Fatigue is good, pain is bad. I like to perform these exercises in a small range of motion and then increase the motion over days/weeks to gain more strength in a controlled manner. Remember, the intent of the L-Protocol is the loading of the hamstring in a lengthened eccentric state, so progression with motion is important.

Askling, C. T. (2014). Acute Hamstring Injuries in Swedish Elite Sprinters and Jumpers: a Prospective Randomised Control Clinical Trial Comparing Two Rehabilitation Protocols. British Journal of Sports Medicine, 48 (7), 532-539.

How Can You Improve Your Gait Speed?

February 2019

By Dr. Julie Hawthorne Adamski

In my last article – How Fast do You Need to Walk Across a Street Safely? – you learned how to determine your gait speed and the importance of gait speed an indicator of your overall health. Now, you may be wondering, "How can I improve my gait speed?"

There are many ways to improve your speed of walking. I like to look at the whole body and not just focus on one part of the body. For learning purposes, let’s break it down into 4 main parts to improve gait speed. I do stress that you need to treat the whole body not just one part of the body.

1. Cardiovascular system

2. Strength of legs and core

3. Flexibility of legs and core

4. Muscle memory and motor control

Cardiovascular system: Whether you are a fast or a slow walker, you can always improve your cardiovascular system. You can do this by going for a walk outside, pedaling on a stationary bike, water walking, or walking laps inside your house.

Duration of a cardiovascular workout varies depending on your current fitness level. Some folks are getting a cardio workout with just a few minutes of walking if they are deconditioned, whereas others can easily walk 30 minutes or more. As for intensity, you want to exercise where you can still hold a conversation while walking. If you are not able to hold a conversation, you may be exercising too aggressively.

Strength of legs and core: You can improve your strength and core in a multitude of ways. Some folks participate in local classes such as Sit and Get Fit or 50+Fit that are offered at the TriCounty Active Adult Center. Some individuals prefer to exercise at home. You can get a great work out using your own body weight such as standing mini squats, standing leg lifts, laying down bridges, and laying down straight leg raises.

Flexibility of legs and core: You want a fluid gait and a nice cadence when you walk. Shortened or altered step length will affect gait speed because your body is working less efficiently. Sometimes, body structures such as the hamstring muscle may be very tight and negatively affect your step length.

One way to stretch your hamstring is to sit in a chair with one leg out straight and one leg bent to balance you in the chair. You want to gently lean forward and feel a medium stretch in the back of your straight leg.

Muscle memory and motor control: In plain English, practice walking. You want to practice so that your brain and your body are working effectively and efficiently. You want to retrain your brain, legs, and the communication between them so that walking is fluid, effortless, and automatic. This is the same thing as a quarterback throwing a ball under a multitude of different conditions in practice so that during a game he throws that ball automatically with success.

Perfect practice makes perfect! You may need to work on the first three categories: cardiovascular system, strength of legs and core, and flexibility of legs and core before you can maximize your gait for proper muscle memory and motor control. If you need assistance in any one of these categories, a physical therapist can assist and educate you to increase your gait speed and overall health.

How Fast Do you Need to Walk Across a Street Safely?

January 2019

Sounds like the start of a good Pennsylvania road joke. However, those that have physical difficulty like knee pain, a recent surgery, or balance issues could attest that getting across the street is a real problem.

Gait speed or walking speed is a reliable, valid, and inexpensive tool that can tell us about our health and even about our life expectancy (Fritz, 2009). Walking speed, once you know your baseline speed, can tell if your overall health is improving or declining. Gait speed also helps determine if you are able to return home after a hospitalization or require rehabilitation for further care.

Gait speed typically decreases as we age. Gait speed may be different for men and women because typically men are taller (Fritz, 2009).

How do you determine your gait speed? All you need is a long hallway and a stopwatch. The official test is called the 10-meter walking test. However, it can be modified for a shorter distance which is what I use in a patient's home due to space constraints.

In a gait speed test, I start with my patient’s self-selected walking speed and then re-test with a fast, but safe, walking speed. You can try this yourself at home with these simple steps:

First, measure out 5 feet and put a marker there.
Next, measure 16.4 feet (5 meters) and place another marker.
Lastly, measure 5 more feet and put the remaining marker at the end.
You will use the first and last 5 feet as a ramp for your acceleration and deceleration of gait.
Use your stopwatch to time how long it takes you to walk the inside 16.4 feet (5 meters) to determine your gait speed.
Write down your walking style (fast or self-selected), date, and your raw timed speed.
Gait speed = 5 meters/x seconds.

For example, Julie walked 5 meters (16.4 feet). She timed herself at 3.69 seconds at a normal walking pace. Julie's typical walking pace is 5m/3.69s = 1.35m/s

It’s important to repeat the test and compare your gait speed over time to determine if there are any positive or negative changes in your health.

The speed to walk across the street safely is 1.14 meters/second (m/s) (Fritz, 2009). The typical walking speed is 1.2 to 1.4 m/s. Knowing your gait speed can also help determine what type of ambulator you are and if you would benefit from outside assistance (Fritz, 2009):

Household Ambulator = less than 0.4 m/s
Limited Community Ambulator = 0.4to 0.8 m/s
Community Ambulator = greater than 0.8 m/s

So, what is your gait speed? Do you have the speed to make it across the street safely? If you find yourself below the time of 1.14 m/s, you want to make a goal to increase your level of ambulation. In the next article, you will find tips to increase your gait speed.

Fritz, S. &. (2009). White Paper: Waking speed: the sixth vital sign. Journal of Geriatric Physical Therapy , 32 (2), 2-5.

The Star Excursion Balance Test for the Active Adult

November 2018

The Star Excursion Balance Test (SEBT) is a test that I typically reserve for my more advanced or active patients and also for the healthy population. I tend to add this test as an exercise with modifications for individuals with deficits in the lower body. The SEBT is a tried and true test that can quantify dynamic balance, predicts risk of lower body injury, and can show progress in a patient's rehabilitation (Gribble, 2012).

The point of this test is to maintain balance on one foot while simultaneously reaching as far as possible with the other foot in different directions. Difficulty in certain directions, movement patterns, and quality of your reach tell me about different types of deficits that you may have.

The SEBT requires tape placed on the floor in the pattern of an asterisk or 2 X's which yields 8 different measurement directions. In my practice, I prefer the modified SEBT also called the Y balance test, because it is quicker and less redundant, yet still is a valid and reliable test (Gribble, 2012).

The Modified SEBT or Y balance test looks like the letter Y upside-down on the floor. I have also used 3 yards sticks on the floor in the shape of a "Y" when I cannot use tape.

After you place your foot in the middle of the upside-down Y, I measure three directions of reach: anterior, posterior medial, and posterior lateral. The key is to be consistent on your foot placement for measurement accuracy to determine progression.

Of course there are more rules to the SEBT or Y balance test such as: no loss of balance, you can't move your stance foot, and you can't rest or have a heavy touch with your reaching leg.

There are 4 trials to this test and you take the average to determine your distance at each point. The test should be performed on both your right and left leg and be sure to look for differences between the two legs. This test can be used as a screen or can be used for practice. Remember, the goal is control and distance.

Performing this test can determine if you have decreased postural balance, chronic ankle instability (CAI), ACL deficits, or patellofemoral pain syndrome (Gribble, 2012).

Practicing the Y Balance or SEBT can also be used to treat balance, CAI, ACL deficits, and patellofemoral pain syndrome. It should be noted that I use the Modified SEBT in addition to other treatment techniques to treat these conditions.

I allow for temporary modifications in the standard Y balance or SEBT test to get the desired outcome I want, which is perfect practice. Then ultimately, over time, a better reach score. Here are some examples of modifications.

1. Hold on. Add some upper body assistance to maintain balance such as holding on lightly to a countertop or chair. Over time, as your proprioception, balance, strength, and motor control improve, lessen the assistance from 1 hand, to 1 finger, to no assistance.

2. Shorten the distance. Reach for a smaller distance with a focus on no compensation techniques. In shortening your reach, you can then practice perfect reach in a shorter distance. Over time, you will be strong enough to maintain balance and control and reach further without compensation techniques.

3. Change up the repetitions of reach. Instead of the determined 4 standard reaches at each point, you can focus on one direction that you scored poorly on and perform 10 times in a shorter distance with upper body assistance. This will increase quality motor control and strength. Conversely, you can also perform 1 attempt to assess your ability when you are fresh and not tired.

4. Instead of reaching with your foot, try maintaining the single leg stance in the middle of the Y and reach with your hand in the different directions. This is an advanced balance and strength exercise.

If you want to progress your dynamic balance, lower body strength, and motor control, you can try the SEBT or the Y balance test. Your scores will demonstrate how much you are progressing over time if you keep practicing. Talk to a physical therapist if you have difficulty with this test and other activities of daily living to determine if you may benefit from skilled care.

Gribble, P. H. (2012). Using the Star Excursion Balance Test to Assess Dynamic Postural-Control Deficits and Outcomes in Lower Extremity Injury: A Literature and Systematic Review. Journal of Athletic Training , 47 (3), 339-357.

Physical Therapy vs Arthroscopic Knee Surgery

September 2018

Arthroscopic surgery is the number one orthopaedic surgery in the country. Many people with knee pain think if they get a knee scope to get their knee cleaned up, that will solve all their problems. However, the medical community is now recommending against arthroscopic surgery for knee osteoarthritis or meniscal tears for most individuals.

Based on a systematic review, there is a "strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation (BMJ 2017)." BMJ also found that "knee arthroscopy was no better than exercise therapy (BMJ 2017).”

This recommendation is for individuals with mild to severe osteoarthritis (OA) or degenerative joint disease (DJD), with or without imaging for OA, acute or sudden onset of knee pain, meniscus tears, and mechanical symptoms. This recommendation is not for major knee trauma or individuals that have a locked knee. Total knee replacement is still recommended for those in need after conservative care has failed.

Knee scope has been found to do more harm than good for a majority of individuals with knee pain, and the negatives outweigh the positives for the short term. Negatives may include blood clot or deep vein thrombosis (DVT), infection, possible time off work of 1-2 weeks, and costs. Furthermore, there is a recovery time of 2-6 weeks in which you may be non- or partial-weight bearing, have increase in swelling, pain, and decrease in activities of daily living.

What can you do if you have knee pain?

Try conservative care first. Conservative care can be in isolation or combination of:

Physical Therapy
Weight loss
Exercise
Medications
Injections

There is no recovery time from conservative care and time off work is limited to appointment times for physicians or physical therapy.

Know your risks and benefits before deciding on arthroscopic knee surgery. Try conservative care first.

Dr. Julie Hawthorne Adamski is a licensed physical therapist and the owner of Energy Physical Therapy LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of local residents. Information in these tips is intended for educational use only. You should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Works Cited:

BMJ 2017;357:j1982

Diaphragmatic Breathing

June July 2018

If you are healthy, breathing is natural and involuntary. As we get older, we sometimes change our breathing patterns from our diaphragm to our chest and neck. Some folks pick up bad habits when they have a cold, pneumonia, COPD, asthma or allergies, and then start to use accessory muscles to breathe or other compensation techniques to get air into the lungs.

The diaphragm is the primary muscle for breathing in air. Over time, a dysfunctional breathing pattern can occur when you overuse the accessory breathing muscles and underuse the diaphragm. The accessory muscles are located at the neck, chest, and shoulders. Accessory breathing can contribute to neck or shoulder pain or other impairments like decreased posture.

The diaphragm is the primary muscle for active inspiration, but it also works with other core muscles to help stabilize the spine for posture and complex movements. Being aware of your breathing will help you use the correct muscles to breathe and lessen the chance of musculoskeletal problems at the neck, shoulder, or spine.

Like all muscles, if there is dysfunction or weakness, the diaphragm may need to be re-trained just like you would need to re-train your legs to walk after a knee or ankle injury.

We all know that breathing affects the cardiovascular system by moving that precious air in and out of the lungs. When you diaphragmatic breathe, you maximize your ventilation to the whole lungs not just the upper part of your lungs like in accessory muscle breathing.

But did you know that breathing can also affect the nervous system? The cardiovascular, musculoskeletal, and the nervous system all work together. Diaphragmatic breathing, when you focus on a long expiration, can affect you emotionally and physically to help decrease stress by decreasing heart rate, blood pressure, relax muscles and increase an overall relaxation state via the parasympathetic nervous system.

You want to be aware of your quality of breathing throughout the day especially during times of stress and anxiety or a change in health status. If you have a fight or flight response due to fear, anxiety, or pain, you may see short quick breaths that focus on inhalation(hyperventilate). This increases your blood pressure, your heart rate gets elevated, and your muscles can tighten. Your body is in a heightened response state. That is the sympathetic nervous system.

Folks with chronic pain or stress that are already in a heightened state, may benefit from diaphragmatic breathing to enhance their relaxation state via the parasympathetic nervous system.

I personally like to focus on diaphragmatic breathing when I am with my young teenagers to help decrease my stress levels, control my blood pressure, and heart rate.

Practice Breathing

To practice diaphragmatic breathing, start by laying on your back to focus on your quality of breathing. Once mastered, you can progress to different positions such as seated, walking, and then during exercise or activity.

While lying on your back with knees bent, place one hand on your stomach and the other on your upper chest in order to compare the excursion of the different areas. During breathing, you want the hand over the stomach to rise on inhalation and fall on expiration. You want to see minimal to no movement on the hand at the upper chest.

Breathe in slowly through your nose so that only your hand over your stomach rises. When we breathe during inspiration, the diaphragm contracts, and the lungs are inflating like a balloon. "Smell the roses" is the phrase I use to teach people corrective breathing. You could try starting with a slow 3 second inhalation through the nose then hold that breathe for 3 seconds.

Next you want to "blow out the candles". You want to used pursed lip breathing to slow your rate of exhalation to get the many benefits of the corrective breathing patterns. Pursed lip breathing is when your lips look like you are whistling or blowing out the candles on a cake. You are slowly and gently pushing air thru your lips from your diaphragm. It is important to focus on a slow expiration rate and ratio of 1:2 inhalation vs exhalation.

Be mindful of fatigue of the diaphragm muscle. You may see some individuals revert back to old habits of using accessory neck and chest muscles. The goal is to re-train the diaphragm, even when tired, to be the primary breathing muscle. Your neck and shoulder muscles are "off" on both inhalation and exhalation. Make sure you mastered the simple corrective breathing in the easiest position and the smallest amount of repetitions prior to moving to a different position and more repetitions.

With regular practice, diaphragmatic breathing will become easy and automatic and you will train your body to use the diaphragm even when you are not consciously thinking of breathing. You can practice 4-5 times per day starting by laying down and over time progress to different positions and activity.

Cleveland Clinic Diaphragmatic Breathing. (2017, November 27). Retrieved May 27, 2018, from https://my.clevelandclinic.org/health/articles/9445-diaphragmatic-breathing

Dr. Julie Hawthorne Adamski is a licensed physical therapist and the owner of Energy Physical Therapy LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of local residents. Information in these tips are intended for educational use only. You should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Chronic Ankle Instability and the Hip

May 2018

Chronic Ankle Instability (CAI), or reoccurring ankle sprains, are a common injury in an active population. This type of ankle sprain usually occurs on the outside or lateral side of the ankle. CAI can occur when walking over uneven terrain, changing directions, or even standing still. Typically, the ankle may feel it is giving way or about to turn in. I have had the “pleasure” of falling on my face when simply walking on flat ground due to my ankle giving out due to CAI. But, that was when I was young and dumb and didn't know about all the different things you can do to treat chronic ankle instability.

An acute, first time ankle sprain is different from CAI. Chronic means reoccurring. When you have multiple lateral ankle sprains and are not rehabilitated properly, you are unfortunately teaching your body very bad habits. CAI is not just an ankle issue but the whole chain, especially the hip. Chronic ankle instability affects the knee, hip, proprioception and neuromuscular control of the whole leg. CAI may affect how your foot lands off a curb, how you place your foot on a gravel path, or even standing still without your ankle giving out.

With chronic ankle instability, I look at the whole chain especially the hip.

