Hayashida & Associates Physical Therapy

California Needs Your Help!

2012-01-23T21:12:00.000-08:00

As acontinuation of the last blog I want to discuss an important issue that is beingheard in the Senate Appropriations Committee right now! Supporting this bill will help change the waythe public receives health care services to the “new approach” (discussed last week) where the personwith musculoskeletal pain can visit their physical therapist before seeingtheir primary care physician. This wouldallow for immediate treatment if it is appropriate, effectively decreasing theamount of time you are in pain. The physical therapist would refer you to a primarycare physician if your physical therapist thinks it’s warranted. You get referred to a specialist forfurther testing only if necessary.

“SB 924 willallow consumers to be directly treated by physical therapists just as in manyother states.”¹

“SB 924 willstreamline health care delivery, increase consumer choice and reduce costs forconsumers.”¹

“SB 924 willallow patients to go directly to physical therapist, avoid extra co-pays and ifappropriate for physical therapist services, begin treatment immediately.”¹

“Currently, 36states allow patients to directly access physical therapist treatment (17 withunlimited direct access and 19 with some restrictions) and they have been doingso safely for an average of 25 years. In 36 other states, Medicare pays for thedirect treatment by physical therapists before a formal diagnosis is determinedby a physician.”¹

THIS IS NOTTHE CASE IN CALIFORNIA!

In CaliforniaMedicare recipients are denied their equal right to direct access to the samephysical therapy services afforded to patients in those 36 other states.

“Lastly, physicaltherapy education and training justifies clarification and recognition by thelegislature that the profession is qualified to treat patients' impairments andmovement dysfunctions without a formal diagnosis of a disease.”¹

Please callor write the members of the Senate Appropriations committee and show your SUPPORT for SB 924.

SenateAppropriations Committee:

Kehoe(Chair, D) - (916) 651-4039,fax (916) 327-2188 - Click Here for Support Letter Template

Walters (Vice-Chair, R) - (916)651-4033, fax (916)445-9754 - Click Here for Support Letter Template

Alquist (D) - (916) 651-4013,fax (916) 324-0283- Click Here for Support Letter Template

Emmerson (R) - (916)651-4037, fax (916)327-2187 - Click Here for Support Letter Template

Lieu (D) - (916)651-4028, fax (916)323-6056 - Click Here for Support Letter Template

Pravley (D) - (916) 651-4023,fax (916) 324-4823- Click Here for Support Letter Template

Price (D) - (916) 651-4026,fax (916) 445-8899 - Click Here for Support Letter Template

Runner (R) - (916) 651-4017,fax (916) 445-4662- Click Here for Support Letter Template

Steinberg (D) - (916)651-4006, fax (916) 323-2263- Click Here for Support Letter Template

Click here to view a copy of SB 924

Clickhere to view the Legislative Action Center

Allreferences are from the California Physical Therapy Association (CPTA) andCalifornia PT Notes

There Is A Fork In The Road: Which Way Will You Go?

2012-01-12T18:00:00.000-08:00

Let me start off my asking you a question. Would you rather have back pain for 20 daysor 50 days? This may sound like a prettysimple question but our current health care system may push you towards the 50days of pain rather than the shorter time frame. I will separate these two groups into the“old approach” of thinking of treatment for musculoskeletal pain vs. the “newapproach” to treat these symptoms. Thereason these words are in quotation marks is because the old approach is stillvery prominent in our health care system and very few partake in the new approach,especially here in California where direct access to a physical therapist isnot allowed.

The old approach consists of you getting some sort ofmusculoskeletal pain. You may not beable to get in to see a physician for up to 1 month. You finally get to see the general physicianand they send you to a specialist for the body region where you are having pain. That specialist may send you for diagnostictesting such as X-Rays, or a MRI. Afterthis you follow up with the primary physician, the specialist or both. At this time the decision for you to see aphysical therapist is made.

