Your Posture Might Be Affecting Your Shoulder!

Your Posture Might be Affecting your Shoulder!

When being evaluated for shoulder pain, a few things that a Doctor of Physical Therapy usually always looks at is your thoracic spine, shoulder and head position! This is because a forward head, rounded shoulders, and limited thoracic spine mobility may contribute to a common condition called shoulder impingement syndrome.
A study published this April in the Physical Therapy Journal states that individuals with shoulder impingement syndrome exhibited a greater thoracic kyphosis and decreased thoracic extension range of motion when compared to those without SIS in the same age and gender population. Another study published in the Journal of Electromyography and Kinesiology reported a significant association with altered shoulder mechanics in individuals with forward head position and rounded shoulders.
Let’s break this down! Shoulder impingement syndrome is essentially a diagnosis of anterior shoulder pain that occurs when the rotator cuff muscles and soft tissues that run under the acromion, the front of your shoulder, become pinched with overhead shoulder movement. These movements can include reaching for a glass in the cabinet, brushing your hair, or putting your shirt on. Thoracic refers to the upper part of your back/spine, just below your neck and just above your low back. Kyphosis is natural rounding of the thoracic spine; however, it can sometimes be increased or excessive, giving an individual the appearance of a “hump” or rounded shoulders. Thoracic extension refers to the ability to lean backwards through the thoracic spine.
So, while shoulder pain and limitation can be caused by several factors, a good place to start is by looking in the mirror!
If you are experiencing shoulder pain, head into Performance Plus PT for a free Discovery Visit to see of your appropriate for Physical Therapy and let us help you reach for that glass in the cabinet without pain!

1. Donald J Hunter, Darren A Rivett, Sharmain McKeirnan, Lyn Smith, Suzanne J Snodgrass, Relationship Between Shoulder Impingement Syndrome and Thoracic Posture, Physical Therapy, Volume 100, Issue 4, April 2020, Pages 677–686.
2. Charles A. Thigpen, Darin A. Padua Lori, A. Michener, Kevin Guskiewicz, Carol Giuliani, Jay D. Keener, Nicholas Stergiou. Head and Shoulder Posture Affect Scapular Mechanics and Muscle Activity in Overhead Tasks, Journal of Electromyography and Kinesiology, Volume 20, Issue 4, August 2010, Pages 701-709.

Suffer from dizziness or balance problems? Physical therapy can help!

Vestibular physical therapy treatment helps patients manage and overcome dizziness, imbalance, and other vestibular pathologies.

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of dizziness. Symptoms of BPPV may include vertigo (spinning sensation) with changes in head position, dizziness, postural instability, lightheadedness, and nausea1. Symptoms typically come and go, and do not last longer than a few seconds to minutes. Some common causes or triggers of BPPV include head trauma, dental work, or hair salon visits. BPPV is curable by repositioning techniques performed by a physical therapist!
Concussion and post-concussion syndrome can also cause dizziness or balance problems. Common symptoms after concussion include headaches, nausea, neck pain, changes in sleep habits, fatigue, difficulty with concentration and changes in behavior. Occasionally symptoms from a concussion last for months after the injury, a condition called post-concussion syndrome. Vestibular rehabilitation can improve persistent dizziness and balance dysfunction after concussions 2.
A certified vestibular rehabilitation specialist (Cert. VRS) is a physical therapist trained to treat BPPV, post-concussion syndrome, Meniere’s Disease, cervicogenic dizziness, vestibular hypofunction, and other causes of dizziness or imbalance.