Two big muscles of the hip are the gluteus medius and maximus. They help position the lower body properly to prepare for foot landing. When they are weak and do not fire at the right time, it may lead to ankle re-injury.

The gluteus medius, one of the outside hip muscles, controls the pelvis, which is important when changing directions in gait. Change of direction is one mechanism of injury for an ankle sprain.
In the therapy setting, I look for changes in neuromuscular control of hip and knee. I look for decreased knee flexion and weak hips. An example may be seen when performing a squat. I look to see if the knee dives in vs. staying controlled at shoulder width distance to the other knee. I also look to see if the pelvis is level. The knee diving in or the pelvis dropping is affected by a decrease in neuromuscular control and weakness at the knee and hip. The gluteus medius plays a huge role in the control of lower body.
The gluteus maximus helps control the long bone, or femur, to allow for proper lower body positioning for landing. Poor lower extremity positioning during activity may lead to ankle sprain.
In the therapy setting, I look for changes in timing for when the leg muscles activate in either the preparatory or reactionary phase of foot placement. I look to see if certain muscles are firing late, too fast, and in the wrong order. You may see this when the foot is landing on the ground. The foot may start to turn in, the ankle may not dorsiflex enough, the knee may look wobbly or dive in and/or be too rigid. The gluteus maximus is a big player is proper positioning for landing.

What are some things you can do about CAI to prevent another reoccurring event? These activities are typically performed when the ankle has range of motion and strength restored and is not in the acute injury phase.

When exercising, practice perfect to get perfect. If you practice or exercise poorly, you are enhancing bad habits and poor control. You want perfect neuromuscular control.
Strengthen your gluteus maximus and medius. Activities such as the single leg squat with trunk flexion and rotation as seen on the star excursion balance test (SEBT).
When performing a single leg squat, look for control from the hip and knee to make sure that knee is not deviating left or right.
Perform double leg activities if you cannot perform perfect single leg activities. Examples are mini squat or a bridge with great form then progress to a single leg squat or single leg bridge.
Some people may need to go even more basic and perform single leg stance without a squat, side-lying hip abduction exercises, or clamshells.
When performing exercise, start with a small range of motion in your desired activity. Start with an inch of motion, then add another inch to that motion with perfect form. Smaller controlled motion is preferred over large uncontrolled motions. Slowly work into more motion with control.
Jump training, plyometrics, and hopscotch. Jump training will not only help address CAI but helps build bones and slow down osteopenia/osteoporosis.
Start with a double leg, 1 inch hop, concentrating on landing slow and controlled. Knees should be soft when landing. Knees should not touch when landing and stay shoulder width apart. You can start by holding on with two hands to a stable surface then progress to no hands. Next progress from 2 feet to 1 foot, and from simple up/down, to forward and back, then side to side.

You do not have to live with chronic ankle instability. You do not have to accept falling when walking on flat ground like I did when I was young and dumb. You can correct the deficits at the ankle, knee, and hip and the pathways and patterns in between.

Most people do not get physical therapy for a simple ankle sprain or maybe they do and do not get the right therapy. If you notice you are getting re-occurring ankle sprains, you may benefit from proper medical intervention to address the problem. Make sure that intervention addresses the whole chain, especially the hip, and not just the ankle.

Gribble, P. A. (2010, February 1). Data suggest proximal links to ankle instability. Retrieved March 2, 2018, from Lower Extremity Review: http://lermagazine.com/article/data-suggest-proximal-links-to-ankle-instability#.Wpc4iWRNsuY.mailto

Reminder: Friday April 20, 2018 at Sunnybrook Ballroom from 9:30-12:30 Energy Physical Therapy will be at the Healthy Lifestyle Expo. Come Visit Dr. Julie Adamski and receive free popcorn and education!

10,000 Steps, Older Adults, and Chronic Health Issues

March 2018

You may have heard that getting 10,000 steps a day is good for your health. But is that number right for you?

In order to find that answer, you have to know your baseline of steps. This is important if you have a chronic health issue or if you are as healthy as a horse. If you have a pedometer, smart phone, or a fitness tracker like a Fitbit, it will assess your physical activity behavior. First, monitor your daily average steps and then check your trends and get your average over a week. That will get your baseline.

Once you know your baseline, then you can set realistic short term and long term goals. If your daily step average is 3,000 steps/day, your weekly short term goal can be 4,000 steps/day. If your baseline is at 10,000 steps/day, then your short term goal can be 11,000 steps/day.

Your long term goal, if you started at 3,000 steps/day, could be 5,000 steps per day or even as high as 12,000 steps per day. It all depends on your baseline steps per day, your current fitness/health level, and your goals.

The key is to use the same device and do not compare yourself to others. Some fitness trackers are more sensitive to activity than others and some have more bells and whistles than others. Do not compare your steps to somebody else with a different device or a different health issue. Compare your daily steps to only your average.

A general recommendation is to add to your daily steps per day slowly and let your body accommodate to that new level. For example, if you average 3,000 steps per day add 1,000 steps per day for a total of 4,000 steps/day. Try 4,000/day until that is easy and you are not challenged by that number. It may take you 1 week or 3 weeks to achieve that goal. Once you do, add another 1,000 steps/day and repeat.

Why can't I just have maintenance steps/day? You can. But most people are not at a healthy maintenance level yet and more steps is better.

Why are more steps better? Walking regularly, which is a free form of exercise, is associated with decreased blood pressure, improved glucose tolerance, improved mood, and decrease in obesity. You can decrease your risk of these health conditions by performing more steps from your baseline.

The Centers for Disease Control and Prevention recommends 150 minutes of moderate activity a week, like brisk walking. If you can walk 30 minutes Monday thru Friday, you meet that goal. Most Americans do not. If you cannot walk 30 minutes straight, then walk 10 minutes at breakfast, lunch, and dinner. Individuals that have chronic health conditions like stenosis may not be able to walk 30 minutes or 10 minutes, but most can walk 5 minutes. Just get your steps in increments and your health will still improve despite your chronic health issues.

30 minutes of walking generally can give you 3,000 to 4,000 steps depending on your gait speed. That means you can get approximately 100 steps/minute (Tudor-Locke, 2008). Keep this in mind when performing short term goals because all those little walks that are recommended throughout the day add up. Those little walks spaced throughout the day increase your overall step count, are manageable for everyone, and also help your overall health because you’re not sitting for greater than an hour straight!

According to a Meta-Analysis by Bohannon, the average steps per day equals 9,501 which is actually under the recommended 10,000 steps you hear about in the news. The average steps per day for those 65 years of age and older is 6,565 steps (Bohannon, 2007). You can keep these averages in mind when you set up your long-term goals for steps.

Another long term goal is improving your step category. These are the step indices for healthy adults by Tudor-Locke and Basset (Tudor-Locke, 2008):

Sedentary <5,000 steps/day
Low Active 5,000-7,499 steps/day
Somewhat Active 7,500-9,999 steps/day
Active >10,000-12,499 steps/day
Highly Active >12,500 steps/day

Do you know your baseline of steps? Do you have a short term goal like performing an extra 5- to 10-minute walk in the day? Can you improve your step category for your long term goal? I have seen many patients with many different chronic health issues. All people can benefit from more steps and activity.

Bohannon, R. (2007). Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis. Phys Ther , 87, 1642-1650.

Tudor-Locke, C. Y. (2008). Revisting "How Many Steps are Enough?". American College of Sports Medicine , S537-S543.

Dr. Julie Hawthorne Adamski is a licensed physical therapist and the owner of Energy Physical Therapy LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of area residents. Information in these tips is intended for educational use only. You should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Energy PT UPDATE AS OF FEBRUARY 11th, 2018

February 2018

1. The therapy cap has been replealed.

2. The 2018 therapy cap for physical therapy is $2,010. Physical, occupational and speech therapy services can be rendered above this threshold and will be pain by Medicare if a KX modifier is included on the claim. Physical therapy is still combined with occupational therapy.

3. The medical manual review threshold has been lowered from $3,700 to $3,000. Services rendered above the $3,000 threshold may trigger a manual medical review for providers who are flagged for meeting certain indicators such as high denial rates and billing outliers in comparison to their colleagues.

Four Square Step Test and Fall Risk

January 2018

Four Square Step Test and Fall Risk

The four square step test, or FSST, is a screening tool used by healthcare practitioners to identify fall risk. The FSST measures dynamic standing balance in which the individual tested moves forward, backwards and side to side. Some people feel this test is similar to dancing which is also known to improve and maintain balance.

The test is valid, reliable, an excellent predictor of falls, and requires little time and equipment. You can use this test as a way to practice balance and measure your progress objectively with time. If you are using this test as practice, you can change some parameters to tailor it to your needs to make it easier or harder depending on how you score.

The FSST measures dynamic balance, change of direction, weight shift, spacial ability, and sequencing skills. Time needed is typically under 2 minutes. Equipment needed is 4 straight canes or dowels that equal 2.5 cm in height.

To perform the test, simply place the dowels in a + pattern on the floor (four square). The position of the dowels makes 4 quadrants which can be numbered 1-4 in a clockwise direction. Start in quadrant 1 with both feet facing forward or north. You then step forward to quadrant 2 and continue in a clockwise direction (1-2-3-4) until you make it back to quadrant 1. Then you immediately side step back to quadrant 4 (4-3-2-1) and continue in a counter clock wise direction until you make it back to starting position quadrant 1.

You have to keep your body facing forward the whole time so that you are side stepping, forward, or backwards walking.
You cannot step on or touch the dowels.
Both feet have to step in each quadrant.
Timer is started when first foot hits quadrant 2 and ends when last foot hits quadrant 1.
If you score less than 15 seconds on the test – you pass!
If you fail the test you may benefit from skilled physical therapy.

Practice Makes Perfect

I have altered this test for practice by making the test easier or harder depending on the individual. To make it easier, try it without the dowels and just use a + pattern on the floor marked by chalk or tiles. Or hold onto a counter top or use a cane during the practice test.

You can make it harder if you have good balance by adding distractions such as music playing in the background, by following unplanned commands, or holding a cup of water. It goes without saying: master the easier version first, before you move to the harder version!

Temple, D. (2002). A clinical test of stepping and change of direction to identify mulitple falling older adults. Archives of Physical Medicine & Rehabilitation. , 83 (11), 1566-71.

Physical Therapy and Spinal Stenosis

October, 2017

Physical therapy has been found to be as effective as surgery for lumbar spine stenosis, but with less complications than surgery (Delitto A., 2015).

Wow.

Now don't get me wrong, sometimes surgery is needed. That being said, try physical therapy first. Just ask for a prescription for physical therapy from your physician. It's that simple.

As a healthcare consumer, you want to look for a well-designed therapy program that is tailored to your specific needs. Typically, people with stenosis benefit from a lumbar flexion biased program and a general strength and conditioning. Therapy should target specific deficits with personalized flexibility exercises and lots of education.

Let’s start with some education.

Stenosis means narrowing. You can have stenosis in your neck (cervical), mid back (thoracic), or low back (lumbar or sacral spine). Stenosis occurs naturally and slowly with aging, similar to arthritis. Many people have stenosis and arthritis throughout their bodies without any problems or symptoms.

If you get a plain film (X-ray) of your spine, chances are most of you will see bone spurs, arthritis, or stenosis. Up to 47% of people aged 60-69 years old have stenosis on films (Jarrett, 2012).

A healthcare provider experienced in reading films and listening to your clinical picture will determine the actual cause of your particular problem. The fact is, not everyone that has stenosis on film has symptoms. What should determine your treatment is your clinical picture (how you present). The X-ray or test just confirms what the healthcare provider already believes.

Some of the typical characteristics of spinal stenosis are:

Increase in pain when walking or standing
Increase in pain and or symptoms with backward bending/extension
Pain or numbness at spine or in arms or legs with extension
Relief with sitting
Relief with bending forward

How can you help yourself?

This next bit of education is very important: When you decide to try physical therapy, do your home exercise program.

When I give a home exercise program (HEP), I stress to my patients that it should be used like medicine. As prescribed. Your home exercise program only works if you take it. If you stop exercising, it is like not taking your medicine. Most people do not question taking blood pressure medicine for life, but balk at doing 5-10 minutes of stretching and strengthening program. Please, do your prescribed home exercises.

Also note that your home exercise program should evolve with time. Your program will change depending on your overall health and individual needs. As my patients get healthier, many see me for a "tune up" to adjust their exercise programs to the next level.

Here’s some research to support the statistics in this article.

Delitto A., P. S. (2015). Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med , 162(7), 465-73.

Jarrett, M. O.-S. (2012, 13:30). The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review. BMC Musculoskeletal Disorders.

Overhead Activities and Shoulder Pain

September, 2017

Painting, power washing, trimming bushes, and trees requires your arms to be over your head for a prolonged period of time. Just the other day, I did a little too much overhead work, and the next day I felt it in my shoulder. I had difficulty raising my arm overhead, getting dressed, and getting ready for work. I knew what I did, I strained my rotator cuff with all the overhead activity. Luckily, I knew how to treat myself. However, I should have known better to begin with.

When working overhead for a prolonged period of time, you have a higher risk of shoulder impingement or rotator cuff involvement than working below shoulder level. If you are 65 years of age or older, you have a higher risk of impingement or rotator cuff involvement than someone in their 20s, 30s or 40s.

In my case, I fatigued my rotator cuff muscles too much, so they could not do their job as a shoulder depressor. In doing so, my rotator cuff was pinched by the bone in the top of shoulder, which caused inflammation and pain.

In retrospect, I should have followed these tips:

Plan better. Spread out all your overhead chores so they are not done in one day, but over time.
Stretch. I should have done a front-of-shoulder stretch (pectoralis stretch), back-of-shoulder stretch (rotator cuff stretch), and/or a reach-behind-my-back stretch (internal rotation stretch).
Rest. Try working overhead 15 minutes and then either stretch and/or rest with a different activity. Your working overhead tolerance may be only 1 min or 15 minutes, so adjust accordingly. Perform below shoulder activities between the overhead work so as not to waste time or just rest your shoulder.
Prevention with exercises. Stay consistent with rotator cuff strengthening exercises that should be performed 2-3x/week throughout the year.

I like to use a doorframe to help me stretch the front of my shoulder. I stand in the doorframe and put my forearm on the frame so that my elbow and shoulder are both at 90 degree angles. I should feel a stretch, not pain, in the front of my shoulder and chest as I hold that position for 30 seconds.

Remember, when working overhead, change position frequently, think smarter, and do not push to pain with any activity.

Julie Hawthorne Adamski, PT, DPT, ATC, and Owner & Physical Therapist of Energy Physical Therapy, LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of area residents. Information in these tips are intended for educational use and you should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Walk Your Way to Improved Health

June, 2017

Walking is an easy, free, and accessible way to exercise. Here are some tips for starting or progressing in a walking program. But remember: always check with your physician or physical therapist prior to starting a new program.

1. Set a reasonable goal: Think marathon not sprint when setting up a walking program. Keep realistic expectations and don’t walk too much too quickly. Overdoing it at the start leads to soreness, injury, and giving up. Start with a 5-10 minute walk twice a week. Time and days per week are the two variables. Do not try to increase both at the same time. Build up the time of each walk, and then start adding more walking days each week or increase days/week but keep time constant. It’s important to allow your body to accommodate to the new exercise.

2. 150 minutes: That is the amount of time the American Heart Association recommends for cardiovascular exercise per week. That equals 22 minutes per day. But remember, you’re looking for long-term health benefits so start slow and work up to these 22 minutes. Did I mention it’s important to build up your walking program?

3. Routine, calendar, and AM habit: I find that people who make exercise a routine, write exercise on the calendar at the beginning of the week, and perform exercise in the morning are more successful than those that do not.

4. Warm up: You may have skipped warm ups when you were 20 years old, but we are all older now. A few examples of warm up exercise are mini squats and leg lifts.

5. Cool down: If you were walking a fast pace, then perform a "lap" at a slower pace. Now is a good time to stretch your muscles.