In the new approach you meet with your physical therapistfirst, maybe also seeing your primary physician if your physical therapistthinks it’s warranted. You get immediatetreatment if it is appropriate and get referred to a specialist for furthertesting only if necessary.

So why has the system not changed? Why does physical therapy direct access getdenied every time it goes through congress? It is because the American Medical Association (AMA) has too much tolose in order to change to a new patient-centered system. Physicians can lose out on “initial visits,follow-up visits, diagnostic testing, drug prescriptions... all of those equateto profit”¹

If you like the idea of the new system you can write yourlocal assembly member or donate to CAL-PT-PAC which is the only politicalaction committee in California representing the profession of Physical Therapy. You can donate HERE

Reference: http://blog.myphysicaltherapyspace.com/2012/01/the-back-pain-story.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+EvidenceInMotion+%28Evidence+In+Motion%29

That MRI May Harm You!

2011-12-27T15:20:00.000-08:00

Magnetic Resonance Imaging(MRI) is thought of as the gold standard diagnostic tool for findingabnormalities of the bones, muscles and ligaments of the body. But there are many reasons you should be waryof the results of your MRI in the future.

A New York Times article by Gina Kolata in October 2011commentated on a study where the authors took 31 professional baseball pitcherswho were both injury and pain free and gave them a MRI. The results found abnormal shoulder cartilagein 90% of the athletes and abnormal rotator cuff tendons in 87% of the athletes. Let me reiterate that these were athletesthat did not complain of any previous injury or past or current pain in theirshoulder. Dr. James Andrews, a topsports orthopedic surgeon put it perfectly. “If you want an excuse to operate on a pitcher’s throwing shoulder, justget an MRI.”

In that same month a Journal, Health Services Research, came out with a study titled “TheRelationship between Low Back Magnetic Resonance Imaging,Surgery, and Spending: Impact of Physician Self-Referral Status” The objective of the study was to examine therelationship between use of MRI and receipt of surgery for patients with lowback pain. Many results came of thisstudy but the most ground breaking was that among patients receiving orthopedicsurgery, the likelihood of having spinal surgery increased by 34% if the orthopedic surgeons ownedthe MRI machine. The moral of the storymay be to ask your doctor if he or she owns the MRI equipment or benefitsfinancially from you getting the MRI before consenting to imaging.

In November of 2011 an article by Tim Flynn et. al waspublished in the Journal of Orthopeadicand Sports Physical Therapy (JOSPT). This article, “Appropriate Use of Diagnostic Imaging in Low Back Pain: AReminder that Unnecessary Imaging May Do as Much Harm as Good,” described anMRI as only a picture of a single moment in time. This picture, let us say of a disc lesion,gives us no compelling evidence that the patient will have prolonged course ofimpairment or disability. In simpleterms, the MRI has no way of looking at function.

Below are two MRI images. The first image (A) shows a small disc bulge in the bottom 1-2joints. The second image (B) shows discbulges at multiple levels of the spine with compression of the spinal cord andnerves that innervate the leg.

B - Multi Level Disc Bulges

A - 1-2 Disc Bulges

Now that you have seen those pictures, I’ll briefly tell youtheir story. Image “A” belongs to a 32year old man with a small disc bulge on MRI and this small bulge has lead tosevere back and leg pain which is debilitating. This patient has missed work for multiple months out of the yearsecondarily to pain. Image “B” shows aspine with severe degeneration and multiple disc bulges. This is an image of a 62 year old. This man has no pain and regularly hikes allaround the world as a hobby.

"A"

"B"

Once again we can see that the MRI does not tell the wholestory. Do not let that next MRI harmyou!

References:

1. http://blog.myphysicaltherapyspace.com/2011/11/education-to-avoid-harm.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+EvidenceInMotion+%28Evidence+In+Motion%29

2. J Orthop Sports Phys Ther2011;41(11):838-846, Epub 3 June 2011. doi:10.2519/jospt.2011.3618

What is My BMI?

