Posted on 7/10/2018 by Nicole Tombers, P.T., DPT
In a culture dominated by cell phones, table stand computers, neck pain and headaches are becoming more and more common. Studies show that up to 45 percent of today’s workforce will experience problematic neck pain at some point.1, 2 As a physical therapist, I often find that these problems are associated with muscle tightness and weakness brought on by poor posture. It can be difficult to maintain perfectly straight posture all day, especially when your thoughts are focused on other things, such as the work project you need to finish this week, the heavy traffic on the roads around you or the emails you are answering from your tablet in the evening.
Here are a few tips and tricks that will set you up for success when it comes to maintaining good posture and reducing the strain on your neck in everyday situations.
Set your car mirror
Many people spend up to an hour or more in their car every day – driving to and from work, running errands and shuttling the kids to their many activities. Having poor posture in the car can place extra stress on the joints and muscles of your back and neck. Leave yourself a little reminder to keep good posture by adjusting your rearview mirror.
When you first get in your car, sit in a tall but comfortable posture; not leaning on the door or console, and not slouched low in your seat. Once you are in a good position, adjust your rearview mirror appropriately. Then, as you are driving, if you look in your mirror and realize you do not have the full view, it will be a reminder that you need to adjust your posture back to that good starting position.
Adjust your workspace
If you are one of the millions of people who spend their work day sitting at a desk, it can be a major source of strain on your neck and back. Modifying your workspace may help keep you in a good posture while you work. Here are a few key things to pay attention to:
When sitting, your hips and knees should be at 90 degree angle with your feet flat on the floor or stool.
Your arms should be comfortably supported on armrests with shoulders relaxed and elbows at a 90 degree angle. The keyboard and mouse should be positioned comfortably under your hands; you should not be reaching forward for the keyboard, nor should you be actively holding your shoulders up near your ears.
The monitor should be directly in front of you (if you work with more than one monitor, try to keep them centralized in your field of vision as much as possible) and the top of the monitor should be at your eye level.
Keep work off of your lap
Sitting on a couch or chair with your laptop, tablet or other papers on your lap tends to lead to a hunchbacked posture. Ideally, you should bring your work up to eye level (as discussed above) to reduce strain on your neck. If you must work from the sofa, try to raise it up a little by placing a pillow or folded blanket on your lap and working from that elevated surface.
Set a posture timer
If you know you are going to be focused on a project for a long period of time, try setting a timer on your computer or cell phone to go off every 20 to 30 minutes as a reminder to be conscious of your posture and readjust as needed.
Use a pillow roll
Ideally, you want to have a neutral spine while you sleep so that you can wake up feeling refreshed rather than cramped and stiff. Stomach sleeping is not good for your neck as it requires you to have your head turned to one side for a prolonged period. Back or side sleeping is preferred.
You want to have your head in line with your body and your neck fully supported. You can accomplish this by rolling a hand towel lengthwise and placing it inside your pillow case so that when you lay down it fills and supports the curve of your neck.
Do some self−massage
Place two tennis balls or racquet balls about one inch apart in a tube sock or nylon. You can hold the ends and place one ball on either side of your spine to give the muscles at the base or your head a nice massage.
Take stretch breaks
When you sit at a desk all day, your body grows stiff and your mind grows tired. Take a short break every hour or so. Stand up, look around, go for a short walk, take some nice deep breaths and do a few stretches. Here are a few options that can easily be done at your workstation:
Segmental rolling: Start with a nice tall posture (either sitting or standing) and focus on slowly bringing your chin to your chest one vertebra at a time until your neck and upper back are rounded forward. Hold at the bottom for a few seconds, then slowly return to upright posture one vertebra at a time.
Cat stretch: This is a popular yoga-style stretch that can be done sitting, standin, or on hands and knees. With arms stretched out in front of you, gently round your back, tuck your chin and pull your shoulder blades apart. Hold this pose for five to 10 seconds.