6. Stay warm: If it’s cold outside, use a scarf over your mouth to warm the air. Then your heart, lungs, and body do not have to work as hard to adjust to the cool air temperature.

7. Bad weather: When it’s too cold, hot, humid, or inclement outside, don’t let that stop you! Walk inside at the mall or big box store for exercise. Shop only after you’re finished your designated time of walking.

8. Cell phone: Take it with you and turn it on!

9. Exercise buddy: Having an exercise buddy is great for accountability. Use that cell phone to call a friend or family member to "walk" with you and go for a walk in different locations at the same time. Sometimes talking on the phone and going for a walk is a bad idea. You can still phone a friend to let them know you are leaving for a walk and then call again when you are finished your walk. That shows accountability for your walking program and lets family and friends know that you are safe.

10.Carry on a conversation: If you can walk and talk, then you are exercising at the right intensity. If you cannot carry a conversation, you may be exercising too hard.

11.Look up: Break that habit of always looking at your feet. Look up to scan the distance in your walking path. When you see an obstacle in your path, then you can look down to avoid the obstacle. People who look down all the time, tend to have a fear of falling. Look ahead to prevent a fall.

12.Check your progress: A 6-minute walk test is an easy way to check on your cardiovascular progress. Take the same walking route and measure the distance you cover in 6 minutes. Compare this week to week.

13.Drink water: Hydration is always important for your health, but especially when you’re exercising. If you hate water, try decaf teas or half decaf, half caffeine.

Energy Physical Therapy Balance and Fall Prevention Screens

May, 2017

Energy Physical Therapy performs FREE Balance Tips and Fall Prevention Screens EVERY 2nd Tuesday of each month at TRAAC. TriCounty Active Adult Center is located on Moser Road in Pottstown, PA 19464.

Getting a montly balance screen is like getting your blood pressure monitored by a doctor every month. Instead of measuring your BP, we are measuring your balance health. The screens are quick so you can drop by at your conveince between the hours of 10:30am to 11:30am.

The Balance and Fall Prevention Screens do vary month to month but the screens are repeated approximately every six months. There are about 6 different balance screens performed for free. You are given a card and or handout for your score for that particular screen. Keep your card to compare your individual balance scores to assess your overall balance health.

Julie Hawthorne Adamski PT, DPT, ATC Owner & Physical Therapist of EnerARgy Physical Therapy, LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of area residents. Information in these tips is intended for educational use and you should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Energy Physical Therapy

May, 2017

Energy Physical Therapy sponsored the TriCounty Active Adult Center (TRAAC) May Birthday Party Celebration. Members were able to enjoy themselves during lunch with a special treat.

Julie Hawthorne Adamski PT, DPT, ATC Owner & Physical Therapist of Energy Physical Therapy, LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of area residents. Information in these tips is intended for educational use and you should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Physical Therapy Tips for Total Hip Replacement

April, 2017

Physical Therapy Tips for Total Hip Replacement

Physical Therapy Tips for Total Hip Replacement

Total hip arthroplasty (THA) or total hip replacement is performed to address the damaged hip joint to improve the biomechanics of the hip and return a patient to his/her activities of daily living (ADLs). This article is meant to help ease the fears and worries for patients undergoing THA. I’ll provide typical expectations from a PTs point of view of this surgery in order to help patients with a THA know what to expect and to best plan for this surgery.

A total hip arthroplasty consists of the long bone in your thigh (femur) and the pelvic hip bone (acetabulum). A skilled surgeon may use metal, ceramic, plastic parts or even cement in the procedure. Depending on the patient's need and what the doctor determines, a patient may receive a total hip arthroplasty, hemiarthroplasty, or hip resurfacing.

Do you Need a THA?

Some indications for surgery are when patients have moderate or severe osteoarthritis, rheumatoid arthritis, or traumatic injuries like a hip fracture. However, these disorders alone may not be indicative of surgery, but when they affect the patients ADLs. For example, limping when walking, avoiding stairs, inability to put on or off shoes and socks, or pain that affects sleep.

Conservative Therapies First

THA is an elective surgery and you can schedule this surgery if conservative therapy fails. Like most elective surgeries, exhaust conservative therapy prior to surgery.

Conservative therapy includes physical therapy, alternative therapies, NSAIDs, and injections. You can combine conservative therapies to maximize results. Please keep in mind that most conservative therapies are not a magic bullet and do take time, so ask your provider when results should be seen in your individual case.

Preparing for THA

Once it is determined that you need a THA, you and your physician can plan your surgery. Planning allows you to have help available to you postoperatively, prepare your house, and for timing due to insurance reasons.

Prior to any surgery, do your homework on the surgery and weigh your individual risks to the desired outcome. Every surgery has risk and some more than others. Some risks may include infections, dislocation, and blood clots.

There are different approaches to addressing a THA, such as posterior or anterior, and you should speak with your physician about which one is best for you individually and which approach the physician prefers for your individual needs or deficits. As with TKA, physicians performing THA do a great job fixing the joint. Different approaches may have a quicker short term recovery, but long term results are typically the same regardless of approach. Listen to your physician on which is better for you.

Post-Op Expectations

You may be in the acute care setting for 1-3 days post operatively. Your physical therapist will focus on prevention of blood clots, education on use of a walker or another assistive device, navigating stairs or curbs, transfers in/out of a car, and exercises for return to a typical gait pattern.

Your physician will determine your specific THA precautions and may vary depending on surgical approach, bone health, or past medical history of each individual. Duration of precautions may be for life or no precautions at all. Nowadays, as an outpatient physical therapist, I see little or no precautions given for a patient recovering from a THA. Precautions, if needed, of a THA may include but are not limited to:

Weight bearing status
No hip flexion greater than 90 degrees (no low sofas!)
No hip adduction or no hip internal rotation (no crossing your legs)

If no precautions are given, you may want to avoid uncomfortable positions or motions post-operatively.

After acute care, a majority of patients are sent home to get outpatient physical therapy and typically do not need a rehab setting. Some patients do receive home care and are considered homebound for a few weeks and receive physical therapy in his/her home.

Physical Therapy After Surgery

Physical therapists can assist you in your progression of attaining your activities of daily living in a safe and timely manner. PTs will address the muscles shortening, muscle imbalances, decreased motor control from spine to foot, range of motion deficits, and balance deficits. Surgery alone will not fix these problems.

Physical therapists also excel at addressing the bad habits that were formed during your compensatory painful gait patterns prior to surgery. If you were walking like a pirate, sashaying your hips, or otherwise limping, physical therapy can address those issues to assist in returning to a typical gait pattern.

More Tips for THA

Leg length discrepancy: May be corrected with a THA if it is a true discrepancy versus a muscle or spinal leg length discrepancy. This problem may be fine-tuned with specific stretches, muscle techniques, and/or orthotics.
Return to driving: Ability to use the brake will affect return to driving. Pain medication may affect ability to drive. Watch precautions in different size cars and SUVs. Low bucket seats and a posterior approach will break precautions.
Pain resolution: Pain from arthritis is typically resolved from surgery, but you will have some incision and surgical pain.
Gait resolution: If you have a bad limp prior to surgery and had the limp for a while, it will take you longer to obtain a "normal" gait. Physical therapy will help. THA recovery is quicker than TKA and is typically "easier" in regards to pain, however, gait is harder to fix in a THA due to back and pelvic muscles involved.
Recovery outlook: A typical THA may last for 15-20+ years depending on the individual.

Use the assistive device prescribed to walk "normal" and without a limp. Most individuals do not need a device 6 weeks post-op but that depends on your strength and motor control in hip, pelvis, and back, and how long you limped prior to surgery.

Physical Therapy Tips for Total Knee Replacement

January, 2017

Physical Therapy Tips for Total Knee Replacement

As a physical therapist, I commonly treat patients for post surgical evaluations of total knee replacement or arthroplasty (TKA). I find that most patients don’t know what to expect before and after a total knee arthroplasty. This article is meant to help ease the fears and worries for patients undergoing TKA. I’ll provide typical expectations from a PT's point of view of this surgery in order to help TKA patients know what to expect and to best plan for this elective surgery.

TKA is performed when the knee joint is damaged and is affecting the patient’s activities of daily living (ADLs), such as walking, stair climbing, or other life tasks. The knee joint can be damaged from osteoarthritis, rheumatoid arthritis, fracture, or other issues. Most X-rays will show wear and tear and signs of arthritis, but that is not reason alone for surgery. Your complaints, signs, and symptoms must match your images.

People ask me what a TKA involves. It is carpentry of the body by a skillful physician, in which the physician removes the end of the long bone in your thigh (femur) and the shinbone in your lower leg (tibia) and replaces those parts. Those parts are made of metal and plastic. Sometimes, if your knee cap (patella) has a lot of arthritis, it too can be capped. Orthopedic surgery of the knee is a very effective way to fix the joint, but it does not address the muscles, motor control, or gait dysfunction issues.

How Can Physical Therapy Help You Decide on a TKA?

Try PT first. Do this before you make up you mind about surgery. Your knee issues might be resolved with PT alone or PT plus a less invasive technique. You can always opt for surgery at a later time if conditions do not improve.

People think if there is arthritis, then that they need to fix it. However, it may not be an arthritis problem, it could be a motor control problem, muscle imbalance problem, tissue shortening problem, or an activity problem causing your pain and loss of ADLs. Surgery will absolutely result in muscles weakening around the knee joint, and it takes work after surgery to get the muscles working again and to walk and perform ADLs properly. It requires a lot less work to get the muscles working without surgery (if surgery is found not to be needed).

Sometimes you will need surgery. After speaking with your physician and your PT, you can plan for surgery. Most people try to plan a time of the year that works for his/her family, work, and life schedules. Timing is very important depending on your insurance. Understand your insurance because it will affect your total visits allowed and how often you get services despite what the physical therapist or physicians recommend about your care.

Different Settings for Physical Therapy for TKA

Setting is affected by medical need, insurance, cost, risk of infection, physician, and patient request. Not everyone will go on the same journey when getting a TKA. Some terms you may want to know and help determine your pathway are:

Acute Care. Hospital or surgical site. Typical stay 1-3 days. You will have therapy in this setting to decrease blood clots, teach you how to safely walk and transfer, start exercises for motion, motor control, and strength.
Rehabilitation centers. Could be associated with hospital. Typical stay is 1-2 weeks. You typically can choose where you want to go depending on need, insurance, census, and location. Have a top three list of where you would like to go.
Home Health. Setting is at your home. You are considered homebound. This is a temporary classification. Once you are not considered homebound, then you are discharged from this setting. Duration is dependent on need and determination of being homebound and could be a few days to many weeks. You can choose the company for home health.
Outpatient Clinic. Typical setting is a clinic, or it could be your own house if you have traditional Medicare Part B. Duration could be day 3 of surgery and up until goals are met typically in 2-3 months. Limited by insurance and patient goals. Choice is plentiful, but may be limited due to insurance. Some clinics treat 4 patients an hour and skimp on manual treatment due to time constraints. Look for 1:1 time and manual therapy, and consider in-home outpatient services (such as those offered by Energy Physical Therapy).

Top 12 Tips by a PT Regarding Total Knee Arthroscopy

Know your insurance. It will dictate total visits, costs, and where you go for services. Ask about outpatient services and allowable visits. Are you able to get pre-physical therapy? The stronger you go in, the stronger and quicker you recover.
1 or 2 TKA's? Census at the local rehab centers may affect your pathway to rehab center, home health, or straight to outpatient clinic. You may be considered "too healthy" for a rehabilitation center with 1 TKA vs both knees getting a TKA.
Right vs Left? Typically, you are not driving for a month if you get a right TKA.
Use the assistive device until you walk "normal" again. Otherwise, your gait may affect other body parts. You don't need low back pain on top of knee pain.
Typically, outpatient rehab is 2-3 months of 2-3x/week. This varies on need and insurance.
Exercise is medicine! Do your home exercise program or you are not taking your medicine.
Extension of the knee is the most important motion to get back. Straightening your knee is essential to gait.
The first month is tough. The second month you feel progress. The third month is when people state they should have gotten the surgery earlier because they feel so good.
Emphasis is on motion first then strength. Return of motion typically coincides with a decrease in pain.
Make sure your therapist performs manual therapy as part of your treatment plan. Make sure you touch your own knee. Your homework may include moving your kneecap and or moving your scar.
Germs. Your house has your germs, but public places have everyone's germs. This may be a factor in determining your therapy pathway.
Diabetes and smoking will affect your healing rate; don't compare yourself to a neighbor that has an excellent BMI with no other health conditions, eats well and exercise regularly.

Reminder:

Energy Physical Therapy will be performing free Fall Prenvention and Balance Screens at Tri County Active Adult Center at the Berean Bible Church.

Ongoing: Every Second Tuesday of Each Month. Drop in 10:30-11:30 am

Screens take less than 1 minute but give you valuable information. Perform every month to see your progress.

Do You Have Pain in your Elbow or Forearm?

November, 2016

You may have signs and symptoms of tennis elbow. And NO, you do not need to play tennis to have Tennis Elbow. Majority of people diagnosed with Tennis Elbow have never played tennis in their life. Tennis Elbow, or Lateral Epicondylitis, is an inflammatory condition or tendinopathy of the extensor tendons in your forearm and elbow. Those that have experienced Tennis Elbow know that this condition can be very irritating and often reoccurs in the same arm or other arm.

Your Physical Therapist can help by: resolving the inflammation, giving education on how to prevent the condition from reoccurring by altering body mechanics that cause the problem, strengthening, and stretching the whole upper extremity or arm.

Physical Therapists look not just at the elbow but at the whole arm to see how you as an individual works to get to the cause of the problem and not just treat the symptoms. When you are treated by a Physical Therapist, he or she may use modalities such as heat or ice, ultrasound, electric stimulation, manual therapy, and /or instrument assisted devices to resolve pain and restore function. Therapeutic exercises may be utilized for the whole arm to address weakness that may be contributing to the elbow problem. Physical Therapists will be able to rule in or out if the elbow pain is actually coming from the elbow or another source like the neck or cervical spine. If you have any of the symptoms of Tennis Elbow or Lateral Epicondlylitis, call Energy Physical Therapy today.

Julie Adamski is Owner and Physical Therapist of Energy Physical Therapy LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of local residents . Information in this article is intended for educational use and you should seek medical advice from your individual physical therapist. www.energy-pt.com 610-310-0915

Rotator Cuff Injuries and the Older Adult

September, 2016

Shoulder pain is a common complaint heard by physical therapists. Typical complaints are pain at night, a painful arc while raising or lowering your shoulder, and weakness. Shoulder pain can be caused by a variety of reasons and can be either acute or chronic in nature. Acute injuries can occur from a single traumatic event whereas chronic injuries are degenerative that may start with tendonitis then progress over time to a partial or full thickness tear of the rotator cuff (RTC). This article will focus on the chronic and degenerative shoulder.

The prevalence of shoulder pain increases as you age. In one study, older adults 65 years of age had a prevalence of 22% full thickness tear (Fehringer, 2008). It is also noted that you can have a positive MRI indicating a tear of the RTC and be without pain or loss of function. Many older adults are walking around with a torn RTC and performing everyday life without complaints. What does that mean to you? If you do not have a loss of function and you do not have pain, you do not need surgery despite having a tear in the RTC.

What do you do if you have pain in your shoulder and loss of function? There is a range of treatments for shoulder pain that offer both conservative and non-conservative care. Tendonitis and partial tears of the RTC respond well to physical therapy and rest. In a majority of cases, conservative care resolves the shoulder pain. Patients are under conservative care are typically watched by surgeons for 6 months, but in older adults, patients are watched up to 12 months. Surgeons look at acute vs. chronic shoulder pain in timing of surgery, and the quality of muscles and bones. If rest and rehabilitation are unsuccessful with pain management and function, and/or you have a massive, complete or high-grade tear of the RTC, then surgery may be warranted (Khan, 2013).

There are three phases that are addressed for conservative rotator cuff pain.

