Move Well!

Do you think you move well?

How do you bend over to pick something up from the floor?  Do you find yourself having to "push" yourself up after sitting for a while?  Do you feel "unbalanced" when you walk?  If your child is doing something in the back seat of your car that warrants your attention, can you easily rotate around to look?  When you get out of bed every morning, do you feel like you sometimes have to "unfold" yourself for the first few steps?  I'm asking you these questions because most likely you've never actually stopped to think about such things.  Who has time?  You just go about your life because you have to get things done, right?  "Who cares if I have the occasional ache or pain along the way, that's life," you may think.  It doesn't have to be that way.

If you ever want to observe the way we're supposed to move as humans, check out your kids.  Watch them play.  Watch an 18 month old squat down with perfect form and correctly pick up an object.  Nobody instructed them on how to move, they just do so innately.  Somewhere along the way (my colleague hypothesizes that it's when we're 6 years old and go off to first grade and begin to sit for longs stretches of time), we begin a gradual assault on our natural, healthy movement patterns.  It's a shame, because we were all gifted with these incredibly complex and capable machines that are our bodies.  But rather than treat them with the care that we should (after all, we only get one), we tend to let life's demands override that needed attention.  Sometimes it seems as though we're more willing to invest time and money into protecting our "stuff" than we are our own health.  Why do we have the tires on our car rotated, the belts tweaked, the fluids checked, etc.?  Isn't it to maximize performance and ensure the longevity of the investment that is our automobile?  Why would we treat ourselves with any less care?

With proper, healthy movement in mind, I wanted to write about the concept of moving well in all dimensions.  There are three planes of movement the I'd like you to think about.  Using your body as a point of reference, the sagittal plane runs front/back.  The coronal (frontal) plane runs side to side (think of how your limbs move while making a "snow angel").  And the transverse plane is a rotational plane.  Stick your arms out to the side and swing them around your trunk like helicopter rotors, and you're moving in the transverse plane.  In daily life, we move in combination of all three planes.  However, as we get older, this combination of movement probably becomes thrown out of proportion.  For those of you with sitting jobs, my guess is that your daily existence is dominated by movement in the sagittal plane.  Unless you prefer to sidestep or roll your way to work each day, you're probably spending most of your time in one dominant movement pattern.  Sure, every time you take a step there are many moving parts working in all three planes.  It's just that they're probably working in relatively narrow ranges of motion.

"Who really cares about my planes of movement," you may ask?  Well, if your body adapts over time to moving in diminished ranges of motion in one dominant plane (i.e., your day mainly consists of getting up, showering and dressing, commuting to work, sitting for 8-10 hours, commuting home, eating dinner, and plopping on the couch for some mindless television watching), you're setting yourself up for potential injury.  How will your body respond when it is asked to move out of it's "comfort" lane?"  Will it be up to the demands, or will it rebel and say, "Whoa, you haven't prepared me for this!!?  What do you mean you want me to lean into this car and pick up this child?  What do you mean you want me to swing this golf club?  What do you mean you want me reach overhead and pull down that suitcase?"  These are examples of the typical answers I receive in the clinic to the question:  "Was there an event that lead to the pain that brought you in today?"

So, what can you do about it?  If you are somebody who exercises already, that's fantastic.  You are already taking care of your body.  But ask yourself if you are training in all three planes.  I see people working out in the gym all the time who look like they are in great shape, but that doesn't mean that they necessarily move well or are protected against injury.  The guy who can bench press a small house undoubtedly has great strength in the sagittal plane, but unless heavy furniture is constantly falling on him throughout the day, there's not too much functional use for those overdeveloped pecs.  One example of multi planar movement for an incredibly important joint (the hip) would be clock lunges.  Rather than performing your basic front/back lunge, try rotating your "lunging" foot along an imaginary clock dial on the floor.  This will strengthen your hip joint in multiple ranges of motion.  Free moving, strong hips are very important for long-term back health, in case you were wondering.  We were granted an incredibly stable ball-and-socket joint at the hip.  But if our movement becomes stiff and limited there over time, the body will seek to dissipate it's rotational forces elsewhere up the kinetic chain.  We're all much better off leaving that work to the ball-and-socket hip joints rather than the lumbar spine, which is not designed to rotate much at all.