Upper trapezius stretch: Sitting up tall with hands resting in your lap, gently tip your head to one side and turn chin into shoulder until a stretch is felt in your neck. Hold this pose for 30 seconds and repeat on the other side.
Upper trap stretch
Chin tuck: With ears directly over your shoulders, gently tuck your chin as if trying to make a double chin. You should feel a gentle stretch at the base of your skull.
Scapular squeeze: sitting or standing tall with ears directly over your shoulders, gently squeeze your shoulder blades together without pushing your chin forward or raising your shoulders up. Hold this pose for five seconds, relax and repeat five to 10 times.
For persistent neck pain, please consult with your physician or contact one of our outpatient physical therapy centers conveniently located near you to speak with a licensed clinician today. Our highly trained physical therapists will help to alleviate your pain and get you back to work, athletics and daily life!
By: Nicole Tombers, P.T., DPT. Nicole is a physical therapist for Select Physical Therapy in Eagle River, AK. She treats a variety of conditions, but specializes in post-surgical rehabilitation and treatment of dizziness and vertigo. Nicole loves helping people improve and providing them with the education they need to have power over their circumstances.
Posted on 6/18/2018 by Erica Zettlemoyer, P.T., DPT
Multiple Sclerosis (MS) is a progressive disease in which the body’s immune system attacks the central nervous system (CNS). The CNS is composed of the brain, spinal cord and optic nerves. Our nerves are surrounded by a fatty substance called myelin, which allows electrical messages to be delivered quickly from the brain to the correct muscle. In MS, the myelin is damaged, scars are formed and the electrical message from our brain is disrupted. This creates a less efficient movement pattern, as well as pain, weakness, heat sensitivity, fatigue, numbness, vision changes and other impairments.
Multiple Sclerosis and Exercise – Though researchers are making significant advances in treating MS, there is still not a cure. However, there are various treatments which focus on slowing the progression of the disease and managing symptoms. Exercise is considered one of these treatments. In a published study, people with MS who participated in 15 weeks of three 40-minute training sessions per week were shown to demonstrate improved cardiovascular fitness, strength and overall health.¹
Multiple Sclerosis and Physical Therapy – Due to the complexity of MS, it is important to work with a physical therapist who will create a specialized exercise program based on one’s progression and severity of symptoms. Treatments will focus on general conditioning, strengthening, flexibility and balance as well as postural education, positioning and respiratory function. In more severe cases, a therapist will assist in the utilization of equipment, such as bracing, wheelchairs, standing frames. Several of the challenges that must be considered include:
Heat Sensitivity: Many patients with MS report a sensitivity to heat. A rise in core body temperature of as little as 0.5ᵒ C can intensify symptoms. A physical therapist can guide patients through several ideas that will assist in controlling body temperature while exercising. Using a fan, drinking cold water prior, during and after activity as well as utilizing cooling vests and wrist bands are helpful in controlling body temperature. Other ideas include placing a cooler in the car with cold drinks and starting the air conditioning in the car 10 minutes prior to leaving.
Lassitude: Fatigue affects 74 to 89 percent of those diagnosed with MS.² It is the initial symptom for almost half of those diagnosed, even predating diagnosis by as much as 10 years.³ A physical therapist can help patients address modifiable factors that increase fatigue, such as activity, respiratory weakness, thermosensitivity, pain, deconditioning and movement compensation.
Bone Density Loss: When exercising, it is important to focus on strengthening with resistance. Those diagnosed with MS may suffer from bone density loss due to Vitamin D deficiency and increased use of steroids. Participating in a weekly strengthening program while utilizing weights may improve bone health. A physical therapist can guide patients in safely incorporating resistance into an exercise program.
Examples of Appropriate Exercises – It is helpful to know that when exercising with MS, we should look at the total amount of exercise minutes for the day. For example, if someone can participate in riding a stationary bike for five minutes in the morning, five minutes in the afternoon and five minutes in the evening, that will give them 15 minutes of total cardio exercise for the day. Walking on a treadmill, walking inside or standing activities are other examples of exercises that can be modified to one’s functional and physical capabilities.