Pain management: Rest, ice or heat for pain control, and anti-inflammatory medication. Physical therapy is used for pain management and can consist of passive/active range of motion, manual therapy, and joint mobilization. Some treatments such as ultrasound, iontophorisis, and electric stimulation are debated about efficacy. Anti-inflammatory medication can be non-steroidal or steroids. Injections may be used to help with pain control but are considered more invasive then oral medications. Injections can be combined with physical therapy.
Restorative: Restore and regain range of motion, strength in rotator cuff, scapular movement and motor control of shoulder girdle. Addressed at this time are the muscle imbalances of the shoulder. Imbalances are often seen with weak RTC, tight pectoralis muscles, forward head/round shoulders, poor timing of the shoulder blade (scapula) and humerus (long arm bone) with elevation, and poor body mechanics. This can be addressed with physical therapy and will not be addressed with pain medications.
Integrative: Integrating back into normal higher end activities of daily living, work functions, and sporting activities.

Treatment time for conservative rotator cuff pain is between 4-6 weeks for less involved healthier patients and up to 12 weeks for more involved, less healthy patients. Patients with diabetes and patients that smoke should expect to take longer than those who are not diabetic and do not smoke. Surgical rotator cuff care will follow the same 3 phases of pain management, restorative, and integrative phases, but the time frame is extended to 6 months up to a year for recovery (Erickson, 2014).

Braun, C. H. (2016). Prognostic Models in Adults Undergoing Phhsical Therapy for Rotator Cuff Disorders: Systematic Review. J. of the American Physical Therapy Association , 96 (7), 961-971.

Erickson, M. (2014, December 5). Rotator Cuff Repair Surgery. Retrieved 7-30-16, from Sports-heath.com .

Fehringer, E. S. (2008, November/December). Full-Thickness rotator cuff tear prevalance and correlation with function and co-morbidities in patients sixty-five years and older. J. Shoulder Elbow Surg , 881-885.

Khan, Y. N. (2013). The Painful Shoulder: Shoulder Impingement Syndrome. The Open Orthopaedics Journal , 7, 347-351.

Julie Hawthorne Adamski PT, DPT, ATC Owner & Physical Therapist of Energy Physical Therapy, LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of area residents. Information in these tips are intended for educational use and you should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Fall Risk and the TUG

July, 2016

Timed Up and Go, or TUG, is a screening tool used by healthcare practitioners to assess balance. Individuals are timed to identify who is at risk for falls compared to their age group. The test is very reliable and valid, and typically does not take a long time to administer. The TUG is an important part of a geriatric tool kit to assess if a patient is at high or low risk of falls, and may also reveal a lot about an individual's gait.

The test is typically given as such:

Sit in a chair, walk 3 meters or 10 feet, turn around, and sit back down. The chair is of typical height 40-50cms. The directions for speed are a "normal, safe pace" but some practitioners may say "quick, safe pace". You can perform the test one time or get an average of 3 trials. The timing is started with movement or on a command such as "go" or "start". (Bohannon, 2006)

If you time exceeds 13.5 seconds to perform the test, you are at a HIGH risk for falls. (Shumway-Cook, 2000)

Age group norms tell you the mean time it takes for your peers to perform the TUG by decade:

60-69 years 8.1 sec
70-79 years 9.2 sec
80-99 years 11.3 seconds

As a physical therapist, I administer this test often in addition to a host of other balance tests to determine a patient's overall balance health. Not all balance tests have a walking component. This test has three components: sit to stand from a chair, a straight walk, and a turn. This test is significant because it allows for the use of an assistive device, whereas not all balance tests do.

This short balance screening provides a lot of important information about a patient. Going from sit to stand, I look to see: where on the chair the person is attempting to rise from; placement of feet on the ground; use of arms to assist with the rise; and I listen to respiration. From stand to sit at the end of the test, I assess the control or eccentric contraction of the quadriceps muscles and if the individual can sit without “plopping” into the chair.

The straightaway portion of the TUG is where physical therapists assess gait. I look for any deviations from the norm, such as inability to walk in a straight line, circumduction of the leg, uneven step length, foot drop, shuffling, abnormal lateral movement of the hips, and cadence.

The last portion of the TUG is the turn. I look for how many steps it takes to make the 180-degree turn, if the turn is smooth or does the individual wobble, and if the speed is timely.

The cutoff time of 13.5 seconds for the TUG can give all healthcare providers and laypeople a simple one-sided view if an individual is at risk for falls. Analyzing all three components of the test allows a physical therapist to not only assess high or low risk of fall, but WHY an individual may be falling. If you score greater than 13.5 seconds, you may benefit from physical therapy to address the reasons why you are at high risk of falls.

Julie Hawthorne Adamski PT, DPT, ATC Owner & Physical Therapist of Energy Physical Therapy, LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of area residents. Information in these tips are intended for educational use and you should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Bohannon, R. (2006). Reference Values for the Timed Up and Go Test: A Desccriptive Meta-Analysis. Journal of Geriatric Physical Therapy , 29 (2), 64.

Shumway-Cook, A. B. (2000). Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Physical Therapy , 80 (9), 896-903.

Osteoporosis and Physical Therapy

May, 2016

Decreased bone strength, low bone density, and bone tissue break down is commonly called osteoporosis. Osteoporosis results in thin weak bones that can result in up to 1.5 million fractures per year.* The bones that are most commonly fractured are spine, hip, and wrist. It is important to know if you are at risk for osteoporosis in order to decrease your risk of fractures.

Osteoporosis can affect both men and women and across all races. However, it is more likely seen in women over 50 years of age. It is also more likely that an Asian female will have osteoporosis than an African American female because African-Americans typically have higher bone mineral density than most other races. The order of least-to-greatest bone mineral density for each race is: Asians, Caucasians, Hispanic-American, then African-American.

There are some factors that you can change and others that you cannot in regards to risk of osteoporosis. If you are at a higher risk due to age, gender, and genetics, you may want to be more proactive in factors that you CAN change to decrease your overall risk of osteoporosis.

Factors you CANNOT change:

gender
race and genetics
age >50 years old
some medical conditions/surgeries (Celiacs, epilepsy, inflammatory bowel disease, gastric bypass, cancer treatments, chemotherapy, radiation)

Factors that you CAN change:

immobilization(due to fractures, stroke, Parkinson disease)
inactive lifestyle
smoking
excessive alcohol consumption
hormone levels (sometimes this cannot be controlled)
Calcium and Vitamin D deficiency
Drugs(corticosteroids, some cancer treatments)

What does osteoporosis look like? Osteoporosis is a silent disease and you may not have any outward signs or symptoms. That is why you should be aware of the above risk factors. However, some people may notice a loss in height or stooped posture. Osteoporosis is usually diagnosed by the gold standard of a DEXA scan, but can be diagnosed by ultrasound, plain films or x-rays.

How can physical therapy help lower your risk or prevent osteoporosis-related complications? Physical therapy can:

Reduce the amount of controllable risk factors
Decrease fall risk
Improve balance
Prescribe tailored weight-bearing and resistance exercise programs

Physical therapy is well known to help those who have suffered from a fracture to recover their range of motion and strength, and to return to previous levels of activity. Did you know that physical therapy could also help an individual who is at risk for osteoporosis and has an inactive lifestyle to achieve a more active lifestyle in a safer manner; and thereby decrease osteoporosis risk factors? Physical therapist can assess your balance and fall risks to prevent and decrease risk of future falls. Home exercise programs are given to address balance deficits and address some coping techniques if needed.

Physical therapists can also prescribe a home exercise program that incorporates weight-bearing and resistance exercise, and that targets back muscles that support your spine, improve posture, and address bone mineral density at the spine.

Some medical treatments that may be used in conjuncture with physical therapy may include:

Bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), or etidronte (Didrocal).
SERMS or selective estrogen receptor modulators such as Raloxifene (Evista).
HRT or hormone replacement therapy such as estrogen, progesterone or both.
Calcitonin

Addressing the controllable risk factors and moving toward a healthier lifestyle may help manage osteoporosis. Physical therapy can help you achieve those goals.

*Badiyani, K. B. (2014). Osteoporosis and its Managment in the Elderly. GeriNotes , 11-18.

How to Properly Walk with a Single Point Cane

February, 2016

People walk with the cane in the wrong hand all the time. It is even perpetuated on television by actors that use the cane incorrectly. Many healthcare practitioners even get it wrong. At the end of this article, you will settle the debate of which hand the cane should be in for proper use and maximized benefit.

The purpose of the cane is to assist someone with an increase in support or balance. A cane may enable a person to walk further with less pain, increase stability, and may allow an individual to walk on a surface typically avoided such as grass. A cane can also allow assistance ascending or descending stairs or a curb. A cane is very helpful on the steps where a walker cannot go.

Before you can determine which hand the cane should be placed, you should understand a little science about surface area. The cane is a third point of contact to the ground, the more points of contact, the more stable. Since the goal of the cane is to provide support and balance, we want to maximize the area where the cane can most help. If you put the cane in the proper hand, you can increase the total surface area that weight is distributed to assist your balance.

The surface area is measured on the ground from the point of the cane to the opposite foot. Conversely, if you put the cane in the wrong hand, the surface area that is supposed to assist your balance and weight is greatly diminished. If the cane is in the wrong hand, the surface area is only a few inches from same hand to same foot. Furthermore, not only is the surface area decreased when placed in the wrong hand, but you are more likely to walk like a pirate. Not many people want to walk like a pirate.

So how do you figure out which hand to place the cane? Easy. Determine which leg is the "bad" or affected leg. Then you place the cane in the OPPOSITE hand. Example: your RIGHT knee has a lot of pain. You place the cane in your LEFT hand. That maximizes the surface area to assist in balance and weight distribution.

In a typical gait, or walk, you should have reciprocal arm and leg swing. That means when your right foot steps forward, your left arm swings forward. Vice versa with left foot forward and right arm swing. The cane should act as an extension of your arm. If your right "bad" affected leg swings forward, the cane in your left hand should also swing forward at the same time.

When you first learn how to walk with a single point cane (SPC), this may take some time to learn. When you walk properly with a SPC you should feel a good cadence with your footsteps. You will hear a nice rhythm and even sound. If you do not hear a nice even rhythm, you may be limping and a physical therapist can address why you are limping and how to address the issue.

And remember, a cane is for support and balance. If your condition requires more assistance, you may need a walker, Lofstrand, or axillary crutches. A physical therapist can help you determine which assistive device is best for your individual needs.

Given the Boot. Recovery from a Metatarsal Fracture to Street Shoes.

January, 2016

Controlled Ankle Movement, or CAM walker boot, is a big black or gray hard plastic boot that immobilizes or allows minimal movement at the ankle joint to protect the foot and/or ankle region. Depending on the type of injury you have in your foot, you may be placed in a CAM boot.

One type of injury that may be placed in a CAM boot is a fifth metatarsal fracture. The fifth metatarsal is a long bone that is located on the outside of the foot. If you place your hand on the outside of the middle of your foot, you may feel a little bump which is a part of the fifth metatarsal. This bone can be fractured, or broken, when rolling or inverting your ankle. The muscle that attaches to the fifth metatarsal is called the peroneus brevis and can tear away from the bone causing a fracture. Sometimes a stress fracture can occur when progressing in a walking program too quickly or changing the surface on which you walk (Hamilton, 2007). Your body needs times to adjust to the intensity of the activity or surface where the activity is taking place.

The CAM boot does a good job of letting an injury like a fifth metatarsal fracture heal; however, it does come with a price. Immobility allows for healing but the unattended consequences are muscle atrophy and stiffness(Brooks, 2015). You can actually feel the secondary effects of the boot all the way up to your back. That is where a physical therapist can help.

One simple way to help you get back to your normal is weaning from the CAM boot. This sounds easy, but many patients have difficulty with this and frequently rush the weaning process. This may result in other issues such as pain in different parts of the now weakened foot, plantar fascia inflammation, or achillies tendon irritation. Most people want to burn their CAM boot in a festive ceremony or shame the boot with a dunce hat. I advise against throwing away the CAM boot suddenly but rather progress slowly into the next shoe. You may be weaned from a CAM boot, to a hard sole shoe, and then finally your street shoe. A weaning program is very important to not aggravate your body and get your body prepared for more weight bearing and normal activities. You may ask your physical therapist and or physician about specifics for your individual case. Prior to weaning, here are some general tips to help the rest of your body.

Wear a sneaker that is the same height as the CAM boot to prevent low back pain. Your therapist may need to fine tune this with a heel lift in your sneaker.
Perform non-weight bearing exercises for your back, hips, and knees for both legs. This to prevent pain or atrophy in theses joints.
Use a stationary bike to keep up your cardiovascular system and lower body strength.
Some individuals may swim or do pool exercises.

The patient, physical therapist, and physician will communicate with each other and about when your body is ready to start the weaning process. So how do you wean?

Start the weaning process at night versus the morning. This will allow you to just go to bed if your foot and body are tired as opposed to being uncomfortable for the rest of the day.
Progress by removing your boot earlier in the day by a few hours until you are boot free.
One example is to wear the CAM boot from morning to after dinner, then put on sneakers. Keep that schedule for a couple days. If successful, then progress to wearing the CAM boot from morning to lunch, then put on sneakers. Keep that schedule for a couple days; if successful, then progress.
If you know you have a lot of walking that day, you may need to wear the boot for that activity.
If you have muscle soreness from weaning, go back to previous level of weaning in which you were symptom free. Speak with your therapist or physician if you get pain.
You can adjust hours depending on your activity level and schedule.

Many people increase exercise and activities of daily living at the same time that they are weaning from the CAM boot. It requires a lot of strength and flexibility to go up and down stairs for a foot and ankle that was just immobilized for weeks. The take home message is to progress slowly and steadily to acclimate your body to weight bearing. When you are in physical therapy you will get specific and individualized exercises for the hip, knee, ankle, and of course the foot. You can also get balance exercises because the boot may negatively affect your balance. Physical therapy can help you get back to your level of activity quicker and safer. Physical therapy can help minimize the secondary effects such as low back pain, hip or knee pain. Depending on your individual needs, some patients only need a few visits to achieve his/her goals and some need more guidance.

Brooks NE, Myburgh KH. Skeletal muscle wasting with disuse atrophy is multi-dimensional: the response and interaction of myonuclei, satellite cells and signaling pathways. Frontiers in Physiology. 2014;5:99. doi:10.3389/fphys.2014.00099.

Hamilton, W. G. (2007). Insall Scott Kelly Institute. Retrieved November 24, 2015, from http://www.iskinstitute.com/kc/feet/fifth_metatarsal_fracture/fifth_metatarsal_fracture.html

How to Survive the Holidays without Hurting your Back: Lifestyle and Lifting Tips.

November, 2015

More cooking, more baking, more shopping, and more laundry. Starting with Thanksgiving and ending on New Year's Day, there is just more of everything. Doing more activity when your body is not used to the increase in work load, with the addition of the stress of the holidays, can make you more likely to aggravate your neck or back. Here are some tips on how to keep your back healthy and less likely to get back pain.

Schedule your activity for the week. Try not to do too much in one day. Enjoy the holiday season not just one day. This is the simplest but most ignored tip.

Think smarter not harder. When you plan out your week, are there any heavy groceries like a bag of potatoes or water that could be lifted into your house by a family member or helper? Can you split the heavy load into smaller loads? Can you wheel the items in on a cart?

Take rests. Bring in groceries that need to be in the freezer or refrigerator first. Then if you need a rest because you have more groceries than normal due to holidays, take the rest.

You scheduled your week, thought about making your life easier by working smarter, so now it is time for lifting techniques. It is recommended to perform The Basic Lift as much as you can. The Real Life Lift can be used in conjuncture with all lifts and should only be used alone for exceptional cases. The Golfers Lift is for very light items and can be used on occasion.

THE BASIC Lift

Family and friends not around to help you lift that bag of potatoes or case of water? Try these basic lifting techniques:

Keep item very close to your body-hug it.
Use your legs. That means stick out your backside and bend the knees. Now get your backside even lower and under you.
Square yourself to the object you intend to lift. This is so you can avoid twisting.
Hold your stomach tight with your abdominal muscles. Think "skinny pants" or sucking it in after a big meal. Those are the muscles you want to engage in your stomach. You are not moving your pelvis or doing the hula. Just bringing your belly button away from your pants. This is important so read on!
Lift item straight up then move your feet. Do not combine steps because then you tend to rotate or twist.

