Not all physical therapy is created equal. A physical therapist (PT) can quickly and effectively treat neck pain...if they use a specific treatment.
The January 2012 issue of the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) reported a study showing that using a particular thrust technique to mobilize the neck and upper back is “appreciably more effective than non-thrust mobilization in patients with mechanical neck pain.” In the short term patient reported nearly a 60% reduction in pain versus less than 13% reduction if the thrust techniques were not used.
The idea of most orthopaedic PT treatment plans is the accomplish the following:
1. Reduce pain
2. Restore normal movement
3. Teach muscles to function properly
4. Return to normal, pain-free functional activities
The faster and easier this can be accomplished, the greater benefit for the patient, the payer, and the reputation of the PT. A skilled manual PT will regularly employ these thrust techniques and will help their patients recover more effectively than a practitioner utilizing generic treatments. Treatments that can quickly reduce pain, increase motion, and improve the ability of the muscles to protect the neck may help decrease long-term disability associated with neck pain.
Thrust techniques are regularly employed by skilled manual therapists following a thorough assessment to qualify a patient. Once moving properly with decreased pain, the patient can be taught how to strengthen the supporting muscles and then move into activities that simulate their normal day.
Before receiving treatment for neck pain, ask your doctor to refer you to a PT who specializes in manual therapy. Once you meet the PT, it’s a good idea to discuss with them if they are familiar with this study and the techniques that are utilized. It may not be appropriate for you, but be sure that they are considering the best treatment specifically for your condition.
Posted by
Jeni P. on Wed, Feb 08, 2012 @ 11:18 AM
Jeff Hurm is a Physical Therapy Assistant student here at WSPT. He has been working with Lillibeth Gonzalez for the last month, and has already greatly benefited from her years of experience.
Jeff originally attended Ithaca College and received a degree in TV and Radio Communications. He worked in video production and post-production for 13 years. After deciding his heart was not in that type of work, Jeff enrolled at LaGuardia Community College to obtain a degree as a Physical Therapy Assistant.
Having received physical therapy after going through an ACL reconstruction, his interest in PT as a career began to grow. His friend, a chiropractor, confirmed that this was a good path, and recommended Jeff get a degree as a PTA.
WSPT is Jeff’s second of three clinical requirements. His first clinical requirement was fulfilled at an outpatient facility, Miccass Physical Therapy, in Manhattan. At WSPT, Jeff will be completing his clinical specialty, and the track he intends to pursue, Sports Medicine.
Jeff appreciates that Lillibeth allows him to have a generous degree of free license while working with patients. Jeff points out that what you learn in the classroom as a student can only be the framework; real learning takes place when the student is allowed to be hands on, and to participate in the actual treatment of patients.
One of the most valuable insights into practicing physical therapy that Jeff has been privy to is the realization that no two patients are alike. Every patient will have his or her own personality, medical history, anatomy and will. Understanding and appreciating that a patient’s perception of their own pain is a heavy factor in the plan of care will help make Jeff a more intuitive and effective PTA.
You may find this hard to believe, but until recently, the ADA and the ACSM guidelines had recommended that people with Diabetes Mellitus (DM) and Peripheral Neuropathy (PN) refrain from weight-bearing activity. Just to be clear, this means they were recommending that people with DM+PN should do exactly what was contributing to their condition.
The rationale was that the risk of skin breakdown was greater than the rewards associated with getting off their butts and moving around a little. Skin breakdown and ulceration can lead to gangrene, amputation and potentially death. These are extreme risks, but they are easily monitored and controlled, enabling a person with DM+PN to live a normal life.
A case study published in Physical Therapy (Jan 2012) details the benefits of weight-bearing activity. The study utilized a moderate intensity 12-week, progressive walking and resistance program reflecting the recently changed guidelines for people with DM+PN. Three times a week for 12-weeks, the 76-year old man (with a 30-year history of DM+PN) performed the following exercises:
- Stretching - toes, hamstrings, quadriceps, calves
- Balance - progressively challenging exercises with decreased support
- Strengthening - body-weight ankle strengthening exercises, stair climbing, sit-to-stand
- Aerobics - progressive treadmill walking
Precautions were taken to avoid skin injury and all exercise sessions were monitored by a physical therapist. Overall the program was successful in increasing some measures of muscle strength, physical function, and activity without causing injury in an individual with DM+PN.