Strengthening exercises can include bridges, clams, heel raises, sit-to-stand transitions squats, step-ups and rows. Wall push-ups and triceps dips are especially important for fall recovery training. I recommend working on eight to 15 repetitions while using an appropriate resistance level.
Stretching is important and should focus on calf muscles, hamstrings, hip flexors and pectorals. When incorporating balance activities, vary the surface you are practicing on, whether seated or standing. For example, sitting on a wobble board or standing on foam will maximize training.
Beginning an exercise program does not have to be overwhelming or intimidating. Each patient with MS will tolerate exercise differently and a physical therapist can individualize each program to meet the needs of that individual. The MS Society and Multiple Sclerosis Association of America are also valuable resources for those who are seeking information on exercise.
For more information regarding physical therapy for MS, please contact a center near you today!
Petajan J, Gappmaier E, White A, Spencer M, Mino L, Hicks R. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology. April 1996 39(4):432-41
Murray TJ. Amantadine therapy for multiple sclerosis. Can J Neurol Sci 1985; 12:251-254
Krupp L, Alvarez L, LaRocca N, et al. Arch Neurol. 1988 45(4):435-437
White L, Dressendorfer R. Fitness testing in multiple sclerosis: a case report. Med Sci Sports Exerc 2003;35 (5): S314
By: Erica Zettlemoyer, P.T., DPT, is a licensed physical therapist at Baylor Scott and White Institute for Rehabilitation. She received a doctorate of physical therapy in 2010 from Texas Woman’s University and is a Certified Multiple Sclerosis Specialist.
Posted on 5/16/2018 by Erin Longhurst, P.T., DPT
National Women’s Health Week is hosted each year by the U.S. Department of Health and Human Services’ Office on Women’s Health. The week serves a reminder for all women to be vigilant of their health and wellness and to make healthy habits a priority for life.
During National Women’s Health Week, we are proud to recognize some of the more under-served issues that women deal with regarding their health. At NovaCare Rehabilitation and Select Physical Therapy, some of our physical therapists who treat women’s health issues have received specialty training specific to the pelvis and pregnancy and provide specialized treatment, education and training to help overcome challenges.
If you or a loved one are experiencing any of the below conditions, physical therapy may be able to help you maximize function, minimize pain and improve overall quality of life. Patients are evaluated by a licensed physical therapist and a personalized plan of care is designed to meet individual needs. Together, we will establish clear goals and begin treatment to help the healing begin in a positive and encouraging environment.
Incontinence refers to the accidental loss of urine, gas or stool. This most commonly happens during a cough, sneeze, laugh or force from exercise (stress incontinence) or with a strong urge to urinate or defecate (urge incontinence). Incontinence is generally caused by weakness of the pelvic floor muscles, whose primary functions include supporting the pelvic organs. Our conservative physical therapy approach includes bowel or bladder retraining, an exercise plan to strength the muscles that support the pelvic floor and non-invasive biofeedback or electrical stimulation, as needed.
Pelvic organ prolapse occurs when one or more pelvic organs (bladder, uterus or rectum) moves out of its normal position, usually in a downward direction, because of weakness of the pelvic floor muscles or pressure exerted downward on the pelvis, e.g. long pushing phase of labor. Usually, this causes a sensation of heaviness or pressure in the lower abdomen or vagina. Guided strengthening of the pelvic floor muscles by a pelvic-trained physical therapist can help reverse early stage prolapse and prevent worsening of symptoms.
Pelvic pain is experienced by many women, but it is not considered normal if the pain persists longer than three months or occurs during sexual intercourse. Women experiencing pelvic pain may also complain of pain (or referred pain) in their hips, back or abdomen. Treatment of pelvic pain by a specialized physical therapist may include exercise to stretch or strengthen muscles in the hips, core and pelvis; relaxation and breathing techniques; hands-on soft tissue work; and, biofeedback for muscle retraining.