2011-12-15T21:54:00.000-08:00

When I ask my patients or clients what their height is, Iget a quick response. When I ask themtheir weight I get a hesitated response but I do get a number. When I ask these same people what their bodymass index (BMI) is I get blank stares of uncertainty. BMI is a good and reliable screeninginstrument of body fat for people. Areliable tool is one that actually measures what it is meant to measure. BMI is calculated by comparing weight andheight.

To calculate your BMI you will need your weight in kilogramsand your height in meters. The equationis as follows:

BMI = weight (kg) / (height (m))²

I’ll give you a second to calculate that …

….

Ok, BMI ranges fall into these categories:

· 18.49 or less = underweight

· 18.5 to 24.99 = normal weight

· 25 to 29.99 = overweight

· 30 to 39.99 = obese

· 40 and higher = morbidly obese

Some disparities need to be noted. “At the same BMI, women tend to have morebody fat than men. At the same BMI, older people tend to have more body fatthan younger adults. Highly trainedathletes may have a high BMI from increased muscularity rather than increasedbody fatness.”¹

These numbers can serve as a good guideline for youroverall health. Those who have higherBMIs or are overweight are at higher risk for many health problems involvingthe joints, lungs, and heart. If youfound your BMI to be higher than you expected you should talk to your physicianabout a diet and exercise plan. Exercise,such as the group fitness classes at Hayashida and Associates, has proven tolower BMI while improving overall health. Do I smell a New Year’s Resolution?

1. Anthem Healthy Solutions - 2011 - Issue 01

Get Smart by Exercising!

2011-11-30T18:00:00.000-08:00

That title can be a little misleading. You would be smart to exercise more as thiswould help you stay healthy and physically fit. But a new study shows that you can strengthen your brain with physical exercise. Researchers at the University of SouthCarolina conducted a study where they analyzed cellular activity of the brainof two populations (of mice), those who ran on a treadmill and those who justsat around their cages.

We already know that exercise can help remodel muscles inour body. Part of this remodelingincludes the synthesis of Mitochondria in the cell. This part of the cell floats around and actsas an energy powerhouse to the cell. This in turn makes our muscles stronger and healthier. The researchers wanted to see if the samechanges occurred in the brain.

The group of exercising mice not only performed better ona “run to exhaustion test” on a treadmill but upon studying cells in the brainshowed an increase in the amount of Mitochondria. This is a very important finding. “There is evidence…that mitochondrial deficienciesin the brain may play a role in the development of neurodegenerative diseases,including Alzheimer’s and Parkinson’s diseases.”¹

So get out there and revitalize your exercise program orbegin an exercise program if you have not already started. The physical exercise can potentially sharpenyour thinking, reduce mental tiredness, and decrease your chances of developinglife changing diseases such as Alzheimer’s and Parkinson’s disease.

The smartest thing you could do is beginan exercise programat Hayashida and Associates Physical Therapy Inc. Contact Training@HayashidaPT.comfor more info..

Ref: http://well.blogs.nytimes.com/2011/09/28/how-exercise-can-strengthen-the-brain/#?wtoeid=growl1_r1_v3

My Neck Hurts… So Why is My Physical Therapist Treating My Back?

2011-11-15T21:11:00.001-08:00

Many people will have neck pain at one point in theirlife. It is estimated that up to 50% ofall Americans will suffer from neck pain each year. It is only second to low back pain on thelist of disabling musculoskeletal disorders. Some neck pain is caused by injury such as falls or whiplash injuriesbut the majority of pain in the region is caused by gradual stresses, such aspoor posture, abnormal lifting patterns or awkward sleeping positions. It is common practice in physical therapy formobilizations or manipulations to be used to decrease spine pain and restorenormal movement patterns. Many peoplethat I talk to are uncomfortable having their necks manipulated or“popped.” Luckily for those who areagainst mobilizations/manipulations of the neck a recent study in the Journal of Orthopedic and Sports PhysicalTherapy(JOSPT) shows that mobilizations of the upper back may ease oreliminate neck pain.