I'm very much interested in the concept and importance of quality human movement.  I think that if we move better, we'll ultimately be able to prevent a lot of the painful conditions that we see exist today.  This will translate into health care cost savings.  But more importantly, it will lead to a better quality of life for those who recognize its importance and act to do something about it.  That's really what I care about most.

If you ever want any ideas about what to look for in terms of movement quality, or on how to exercise to attain more healthy movement patterns, please feel free to reach out to me.  I'm always happy to offer any advice I can.  Move well, my friends!

James W. Horn, MSPT

Owner/Director

Chelsea Physical Therapy & Rehabilitation, LLP

119 W. 23rd Street, Suite 1002

New York, NY 10011

(212) 675-3447 (W)

(212) 243-5213 (F)

@Manhattan Spine & Sports Medicine

300 E. 56th Street

New York, NY 10022

(212) 935-1700 (W)

(212) 753-9856 (F)

chelseapt.com

Look up!

I am going briefly revisit a topic that I wrote about a few months ago.  On Friday afternoon, I got in the elevator to leave my clinic and head home for a relaxing weekend.  On the way down from my 10th floor office, a few other people joined me.  All three had their heads down and shoulders rounded forward so that they could attend to the task on their small screens and type aways on the tiny buttons with their thumbs.  "It's no wonder I see so many people come into my clinic with non-traumatic neck and shoulder pain," I thought.

Odds are that at least two of those three people just finished working at a desk for 8-9 hours, where they likely held that same forward head, forward shoulder carriage posture.  So I have a suggestion for all of you that hopefully you'll find helpful, on a couple of levels.  Rather than continue to stay "plugged in" for that brief ride on an elevator or escalator or anywhere else for that matter, why not give yourself a mental and physical break?  Instead of craning to take in the latest piece of digital information that's continually bombarding us (and which I readily acknowledge is here to stay), take a moment to lift your head up, pull your shoulders back, and just breath.  I know this seems like such a small and insignificant gesture, but as I always tell my patients, good posture starts with awareness.

Emails, texts, videos, facebook posts, and blogs will always beckon.  But don't allow your mind and body to be consumed by them.  We can still be up-to-the-minute informed without having to endure physical pain if we just take a minute for ourselves.

An Ounce of Fall Prevention

If you have anyone in your life who is getting up there in age, please read the below article about fall prevention.  There are such simple steps to take that will help minimize a loved one's risk of falling, some of which are enumerated towards the end of the article.  I was just with a client on Sunday morning and she mentioned that she doesn't believe she can get up from the floor without help.  This 83 year-old woman happens to live alone in a split level home, with no contingency plan in case she ever needed help.  I am well aware of the pride people have in maintaining their independence as they grow older and I am all for that.  However, I thought this was an important topic to address because as usual, an ounce of prevention can help avoid the much bigger problems that typically accompany falls.

Roughly ten years ago, my grandmother fell in her home and broke her hip.  She was living alone despite her age of nearly ninety.  She was unable to get to a phone or contact anyone for help.  My aunt, who lived four doors down the street from her and who checked in on her regularly, discovered her mother on the floor 24 hours later.  I don't want that to happen to any of your family members.  Please consider some of the steps mentioned in the accompanying article, and how they might be applied to someone in your life.  This may be a family member, but it could also be an elderly neighbor who might need your help.  Those folks for whom you take precautions will thank you for helping them continue to live safe, independent lives.  One day down the road, we'll all hope to have someone looking after us in the same way.

http://newoldage.blogs.nytimes.com/2012/07/12/scientists-weigh-in-on-fall-prevention/?ref=health

Why Can't/Won't We So Something?

Ironically, I started writing this early last week, before Mayor Bloomberg's announcement about his desired ban on large sugary drinks and the ensuing outcry.  This topic has been on my mind though for quite some time.  The thing that bothers me most is that this is a problem for which we already have a solution.  However, we are either unwilling or unable to act.  Why?