Studies estimate that 40 to 50 percent of expectant mothers will experience some form of aches and pain during pregnancy. These pains are often caused by the dramatic changes in posture and increased demand that weight gain and weight distribution can place on the woman’s body. Following birth of the baby, mothers then spend a lot of time bent over, which can cause pain in the back, neck and arms. Physical therapy treatment during or after pregnancy includes education in proper posture and body mechanics, soft tissue manual therapy and muscle strengthening to help manage and treat pain.
Normal urinary frequency is between two and four hours, but some women experience urinary urgency that leads them to urinate more than every two hours or that wakes them up at night. Women’s health physical therapy can assist with bladder retraining and help you take back control of your bladder.
Diastasis rectus abdominis is separation of the abdominal muscles and happens frequently during the later stages of pregnancy. This often resolves on its own in the 13 weeks following birth; however, sometimes the abdominal muscles stay separated and can contribute to poor core strength and back pain. A women’s health physical therapist can help to create a targeted exercise program that resolves the diastasis recti and allows for a return to full activity.
Contact a center near you today for more information!
By: Erin Longhurst, P.T., DPT. Erin is an orthopaedic physical therapist with NovaCare Rehabilitation in Washington, D.C. She specializes in treating women's health conditions, with primary focus on pregnant and postpartum women and women struggling with pelvic pain or incontinence.
Posted on 5/4/2018 by Shannon K. Holman, OTR/L, BCP
There are many amazing children and families that will shape your growth and development as a pediatric occupational therapist. As a pediatric therapist you will not go a day without learning something new, that you will learn just as much from your patient as you expect them to learn from you and that play is the hardest thing you will ever do.
Julian and I met in January 2011. He was about 7 years old and had a shy smile that would melt your heart. He was the “typical” child with autism, presenting with some motor skill challenges, social difficulties and underlying sensory processing struggles. Intervention initially incorporated sensory integration to address organizational skills, regulation and modulation of self, tolerance to transitions and changes in routine, fine motor skills, leisure skills and social interactions. As an additional intervention bonus, Julian’s mother was very organized and dedicated to ensuring her son was engaged in activities that facilitated his optimal potential and functional independence. With this energy behind our intervention strategies, Julian continued to demonstrate growth and gains in all areas, most noted in social and self-confidence. Standard and textbook, Julian was making progress.
In October 2012, Julian, his brother and his mother participated in a hiking activity at Red Rock that went unusually and unexpectedly well. Julian had such a good time that he was eager to share the experience with his father. The family decided they would return to the national park on the weekend, and Julian was looking forward to the outing. Unfortunately, they had forgotten to account for the popularity of the park on the weekends. What had been a quiet day on their original mid-week outing was met with a significant increase in the number of people… and their dogs.
It was in this manner that I learned of Julian’s fear of dogs. A fear that had never been discussed in therapy, as tolerance to animals was not something I thought of as affecting developmental skills or level of independence. I was in for a lesson on occupational profile and performance.
The story unfolds as such: a very excited Julian eager to show his dad his success, a family participating in an ordinary outing, an off-leash dog racing past Julian on the trail, Julian frozen in fear and screaming inconsolably. This led to a mother attempting to console her son, a frustrated father, a sad younger brother and a devastated Julian.
Julian had had dogs in his life as a toddler with no concerns or issues. A recent move had the family now living next door to two very large, loud and out-of-control dogs. Julian was terrified. He no longer played outside, would only exit the house to go to the car while it was in the garage with the door closed and would not go to visit friends if they had dogs. Conflict, anxiety, fear and sensory struggles. Julian had worked so hard and was doing so well and now we were losing ground.