This study was actually a review of many past studies inthe area. This type of study is held in highregard because many different factors are considered and only high qualitystudies are compiled for results. Theresearchers looked into studies where patients received upper backmobilizations/manipulations and were then compared to patients who receivedother forms of physical therapy. Theresearchers found that mobilizations/manipulations of the upper back “as partof the treatment resulted in less pain, increased neck motion, and improvedfunction.”¹

Patients in my clinic who prefer not to have mobilizations/manipulationsof the neck can receive these same treatments to the back in order to decreasetheir neck pain while increasing their function. Mobilizations and/or manipulations to theupper back are very safe and may help you feel better faster. Your Physical Therapist can help determine ifyou are a good candidate for this type of treatment. This evidence only further validates thetreatment choices already in place at Hayashida and Associates Physical Therapywhere upper back mobilizations/manipulations have been used often to treatpatients with neck pain.

J Orthop Sports Phys Ther 2011;41(9):643.doi:10.2519/jospt.2011.0506

How Am I Supposed to Workout When I Am So Busy?

2011-11-02T21:08:00.000-07:00

Everyone seems to get all excited about getting their beachbodies in prime condition once the warm weather of the spring rollsaround. But during the fall and wintertime many people complain that they do not have enough time between work,school, fall cleaning, holidays, along with many other daily activities. I know it is difficult as even I amconstantly battling getting to the gym or doing a short run after work. We are often tired, can think of a million thingswe need to do around the house and most of all we would like to justrelax. Below are a couple ideas to getyou motivated, if your physical and mental health as well as weight control arenot big enough motivators.

WORKOUT WITH OTHER PEOPLE – This is a great way to keep ontrack. In the digital age you can evenset up workout plans with your friends or family across the country withFacebook or E-mail. In this fashion youcan post your daily workouts, goals, and progress towards those goals. If you do not post your workouts or do notmeet your goals, everyone will see. Thisis a great motivator. Of course you canalso go the conventional way and join group fitness classes such as the ones atHayashida and Associates where everyone will know when you are missing.

PUT YOUR WORKOUTS ON YOUR CALENDAR – Often if you scheduleit on your calendar you will see it and this can motivate you to followthrough. This will also make sure thatyou do not schedule other activities during this time. Most calendars on computers or phonesnowadays will pop up reminders which will jog your memory (no pun intended)that you need to get working out.

FIND A FORM OF EXERCISE THAT YOU ENJOY – This might be themost important aspect of this whole blog entry. If you choose to run because it is the easiest thing to do and the mostaccessible but you hate every moment of it, you are less likely to do thatactivity. If you enjoy watching TV orlistening to a podcast make sure to incorporate that into your fitness routine.

For those of you who dread your workout each day hopefullythese simple ideas make you look forward to your next workout so that you canstick to a schedule, meet your fitness and health goals, and maybe even catchup on your favorite TV show while you do it. If you need a kick start, come to a FREE fitness class here at Hayashidaand Associates Physical Therapy to see how fun exercise can be.

Reference: http://lifehacker.com/5854874/how-can-i-fit-a-workout-into-my-daily-routine

When Should an Athlete Return to Sport After an ACL Surgery?

2011-09-30T18:29:00.000-07:00

As a physical therapist I am asked this question many times as athletes are always anxious to get back to playing their sport after ACL reconstruction. The answer to this question is becoming more and more important to patients, athletes, and coaches as an increasing amount of athletes are playing for high stakes such as scholarships. The main problem that there is not one answer. Most textbooks will suggest return to sport anywhere between 5 and 9 months after surgery. These numbers don't make me too confinement in telling an athlete that they can begin to play their sport again. Luckily a study recently published in June 2011 in the Journal of Sports Physical Therapy gives us evidence based tools to help determine correct time for return to sport.