Has anybody seen the HBO series that's been airing recently called "Weight of the Nation"?  It's a sobering look at the obesity epidemic in this country.  One episode highlighted the school lunch problem that our kids face these days.  Administrations, hamstrung by cost restraints, are left no other option but to serve up mass-produced, over-processed food to our kids.  Coupled with the sodas and juices that are readily available in vending machines throughout our schools, these meals fall far short of what we should expect and demand from a nation that's so wealthy.  Why should we care?  Just look around.  With more children tethered to electronic devices, parents too fearful to send their kids outside to play without supervision, and physical education cuts across the board, we're watching our kids blow up.  Now, I'm not writing this intent on stigmatizing overweight kids.  They are undoubtedly already dealing with that burden.  But when more and more children are visiting doctor's offices across the country displaying signs and symptoms of problems more typically seen in much older people, I find it alarming.  And sadly, when you see a kid who's 50 pounds overweight, you usually don't have to look very far to find the parents.  The problem is becoming generational.

So who cares, you might ask?  There are so many reasons that we should care about this problem that have nothing to do with the aesthetic of being thin.  The most obvious one to me is economic.  I see a huge irony at play regarding efforts to control trans-fats and other bad foods by some governmental officials, New York City Mayor Michael Bloomberg most notably.  Those in opposition cry out that they do NOT want the government to tell them what to do.  "How dare they!  If I want to eat a greasy cheeseburger, that's my right!!"  On the flip side, these same "hands-off" folks howl about the notion of "socialized" health care.  Well, there are huge economic costs to obesity and we all share in those costs whether we think we do or not.  Obesity is a socialized problem, not just an individual issue.  How, you might ask?  Well, with all the medical issues associated with obesity, more and more health care dollars are allocated towards treatment of those problems.  Who is paying for it?  Usually insurance companies.  How do insurance companies pay providers while still maintaining their own ever-increasing profit margins?  Through raising your premiums!!  It would be great if your insurance premiums were directly tethered to your own personal habits.  Consumers would have a lot of control over their own costs, which ought to incentivize good behavior.  However, the insurance companies don't do nearly enough to reward good individual behavior.  Instead, your high premiums go toward treating many of these preventable maladies in other people.  I don't know, but to me, that sounds kind of like socialized medicine in some regard, doesn't it?

I'm going to go off on a brief tangent here regarding our current health insurance crisis.  I call it a health insurance crisis rather than a health care crisis, because I believe that by fixing the way the insurance companies conduct themselves, then the health care crisis will be vastly improved, meaning there will be far fewer uninsured people.  I love my work as a physical therapist, but I hate dealing with insurance companies.  I find it laughable how they go to great measures to make their members and providers fight for reimbursement.  One quick example that is a microcosm of the type of behavior I'm referencing.  I had a patient tell me last week that his wife was denied reimbursement for an emergency appendectomy which required a 4 day hospital stay (price tag: $40,000).  The reason for the denial?  It was a pre-existing condition!!!!  You've got to be kidding me!  Since when is an emergency appendectomy (is there really any other kind?) a pre-existing condition.  If you've ever spent any time trying to rectify an insurance claim, you'll understand the frustration of navigating the automated systems.  Something has to be done, because our current course is not sustainable.  Which brings me back to the economics of healthcare and socialized medicine.

Mitt Romney has vowed to make repealing Obamacare the number one priority should he assume office in January.  In some ways, I don't blame him.  The reality is that President Obama's health care act is nothing like he originally intended it to be.  It was rammed down our throats and nobody really knows how it's going to play out long-term.  How can we?  When the very people drafting this monstrous bill admit to not reading it, how high can we reasonably set our expectations?  Aside from being too unknown and unwieldy, the primary argument against it appears to be that we must fight socialized medicine at all costs!  But as Thomas Friedman recently pointed out in his New York Times column, we already have socialized medicine.  The fact that someone (yes, even an illegal alien) can go into a hospital and cannot be turned away means that we are already caring for everyone.  Now, is this an ideal system?  Of course not.  It is completely inefficient and costly.  We have already been paying for these uninsured people well before Obama's plan in the form of higher premiums through our "private" insurances.  And we've also frequently heard the concern that "I don't want anyone coming between my doctor and me."  Please, stop kidding yourselves.  Unless you pay directly out of pocket and don't rely on private health insurance (not many of us), then your relationship has never been between just you and your doctor.  Rather, it has been about you and your doctor in his/her office, with the out-of-sight insurance company heavily influencing your health care decisions.