This is very encouraging for patients with DM+PN. PTs should be encouraging this population to be more active and we can even design programs based on the protocol outlined in this study. I know we will be doing exactly that here at
WSPT.
If you have Diabetes Mellitus and are interested in a program to safely increase your activity level, strength, balance and overall conditioning reach out to WSPT @
info@wspt.org.
Posted by
Jeni P. on Mon, Feb 06, 2012 @ 02:55 PM
Class #2: Common Nutrition Myths – Debunked!
Written By: Maria C. Romano, MS RD CDN
With all the conflicting nutrition advice floating around these days, in magazines, on the Internet, in diet books, and on health and wellness TV shows, telling the difference between fact and fiction can be pretty challenging. This week’s BronxFit topic is “Common Nutrition Myths”. Here is a preview of some common nutrition advice that’s not as true as it may seem. For more nutrition facts, and to learn who is your best source for nutrition information, join us in our next BronxFit class!
Myth: Skipping meals isn’t so bad for me.
Fact: You may think skipping meals won’t affect your weight loss efforts, but studies have shown that people accumulate more body fat when they eat fewer, larger meals instead of smaller, more frequent meals. Skipping meals typically leads to eating more food than you need at your next meal and throughout the day. Eating more frequently will help reduce bloating, control blood sugar, hormone levels, and manage hunger. Be sure to choose healthy foods like fruits and vegetables to help your body get the nutrition it needs.
Myth: I’ll never lose weight if I eat “bad” foods.
Fact: While most cravings pass in about five minutes, research has shown that eating a healthy diet doesn’t mean you have to deprive yourself, so long as you eat the not-so-healthy fare in moderation and keep it to a “once in a while” basis. So, you can have your cake and eat it too, but if you are trying to lose or maintain your weight, you may want to add an extra 15 minutes of physical activity to your day. This will help you to burn the extra calories you’ve taken in, keeping in mind the importance of balancing calories in with calories out. Another option is to give your favorite foods a “nutrition upgrade”. The easiest way to do this is to take control of your food by preparing it yourself. Sprinkle sliced potatoes with some garlic powder and bake them for healthy fries. Use whole wheat pizza dough or pita bread, low fat mozzarella cheese, and tomato slices to make a healthy pizza. Top frozen, sliced bananas and low fat whipped cream with chocolate syrup for a low calorie “banana split”!
Myth: If a food package says “all natural”, it has to be healthy.
Fact: Even if something is labeled “all natural”, it can still contain high amounts of sugar, fat, sodium, or any other ingredients than can derail your healthy eating. To truly determine if a food product is healthy, be your own judge and read the food label and ingredients list. If you’re still not certain, choose something that you know is “natural” because it’s packaged in it’s most natural state….think whole fresh fruit or vegetables.
Myth: If I eat mostly low-fat foods, I will lose weight.
Fact: Research has shown that low-fat or reduced-fat foods may actually have the same or more calories than full-fat versions of the same food. This is because fat is often replaced with sugar or salt to compensate for flavor. In addition, knowing something is “low fat” or “fat free” sends the incorrect message that it’s okay to eat more of these foods, when that is not the case. Your best bet is to control your portion sizes and stick with a balanced, minimally processed diet, choosing foods that are closest to their most natural form most of the time. This can include healthy fats, which can actually help weight loss efforts by providing a feeling of fullness and keeping us satisfied longer so we don’t overeat. Almonds, walnuts, olives, avocados, salmon, mackerel, and sardines are all foods that are rich sources of omega-3 fatty acids, which are essential to our overall well-being.
Myth: Frozen fruit and vegetables are not as healthy as fresh ones.
Fact: Produce that is picked and eaten within a few days contains more vitamins and minerals, and is therefore the best choice, but nutrient levels drop during shipping and storage. So in winter months when most fresh produce is traveling for days, if not weeks, before it gets to your local supermarket, frozen produce may be the better choice. Frozen fruit and vegetables can be just as healthy as freshly picked produce since they are picked at peak ripeness and frozen soon after harvesting to preserve their nutrients. When choosing frozen produce, remember to avoid those packaged in sauces, which only add sodium and fat or sugar and calories.