The researchers tested athletes on 9 tests that would test a participant's strength and power, both important for return to sport. There were 3 tests that were able to find side-to-side differences between involved and uninvolved knees. The three tests found to be most specific were the single hop, the crossover hop, and the triple hop. The researchers concluded that "the surgically repaired leg should perform at least 90% as well as the uninjured leg before you return to sport."¹

Be sure to visit your local physical therapists at Hayashida and Associates Physical Therapy in order to get the latest evidence-based practice so that you or your athlete can return to their sport as soon as safely possible.

Those With Osteoarthritis Are Often Too Inactive

2011-08-30T20:44:00.000-07:00

For years now health professionals have been advising those with osteoarthritis (OA) to stay active to avoid further stiffness and pain. Even with these warnings a recent study in the journal, Arthritis and Rheumatism, found that only 10% of people with knee OA follow through with recommendations of physical activity. The researchers also found that many of the people in the study did not participate in any form of physical activity beyond their normal essential daily activities.

Recent research has shown that physical activity can increase mobility, reduce pain, and prevent disability in those with OA. Exercise has also shown many other health benefits including improving one's mood.

The researchers in this most recent study placed accelerometers on over 1000 participants to analyze how much people moved throughout the day. They took x-rays of all the participants and found that those with arthritis moved much less throughout the day when compared to those without OA. Some may argue that maybe they did less movement because they were in pain. This is an understandable argument since decades ago people with OA were told to rest but we now know that movement and exercise is more beneficial.

So if you have ever been told by a healthcare professional that you have OA you should begin an exercise program. Exercise programs should start with low-intensity exercises such as small walks or working around the house or yard. Once acclimated to new activities you can increase to more vigorous exercise such as cycling or swimming. "Although it seems counterintuitive to exercise a stiff and painful joint, the evidence shows that moving a joint today is one of the best ways to ensure that it will keep moving tomorrow."¹

Be sure to visit your local physical therapist for an individualized exercise prescription in order to avoid injury.

Reference: http://arthritisselfmanagement.com

Be Prepared for Your Next Round of Golf

2011-08-15T18:16:00.000-07:00

If you were to poll 100 people I would bet that 90 of them would say that golf is an easy sport that does not require a great deal of athleticism or physical conditioning. If golf does not take a great deal of conditioning why is the common trend of current professional golfers to be leaner and stronger? Also, why are there so many golf conditioning classes and books out on the market? The misconception that golf is an easy, leisurely sport has lead many people to injuries; these players are not ready for the sport of golf. If as an amateur golfer, you would spend some time improving your flexibility, core and extremity strength, endurance, and balance you would not only avoid injury but also improve your game.

Flexibility: The key to a golf swing is the smoothness and fluidity of the swing; flexibility of your trunk, arms, and legs will help achieve this. If your hips, back, or trunk are stiff you will compensate with other muscles altering your swing.

Core Strength: After achieving flexibility of your core you need to be able to control it or you can torque your back with each swing and end up with pain before the round of golf is over. Core strength, along with decreasing the chance of injury, will increase your power during your swing.

Extremity Strength: Power also comes for your legs. If your legs are weak you lose stability from the ground up which will make it even harder for you to activate your core. Arm strength, especially in the shoulder, elbow, and wrist is important to drive the ball, generate rotational power, and follow-through at impact.

Endurance: Not many people understand that a round of golf can take more than 5 hours at times. Between walking from hole to hole, swinging every time you approach the ball, and dealing with adverse weather conditions, your overall endurance will dictate how well you play. This is one of the main reasons participation in a conditioning program to increase not only your strength but your endurance is essential.

Balance: This may be an easy thing to deal with when you are on flat ground but there are many times where you will be swinging while standing on uneven surfaces. Having good balance during these times can help prevent hooking or slicing the ball.