How does our increasing obesity epidemic and our current health care system tie together?  The answer lies in the fact that we don't allocate our health care dollars efficiently.  Not even close.  The finances of our health care system and our health itself can both be greatly improved through one simple solution:  PREVENTION.  Years ago I read an article about the epicenter of diabetes in this country, East Harlem.  The article sited the fact that private health insurance companies wouldn't cover a $200 well visit to a podiatrist for diabetics (a population for whom maintaining healthy, clean feet is essential if they want to keep them), yet it would pay for a $30,000 amputation.  Does this make sense?!!  Of course not.  And to make matters worse, that uninsured person showing up to the ER is undoubtedly not there because they have the sniffles.  They're likely there as a last resort, meaning their medical care is probably going to cost a lot, not a little. Now, imagine if that emergency room patient was able to seek attention in a preventative setting 6 months prior?  Perhaps the person would not only be in much better shape, but their level and cost of care would likely have been much less in the beginning.

If prevention is really a key answer to two HUGE health care issues, then why aren't we doing anything about it?  The solution is right there in front of us!  Is it because we are incapable?  We don't have the time or money to eat healthier?  Are we too lazy to get more exercise?  Are we much happier to get a shot or take a pill to handle things on the back end, rather than to live our lives with prevention in mind?  Another recent article I read sited a doctor who described the following scenario: If a patient comes into his office who is 150 pounds overweight, with all the maladies that typically accompany such obesity (diabetes, high blood pressure, COPD, heart disease, painful joints, etc.), he knows that the single best thing that he can do for that person is take them for a walk.  Imagine that!  But he can't, because guess what?  He won't get paid to take his patient for a walk.  Nor should he.  Instead, he will choose the best medications to control all those issues, at huge costs to the insurance companies and large profits to the pharmaceutical companies.  And the cycle just continues.

So, when Bloomberg gets lambasted for infringing on the freedom to eat a bacon cheeseburger, I say to him, "Kudos"!  If adults (and the kids who model after them) can't control themselves via the course of prevention, then I'm fine with the government stepping in.  For those of you who can't stand this take, think of the next time you're ready to bemoan the high cost of taking care of our citizens (which I think is pretty important).  Would you rather the government reach across your table and remove your salt, or would you rather they dip into your pocket to take your money?  I for one say, "take my salt, and while you're at it, feel free to tax my soda as well.  It's not doing any of us any good anyway."

What is Your Goal?

I had a patient with a surgically repaired shoulder ask me the other day, "Do you think I will be able to swim by the summer?"  I replied that I would work hard to help her achieve her goal, and that I was very happy that she asked me that question.  I love to know what is motivating my patients to get their function back.  When I got home from work that night, I had a message in my inbox with the above picture attached.  The accompanying note said "Thanks for helping me set a goal."  I thought the picture was pretty cool so I decided to share it.  But it also made me think of a couple of relevant quotes about plans and goals:

"A goal without a plan is just a wish."  -- Antoine de Saint Exupery

"If you don't know where you are going, then any road will get you there."  -- Lewis Carroll

My swimming friend knew what her plan was........to get better.  But once she articulated a goal, then her plan had a real purpose.

What is your goal?

Why Adults Need "Tummy Time"

When babies develop in utero, they do so in a flexed fetal position.  When the baby is born, you will observe spontaneous kicking and punching of the air, along with some significant crying.  This is the baby's way of stretching out for the first time in this newly discovered universe of space.  What a relief it must be!

Parents are instructed on many "do's" and "don'ts" regarding the care of their newborns.  We know that we should not place our children on their abdomens (prone) to sleep, for concern of SIDS.  However, we are also told to make sure that our babies get some "tummy time" each day.  This entails placing our babies on their abdomens so that they can practice lifting their heads and working on their back extensor muscles.  There was no room for these muscles to get worked on in the womb.  Therefore, we want to allow our kids to start working on the muscles that will provide them with strong upright posture and mobility one day.  It's a pretty cool process to watch develop.

A couple of weeks ago, I was looking around at people on the LIRR.  Virtually everybody was focused on some sort of device, such as their smart phone or ipad.  What struck me was the posture that people assume to use these great toys of modern life.  If you want to use a Blackberry or iphone to send a text, presumably you have to hold it in front of you so that you can use both thumbs to peck away.  In addition, since the screen is so small, usually people are forced to lean their head forward.  Now you're in that forward head, rounded shoulders posture that can lead to neck and back pain.  And this is occurring on your down time!  Odds are, these people I was observing had spent 8-10 hours at a desk, where they likely craned their necks forward looking at a computer screen all day.