1. Lee Seung-Han and Kim Ji Soo. Benign Paroxysmal Positional Vertigo. The Journal of Clinical Neurology 2010; 6:51-63.
2. Alsalaheen, Bara A et. al. Vestibular Rehabilitation for Dizziness and Balance Disorders After Concussion. JNPT 2010; 34:87-93

Chronic Pain and How Outside Factors Can Impact Your Pain

Chronic Pain and How Outside Factors Can Impact Your Pain

Did you know that factors such as stress, lack of sleep, depression, anxiety, financial hardship, relationships or even just a difficult day can result in increased pain and long term chronic pain?
Imagine a glass with just a few drops of water in it. This glass is an example of your tolerance to pain. When the glass is empty, you are far from your next pain flare up, life is going well and you’re in a good place. When you glass fills up, your pain becomes persistent and is at its worst.
Things like stress, anxiety, depression, lack of sleep and worry all act like drops of water filling your glass until finally it reaches its peak. This is chronic, persistent pain.
Thankfully, there are ways to prevent your glass from filling to its brim. There are medical professionals that may be able to assist you with depression and anxiety. Stress relief and stress management techniques are available including meditation and exercise and finally a good night’s sleep can help.
A second strategy is also available and involves increasing the size of your glass. This can be accomplished with slow, steady, progressive exercise, which has been proven to increase your capacity to tolerate pain and increase the size of your glass.
Understanding the factors that fill your glass is the first step to managing your pain and preventing chronic, persistent pain. Give it a try!!

Heafner, J. Hall J. Making Sense of Pain: Stories and Analogies that Help Define Pain. OPTP. 2018; 50.

Delicate Body Parts: Ankle Sprains

How many times have you experienced or heard of “rolled or sprained ankles” that happen on a regular basis? There seems to be a stigma around ankles and their susceptibility to sprains. Many believe it is a normal occurrence and will carry on their entire life dealing with constant “rolled ankles” and never be treated for one. However, did you know that people who experiences multiple ankle sprains throughout their life actually lack a key aspect of awareness that can be addressed by a physical therapist and prevent ongoing sprains?

When someone sprains their ankle for the first time, initial swelling and pain occur with pain intensity being dependent on the severity of the sprain. The body attempts to heal itself and goes through its normal inflammatory healing process. Although this initial phase is good, it has secondary effects that cause ongoing ankle sprains if they go untreated. With inflammation, there is excess fluid in the ankle, this causes the nerve endings responsible for detecting spatial awareness to turn off. When this happens our proprioception and kinesthetic awareness – medical terms that mean knowing where you are in space- no longer function correctly. Because of this, our brain is unable to safely detect where our ankles and feet are in space without looking down. This causes a problem as we shouldn’t walk around looking down at our feet to make sure they’re stepping on flat ground! This not only makes us heavily reliant on our vision for stability which isn’t normal, but also makes us susceptible to accidents because we’re not looking up at our surroundings!

If you or anyone you know suffers from constant ankle sprains, let them know physical therapy can help them out!

Jennifer Santamaria PT, DPT
Performance Plus Physical Therapy
P: (619) 482-3000
F: (619) 482-3001

PPPT Comes to Imperial Beach!!!!

Performance Plus Physical Therapy is excited to announce the opening of our 2nd location in the heart of Imperial Beach. Located at the end of the Silver strand and in close proximity to the communities of Coronado, San Ysidro, National City and San Diego, we are committed to providing exceptional service to the people of the South Bay! We are located at 600 Palm Avenue, Suite 126, Imperial Beach, CA 91932. Hours of operation are M, W and TH from 7am-7pm and T/F from 7am-12pm. Early morning and late evening appointments allow those that are employed the opportunity for therapy before or after work. We accept most major insurances including Medicare, Tricare, VA, Workers Compensation, PPO’s and HMO’s. Cash plans are available upon request. At PPPT, pain is no longer an option. Call or stop in today and decrease your pain, improve your movement and return to the activities you enjoy. We look forward to meeting you!