REAL LIFE: Transverse Abdominis Lift

Okay, we all know that not everything we lift or pick up can be accomplished with good body mechanics. For example, that one sock that is at the bottom of the top loading washer or when cleaning the shower. So when proper body mechanics are just not going to cut it because of how the washer is made or how small your shower is, there is still a way to protect your back. Remember that tip on holding your stomach tight? The reason it is very important is because when you activate those muscles, it prepares your body to lift. That muscle is actually the transverse abdominis muscle that acts as a brace for your core. Do you know those back braces you see workers at the big box stores wearing? Well the transverse abdominis does the job of that back brace and even better! So activate your transverse abdominis by "sucking it in" to prepare to lift that item that is hard to get to. Remember, this is the exception not the rule.

GOLFERS Lift

Another option for lifting is the golfers version. So if a pencil falls on the ground and you need to pick it up, try these tips:

Prepare your body by tightening your stomach for the whole lift-see transverse abdominis above.
Hold onto a counter top for balance.
Extend one leg back while bending forward at your hips to pick up your item. Have your standing knee and hip slightly bent and pick up the item.

Utilizing these lifestyle and lifting tips may help decrease the chance of aggravating your neck or back and more time enjoying the holiday season.

Energy Physical Therapy will be at the Heath and Information Fair at PASC

November, 2015

Where: Pottstown Area Senior's Center @ Berean Bible

When: Tuesday November 17th between 9:00-11:30am

Cost: Free

Come and visit Dr. Julie Adamski and get some yummy popcorn!

Physical Therapy Life Hack: For Weaning into New Orthotics or New Shoes.

October, 2015

Start with 1-2 hours with new product for your feet. The key is to wean into them at the END of the day not the beginning. That way if your body has a hard time adjusting to the orthotics or footwear, you can just put your feet up and go to bed vs being in pain all day.

Fall Prevention and Balance Screens

October 13, 2015

Where: PASC @ Berean Bible Church

When: 10:30 AM

Cost: Free

Come and perform a quick screen to check your balance health. This is similar to getting your blood pressure checked but instead of checking your heart health, you are checking your risk of falls per your age group.

Senior Bingo Walk

October 8, 2015

Where: Boyertown H.S Track

When: 10:00 AM

Cost: Free

Park along fence. Come and walk. You can stop and play bingo at the corners. Prizes are given out for winners. October's Senior Bingo Walk you can also dress up in Halloween Costume! Energy Physical Therapy will be there for Wellness Council of Boyertown's Event.

Hamstring Injuries: a Pain in the Thigh.

July & August 2015

Did you ever get pain in the back of your thigh after dancing, kicking, bending over, or exercising? It may be a hamstring strain. It is the most common injury in the lower body. Once you strain your hamstring, it has a high reoccurrence rate(Stephens, 2006). Most people can manage strains with physical therapy, few may need surgery in severe cases.

The hamstring muscle is attached at the pelvis, runs down the back of the leg, and connects at the knee making it move two joints. It moves the hip into extension or backwards which is important in walking. The hamstrings also moves the knee into flexion so you can bend your knee. The hamstring muscle also works to decelerate or slow you down when walking or jogging. Tight hamstring muscles are known to associated with low back pain (Stephens, 2006). The hamstring is made up of 3 muscles: semitendinous, semimembranosus, and biceps femoris. One or multiple hamstring muscles can be injured.

Risk factors and predispositions for a hamstring injury.

History of a previous hamstring strain.
Age. Connective tissue and soft tissue are less elastic as you get older (Feland, 2001).
Poor exercise habits of too much too soon.
Muscle imbalance. Weak gluts and hamstrings(butt muscle and back of thigh) compared to quadriceps(front of thigh).
Poor muscle endurance/muscle fatigue.
Improper warm-up. Older adults require more than younger folks.
Poor flexibility and/or poor range of motion of knee or hip. Can be affected by OA.
Tight hip flexors(muscle in front of hip). This can happen if you sit too much.

Some people call a hamstring strain a “pull” or a “tear” but it is actually a strain which is divided into 3 grades.

Grade I: Mild strain. Muscle stiffness in back of thigh. Can feel like a "cramped or pulled" muscle. Minimal tear of muscle. Little to no swelling. Normal gait or walking but some pain.
Grade II: Moderate strain. Pain can be sharp or more intense ache. Partial tear of muscle. Swelling and bruising at back of thigh. Gait is affected-may limp.
Grade III: Severe strain. Pain during rest and more with motion. Complete muscle tear and may have avulsion fracture(small part of bone torn away). Swelling and bruising at back of thigh. May feel a lump at back of leg. Gait is affected and typically needs assistive device such as crutches, cane or walker(Stanley, 2013).

Can you prevent a strain in the hamstrings? Most literature says yes. As you age, there are physiologic changes that affect your body such as weaker muscles, slower healing time, decreased flexibility and elasticity, and increased stiffness (Feland, 2001). Most people say to themselves that they never used to warm up prior to activity/work/exercise before. But you are older now and physiologically your body is different from when you were 50 years old let alone 18 years old. You CAN address most of the risk factors.

Prevention of hamstring strain:

Older adults need more warm up then younger adults. If you are going to do activities such as mulching, snow shoveling, raking the leaves, mowing the lawn, dancing, or exercising, give your body time to warm-up to those activities.
When starting a new activity think tortoise not hare when exercising. Do not start too much and too intense with exercise. Apply that to seasonal activity too such as gardening, shoveling, and raking.
Address muscle weakness and imbalance. Your physical therapist can help you with which ones are weak and how to address the imbalance.
Address muscle fatigue/endurance. Are you on a walking program?
Daily activity. Do you have good habits of getting up every 30 minutes or do you sit for hours every day?
Address your flexibility with a daily stretching program and good daily activity habits. Combining a flexibility program of stretching, yoga, or tai chi with good daily activity such as getting up every 30 minutes will help muscle stiffness and joint stiffness.
Proper lifting technique so not to strain hamstrings.

What treatment should you expect for a hamstring strain? Typically for the first 24-48 hour most individuals should get RICE. Also known as Rest, Ice, Compression, or Elevation. If needed, you may need to see your health care provider. Since hamstring injuries have a high prevalence rate, you may consider seeing a physical therapist if you are a grade I injury. Grade II and III are typically referred to a physical therapist. If you have Medicare, you do need a prescription from your doctor to see a physical therapist. Some other insurances or self pay patients can see a physical therapist without a script, in the state of PA, for the first 30 days of treatment if the physical therapist has a direct access license.

Once in physical therapy, your body will be tested for deficiencies in flexibility, range of motion, strength, muscle imbalances, muscle endurance, activity/functional training, and gait(how you walk). Treatment will then address those needs.

Typical treatment may include:

Education on how to prevent further injuries. This should encompass overall activity during your day, lifting techniques, and functional training to be specific to you and your needs. This part is important to teach your body how to work properly with less compensation and to reduce further injury.
Manual therapy. Therapist may stretch, manipulate, massage your body through various techniques using their hands. Sometimes therapist may use instruments to assist them to achieve a certain goal. You may see plastic or metal devices to aid manual therapy or a therapist may use their fingers, hands, elbows, or forearms.
Range of motion. This can be achieved with manual therapy or with exercises. Most people are familiar with static, short duration stretches to lengthen a muscle that are held for a short time like 10, 20, or 60 seconds. Sometimes stretches are held for minutes for a slower, longer stretch. You may also receive different techniques such as foam rollers, tai chi, yoga, or other exercises to achieve range of motion.
Strength. You will receive a variety of exercises to address the weakness found in your evaluation. Weakness may be found not only in the hamstring muscle but the gluts, quads(muscle in front of thigh), or back.
Pain management. This will be addressed with the above said treatments and/or in conjuncture with medicines prescribed. Some people also receive treatments such as electric stimulation, ice, or heat.

Feland, B. M. (2001). The Effect of Duration of Stretching of the Hamstring Muscle Group for Increasing Range of Motion in People Aged 65 Years or Older. Journal of the American Physical Therapy Association , 81, 1110-1117.

Stanley, L. (2013, February 8). MoveForwardPT.com. Retrieved August 2, 2015, from www.moveforwardpt.com: www.moveforwardpt.com

Stephens, J. D. (2006). Lengthening the Hamstring Muscles Without Stretching Using "Awareness Through Movement". Journal of the American Physical Therapy Association , 86, 1641-1650.

Parkinson's Disease: What Is It And How Can Physical Therapy Help?

June 2015

Parkinson's disease (PD) is a progressive degenerative brain disorder that is characterized by a loss of nerve cells in your brain that normally produce dopamine. The area of the brain is in the substantia nigra of the basal ganglia (Gisbert, 2015).The job or function of dopamine is to control movement. This is important for many daily living activities such as walking, handwriting, balance, posture, getting in/out of bed, driving, and independent living activities.

The cause of PD is unknown but family history, aging, environmental chemicals may affect onset of the disease. The onset of PD is around 60 years of age. There are different stages of Parkinson's disease and you can get help in each stage. People with PD vary with progression, some slow with managing symptoms for 20-30 years, and some see more signs/symptoms in 5-10 years (Ellis, 2012). There are more men than women who have PD and Parkinson's can be seen in all ethnic groups. There is no cure for PD but you can manage Parkinson's disease.

There is no specific test to determine if you have PD and if you have mild symptoms, it may be hard to diagnose. A clinical diagnosis is given if you have at least 2 of the signs or symptoms (such as resting tremor, slow motions, or rigid muscles) and benefit from Parkinson's medication such as levodopa.

Signs and Symptoms:

resting tremors in the hand (pill rolling)
shuffling your feet when walking (small steps)
loss of arm swinging when you walk (not reciprocal and smooth)
freezing when walking between rooms or turning
poor or small handwriting
masked face, loss of expression, blank face
loss of smell
trouble with balance (increase in falls or near falls)
stooped posture
soft or low voice
depression
symptoms started on 1 side of the body
difficulty with sleep
difficulty with dual task performance (walk, talk and maintain balance)

Some of these signs/symptoms can lead to complications that may affect life span. You do not die from PD but can from complications from PD.

Types of Treatment: it is generally recommended to use multidisciplinary management approach

Drug therapy/ pharmacological options to replace the lost dopamine or uptake of dopamine, depression, and sleep disturbances.
Physical Therapy, Occupational Therapy, Speech Therapy for deterioration of body function and activity of daily life
Neurosurgical

Talk with your physician. Individuals with Parkinson's disease may benefit from some specialist such as a Neurologist, a Movement Specialist (who may be a Neurologist), or a Gerontologist. These specialist may help you manage your medicines, refer you to therapies, address depression and sleep issues, and relay the importance of an exercise program.

How can Physical Therapy Help?

The goal of physical therapy is to maximize quality of life. Do not wait until you have lost your quality of life-try to preserve and prevent loss of your activity of daily living. Not many people live up to his/her full potential physically, whether you have PD or not. If you can maximize or raise your fitness or health level, then you decrease your risk of falls, which is a complication of PD.

Physical therapists can you get started exercising safely. We can address your individual deficits and enable you to get to an independent exercise class or home exercise program. Since PD is progressive, you can see a physical therapist in any stage to address your particular needs. Physical therapy can address:

coordination
balance
walking (with or without an assistive device such as a rolling walker or cane)
risk of falls
transfers (sit to stand from a chair, bed mobility, in/out of a car)
strength (to help navigate steps or walk)
endurance (to walk in the supermarket)
flexibility (to aid with walking, bed mobility)
dual tasks (shopping, make meal)
activities such as gardening, golf, dance, tai chi etc.

It is important to continue exercise once physical therapy has ended. A goal in physical therapy could be to maintain your exercise program at a local gym or senior center with exercise classes. You may receive physical therapy yearly to maximize your activity of daily living but there is a need to continue exercise when finished. Physical therapists can use a wide range of approaches to improve your quality of life. Try to find a therapist that can tailor your needs individually to maximize your goals.

Julie Hawthorne Adamski, Owner and Physical Therapist of Energy Physical Therapy LLC. Dr. Adamski serves the greater Pottstown and Boyertown area and is a local resident committed to the health and well being of local residents. Information in these tips are intended for educational use and you should seek medical advice from your individual physical therapist or physician if needed. www.energy-pt.com 610-310-0915

Ellis, T. (2012, March 1). www.moveforwardpt.com. Retrieved May 24, 2015, from www.moveforwardpt.com: http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=98297eb9-eaa1-452e-9489-b46eedf27e80#.VWMeIk_BzGc

Gisbert, R. S. (2015). Physical Therapist Interventions for Parkinson Disease. Physical Therapy , 95, 299-305.

Update on Therapy Cap

Per APTA website searched 5-31-2015

HIGHLIGHTS OF THE MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015 (Pub. L. 114-10) April 16, 2015 INTRODUCTION Following years of advocacy by physicians, physical therapists, and other health care professionals, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to repeal the flawed sustainable growth rate (SGR) formula. Enacted April 16, 2015, this legislation was the last in a long line of annual temporary "fixes" since 2003 that had prevented the SGR from activating a large payment cut for physical therapists and other health care professionals. The SGR repeal law also further extends the Medicare therapy cap exceptions process to December 31, 2017, and includes numerous other provisions that will impact physical therapy. With the passage of this law, Congress has laid the groundwork for significant changes to Medicare reimbursement for physical therapists and other health care professionals over the next decade and beyond. KEY FEATURES OF THE LAW

The Therapy Cap  The therapy cap amount for 2015 is $1,940 for physical therapy and speech language pathology combined, with a separate $1,940 cap for occupational therapy.  Hospital outpatient claims for therapy services with dates of service through December 31, 2017, continue to apply to the therapy caps.  Providers may obtain an exception to the therapy cap until December 31, 2017.  The manual medical review process at $3,700 is replaced with a new medical review process that becomes effective 90 days after enactment of the law (around mid-July, 2015). It applies to exception requests for which a medical review had not been conducted by the July date.

Healthy Lifestyles Expo-Energy Physical Therapy is a vendor

Friday May 8th 2015

Dr. Julie Adamski will be performing free Balance Screens.

Balance and Fall Prevention Screens

April 2015

Dr. Julie Adamski will be at Pottstown Area Senior Center.

When: Every second Tuesday of each month.

Time: @10:30-11:30.

Where: Currently held at Berean Bible Church, across the street from Cutillo's.

What: Balance and fall prevention screens. There will also be education tips. Most screens only take 30 seconds.

Cost: FREE

Senior Walkiong Bingo

April 2015

Dr. Julie Adamski is Chairing Senior Walking Bingo for the Wellness Council of Boyertown.

Free event encouraging activity and fun!
Grandparents bring your grandkids, kids bring your senior parents, caregivers bring the seniors you care for. Bingo cards, prizes, water, and snacks are provided for Seniors.
We encourage multigenerational activity for fun & fitness!

What may you ask is “BINGO Walking”?
When you arrive, each Senior will receive a BINGO card. For each half lap you walk around the track, 10 BINGO numbers will be pulled. Mark your BINGO cards with pulled numbers. Each 5 in a row (horizontal, vertical, or diagonal), you get to choose a prize from our Prize Table including household goods & healthy living items.

Thurdays @ 10:00am

May 14th, June 11th, Sept. 10th, October 8th are upcoming dates.

Boyertown Area Sr. High School

Memorial Stadium Community Track

120 N. Monroe St. Boyertown, PA

OR if bad weather.....

New Hanover Rec. Center, 2373 Hoffmansville Rd, Frederick, PA 19435

Call Dr. Julie Adamski @ 610-310-0915 or check Facebook page

Call Diane Lauer, Director at boyertownwellness@yahoo.com, 610-334-3710.

Update on Therapy Cap

April 2015

As per APTA.org as of 4/12/15

Under the Balanced Budget Act (BBA) of 1997 Congress placed an annual cap on rehabilitation services under Medicare. Since enacting the BBA, Congress has recognized the cap's potential harmful effect on Medicare beneficiaries and has acted several times to prevent implementation of a hard cap.