Desk jobs and mobile devices are not going away any time soon.  They're a fact of modern life.  My point in writing about this is to remind you to give yourself the equivalent of "tummy time" by stretching out your chest and shoulders and engaging the muscles in your back, particularly between your shoulder blades.  At the very least, try standing up once an hour at your desk, raising your arms overhead, and squeezing your shoulder blades together as you lower you arms back down towards your sides.  Think of making a snow angel.  Doing this or other similar exercises will help you maintain the back strength that your parents helped you build up years ago by placing you on your bellies.  Don't let your gadgets draw you back into the womb.

I need to clarify one point.  I am not suggesting counteracting flexed postures by sleeping on your abdomen.  This is NOT an ideal way to sleep.  Besides, that would only passively stretch your front but do nothing to actively engage your back extensors.

As always, feel free to call me if you want some pointers on how to stretch and strengthen for good posture.  Good luck!

James W. Horn, MSPT

Owner/Director

Chelsea Physical Therapy & Rehabilitation, LLP

119 W. 23rd Street, Suite 1002

New York, NY 10011

(212) 675-3447 (W)

(212) 243-5213 (F)

@Manhattan Spine & Sports Medicine

300 E. 56th Street

New York, NY 10022

(212) 935-1700 (W)

(212) 753-9856 (F)

chelseapt.com

Fix the "Stick"

Have you ever experienced a pulled muscle?  The chances are that you have, whether through some sports endeavor or just an every day task such as bending over to tight you shoe.  If you have, then you're familiar with the pain and functional limitation associated with it.  For mild (grade 1) strains, some simple rest, ice and ibruprofen will do the trick, and you'll be feeling better within a few days.  But that can lead to a false sense of security.  The reality is that you may be more prone to re-injuring yourself in the near future.  Here's why.

When you strain a muscle or tendon (you sTrain a muscle/tendon, you sPrain a ligament), microtears occur in the tissue.  Your body responds accordingly by beginning a cascade of repair responses.  Fluids rush to the site with all sorts of tools to begin the repair.  It's similar to an emergency response team rushing to a collapsed construction site.  This rush of "first responders" to your injury site is what causes swelling in the area.  This is when we ice, not to completely shut down the repair process, but rather to control it so as to avoid compression injuries to nerves in the area.  As part of this process, the body begins to lay down scar tissue to repair the damage.  And here's the key to long-term management of a muscle strain.

Think of that scar tissue adhesion as "glue" in your muscle belly.  Muscles rely on the smooth gliding of fibers over one another as they contract and release.  Now picture a spot in that smooth gliding mechanism that won't move.  It's stuck.  If left alone, the next time that muscle is put under a rapid change and stressed, the muscle is likely to re-tear near that "stuck" point.  The same healing cascade effect will begin all over again, with more scar tissue being laid down.  Without proper treatment, this can become a chronic condition.

Many of you have probably been taught that once your strained muscle feels better, then you should begin some light stretching of that muscle.  Not a bad idea, but that's only half the picture.  Let's say I strained my hamstring (muscles in the back of my thigh).  Two week later, I might have no pain and pretty close to normal function.  I may begin to diligently but cautiously work on my hamstrings with slow, static stretching.  That's great for all the muscle fibers that are still smoothly gliding over one another. But what about that stuck, "gluey" adhesion?  That area is not getting stretched!

The solution?  I highly recommend seeking help from somebody who can teach you how to "release" that adhesion.  I'm not just talking about your typical Swedish massage, which will bring much needed blood flow to the area but won't necessarily break up the adhesion.  There are techniques that are VERY effective in undoing these adhesions, and the good news is that they work fairly quickly.  The technique involves finding the "hot" spot (you can typically feel the area of restriction by palpating with your fingers), applying pressure, and lengthening the involved muscle through it's range.  Picture dragging knotty hair through a hairbrush that is held static.  

So, don't let those muscular sore spots turn into a chronic problem.  Learn how to "free up" your muscles after injury (or even restricted spots due to chronically poor posture) so that they can move correctly and reduce you chances of re-injury.  As always, feel free to call me with any questions!