The Muscles No One Talks About

Did you know that the concept of joint movement being controlled by muscles and ligaments applies to our bladder and bowel movements as well? These activities are controlled by a group of muscles conveniently called the pelvic floor muscles. They sit between the coccyx and the anterior pelvis and have a role in our normal micturition, excretion, and sexual functions. These muscles are susceptible to under or over activity just like any other muscle and can alter the normal flow of our bowel and bladder movements causing incontinence, constipation, leakage, and perineal pain. Dysfunction of these muscles are often seen after childbirth, surgical/traumatic/emotional events, pelvic organ prolapse, and diabetes. More so, pelvic floor dysfunction can be caused by repetitive tasks involving heavy lifting, straining, and advanced age.

Treatment for pelvic floor dysfunction does not have to involve surgery or medications; physical therapists are able to specialize in the treatment of pelvic floor dysfunction and assist those with varying diagnoses stemming from the pelvic floor muscles. Research has confirmed that conservative, physical therapy interventions demonstrate the best possible outcomes for those suffering from pelvic floor symptoms more so than surgical or pharmaceutical interventions. Male or female, there is no reason someone should continue suffering from leakage, incontinence, or pain within their perineum and a Doctor of Physical Therapy is the best professional to help you overcome these dysfunctions and improve your quality of life!

Jennifer Santamaria PT, DPT

1.Bo K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. J Physiother . 2013;59:159-168. (a)

2. Bernards A, Berghmans B, Hove M et al. Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update. Int Urogynecol J. 2014;25:171-179.

3. Bo K, Hilde G, Jensen J, Siafarikas F, Engh ME. Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparious pregnant women. Int Urogynecol J . 2013:24;2065-2070. (b)SOWH PH1B4 Physical Therapy Treatment of Underactive Pelvic Floor Muscles and Prolapse.E Miracle©Section on Women’s Health, American Physical Therapy Association 2016.131

4. Braekken IH, Majida M, Engh ME, Bo K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol .2010;203(2):170e1-7.


Have you received scary MRI results or been told you have degenerative disease/degeneration in your spine?

Have you received scary MRI results or been told you have degenerative disease/degeneration in your spine?

Imaging (MRI) results showing degeneration in the low back are common in asymptomatic individuals (people without pain). Examples of degenerative findings include disc degeneration, disc bulging or protrusion, and facet degeneration. These findings are normal age-related changes (usually unrelated to pain) and are likely an incidentally finding.

Normal MRI findings in the low backs of “pain-free” individuals:

45% of 20-40 year olds
75% of 40-60 year olds
Over 90% of 60-80 year olds
…have disc degeneration

30% of 20-40 year olds
55% of 40-60 year olds
Over 75% of 60-80 year olds
…have disc bulging

25% of 40-60 year olds
Over 65% of 60-80 year olds
…have facet degeneration

Have questions about your MRI findings or what’s causing your low back pain?
A physical therapist can help answer those questions and get you moving again!

Reference: Brinjikji, W. et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Propulations. Am J Neuroradiol. 2015 April; 36(4): 811-816.

Can Your Sleeping Position Affect You Low Back Pain?

Low Back Pain (LBP) is the second most common cause of disability in the U.S. Over 80% of the population will experience a form of lower back pain at some point in their life and one of the biggest complaints that Physical Therapists receive about low back pain is how it can impact one’s ability to sleep through the night.
There are many components that can contribute to low back pain at night such as sleeping surface (mattress quality, mattress pad), pillows, room temperature and sleeping position. Research shows that sleep position can affect the alignment of the spine. Aiming for the proper sleep position can put the body into its neutral, or most natural, body position.
• SIDE SLEEPER: try placing a pillow between your knees. Your knee and hip should be in alignment with each other, so make sure the pillow is not too high or low

• BACK SLEEPER: try placing a pillow or two under your knees. This will put your spine into neutral position.

• STOMACH SLEEPER: try placing a pillow under your hips. This will help take the curve out of your back and put your spine into neutral position.