What to expect in Class #3… What’s the hype about whole grains? Next session we will discuss the truth about whole grains and why some carbohydrates are better for you than others.
Posted by
Jeni P. on Fri, Feb 03, 2012 @ 01:44 PM
Welcome to BronxFit Buzz, a nutrition blog dedicated to providing you with real tips that take the guesswork out of making healthy choices for your life. This week’s BronxFit class topic is “Healthy Eating and Living”. We will learn basic principles about what makes up a healthful diet and how to best plan our meals to achieve our nutrition goals.
Don’t Let Winter Put Your Exercise Routine on Ice!
Created By: Maria C. Romano, MS RDC DN
During the winter months, the short days, icy temperatures and snow-covered streets can make sticking to your exercise routine a challenge – but not impossible. When the weather refuses to cooperate, there are a lot of ways you can keep your exercise routine indoors. Try these suggestions so you can stick to your goals of getting and staying fit!
- Take the stairs! Whether in your place of work, your apartment building, the doctor’s office, or the mall, the stairs are an excellent indoor form of cardio activity. Start gradually if you need to by climbing the stairs for one or two flights and then taking the elevators the rest of the way. Add one floor per week, as you feel ready. Before you know it, you will be able to climb several flights of stairs without feeling winded and you will begin to notice your leg muscles firming up. On brutally cold days, a few trips up and down the stairs will be just what’s needed to keep your fitness routine on track.
- Hit the treadmill ! If you already belong to a fitness club, now is the time to get back into the routine of going back to the gym. Start by going once per week and gradually increase to twice per week, etc, as you are able. You can walk on a treadmill at your own pace and can gradually increase your speed, distance, and incline as you build up your stamina. If you haven’t yet joined a health club, now is a great time to sign up for one of WSPT’s membership plans that allow you to work out in a state of the art facility under close the supervision and guidance of highly trained fitness professionals. Who better to motivate you than a personal trainer who is just as dedicated to your fitness goals as you are?!
- Multi-task! While out running errands, take a few laps around the mall or walk the store aisles a few times. Take breaks from sitting at your desk to take a lap around your floor at the office. While home chatting on the phone or watching TV, march in place or pace back and forth to get your blood flowing, or pick up some weights to squeeze in some strength training.
- If you do head outside, dress in layers to protect yourself against the cold! Exercise can generate a lot of body heat, and wearing several layers of clothing will keep you from catching a chill as your sweat dries. Start with a shirt made of synthetic material so your sweat will be drawn away from your bosy and then add a cotton top and a fleece or wool coat. Pay extra attention to your extremities, making sure to keep your hands, feet, ears, and head extra warm!
I swam this morning. I swim 2-3 days a week now. Compared to last year or even a few months ago, I feel much stronger. Unfortunately, I’m not getting any faster.
I should probably preface the remainder of this blog by saying that I’m writing as a novice/intermediate triathlete and not as a PT. As much as I try, my thoughts and opinions as an athlete often don’t coincide with the PT in me.
I haven’t taken a lesson recently, but I read and watch videos about technique on a regular basis. I also speak to a lot of swimmers, which is always interesting. Some tell me to lengthen my stroke, others say to shorten my stroke. Some say breathe however you’re comfortable, others say force yourself to breath on alternating sides or every 4th or 6th stroke. Some say the kick is the key, others say save your legs for the bike and run.
So, since it’s only February, I’m experimenting. I’m trying different techniques to see how I can be most comfortable and maybe cut off some time. I realize there’s always going to be a learning curve, so it may take time to find what works best for me.
I may suck it up and take a few lessons at some point or enroll in class. A little professional feedback may be extremely helpful.
The good news is that I really enjoy swimming for exercise and I’m going to keep at it, even if I’m the slowest dude in the pool.