Representatives Charles Boustany (R-LA), Xavier Becerra (D-CA), Marsha Blackburn (R-TN), and Lois Capps (D-CA), and Senators Ben Cardin (D-MD) and Susan Collins (R-ME) introduced the Medicare Access to Rehabilitation Services Act (H.R. 775/S. 539) in the 114^th Congress. H.R. 775 and S. 539 would permanently repeal the $1,940 therapy "cap" imposed on physical therapy, occupational therapy, and speech-language pathology services. An arbitrary cap on outpatient therapy services without regard to clinical appropriateness of care discriminates against the most vulnerable Medicare beneficiaries. APTA believes that a full repeal of the therapy cap is necessary to ensure patients have access to timely and appropriate care.

There is a two-tiered exceptions process, an automatic exceptions process and a manual medical review exceptions process. The automatic exceptions process applies when patients reach the $1,940 threshold and the manual medical review exceptions process is required at the $3,700 threshold.

April 6, 2015: Last week, the House of Representatives passed a package to repeal and reform the Sustainable Growth Rate (SGR) while only extending the Medicare therapy cap exception process until December 31, 2017. However, Sen Ben Cardin (D-MD) announced that he is prepared to lead the way in the fight to end 18 years of temporary fixes to the therapy cap by ending the cap completely. The historic change could come through an amendment to a bill, passed by the House of Representatives and awaiting Senate consideration, that seeks to end the flawed sustainable growth rate (SGR). The challenge? Senators need to agree to allow a vote on Cardin's amendment.

APTA is calling on its members and supporters to contact their senators as soon as possible to urge them to support Cardin's effort to get a vote on the amendment—and then to vote in favor of it. The Senate is anticipated to take up the entire SGR repeal bill soon after it returns from the Congressional recess on April 13.

Please contact your senators now, following the instructions below.APTA members and nonmembers can help repeal the therapy cap by:

Call your senators (preferred method).Look up the phone number for your senator. Call! Ask for the health legislative assistant, and share this message: "Senator Cardin is pushing for an opportunity to offer an amendment to fully repeal the therapy cap. I strongly urge you to (1) support his efforts to get a vote on the amendment and (2) then to vote for this critical amendment. Since Congress established the arbitrary cap on Medicare outpatient therapy services, Congress has acted 12 times to prevent the cap's implementation. Continual extensions of the therapy cap exceptions process costs significantly more in the long run than addressing a permanent solution NOW."
Email your legislators. APTA has provided prewritten letters for APTA members on theLegislative Action Center and for nonmembers/patients on the Patient Action Center. You can also send letters through the APTA Action App.
Meet with your legislators. Schedule a district meeting, attend a town hall event, or invite your legislators to visit your practice over recess. This is a great opportunity to meet with your members of Congress locally and discuss the importance of repealing the therapy cap.
Join PTeam. Join the PTeam to receive e-mail updates on the latest SGR and therapy cap news and receive alerts when it is time to take action and contact your members of Congress on these reform policies.

Keeping Pain Away

April 2015

Stenosis, sciatica, and strained muscles. Oh my! There are many anatomical reasons for low back pain (LBP). We, as physical therapists and others in the medical community, are effective at alleviating pain in the back. Treating back pain has been successful with exercise and activity; whereas, bed rest is known to be not effective (Choi, 2010).

Did you know that in the past 3 months, 25% of all Americans had low back pain that lasted at least one whole day (Chou R, 2007). But what is more unfortunate? Back pain comes back. Why? And how do we prevent it from coming back?

LBP has a high recurrence rate. Recurrence rate of back pain can be between 35-60% (Choi, 2010). It has been found that the "recurrence rate and the number of recurrences of back pain could be reduced and the time to recurrence could be prolonged by providing post-treatment exercises" (Choi, 2010). What the authors found is that you can decrease your back pain during treatment in a variety of ways during therapy, but exercise is important to prevent back pain from recurrence when the patient is well.

Low back pain(LBP) treatment should do the following:

Address the current episode of LBP.
Include exercises and home program for current episode of LBP.
Include education on behavior in a typical day(work & home) to prevent LBP in the future.
Include tailored home program for when you are well.

Most people who suffer from low back pain work really hard in physical therapy to do their exercises, show up for treatment, pay his/her co-pay or deductible, and spend time away from either work or home performing treatment. Don't let your hard work and your time go to waste.

This is most people: "I feel great. Since I am finished with physical therapy (or chiropractic or medical doctor) I am going to stop exercise and get back to my normal life." Then a few months go by or even a year and guess what? Ouch, my back hurts. Again.

After you finish physical therapy and you feel good and return to work and/or recreational activities, don't stop exercising! Perform a maintenance program, that could be given to you by your healthcare provider, that can be performed at home, work, or at a gym, when you are well and finished with your therapy to prevent low back pain from reoccurring. If you stop exercising, that's like going to McDonalds after you hit your ideal weight when on a diet.

There are many types of professions and personalities that can give exercise programs when you are well to prevent recurrence: physical therapists, athletic trainers, strength coaches, and fitness instructors to name a few. Education varies from 8 years of graduate school to a high school degree. Find someone that knows your individual history, listens to you, and can apply your exercise prescription to fit your life.

So save your time, money, avoid low back pain, and increase your overall health by continuing to do your tailored home exercise program or well program.

Choi, B. K.-S. (n.d.). Exercises for prevention of recurrences of low-back pain. Cochrane Database of Systematic Reviews 2010 , CD006555 DOI:10.1002/14651858.CD006555.pub2.(Issue 1).

Chou R, Q. A. (2007). Clinical Guidelines: Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med , pp. 147:478-491.

Visit Energy Physical Therapy at BASH at the track for Senior Walking Bingo or inside as a Vendor

Spinal Stenosis: A Pain in the Back

February 2015

What is it? Spinal stenosis means a narrowing in your back that could be of your central spine or where the nerves branch out from the spine. You can have stenosis in your neck (cervical), mid back (thoracic), or low back (lumbar or sacral spine). Stenosis occurs naturally and slowly with aging, think arthritis. Due to normal wear and tear, the body tries to compensate by growing more bone as a means of support. This is sometimes called bone spurs, which can happen throughout your body. Most of you have bone spurs and arthritis throughout your body and you may not have any problems or symptoms.

If you get a plain film, or X-ray, of your spine, chances are most of you will see bone spurs, arthritis, or stenosis. Up to 47% of people aged 60-69 years old have stenosis on films (Jarrett, 2012). A healthcare provider experienced in reading films and listening to your clinical picture will determine if arthritis, bone spurs, or stenosis is actually the cause of your particular problem. What should determine your treatment is your clinical picture (how you present) and the plain film or test just confirms what the healthcare provider already believes.

Just because you have these bone spurs does not necessarily mean that they are causing your current low back pain. Most do not need any surgery. However, sometimes they do.

Lumbar spine stenosis is the number one cause of spinal surgery in those 65 years of age and older (Jarrett, 2012). Surgery can be beneficial in severe cases of stenosis. However, there are known complications of surgery and conservative care should be considered first to manage low back pain (Macedo, 2013).

These are some typical characteristics of spinal stenosis:

Increase in pain when walking or standing
Increase in pain & or symptoms with backward bending
Pain or numbness at spine or in arms or legs
Weakness in arms or legs
Bowel or bladder problems
Relief with sitting
Relief with bending forward

The low back pain that you had when you were 30 is typically different than the back pain that you have when you are 65. Since stenosis is a natural and slow aging process that affects your back, your back pain and symptoms are probably different then when you were 30. This is not necessarily due to your age but because your back and your pain has changed. Therefore, your treatment and exercise may change from when you were younger. Tell your healthcare provider what brings on your pain and when; it is important in a healthcare providers clinical decision making. If you are having symptoms of spinal stenosis, your healthcare provider may do a variety of treatment.

Conservative care treatment may include the following:

Nerve flossing or other exercises to address the nerves involved.

Manual therapy to address mobility of spine, tight muscles, and pain
Flexibility exercises to maximize your body's ability to work
Strengthening and stability exercises to support and enhance your body's ability to work.
Directional exercises to maximize your pain management and healing
Aerobic exercises to enable you to maximize your walking and activity of daily living.
Home exercise program to stay well.

If you are experiencing low back pain, you can get help by going to your healthcare provider. Ask for physical therapy to help manage your stenosis and you may avoid surgery, need less prescription medication, or injections (Fritz, 2008). Your healthcare provider will let you know if you need further tests, most do not. Typically, only the most severe cases would benefit by and need surgery. The treatment you receive should include a home program to continue exercises at home to stay well. Physical therapy can help you get back to your activities of daily living & recreational activities with less pain.

Fritz, J. C. (2008, July 15). Physical Therapy for Acute Low Back Pain: Associations with Subsequent Healthcare Costs. Spine , pp. 1800-1805.

Macedo, L. H. (2013, December). Physical Therapy Interventions for Degenerative Lumbar Spinal Stenosis: A Systematic Review. Physical Therapy , 93 (12), pp. 1646-1660.

Snow Shoveling Tips

January 2015

Snow shoveling + sitting on the couch = trouble. Avoid low back pain with this upcoming storm and prepare for shoveling. Shoveling is typically a flexion activity. Here are some tips:

During shoveling: between shovels to combat all that flexion.

Some people benefit from hip flexor or "runners stretch".
Some people prefer standing lumbar extension stretches.
Take breaks

After shoveling:

Cool down with a walk-walking is an extension exercise.
GET OFF THE COUCH! Avoid sitting because that is just more flexion. It is better to lay on the floor to watch t.v. than on the couch because laying down is an extension activity.
More stretches-see above.

Couch Potatoes are Dying to Sit Down. Tips to Affect Your Health.

December 2014

Do you sit more than six hours a day? Do you work behind a computer, have long commute times, and like to watch TV or a tablet? If so, you have a higher mortality rate than those that sit less than three hours a day according to a study published in the American Journal of Epidemiology(Patel, 2010).

You might be thinking, "That's okay because I walk, run, or go to the gym three times week, so it counters all the sitting I do." Guess what - it doesn't. Does walking, running, or going to the gym negate the pack of cigarettes that you smoke? No, but you already know that.

What you may not know is that sitting all day has a huge impact on your mental health, glucose use, and cardiovascular health. Too much sitting can also shorten your life.

I have also seen over and over again how sitting for long periods of time affects individuals musculoskeletal health with resulting bulging discs, sciatica, and tight leg and back muscles that could cause debilitating low back and leg pain. All of this is possible, whether or not you do moderate exercise multiple times per week.

Does that mean you should stop running, walking, or going to the gym? No! Keep performing your current exercise routine, but it is also recommended to change you daily habits of prolonged sitting. If you currently exercise but then have a long commute, sit behind a desk, then drive all the way home, and top it all off with screen time, you have a new nickname. You are called an "active couch potato" according to Genevieve Healy, from the University of Queensland (Yeager, 2013). Active couch potatoes do get health benefits from their current exercise program, but remember the smoking analogy. Sitting all day then exercising is like being a smoker and exercising. You need to address the problem.

Now, for those that do not even perform moderate exercise multiple times per week, keep reading (you too active couch potato). The US obesity epidemic is related to inactivity. "Physical activity has a beneficial impact on the incidence and mortality of many chronic diseases, including cardiovascular disease, diabetes, stroke, and various types of cancer including colon and postmenopausal breast cancer (Patel, 2010). Put simply: exercise is good for you in many ways.

Obviously, I believe physical exercise is good for you, and I make my living as a doctor of physical therapy. That being said, if you choose not to exercise, you can still make positive choices by changing your sitting habits. So ask yourself - "Do I take breaks when traveling long distance from PA to Florida? "Most likely you do because you know sitting in that car you will need to get out and stretch. So if you take breaks when driving/sitting long distances, why don't you take breaks when watching a long movie or sitting at your computer?

The fix? If you are an active couch potato, keep exercising as you do but try these tips at work or home by getting up every 20-30 minutes. If you are a traditional couch potato you may want to try some of these small changes; they are a great start for either at work or home.

Tips to positively affect your metabolic health:

Get up every other commercial break.
Change the channel by hand instead of the remote (gasp - do you remember doing that?).
After every chapter you read in your novel, stand up and stretch for 1-2 minutes (yes you can read standing up).
When you are on the phone, stand up and talk.
Walk in place for a minute or pace the room.

Just stand up for a few minutes. Yes, you can still be productive and stand up while working. In fact, you may be more productive because you are now getting healthier (which may mean less time off of work due to those metabolic changes, musculoskeletal, and cardiovascular effects).
Standing stretches (yoga tree pose or quadriceps stretch)
Changing your standard workstation to a standing workstation
For those more adventurous, a treadmill workstation is an alternative.

Energy Physical Therapy provides personalized tips and education during treatment. Whether you need physical therapy or not, stand up to prolonged sitting to become a healthier individual and live a longer life.

Lovett, R. (2013, July 15). Desk Jobs can be killers, literally.

Patel, A. B. (2010). Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults. American Journal of Epidemiology , 419-429.

Yeager, S. (2013, July 20). Sitting is the New Smoking-Even for Runners. Runner's World .

Plyometrics on Flat Ground

November 2014

Plyometrics are a great way to train for sports but also increase bone density. One version is demonstrated with a single leg hop going clockwise then counterclockwise in a 1,2,3,and 4 step pattern. To make this easier, you can hop with two feet to get the hang of it then progress when that is easy to a single leg. You can also incorporate diagonals which make for a good change of direction for sport specific play. Diagonals can be used by starting in box 1, jumping diagonally to box 3, laterally jump to 2, then backwards diagonal to 4, then repeat in reverse. Try to keep pelvis and hips facing the same direction the whole time to get the lateral and diagonal benefits. Start slow and try to increase speed depending on the type of sport or activity you would like to improve.

4 Square Step Test

October 2014

Test your balance: 4 square test for older adults.
Goal of this test is to see if you are at risk for falls. To perform this test, you will need to set up 4 squares which you can do by using 2 canes or jump ropes set up in a "+" position. You start in "square 1" and go clockwise from 1-2-3-4-1, then counterclockwise from 4-3-2-1 ending where you started. You need to stay facing the same wall or direction the whole time so that you will sidestep and backwards step. The goal is to perform safely without touching "+" at any time, no loss of balance, and under 15 seconds. If you do, you may be at risk for falls. Please watch the video for tips.

Eat Right, Exercise, Die Anyway

October 2014

Eat Right, Exercise, Die Anyway. This was a bumper sticker I saw not too long ago that corresponded to a conversation I had not too long ago. I was having a leisurely night out with my family at a friends' house when the conversation turned ugly. Why exercise? What? I was dumbfounded but had to regain my composure after being figuratively punched in the gut. What I find is a normal way of life, some type of daily exercise, some people loathe it. Loathe exercise. Some people think " I will just bypass exercise and eating healthy because I will die anyway." In my head I am SCREAMMING the 50 different reasons on why to eat right and exercise. I start with one big one. "How well do you want to LIVE?" How do you want to feel today, next week, in a month, end of this year, and long term? Now I am outnumbered in this conversation, four to one with people who hate, despise, and downright loathe exercise, to me, who lives and breathes exercise. We just started to get into how exercise can help daily life activities such as steps when we got interrupted by a hungry and tired child that I had to feed and comfort. So the conversation was not finished.

Here is the rest of the conversation I wish I was able to share that memorable night.