*Side sleepers can use a regular sized pillow, body pillow, or snoogle which is usually recommended during pregnancy but can be helpful for people with low back pain. For all positions however, the size and thickness of the pillow may vary from person to person based on flatness/density of the pillow. It is best to test out different sized pillows for each position to see which works best for you and your spine.
If none of these positions help relieve your lower back pain after a few nights, schedule an appointment with us at Performance Plus Physical Therapy so our Therapists can help identify the cause of your pain. Other than that, happy resting!

Hydration, Physical Performance & Recovery

With the warmer months rapidly approaching it is important to remember the significance of our daily water intake. Especially combined with physical activity, hydration can play a huge factor in performance and muscle recovery. Approximately 1-2 Liters of water are required to replace obligatory losses for even sedentary adults in a temperate climate. Therefore, almost double that should be consumed for modest amounts of exercise. That means increased activity during sport, a gym workout or even a physical therapy session can further dehydrate our bodies.

Proper hydration can help ensure optimal muscle function and prevent muscle cramps as well as excess fatigue. Along with enough rest, staying properly hydrated can aid in muscle recovery and repair after an injury or workout. Water intake also directly contributes to heat exchange and the demands of body temperature increases with physical activity or environment. This means that when we sweat due to exercise or hot temperatures, we are losing valuable fluids and we should drink extra water to make up for the loss. Studies show that the average male and female should have a water intake of 3.7 and 2.7 L per day, respectively. Although, considering factors such as metabolism, diet, climate and clothing, additional water should be considered for daily consumption.

We also must pay attention to some of the food we eat or the beverages we drink as either helping or hurting our hydration status. When in doubt, enough water can always help meet our bodies’ needs for hydration, peak physical performance, and recovery!

Is Stretching Effective?

Is stretching effective? The short answer is yes! Stretching is practiced frequently here at Performance Plus. However, to completely answer that question we first need to be more precise. What does it accomplish, and how or when should we stretch? Some sources may suggest that stretching is a cure all for muscle soreness, an important step in your pre-workout routine, or aides in increasing ROM (range of motion). These benefits, however, need to be taken with a grain of salt. We will discuss or debunk each of these theories.

Let’s begin with the idea that stretching cures muscle soreness. We all have those days: a couple days after a hard workout, during which we targeted a muscle group that we had ignored for a while. We are sore and seeking relief, when someone suggests a stretch. While it may feel good to stretch a sore muscle, stretching will not actually aide in relieving the soreness. You may develop a tolerance for the pain, but the real reason for muscle soreness is from minute tears in your muscle fibers, which ultimately just need time to heal. Avoid stretching aggressively at this time, as it could do more harm than good by further tearing the muscle fibers.

Next we have the idea that stretching is beneficial –necessary, even – for your pre-workout routine. Do you find yourself doing static stretches, where you hold position for just around 30 seconds? If you do, consider instead warming up in a more dynamic way (if you are physically capable of doing so), such as jumping on a stationary bike for a few minutes. Something light, but enough to get your heart rate up. Stretches will serve you much more effectively after your workout and when done consistently. For the same reason that aggressive stretching should be avoided while very sore, stretching over time will strengthen muscles. As in a dynamic workout (albeit on a smaller scale), stretching contributes to hypertrophy or muscle growth via the minute tears it creates in muscle fibers. Therefore, recovery time is so important for gaining strength.

Lastly, we will tackle whether stretching helps increase ROM. ROM is described as the full movement potential of a joint. Very often after an injury ROM is decreased. While stretching has been long known to increase flexibility, as mentioned earlier, more dynamic stretching will serve you better. It is important to know, especially within a sports setting, that static stretching may temporarily weaken the muscles you are stretching. They will get stronger in the long run, but a quick fix is not found in static stretching. Dynamic stretching, on the other hand, such as squats or lunges, is better backed by science to help increase flexibility, range of motion, and strength.

Remember that stretching is beneficial and effective when done appropriately AND at the appropriate times. Consistency is key. Happy safe stretching!