My brain scrambled, remembering lessons on activity analysis, occupational profile and performance and what has value to the patient and family. And then, inspiration hit. Without knowing how or having experience, out from my mouth came the words, “Let’s bring a dog into the therapy sessions.” Mom agreed. Now in all honesty, I had no idea what this would look like, how to make it happen and, most of all, how to get Julian to buy into it. I had some basic knowledge of therapy dogs and had experience with a service dog, but this is the type of moment occupational therapy is made for! Inspiration, creativity, foundation of activity analysis, thinking outside the box and relying on our gut; that is the art and science of occupational therapy. Sometimes the best interventions come from the support of families, trusting your therapy instincts and sheer luck. Our luck just so happened to come with four paws and a wet nose.
Love Dog Adventures is an organization that inspires physical and emotional healing by creating custom protocols for therapeutic and educational animal-assisted interactions. They came to us in late November in the form of Kirby, the dog, and owner, Sue. Both Sue and I had no idea what was going to happen. She trusted I knew the therapy part, I trusted she knew the dog part and mom trusted we knew what we were doing. The all-amazing part, Julian trusted all of us.
Sue and Kirby, a Pet Partners-certified therapy dog, became a part of our weekly therapy sessions. On Julian’s time, we worked toward proximity of the dog, activities next to the dog and touching the dog. With time and patience, Julian progressed from Kirby always having to have his tail end toward Julian to Julian touching and holding Kirby. Sadly, Kirby passed unexpectedly. Together, as a team, we carefully explained to Julian what had happened and, true to childhood understanding, he accepted, grieved and picked up with Kirby’s brother, Benny.
Benny and Julian built a strong bond. Kirby was the introduction, Benny became the story. Julian soared through touch and holding with Benny. He began to walk with Benny, dressed and undressed Benny in his service vest and holiday costumes and could tolerate unexpected movements from Benny. We addressed sensory integration, handwriting, reading, fastener manipulations, spatial awareness and all other typical skills that were a part of Julian’s plan of care. With each passing session, Julian’s self-confidence and skill improved. Verbal skills, self-initiation and empowerment grew. With Sue’s knowledge of her volunteers and their dogs, she continued to match us up to amazing volunteers. In the end, Julian would successfully interact with more than 30 dogs of all sizes, breeds and energy levels, as well as a cat.
Julian engaged in play (ball, toy, treat), brushing, dressing, massaging and walking the dogs, as well as tolerating unexpected movement toward or past him, jumping and barking. He could now engage in community outings, walk with his mother around the neighborhood, socialize with friends in their homes regardless of dog, engage in family outings and entertain the thought of a dog joining the family. Tears filled his mother’s eyes on the day Julian let Benny “kiss” him and the day he fed Benny a small treat.
Eighteen months later, Julian participated in an autism walk with dogs present and on-leash with no concerns. The family again hiked at Red Rock. Mother reported she knew that success had been reached and all was going to be fine when an off-leash dog ran past Julian and Julian’s response was that “they aren’t following the rules,” as dogs are supposed to be on-leash in the park. No screams, no tears, no fear.
The inspiration, art and science that takes play to occupation for a child, the ability to take occupational performance and profile and create a treatment plan and intervention strategies, and the ability to learn what a child really needs is both the challenge and most rewarding aspects of pediatric therapy. But what Julian would forever change in my occupational therapy tool box is knowing that you don’t always know immediately what is important to a child and that you should start with the basics. Activity analysis will apply in all scenarios, so you must trust your skills and knowledge. Sometimes in our quest to facilitate optimal level of independence for a child, we learn what truly has value and importance to a family and their child. I am no longer the therapist who just facilitates developmental, executive function or sensory processing skills. I am a therapist who facilitates the skills for living life to its fullest as defined by child and family.
I leave you with this simple quote from Fred Devito that serves as advice for therapists, pediatric patients and their families… “If it doesn’t challenge you, it won’t change you.”
By: Shannon K. Holman, OTR/L, BCP, center manager of Select Kids Pediatric Therapy in Las Vegas, NV. She has treating experience in cerebral palsy, autism, Asperger’s, attention-deficit/hyperactivity disorder, sensory processing disorder and much more, in children birth to 23 years of age. Shannon is board certified in pediatrics by the American Occupational Therapy Association.