Posted by
Jeni P. on Mon, Jan 23, 2012 @ 01:55 PM
Jess has been working at WSPT as a yoga instructor for many years; she would make the early 5:30 trip from Manhattan just so WSPT's founder, Danny, could get his morning fix of yoga. Since then, Jess has grown a loyal following of "yogis". As I was interviewing her, one of her classes' attendees was patiently waiting to give Jess a ride to the train - not because she asked, but because Jess teaches the kind of class that inspires you to give something back and pay a nice favor forward.
I was immediately attracted to Jess's enthusiasm. I caught her right after her 10:30 class, and she was explaining to me the art of putting her normal clothes over her yoga clothes, and how hard she had been working to master this task.
Born and raised in Brooklyn, Jess’s hobbies as a kid were reading books and swimming. Jess was never really into sports, and she proudly states she dropped out of Nerf soccer in kindergarten. Her adventures off the playing field were vast; she spent two semesters abroad, one at Hebrew University in Jerusalem, and another semester at University of Glasgow in Scotland. She graduated Dartmouth Collegewith a duel Bachelors in English and Creative Writing. She received her Masters in English from the University of Chicago.
Jess joined the Peace Corps and served in Bulgaria, teaching English and helping draft grant programs with the local government. Jess thought she might want to return to the states and become and English professor. However, she found herself at a corporate job that had become suffocating. While in college, Jess had dabbled in yoga for the first time. Shortly after, she found a yoga studio she loved, and yoga quickly became a huge part of her life. Feeling unfulfilled at her office job, Jess decided to abandon the cubicle for the studio, and she has been teaching yoga fulltime ever since.
Her first job was at WSPT, and she has developed a fierce loyalty to the facility as well as the faithful class attendance. Jess is an expert in modification; everyone “brings a different body to their mat,” she says. Yoga is meant to be a healthy practice; an instructor needs to make sure it is comfortable and safe for every member, that way it remains a beneficial and fun practice.
When Jess isn’t teaching Yoga, she is busy working with MCC Theatre, writing grants for the office in Manhattan. Check out their latest production, Carrie.
Come take Jess's Class Thursday mornings from 10:30-11:30!
If you’ve recently experienced a herniated disc or herniated nucleus pulposus (HNP) in your lumbar spine, you probably are not very comfortable right now.
Symptoms of a herniated lumbar disc (HNP):
- Pain in the low back region
- Pain, tingling, numbness in the leg, usually below the knee
- Weakness in the lower leg - sometimes resulting in a foot-drop
Symptoms tend to increase with:
- Prolonged sitting
- Weight-bearing
- Movement
- Exertion
Aquatic therapy and exercise can be extremely beneficial for someone with a herniated disc. Here are 5 great reasons to see an Aquatic Therapist if you have an HNP:
1. Water makes a body buoyant. Standing in water up to your chest reduces the effects of gravity by 80%. For someone having difficulty bearing weight on a herniated disc, this changes everything. Once in the aquatic environment, it’s possible to exercise without pain. With an acute lumbar HNP, after a day or two of rest and minimal activity, it’s important to start moving and water makes is easy.
2. The warm water of a therapy pool loosens tight muscles and increases blood flow. Blood carries oxygen to injured areas and facilitates healing. Immersion in warm water along with room to move is an ideal equation for speeding up healing.
3. The treadmill in a Hydroworx Therapy pool allows a patient to walk slowly in a buoyant environment. This puts minimal strain on the irritated area of the lumbar region and lets the patient walk normally without pain.
4. The massage hose is used to apply gentle or deep tissue massage in the water. This relieves muscle spasm and loosens tight regions. The massage hose can even be used to gently massage the length of the sciatic nerve to free up trapped fibers.
5. Anyone with a severe HNP will tell you that it’s stressful to have severe pain and not be able to do their normal daily activities. Lying on the surface of a warm pool, supported with a life vest and noodles is an extremely effective way of relaxing the body and mind, paving the road to recovery.
Once symptoms are relieved and some function is restored, the patient should gradually be transitioned to land treatment and exercise.
Aquatic therapy with an experienced aquatic therapist is an ideal modality for someone with a lumbar HNP. Recovery is faster and complications associated with prolonged are avoided.