James W. Horn, MSPT

Owner/Director

Chelsea Physical Therapy & Rehabilitation, LLP

119 W. 23rd Street, Suite 1002

New York, NY 10011

(212) 675-3447 (W)

(212) 243-5213 (F)

@Manhattan Spine & Sports Medicine

300 E. 56th Street

New York, NY 10022

(212) 935-1700 (W)

(212) 753-9856 (F)

chelseapt.com

Building and Maintaining: Good News!

http://well.blogs.nytimes.com/2010/12/29/phys-ed-if-you-are-fit-you-can-take-it-easy/

Whenever someone comes into my clinic with back pain, I always have the same conversation.  I tell them that I will work hard to help them decrease their pain and help restore their function.  But I also tell them that I can't guarantee that I will cure their back pain for ever.  Rather, I say that I will teach them ways to manage their backs for a lifetime.  I feel it is an important distinction to make so that people develop realistic expectations  about their condition.  I also don't believe that there is a singular cure for back pain.  There are just too many variables.  I certainly know that many conditions that cause back pain are very treatable in a variety of ways.  But whether a person is seeking help from an orthopedic doctor, a massage therapist, an acupuncturist, a chiropractor, or a physical therapist, I believe they should have realistic course of action laid out for them.  If somebody tells you, "I guarantee to eliminate your back pain forever," I would be skeptical and probably seek another opinion.

As a physical therapist, I rely on using active modalities (exercise) to address many physical ailments, including back pain.  This always involves developing a home exercise program for my patients.  Inevitably I am asked, "Do I have to do these exercises every day for the rest of my life in order to prevent the pain from recurring?" The answer is no.  First of all, if I tell somebody who is generally sedentary that they now have to do daily exercises forever, they will probably head for the door.  Instead, I let them know that once they begin to demonstrate strength gains from their routine, they can begin to dial back the frequency.  I tell them that I will give them a "box of tools" (i.e., stretching, strengthening, balancing, ergonomics, etc.) that they will be able to go to when they feel that their back (or other body part) may be starting to act up again.

I posted this article from the Times which cites some studies that should be encouraging for everybody, pain or no pain.  Just like my patients, I think that people want to know that they can derive health benefits without having to put too much time and effort into exercise.  The answer is yes, you can.  The initial stages of getting into shape are generally the most arduous and painful, which is why most people throw in the towel on their fitness resolutions.  But if you can just get to the top of that mountain, then the rewards can be great.  And they can be maintained with much less time and energy!  That is the key.  I've known this through practice and personal experience, but I think these studies clarify this point.

The bottom line is this.  To build any machine takes time and effort, but to maintain it requires much less of each.  Our bodies are the world's most complex machines and this same principal applies.  If you can just get past the initial difficult stages, the rest should be smooth sailing.  Your body (and mind) will be very appreciative!

Escalators: Rides or Opportunities?

http://nyti.ms/wlTYfi

The above article on interval training caught my eye last week.  It discusses the benefits of performing high-intensity exercise interspersed with light or moderate intensity periods.  One of the primary benefits of interval training is that it takes much less time than your typical gym workout.  With interval training, people have a harder time relying on the excuse, "I just don't have the time."

A few years ago the American Medical Association (AMA) changed it's guidelines for the amount of exercise recommended for good health.  Rather than 3-5 times a week of 30 minutes of moderate activity, they said people required 7 days a week of 1 hour of moderate to intense exercise.  I hated reading that and thought it was the wrong message to send.  I thought that by setting the bar so high, more people would be inclined to throw in the towel on regular exercise all together.  I felt that people would say, "It's so far out of reach that I'm not going to bother doing anything at all."

Another study demonstrated why interval training works.  In a test with two individuals, one ran on a treadmill for 60 minutes at a steady moderate pace.  The other ran for 20 minutes doing bouts of intense running (one minute at a time), interspersed with periods of light jogging for 3 minutes.  At the end of the exercise period, the person running for a longer period had burned more calories than the interval trainer.  However, as the post-exercise hours wore on, the interval trainer burned significantly more calories than the steady-eddie runner.  In essence, the interval trained individual kept their internal furnace stoked much longer than the steady pacer.  Hence the benefits of interval training; more calories burned with less time spend exercising.  What's not to like?