LIVE your life. Own it. Do not just dream of being healthy-do it.Start small. Find your goals. For example, the one gentleman in the conversation has "bad knees". The gentleman does not want surgery as his MD suggested, so he does nothing to help his knees. Nothing. Nada. Zilch. This gentleman does have difficulty with: sitting too long and then trying to walk, going up/down steps, walking on uneven surfaces. If you have a problem, don't wish it away, set realistic goals to attack the problem. Don't know how?Call a physical therapist-we are great at goal setting.
Find ways to make exercise fun. First of all, find out why you hate exercise. Some people think it is too time consuming. So start with 5 min a day. Put on your radio and walk continuously in your house, to your favorite song. Some people think exercise is boring. Find a kid. Preferably your relative or nice neighbor. Kids know how to have fun. For example, hopscotch. Young kids like hopscotch-it teaches balance, strength, and coordination. For those who are older, it REALLY teaches balance, strength, and coordination. And guess what? It IS exercise. Don't like kids?Go shopping. Walking is a great form of exercise. The Coventry Mall is air conditioned in the summer months and heated in the winter for a perfect flat, all weather, walking and shopping area. Figure out why you do not exercise. Then find an exercise that is enjoyable to you.Having a hard time figuring out how to exercise and you have difficulty with daily activities such as reaching overhead, getting in/out of car,or even golfing? Call a physical therapist-we can help create an individualized program tailored to fit your needs. We can also make it fun and painless.
Get an exercise buddy for accountability. It can be kids, grandkids, a friend in Ohio or Florida, or a neighbor. Kids and grandkids are the best at lovingly nagging you to exercise more than healthcare workers! If your favorite relative or friend is not nearby-use technology. Most kids or grandkids can set up video chats on your computer or phone. If that sounds too techy or do not know anyone who is tech enabled, just call your exercise buddy and exercise and talk on speaker phone.
What are you afraid of? Exercise should not be painful. The era of "No pain, No gain" is outdated. We have progressed with science since you played football in high school. You CAN exercise, get a great workout, and actually feel better the next day. If you are exercising to pain, you are increasing inflammation, thus slowing your healing down. Exercise smarter. Most physical therapist have their Doctorate degree. That means college + graduate school + doctorate of physical therapy school + yearly continuing education classes. Who better to help you exercise to achieve your personal goals?
Why wait to do exercise until after surgery? Guess what? Most surgeries require exercise to get better. Why not prevent the surgery to begin with? Plus, if you do require surgery, getting specific exercise and education on an assistive device will help you recover from surgery quicker if you get physical therapy prior to surgery.

The Best Abdominal Exercise

The Best Abdominal Exerise

October 2014

How do I work my midsection the best way? How do I get rid of this line of fat below my belly button? I run, eat right, and do crunches and planks but can't get great abs-how do I do it? I believe I just experienced the answer. Raking the leaves. I have never been so sore in my abdominals in my life and I played 2 college sports. I should just rake the yard for the heck of it because it was by far the best ab workout I have ever experienced. And my yard looks good! So here are some physical therapy tips for raking the leaves.

Do a section of the yard and save some raking for later.If you do too big of an area, your body mechanics will crumble and bad form will arise, possibly leading to injury.
Pull the rake in 3 different directions.Straight towards you (easiest one if you are a novice raker), left, and right angles to get oblique's.
Hold your stomach tight to activate your transverse abdominis.Draw your belly button away from pants and try to hold this while raking.Do not hold your breath.
Switch hands to pull right and left to get diagonals.Think ambidextrous thoughts.

Try these tips on raking for a safe and productive abdominal workout and your yard and core will love you for it.

Use a kitchen chair that is placed against a wall.

Fall into Fall-or try not too...

Sept 2014

The Five Times Sit to Stand Test (FTSTS) is an easy way to test and practice fall risk and fall prevention. Directions are to stand up and sit down as quickly (and safely) as possible 5 times, keeping arms folded across your chest. Place your chair against a wall for safety. Time yourself from when you lift from chair to last repetition. For fall risk, the cut off time is 15 seconds. If this test takes you longer than 15 seconds, you are at risk for falls. If you cannot perform this test without your arms, you are at risk for falls. You can practice and modify this test by using your arms in a safe manner to practice better balance. You can further modify this test by raising the seat height so that the test is easier for you to practice.

There are norms for age groups for the FTSTS: 60-69 yo 11.4 sec, 70-79 yo 12.6 sec, 80-89 yo 14.8 sec.
Falls can happen due to weakness in your legs. The test FTSTS can also increase the strength of your upper leg muscles in addition to increasing your balance.
Remember to never exercise to pain.

Physical therapy can help knee pain without the use of surgery.

ALL or Nothing: There is Middle Ground for Knee Pain.

Sept 2014

Do you have anterior knee pain? Does it hurt your knees when you squat or go up or down the stairs? Do you have pain in the knees after sitting for greater than 30 minutes? Physical therapy can help your knee pain without the use of surgery. One study out of The New England Journal of Medicine reports that some knee surgery may not be appropriate for some individuals of knee pain. The study found that people with knee pain and meniscus tears received either a fake surgery or a real surgery all with the same outcome one year out. They both felt better. This study indicates that some people are getting surgery that do not need it. Just like low back pain, MRI results may show problems in the knee like a meniscal tear, but it may not be the source of the pain. What does that mean? A lot of people that are older have wear and tear on their knees, a lot have meniscal tears, but it may not be the reason they have pain. You may get surgery and address the meniscus but still have problems one year out because that may not have been the cause of your pain. You can talk to your orthopedic surgeon or physical therapist and determine what is the reason for your particular pain and determine if you actually need surgery or would benefit from more conservative treatment like physical therapy.

So is your pain actually from your meniscus (the cartilage and shock absorbers of the knee), knee cap (patellofemoral pain syndrome), or other problems that may be the source of your knee pain. There are many easy fixable problems that could be contributing to your knee pain without the use of surgery. Some problems that may affect knee pain that can be fixed without surgery are quadriceps strength, timing of quadriceps muscles in relation to each other, inflexibility of leg muscles, knee cap position, leg strength, foot position, gait (how you walk), and training errors. A physical therapist can determine if you have any of these issues and make a treatment plan that is specific to you. For example, if your therapist determines you have a flexibility problem affecting your knee cap, he/she may give you iliotibial band stretches (side of thigh), quadriceps stretches (front of thigh), or gastrocnemius stretches (calf) . Sometimes the source of knee pain is actually weak hip muscles which effects how your walk by your legs turning inward, putting you in a downward spiral of knee pain. These are just a few examples of what a physical therapist can address in a conservative fashion to address your knee pain. Time frame for pain relief may be seen in as little as 0-2 weeks. Typical results can be seen in 4-6 weeks for strength gains which are the long lasting results for your activities of daily living. You may not need surgery, but the choice of doing nothing does not have to be an option.

Dutton, R. K. (2014). Update on Rehabitiation of Patellofemoral Pain. American College of Sports Medicine , 13 (3), 172-178.

Sihvonen, R. M. (2013). Arthoroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. New England Journal of Medicine , 2515-2524.

ALS and Physical Therapy #icebucketchallenge

ALS and Physical Therapy

August 2014

My Husband and I were nominated for the ice bucket challenge for ALS by our good friend. Although we are not getting ice dumped on us, we are donating to www.ALSA.org which is a BBB accredited charity. In lieu of cold water, we are donating and educating our friends about ALS and physical therapy.

A (without) MYO (muscle) TROPHIC (nourishment) Lateral (side in reference to spinal nerve location) Sclerosis (hardening) ALS=Amyotrophic Lateral Sclerosis.
Who can get it? There are .4-2.4 cases per 100,000 people worldwide. Most cases have no family history but 5% may. More men than woman have ALS with average age of onset is 55years old. (Bello-Haas, 1998)
What is it? A disease that affects nerve cells which affects the voluntary muscles such as those found in arms, legs or swallowing muscles as opposed to heart muscle, some eye muscles and the brain's ability to think. ALS is a progressive disease which means the ability to control the muscles in an individual's body eventually stop working and become paralyzed; ALS eventually leads to death.
PT can maximize quality of life with individuals with ALS with assistive devices, assisting with posture to increase breathing ability, use of equipment to keep and maintain his/her activity of daily living. Depending on the stage the individual is, you can maximize his/her current functional abilities, maintain the current activities he/she can do now, and use of aids/assistive devices to increase quality of life.
Individuals and family members can be seen in outpatient physical therapy in a traditional clinic or at home with Energy Physical Therapy for outpatient physical therapy. Once deemed homebound by medical doctor, the individual with ALS and family members can get treatment at home from home care physical therapists & nursing. Whether it is outpatient or at home care, treatment is tailored to the individual. Education is for the patient and caregivers.
How can you help? Individuals may have difficulty getting to his/her doctor appointment or therapy appointment. If you know someone with ALS, ask if they need a ride or assistance.
How can you help? Durable Medical Goods are not always covered by insurance. Get your community involved to raise money for a wheelchair, motorized aid, or reaching tool that is needed by your neighbor.
How can you help? If an individual with ALS owns a home, during the summer offer to mow the lawn. Or fall-rake the leaves and winter-shovel snow. It will help not only the individual but the caregivers too.
You can exercise if you have ALS but may exercise differently than he/she is used to.
Only one approved medicine, Riluzole, but more are in clinical trials. Thus donation. At www.ALSA.org, they break the money down and 27% is currently given to research.
More info at www.ALSA.org
Bello-Haas, V. K. (1998). Physical Therapy for a Patient through Six stages of Amyotrophic Lateral Sclerosis. Journal of the American Physical Therapy Association , 1312-1324.

Physical Therapy Tips on Weeding the Garden

August 2014
When weeding the garden, it is generally not recommended to bend at the waist to weed your garden. Most people know to bend at the knees-get in a kneeling position if you are able. You can use the aid of a foam pad, rolled up towel under your knee to take pressure off the knee. Alternate the knee that is kneeling to give each leg a rest. Weed in front of you, avoid reaching too far, or at angles when working in the garden. Think smarter, not harder by using a milk crate, small stool or chair to sit on if you cannot kneel. Time yourself when weeding-give your body a break. If you are sitting or kneeling for a prolonged period of time, you may want to walk around the garden and get out of the flexed position to a more upright extended position. Think outside the box and have raised beds or container gardens if you cannot flex the spine or kneel. Raised bed can be the traditional 6-8" off the ground to assist in bending less or can be raised to waist level as a table. These are a few tips that may enhance your garden experience.

Energy Physical Therapy LLC attended Hickory Park to assist Wellness Council of Boyertown in Community Field Day Saturday August 17th. Here are a couple pictures of the long jump and standing broad jump.

Long Jump

Standing Broad Jump

How is YOUR Balance Health?

August 2014
SLS or Single Leg Stance is one test to determine your balance health. With this test, you stand on one leg for a sustained amount of time without loss of balance, putting your foot down, or holding on. Ages 20-49 years should be able to hold for 29 seconds. Ages 50-59 yo, 28 seconds. If you are ages 60-69 years old you should be able to hold the SLS for 26 seconds with your eyes open. If 70-79 years old, 14 seconds. If 80-89 years old 9 seconds. If you cannot make the time for your age group, you may be at risk for falls. Physical Therapy may help. Medicare Part B covers balance and fall risk with physical therapy. Energy Physical Therapy can give you free insurance verification. Call 610-310-0915 for a free insurance verification. Times are based off a study by Carmen Abbot at University of Missouri for different age groups TIPS for better balance:

Practice the SLS test below in a safe manner.You may need to start by holding on with two hands and standing on one leg.Progress by holding on with one hand to one finger.
Light it up!Have a night light in your bathroom.Vision is a balance center and greatly influences your balance.

This picture demonstrates a balance test called single leg stance

Rotator Cuff Water Warm Up

July 2014

Rotator Cuff Water Warm Up for Swimmers. Are you a competitive swimmer or have shoulder weakness? Here is a fantastic warm-up pre competition to use for athletes. You can also use this as an exercise program to strengthen your shoulders in the pool. Watch this video for great tips.

Exercise 1. Row-works your mid back muscles to get shoulders in good position. Keep shoulder blades down and back. Turn OFF your upper traps. This exercise is important to "set" your shoulders in the proper place and should be emphasized through this whole warm-up. Once in proper position, this can be made harder with use of a pool noodle or kickboard.

Exercise 2. Shoulder Extension-focusing on the longest triceps muscle. Keep great posture during this exercise or it will not be effective. Keep shoulders down and back. Focus on posterior or back muscles in this exercise and "slice" through the water on the way back to get the least resistance in the water. Goal is to pull the water back not push it forward.

Exercise 3. & 4. Internal & External Rotation. The focus of this exercise is the rotator cuff. Can use a water noodle tucked in arm pits to keep shoulder at ideal position for early on exercise. Have fingers splayed or together for harder or easier resistance. Keep wrist in neutral-do not bend wrist back and forth. Motion comes only from shoulder. Move arm back and forth in water with an even push away from body and even push toward body. Most people will feel going towards body is easier so try to focus on away from body.

Exercise 5. & 6. Shoulder circles clockwise and counterclockwise. Try pulling the water toward you with more resistance. Slice through the water when pushing away to decrease resistance on front of shoulder.

Perform 10 repetitions of exercises 1-6 at a slow pace with fantastic form followed by a faster, sport specific pace of exercises 1-6. Never exercise to pain. Only perform with proper form.

Hydration Tips for Better Balance For Those Young and Not As Young

July 2014

Try to stay hydrated.Many medicines are diuretics or medicines that make you go to the bathroom (urinate). Some people avoid drinking because they don't want to go to the bathroom anymore than they already do.You still need to drink water to make your system run well.If you are not hydrated or drink throughout the day, it is like running a car without oil. Being dehydrated does not let your body work well and can affect your balance negatively and increase your risk of falls.Let the diuretic do its job that the physician prescribed and work with the medicine vs. against it and drink water or another decaffeinated drink.
When you choose your drink, try not to have a caffeinated drink, instead opt for decaf or 1/2 decaf which will allow you to stay hydrated and not urinate as much.Caffeine makes you urinate more than you need to.Examples of caffeinated drinks are coffee, iced coffee, iced tea, Coke, and Pepsi.You don't have to stop drinking your favorite drink but you can be smarter by switching to less or no caffeine.For example, if you make your own ice tea-make with 1/2 decaf and 1/2 regular-you won't taste a difference.That is a easy transition to a healthier choice vs. full caffeine. That may allow the medicine to do its job and your can decrease your risk of fall by not becoming dehydrated.
If you play sports and are not hydrated, your reaction time may be delayed.You can tell if your hydrated by the color of your urine.Think a light lemonade color not apple juice.

60 Second Exercise Challenge

June 2014

No time for exercise? Want to spend time with kids and/or grandkids? Why not have it all with exercise and family fun time. Items needed: Jump rope or pretend you have one, stopwatch/phone.

How many can YOU do? 2 minute exercise challenge. 60 seconds of jumpoing jacks followed by 60 seconds of jump rope. How many jumping jacks? How many jump rope revolutions before the jump rope messes up? If you don't have a jump rope-pretend you do! Have fun!

Hopscotch Family Fun Time

June 2014

No time for exercise? Want to spend time with kids and/or grandkids? Why not have it all with exercise and family fun time. Items needed: Chalk, giggles, and rock or Beanie Baby.

Exercise can come in many forms. Make it fun for the whole family. In this video, we have a grandparent, uncle, and grandkids. Hopscotch is an oldie but goodie. It requires one legged strength and balance. Demonstrated here, the family uses a Beanie Baby to throw on the numbers because it doesn't roll like a rock may. That makes it easier for both grandkids and grandfather. The game is designed to throw the desired item in the numbered box. Once thrown in the correct box, starting with number 1, you jump over that number and continue to number 10, turn around and come back and stop at the higher number. In this example, stop with one foot in box 2 and the other in box 3. Pick up the item and one legged hop in box 1. Everyone completes a cycle if they make it in the correct box. It is harder when you need to stop with a single leg. For example, if your rock is thrown in number 3, on the way back, you need to stop in box 4 with standing on 1 leg and lean over and pick up rock in number 3. This requires a lot of balance and leg strength. If you practice balance, your balance will improve. For both young and old the game cultivates balance and strength and is fun for all generations. If this game is too hard for you, consult your physical therapist on ways to improve your balance before participating.

Here are two of the participants from Walnut Woods of Boyertown that were in attendance for Balance and Fall Prevention Tips by Energy Physical Therapy with Boyertown Wellness Council. June 17, 2014.

Senior Bingo Walking is at Boyertown High School Track June 18th 10:00-11:00. Public invited, cost is free. Here are some pictures of the event.