For more information about Aquatic Therapy, visit
http://www.wspt.org/aquatic-therapy/
Following a comprehensive physical therapy evaluation of the Lumbar, our treatment programs fall into one of three categories; Neutral Spine, Flexion Biased or Extension Biased.
Each of the three categories has a progression of difficulty. As the patient shows the ability to perform an exercise at the beginner level independently, with proper form and demonstrating proper firing patterns of the muscles involved, he or she then progresses to the next level.
What category a patient is steered into will be determined by what their condition is and more importantly what the mechanics of their dysfunction is. For instance, patients suffering from stenosis (a closing of the canal that the spinal chord runs through) generally benefit from an increased opening of the canal through a flexion (forward bending) biased program.
On the other hand, a patient with a herniated disk that is protruding posterioly (towards the back) generally benefits from an extension biased program that takes pressure off the anterior (towards the abdomen) portion of the vertebrae by extending backwards.
Patients with either condition mentioned previously, or other lumbar spine dysfunctions whose symptoms are exacerbated by either flexion or extension are put in the neutral spine category. This category focuses on exercises where the spine is kept in a neutral position through contraction of the abdominal muscles.
As with the treatment of dysfunctions in any part of the body, there is overlap in these groups where patients will perform both neutral and extension biased or neutral and flexion biased exercises.
-J. Ruta
-Sign Up for the Lumbar Educational Seminar Thursday, January 26th @ 12 PM-
-Online Webinar Available to Those Who Can't Make It-
-Four Free Physical Therapy Assessments-
When we last left Sadie she had been evaluated by her new PT at a premier outpatient physical therapy office. The expert PT completed a thorough assessment, provided an initial treatment, created a treatment plan for Sadie and issued her an updated home exercise plan. Sadie was very pleased with the experience and she scheduled 12 appointments over the next 4-weeks.
Sadie attended all of her appointments and diligently complied with the home exercise program. During that 4-week period Sadie achieved her goals of:
- Eliminating any swelling
- Achieving full range of motion of her knee
- Strength has improved to 75% of normal
- Sadie can walk short distances safely without a cane and 1-2 blocks outside with a cane
- She can go up and down stairs with a cane (and railing), but can’t safely carry a laundry basket down to the washing machine in her basement
She’s had minor setbacks resulting in short periods of swelling and pain, due mostly to overworking. (Sadie’s a go-getter and can’t wait to get back to walking with her husband, tennis with the ladies and peaceful gardening.) Her attitude and approach have put her in position to be concentrating on functional activities with her PT today.
Together, Sadie and her PT have decided that today’s session will concentrate on gait training. Sadie can walk, but she still fatigues easily and would like to be able to walk 30-minutes or more on the boardwalk with her husband. Her PT explains that an efficient gait pattern will increase her endurance because she’ll expend less energy with each step.
They begin the session with a 10-minute warm-up on a stationary bike, soft tissue mobilization by the PT, stretching and TRX-assisted squats. Sadie is prepared to focus on walking technique. The expert PT watches Sadie do a few laps through the gym, assessing her progress and gait dysfunctions. Sadie tends to not straighten (extend) her surgical knee completely or push off of that leg at the end of her stride. The PT explains to Sadie how she can improve her walking and they launch into a few drills to emphasize knee extension and push-off. Sadie, being the star patient that she is, grasps the lesson and easily transfers that into her gait pattern, first with a cane and then without.
Once the PT feels Sadie can consistently maintain proper walking technique, she has Sadie go on a treadmill to lock-in the lesson. First Sadie practices on the treadmill for a few minutes with 2 hands holding on and then gradually progresses to normal walking without her hands. Sadie is an exceptional patient, but she has some difficulties and missteps as she fatigues during this exercise. She sticks to it and has significantly improved her walking from this session.
She’ll go home and practice the activities and techniques she learned today to make it her norm. Over the next 3-4 weeks Sadie and her expert PT will reinforce the lessons of today and work on increasing Sadie’s speed and endurance. In addition, they will work on:
- Ascending and descending stairs
- Functional balance and movements that apply to tennis
- Work on kneeling and rising from the ground as it applies to gardening
Follow this blog to read about Sadie’s eventual discharge from physical therapy, her return to all of her activities and her plan for maintaining the gains she’s made.