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.

References:
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
jennifer@performanceppt.com
P: (619) 482-3000
F: (619) 482-3001

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.

———————————————————————-

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!

The Great Debate: Ice vs. Heat

It has long been debated whether ice or heat is better to treat pain. A study published by Garra G et al. in 2010 researched the efficacy of heat and ice in treating neck and back pain, concluding that both treatments provide mild relief. According to this study, the best option is whatever the patient feels most inclined to try. Especially in low back pain and neck strain, people are more likely to want heat, so they achieve relief simply by satisfying that need. “The only real leverage hot and cold packs have is on our nervous system — alarming or relaxing, soothing or irritating — and that in turn is strongly determined by context and how we feel about it.” To elaborate, heat is often thought of as comforting, or with a relaxing element. A hot pack therefore does not tend to “alarm” the brain, as would an ice pack being placed onto someone’s bare back. One may think of going to a spa for a full body massage, where warm oils or heated rocks are used as part of the treatment, thus garnering the correlation of heat to being soothing. Versus the shocking and breath-taking element of, say, the “ice bucket challenge” in which thousands of individuals poured freezing ice water onto themselves.

The bottom line?

• Ice should be used to reduce areas of inflammation and for acute injuries.
o The key characteristics are redness, swelling, pain, and warmth.
o To counteract this heat and reduce the swelling, ice is most often used as the initial treatment for soft tissue injuries such as sprains and strains.
o Soft tissue injuries, or STIs, are damages of muscle, ligaments, and tendons.
o Heat will make inflammation worse and will lead to more pain around injury site
o Ice can be applied using an ice pack covered by a cloth, never directly onto the skin in order to avoid further tissue damage.

• Heat is best to relieve tightness, tension, pulled muscles, and chronic pain
o May be better for chronic pain to give temporary relief
o Chronic low back pain, for example, welcomes heat therapy much more than it would ice.
o Chronic pain, stiffness, and soreness can be treated using heat because heat helps the muscles relax, which then improves blood circulation and reduces muscle spasms.
o Heat also treats trigger points. While they are not complete muscle spasms, they are tiny muscle cramps, which tend to be aggravated in the cold. These sensitive areas of soft tissue are likely what individuals are referring to when they mention a “knot” in their neck, for example.
o Heating pads use dry heat and steamed towels use moist heat to provide the soothing heat. Paraffin wax is used to relieve pain, most commonly as a hand dip for those with arthritis.

And why not both! Introducing contrasting therapy:
• Contrasting therapy act of the immediately switching between heat and ice to make muscles more adaptable to changes
o Contrasting therapy is a quick solution mostly used with athletes looking to recover from a competition and get back in game.
o Easy and cheap solution – little risk of harming the muscles, as it allows your muscles to work out, due to the stimulation of the contrast, without the stress of a physical workout.

 However, more research needs to be done
Ultimately, it is best to use “whatever feels best”
o “Ideal uses of ice and heat are roughly equal in potency” (Paul Ingraham, PainScience.com)
o Using ice when already cold can lead to more muscle tension, and using heat when the body is already hot may shock the body
o When individuals change their mindset from believing that heat is a cure-all for any and all chronic pain, they may find that ice is able to soothe them as well.

References:
Garra G, Singer AJ, Leno R, et al. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Acad Emerg Med. 2010 May;17(5):484–9. PubMed #20536800.

“Did you take a weekend course to become a Physical Therapist”

I am often asked “do you have a certificate to practice physical therapy?” or “did you have to take a weekend course to do this?” I can’t help but chuckle and remind the patient that they are in good hands and in fact, most licensed Physical Therapists now hold a doctorate degree. To be clear, the profession has evolved over the years and at one time a bachelor’s degree was the norm. Next came a master’s degree and currently most accredited universities offer a doctorate degree. A Physical Therapist now completes roughly 7 years of education. All Physical Therapists complete a rigorous doctoral program and are equipped to begin to treat patients. However, Physical Therapists vary in their skill sets, post doctorate educational levels and certifications as well as experience. We highly recommend you seek a licensed Physical Therapist that performs hands on, manual physical therapy and holds a Board Certification or regularly participates in continuing education. Do your homework and don’t be afraid to ask about your therapist prior to your evaluation. Like any profession, therapist vary greatly in their experience, techniques, skill level and of course personality. Find a therapist that you connect well with and most importantly feel comfortable with. It may help to ask to have a brief phone conversation with your potential therapist to get an idea if he or she is the right fit for you. At PPPT, we will gladly jump on a phone call with any potential new patient. We feel it’s also important on our end to assure the patient that their condition, or complaint is something we can handle. We understand that physical therapy may not only be a financial commitment, but also a time commitment and it is important that the patient understand the value of what they will be receiving prior to committing.