My feeling as that ANY exercise, no matter how small, will have cumulative health benefits.  Every day I have to take a long escalator on 53rd and Lexington.  Most people choose to stand to the right, missing a great opportunity to get 30 seconds of FREE exercise!  Why not walk up escalators, or walk on people movers at the airport rather than just stand there?  You will not only get to your destination faster, but you will get there healthier.  There are free stair masters every where you go (and in most homes).  Stairs are one of the best ways to get in a quick "interval" training session.  Another opportunity for "free" exercise can be found in parking lots.  Rather than waste time looking for the closest spot, why not just park a little further and fast-walk to your destination.  These are not ground-breaking ideas, but they're simple examples of how to make yourselves healthier throughout the course of your ordinary work day.  No gym fees required.

"Excuse Me, But......."

Last week I was in my local gym and saw a guy (maybe in his late 20s) performing barbell squats with 135 lbs.  Everything about his form made me cringe because he looked like an accident waiting to happen.  His knees buckled inward, his lower back rounded out, and his movement was choppy and fast rather than smooth and controlled.  Probably the only reason this guy was getting away with his terrible form was that he is still pretty young.  So what did I do or say?  Nothing.

While I am not a trainer, I certainly know biomechanics and understand mechanisms of injury, so I feel qualified to instruct someone on such things as squatting form.  But in my 10 years of being a practicing physical therapist, I've NEVER offered unsolicited advice.  This goes for settings outside of the gym as well.  Another example of seeing something without saying something is when I see a person using a cane that does not fit them properly.  I see it all the time, a person walking down the street, his or her shoulder hunched up because the cane is too long.  The cane may be offering stability, but in the long run that person will likely end up with shoulder and neck pain.  But again, I've never stopped anyone and offered advice.

After my observation of the poor form squatter, I asked a few patients and two fellow therapists what they would do in a situation like the one I described.  The responses among this small sample size were very mixed.  One of the patients said, "Yes", they would absolutely appreciate if someone intervened with the good intention of injury prevention.  Another responded that their pride might make them put their guard up if approached unsolicited.  One of the therapists said he would never say anything because what if, god forbid, the stranger took your advice and ended up getting hurt anyway?  I found it interesting that the responses varied so much, and it made me more curios.  Hence this blog.

I would love to hear from you what you think.  Would you appreciate unsolicited advice on injury prevention?  Or would you find it annoying to be approached?  I suspect that your responses will also be varied.  My suspicion is that most guys would respond, if approached in the gym, "Thanks, but I'm good."  Maybe the women might feel like they were simply being hit on.  I've definitely seen that happen and it's usually a cringe-worthy moment.

So I'm asking for your thoughts on this topic.  If approached in the gym (or elsewhere, for that matter) by a physical therapist or another healthcare professional familiar with biomechanics, would you be open or closed to advice?

What is My Rotator Cuff, and Why Should I Care?

Last week, as I was preparing to depart from a flight, I noticed the woman next to me struggling to lift her arm above shoulder height.  I overheard her mention to her friend that she's been struggling with her shoulder for months.  I asked her what was going on with her shoulder after explaining that I am a physical therapist.  She responded that she had adhesive capsulitis, which is a painful condition that restricts movement.  What struck me was that this relatively young woman (maybe 50's?) didn't stand a chance of reaching overhead to get her bag.  It was a clear example of impairment negatively impacting function.  Nobody should have to deal with such a thing, in my opinion.

I am choosing to write briefly about shoulder pain because I've seen a lot of friends dealing with it recently.  The shoulder is a great joint, with a ton of available range of motion that allows us to perform a myriad of tasks.  But the downside of having all this functional movement is that the joint is not necessarily the most stable (as compared to the hip).  In addition, when we lift our arms overhead, or reach in certain positions, a lot of important structures are prone to being impinged (pinched).  If this impingement happens for too long in a repetitive fashion, these tissue can become inflamed and ultimately wear down.  This is where your all-important rotator cuff comes into play.