Snacks trackside

Approximately 30 participants for Senior Bingo Walking

Energy Physical Therapy LLC at Pottstown Area Senior Center for Balance Screens and Fall Prevention Tips on Tuesday June 10th.

Reminder: Energy Physical Therapy LLC will be at Pottstown Area Senior Center for Balance Screens and Fall Prevention Tips on Tuesday June 10th from 10:30 am to 11:30 AM.

Tennis Elbow

May 2014

Do you have pain in your elbow or forearm with gripping? Does it hurt your elbow to type on the computer or use the computer mouse while clicking? Do you get pain in your forearm when weeding the garden? Is it painful in your elbow to reach your arm out straight? You may have signs and symptoms of tennis elbow. And NO, you do not need to play tennis to have Tennis Elbow. A majority of people diagnosed with Tennis Elbow have never played tennis in their life. Tennis Elbow, or Lateral Epicondylitis, is an inflammatory condition or tendinopathy of the extensor tendons in your forearm and elbow. Those that have experienced Tennis Elbow know that this condition can be very irritating and often reoccurs in the same arm or other arm. Your Physical Therapist can help by: resolving the inflammation, giving education on how to prevent the condition from reoccuring by altering body mechanics that cause the problem, strengthening, and stretching the whole upper extremity or arm. Physical Therapists look not just at the elbow but at the whole arm to see how you as an individual works to get to the cause of the problem and not just treat the symptoms. When you are treated by a Physical Therapist, he or she may use modalities such as heat or ice, ultrasound, electric stimulation, manual therapy, and /or instrument assisted devices to resolve pain and restore function. Therapeutic exercises may be utilized for the whole arm to address weakness that may be contributing to the elbow problem. Physical Therapists will be able to rule in or out if the elbow pain is actually coming from the elbow or another source like the neck or cervical spine. If you have any of the symptoms of Tennis Elbow or Lateral Epicondlylitis, call Energy Physical Therapy today.

This is a picture of a stretch that may be used for Tennis Elbow or Lateral Epicondlylitis

Reminder: Energy Physical Therapy LLC will be at Pottstown Area Senior Center for Balance Screens and Fall Prevention Tips on Tuesday May 13th from 10:30 am to 11:30 AM.

Plantar fascia is located at the arch of your foot

Plantar Fasciitis: Do have pain in the bottom of your foot that is worse in the morning?

May 2014

At the bottom of your foot is an arch that is supported, in part, by your plantar fascia. The job of the plantar fascia is to give support and stability to your arch. The plantar fascia can get an "itis", or inflammation, due to many reasons such as change in shoe wear, change in surface such as walking on the sand, or increase in standing or walking.

A physical therapist can help determine the cause and help you correct the problem. Treatment may include inflammation reduction via ice, stretching, modalities, and/or manual therapy. A physical therapist may look up and down your whole leg to determine contributing factors to your foot pain and address the whole chain. During treatment, you will get education on how to prevent plantar fasciitis from reoccurring. One of the problems might be tight calf muscles that affects the plantar fascia. Stretching of the two calf muscles is a common treatment to plantar fasciitis. Below is a picture of a stretch for one of the calf muscles called the gastrocnemius. Stretching should never be done to pain and is typically held for 20-30 seconds. If you have signs and symptoms of plantar fasciitis call today, we can help. Energy Physical Therapy LLC is an Outpatient Physical Therapy Clinic that comes to you. We currently accept Medicare Part B.

Gastrocnemius stretch. Notice that the knee is straight and ankle bent.

Tree Pose for Earth Day and Arbor Day !

April 2014

Tree Pose, or Vrksasana , is a great way to practice balance. Most people already understand that performing cardio exercises like running, walking, or biking helps increase your heart and lung function. Most people understand weight bearing or resistance exercises such as weight lifting, dumbbells, and bands address strength of your muscles and bones. But, most people do not do anything to address balance. Tree Pose is just one example of a balance exercise that you can perform and improve on at home. Stand near a sturdy countertop if you need to hold on. Starting with both feet on ground, lift one foot and place on the inside of the other leg as pictured. If able, you can raise your arms above your head, while keeping your shoulders down. Time yourself in the position of Vrksasana and try to beat your time. Perform on both left and right legs. If you have a history of falls or near falls, a physical therapist can help address your balance needs.

Tree Pose for Earth Day and Arbor Day

Bingo Walking for Seniors!

April 201

Tell your Parents, Grandparents, Aunts, and Uncles. The Wellness Council of Boyertown will be hosting Bingo Walking for Seniors this Wednesday at 10:00AM-11:00 at Boyertown High School Memorial Stadium Track. What is Bingo Walking? When you arrive, you will receive a BINGO card and for each quarter lap you walk around the track, you will get to pull a BINGO number for your own personal card and mark your number. When you receive 5 in a row you get to choose a prize from our Prize Table. Prizes include gift certificates, household goods and healthy living items.

Energy Physical Therapy will be there as a Vendor this Wednesday-come and visit our table! Bingo Walking is free to any senior who would like to attend. This is weather Permitting. Call 610-334-3710 for questions.

Future walking dates: May 21st, June 18th, September 17th, October 15th so mark your calendar!

Mountain climb out of this Spring snow!

March 2014

Plyometrics are good for athletes but they are also good for women of all ages by slowing osteoporosis and osteopenia because they are weight bearing exercises. One example of a plyometric exercise is the mountain climber. Start with both hands on the ground and shoulder width apart, arms straight. This puts pressure or weight through the upper extremity or arms. Your legs can start together in a squat position or tucked under body. Then extend one leg backwards behind you. Your opposite leg should still be under you. Then reverse this action. Keep stomach muscles tight and back straight like you are in a plank position. Perform for 1 minute. This exercise helps increase anaerobic fitness. Remember, never exercise to pain. Have fun!

Spring into baseball safely with a great shoulder stretch!

March 2014

Baseball players have been known to have both shoulder and elbow injuries. Stay off the bench and avoid injury by stretching the upper body too! Most athletes know how to stretch their legs but not their arms. Overhand throwers can benefit from a side lying internal rotation stretch aka the sleeper stretch. The sleeper stretch is one of my favorite stretches for baseball players especially pitchers. Stretches should never be done to pain-only a moderate stretch. Perform on both arms. Lay on your side with your shoulder at 90 degrees and elbow at 90 degrees. Use other hand to gently bring wrist towards the direction of the floor and hold between 20-30 seconds. If your shoulder comes off floor, you are compensating and stretching too far.

Sleeper stretch. Note shoulder and elbow at 90 degrees.

Get your legs in shape! Proper form for a wall sit.

March 2014

A wall sit is a great exercise that works the legs. This exercise can help your large muscles in your legs get stronger for activities such as stair climbing, running and playing sports. A wall sit offers resistance exercise with your own body weight. The wall sit mimics the muscles being used in a leg press but in the privacy of your own home. You can vary time or repetition to make it easier or harder. Start out with a time of 10-15 second hold and you can progress up to a few minutes depending on your health and strength of your legs. For a beginner, try holding 10 seconds then rest and perform 1-2 more times. See how you feel the next day and if there is no soreness or pain you can progress slowly with an increase of time. If you are a conditioned athlete with good health, you can increase your hold time to start with one minute. I recommend performing this exercise at a 45 degree angle vs a 90 degree angle to decrease the stress on the knee. This exercise can be performed every other day. There should be no pain when performing this exercise but you should feel your quad muscles working in the front of your thighs.

Wall Sit. Notice approximately 45 degree angle of knees, feet shoulder width apart, knees not over toes.

Sportsmanship

Feb 2014

Pottstown Seahawks Washington boys were in the Pottstown Mercury February 16 for winning championships. Congratulations! More importantly, the boys won the sportsmanship award. Swimming like many sports is a great way to teach sportsmanship by shaking hands and being a good sport win or lose. Sports can teach you life lessons on hard work, dealing with all types of people, and health. Not everyone is Michael Phelps when it comes to straight athletic ability. Kids from all abilities can swim for competition, health or just to be with their friends. At Pottstown YMCA there are 2 girls and 2 boys teams with different abilities of swimming. Locally, there are several YMCA's, schools, and summer swim clubs that offer lessons to learn or enhance your swim stroke. Encourage this sport because swimming is a lifelong sport. Once you learn how to swim you can swim at any time in your life: very young, very old, injured and even pregnant. The general population is seeing an increase in obesity, heart disease and diabetes. Swimming is a great way to get or stay healthy.

At Energy Physical Therapy, we not only treat patients for physical therapy, but we also do wellness house calls too. If you have any questions about how to get started with a wellness exercise program, please contact Julie Adamski @ Energy Physical Therapy 610.310.0915.

This picture is from the Mercury February 16th 2014 of the Pottstown Seahawks.

Winter Swimming

Feb 2014

No this isn't the Summer Olympics. This is Washington Penn-Del League Championships. Shown here is the 8 & under boys Medley Relay. Swimming is a wonderful winter or summer sport for young or not so young. The sport is low impact on your joints but can challenge your cardiovascular system to help your heart and lungs. Swimming works arms, legs and everything in between. If swimming is not your primary sport, consider swimming as an alternative to your land based sport to give tired legs a break from constant pounding as seen with track, cross country or soccer. In a pool, you can use a simple noodle to support you in water under your arms and you can "run" in place. If your days of being an athlete are over or never started, simply walking in the water is a great way to keep healthy. Water walking in a warm or therapeutic pool can keep your joints loose and you may find you are able to exercise longer in a warm pool. This may be a personal goal for someone who has a hard time exercising on land. Whatever your personal situation, swimming or exercising in a pool is a great healthy alternative for an active healthy lifestyle.

This picture is from the Penn-Del League Championships at Reading with the 8 & Under Boys Medley Relay.

Superbowl Exercise Party.

Feb 2014

Big game this weekend. The Superbowl is a fun and fabulous time for a football fan. Some people just enjoy the game, some the food and drink and others the commercials. Why not interject some healthy exercise into the mix and make it fun. Make exercise into a game for your family and friends. All you need is a list of exercises that match the football game and a little floor space. Here is an example of how to play Superbowl Exercise Party.

Every time there is a touchdown-do 5 squats and offensive line block. Variations of this activity are number of squats, how deep you squat, with/without arms.
Every time there is a turnover-do 5 high knees.
Every time there is a 1st down-do 5 jumping jacks.
Every time there is a field goal-do 5 squat thrusts into field goal poise.
Every end of quarter-do 5 push-ups. Variations of this easy to hard : wall push up, modified knee push up, traditional push up, triangle push up.
Halftime show-try to perform a single leg stance on each leg. How long can you balance on one leg before you put your foot down?
Every 2point conversion-do a plank for 5 seconds.

Superbowl Exercise Party can be performed with kids all the way up to seniors. Just set the ground rules before the game begins on modifications for each player. Some individuals may need to perform easier versions than others depending on health and their typical activity levels. If any of these activities are too hard, walk in place or add something silly like the sprinkler dance move. You can keep score on how may exercise everyone performed or who gave up in the first quarter. You can decide to perform Superbowl Exercise Party for 1 or 2 quarters or for the whole game. Keep exercise fun and don't exercise to pain. Good luck!

Balance Exercises: Single Leg Stance.

January 2014

Balance is important to prevent falls. There are many ways to test and progress a person's balance. One way to test and progress an individual's balance is the single leg stance (SLS). Single leg stance is when an individual stands on one leg while holding up the other leg in a bent knee position like a flamingo. There are many grades to performing the task of SLS. The easiest and safest way is to hold on with two hands to a study countertop like at the kitchen sink. Lift one leg in the air and hold for thirty seconds. Once you master this objective on each leg, you can progress by performing the task with holding on with only one hand. The next progression of the SLS is with 2 finger tips holding on for balance, followed by not holding on at all. When performing a SLS and not holding on, a safe bet is to have arms ready to hold on in case you lose your balance before your designated time is up. If you think you can safely master the SLS without loss of balance, increased sway and are safe, then try to progress to the next step. With this progression, I recommend you go back to holding on with two hands, perform SLS, but this time eyes closed. You will notice an increase in sway which is normal due to vision being part of the body's balance center. If you don't lose balance, you are safe and there is no increase in wiggles, jiggles or hops you can progress. I do not recommend SLS with eyes closed and with no hands without proper instruction and guarding from a professional. Test your best time without loss of balance or extraneous hops/wiggles. Use a total time of 30 seconds and get your own "record". This is an easy way to view progression of SLS:

1 foot, 2 hands holding on, eyes open, flat surface
1 foot, 1 hand, eyes open, flat surface
1 foot, 2 fingers, eyes open, flat surface
1 foot, hovering hands, eyes open, flat surface

*1 foot, 2 hands, eyes closed, flat surface. Continue progression.

*1 foot, 2 hands, eyes open, unstable surface like pillow, bosu ball etc. Continue

progression.

Single leg stance is just one of many tools that can progress balance. It is important because you stand on one leg when you walk, cross up and over a curb, up and down steps, in/out of a tub/shower, and getting dressed for your lower body. Single leg stance is performed more than most people recognize. This activity can be very challenging to the very young or very old. What is important is what is your specific normal and can you safely beat your best time. You may find that times may vary greatly if you perform 3x on each leg. You may find that times vary greatly between days that you perform the exercise. Research suggests that 24.1 seconds of change is needed to see a true change, but for you as an individual, it is also good to see smaller incremental changes in times of SLS. So keep practicing and keep safe!

Goldberg A, Casby, A, Wasielewski M. Minimum detectable change for single-leg-stance-time in older adults. Gait Posture. 2011 April;33(4):737-9.

Oh my aching back. Physical therapy tips for snow shoveling.

January 2014

Every season offers its own set of positives and problems. This is the season for snow, ice, back pain, falls, sledding, tubing and skiing. Kids love pushing snow around, throwing snowballs, and going down hills at fast speeds; grown-ups, not as much. Get more positives and fewer problems by following these tips when shoveling that beautiful white stuff.

Keep hips and knees bent, remember this is athletic activity
Back should be straight not hunched over
Keep body in a straight line, rotation is not your friend
Lift a small amount of snow and keep load close to body
MOVE YOUR FEET. DO NOT TWIST.
Throw snow nearby not too far away
Counter this flexed activity with an "extension" by placing hands on hips and gently leaning backwards
Listen to your body!

A physical therapist can give you specialized tips individualized to you. And with in-home services offered by Energy Physical Therapy, you can get treatment without leaving the comfort of your home.

Balance yourself. The weather outside is frightful!
December 2013

Driveways, walkways, curbs and outside steps. All places that may be slick from snowy and wet weather. If you have a balance issue, slick surfaces are twice as nerve wracking. Balance can be affected by weak leg muscles, vertigo, poor eyesight, environment, reaction time, and pain just to name a few. Physical therapy can decrease your risk of falls by focusing on your individual needs.

Do you have difficulty getting up and over a curb or walking on grass? Do you plop down in your seat or have difficulty getting in/out of the tub? Physical therapists are experts at addressing these issues.

TIP OF THE DAY: One way to determine if you need physical therapy for lower body strength or for balance is the "Five Times Sit to Stand Test". Stand in front of chair that will not tip over. Cross your arms across chest and start seated in chair. Time yourself on rising. Stand 5 times as quickly and safely as you can without use of arms. After the fifth repetition, stop. If you needed to use your arms to stand up, or you took longer than 15 seconds, then that is considered abnormal and you might benefit from physical therapy.

Bad weather?

You don't have to worry about driving in questionable weather because Energy Physical Therapy comes to you. This means you can keep scheduled appointments without worring about canceling due to fear of driving in our beautiful, but potentially hazardous, PA winter weather. Take the environment out of the balance equation with our house calls.

Energy Physical Therapy

Serving Pottstown and neighboring areas

On the move to help YOU

get moving again!

click map to view our service area

Call to schedule in-home physical therapy

610-310-0915

“No matter what health issues or injuries life sends your way, you can maximize your daily quality of life with the right treatment and training.”

Dr. Julie Adamski
founder, Energy Physical therapy

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