You've all likely heard about rotator cuff injuries, especially if you are a fan of sports requiring a throwing motion.  But what exactly is it?  The rotator cuff is a series of four relatively small muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that come together in a common tendon at the top of your shoulder (deep to the large deltoid muscles that give the shoulder definition).  It's main purpose is to center the head of your humerus (the long bone in your upper arm) in the shallow socket in which it resides, called the glenoid cavity.  The shoulder is a ball-in-socket joint.  When you move your arm overhead, or into extension, or to reach behind your back to scratch an itch, the ball has to roll and glide within this shallow socket.  The large deltoid muscles (which give the shoulder it's rounded appearance) is the primary mover of your arm away from your body (along with a bunch of other muscle actions that simultaneously occur).  If the deltoids are overdeveloped from doing a lot of shoulder presses at the gym, they run the risk of overpowering an unfit rotator cuff.  Without the rotator cuff working well to maintain the head of your humerus in it's proper position, the deltoid will end up overpowering it and you'll increase your chances of developing shoulder pain.

As I've stated in previous blogs, these rotator cuff syndromes are more likely to develop in people in their 30's and above.  Tissues are not quite as flexible and extensible as we get older, making them more susceptible to wear and tear.  If the mechanics of the shoulder are interrupted, then these tendons may wind up becoming damaged.  The entire shoulder complex can get thrown out of whack simply by poor habitual posture caused by mundane things such as prolonged sitting (i.e., at work).  Once these tissues become inflamed, simple acts such as washing one's hair or sleeping with your arm raised above your head can become a painful endeavor.  

As always, there is a solution to this potentially painful and limiting condition.  Now, I should say that there are certainly cases where the rotator cuff tendons are damaged to the point of requiring surgical intervention.  Traumatic events such as falling on an outstretched hand can be enough to tear the rotator cuff.  The extent and exact location of the damage plays a big role in determining the type of intervention that may be most effective.  But for non-traumatic shoulder pain, very often some basic strengthening of the rotator cuff muscles can do the trick.  They can be done with a simple tool call a resistance band (Theraband), a light dumbbell, or a cable column at the gym.  These are not exercises that require lifting a lot of weight.  Rather, you'd be better served doing higher repetitions with lower resistance in order to build your rotator cuff endurance.  In cases where the condition is chronic (lasting more than 6 months), it's very likely that restrictive scar tissue and adhesions have developed in the area.  Before undertaking strengthening exercises to improve rotator cuff function, it's important to release those muscles through certain soft tissue techniques.  This will help to restore the proper muscle length in order to train the muscle properly.  I have seen these soft tissue interventions work very effectively in the clinic with great results.

If you are experiencing any pain in you shoulder that is detracting from your life, please feel free to give me a call.  I would be happy to offer you some advice to help you out, or explain how to perform the above referenced exercises.

Roll Away the Pain

Who doesn't like a massage?  I'm sure if we had the time and money, we'd make it a regular part of our lives.  Whether you're training for something that causes sore muscles, or you want to flush away tension from your every day routines, massages help to keep us loose and pain-free.  But at $60-100 a pop, they're not so economical.  But there's a cheap alternative to making an appointment with a skilled massage therapist.

I recently took a continuing education course where I was reminded about the virtues of using a simple tool called a foam roller.  If you belong to a gym, I'm sure you've seen them laying around the stretching mat, or sticking out of a bin like a bunch of baguettes.  Unfortunately, I don't see them getting much use.  These cheap but effective tools can help roll away muscle soreness and kneed out areas of restriction.  It basically rolls your muscles and fascia (connective tissue surrounding muscles) much like a rolling pin flattens and smooths dough.  Your body weight and gravity assist as you pick a body part and roll yourself over the foam roller.  They come in different sizes and densities, and cost roughly $20 if you buy them online.  I'd recommend getting the bigger one (36" long and 6" diameter).  That way you can do more than just roll out your muscles.  For example, one simple technique you can perform with this longer roller is well-suited for those of you who are buried at a computer all day at work.  With all your work and attention in front of you, the tendency is for your shoulders to roll forward and your chin to jut out as you type away at your computer.  Over time those anterior structures can get tight.  If you lie lengthwise on your foam roller going up your spine, with your arms out to the side, gravity will simply open up your shoulders and rib cage.  Just a few minutes in this position can be very relaxing and beneficial in re-setting your posture.

If you decide to purchase one of these simple self-massagers and store it in your closet, I think you'll find the benefits will far outweigh the costs.  For instruction on how to roll out specific muscles, you can either consult a trainer at your gym or just go to Youtube.  You can also feel free to give me a call and I'd be happy to offer you some advice.

Good luck, and happy rolling!