As you can see your next round of golf is not just a walk in the park. You must prepare for it in many different ways. Visit your local physical therapist or personal trainer at Hayashida and Associates Physical Therapy. There are many personnel at Hayashida who are TPI (Titleist Performance Institute) Certified Golf Fitness Instructors.

Reference: http://www.allaccesspt.com/patient-education/item/prepare-your-body-for-the-rigors-of-golf

Fibromyalgia and Physical Therapy

2011-07-31T10:49:00.000-07:00

What is Fibromyalgia?

Fibromyalgia is a pain condition which is characterized by chronic widespread body pain, fatigue, and tender points throughout muscles, joints, and other soft tissues. These tender points can be located in the neck, shoulders, back, hips, arms, and legs.

What other symptoms are found in people diagnosed with Fibromyalgia?

--Headaches

--Numbness and tingling in hands/feet

--History of depression and/or anxiety

--Difficulty sleeping

How is Fibromyalgia diagnosed?

It is important to know that the cause of Fibromyalgia is not known but it is believed that there is a change in how the brain interprets pain in the body. Physicians will often diagnose a patient with Fibromyalgia if the patient has had pain for longer than 3 months and at least one of the symptoms from the list above. Along with this there must be at least 11 tender points (out of 18) around the body. Before a formal diagnosis is made a thorough physical examination should be completed to rule out other disorders. Physical therapy is often used to rule out this chronic condition by decreasing symptoms with manual therapy and normalizing body movement.

Once diagnosed with Fibromyalgia how can Physical Therapists help?

Recent research has shown that exercise can help decrease the symptoms associated with Fibromyalgia. "Aerobic conditioning, aquatic exercise, stretching, strengthening ... recreational activities, and manual therapy/or modalities for pain relief have shown to decrease pain and improve function, general physical health and sleep in individuals with Fibromyalgia."¹ The problem is that people with this diagnosis are often reluctant to participate in exercise secondarily to the fear of exacerbating their symptoms. "A Physical therapist can help an individual learn to interpret pain signals, and manage and decrease symptoms through exercise."¹ Physical therapists are healthcare's experts in restoring and improving motion in people's lives. Your physical therapist at Hayashida and Associates Physical Therapy can help develop a individualized treatment program.

Reference: www.moveforwardpt.com

Understand Pitching Mechanics to Avoid Injury

2011-07-02T15:17:00.000-07:00

As baseball becomes more competitive at all levels of the game more and more parents, players, and coaches are worried about the health of the athlete’s throwing arm. “Each year nearly 6 out of 10 young pitchers hurt their elbows.¹ One of the main keys to having a long sporting career is preventing injury. Over the past 10 years guidelines have been put in place at all levels to help avoid injury. These guidelines often work to limit pitch counts per practice, per game, or per week. Recently the Journal of Orthopedic Sports Physical Therapy (JOSPT) added new insight to the forces placed on the elbow and shoulder during baseball throwing.

What did the study show us?

The study of 17 college-level pitchers attempted to look at pitching mechanics during fastball pitching both on and off a mound as well as long distance throwing (>180 feet). The researchers found that participants tended to lean farther forward as the pitching distances increased. The forward lean increased the forces placed at the elbow and shoulder.

My Advice

Flat-ground throws fewer than 120 feet should be used as warm-up or conditioning exercises. Increasing the distance beyond this point can cause injury or inhibit full rehabilitation to a recovering player. Physical Therapists are often touted as “movement experts.” This means that physical therapists can best analyze movement patterns during pitching and can retrain athletes to use safer pitching movement patterns. This makes Physical Therapists the best in the medical profession to “progress pitching in a way that helps recover and to limit future injury.”¹

Reference: J Orthop Sports Phys Ther 2011;41(5):304. doi:10.2519/jospt.2011.0503

How Long Will it Take to Recover from a Total Hip Replacement?

2011-06-12T18:16:00.000-07:00

Each year around 200,000 people decide to have a hip replacement.¹ Most people consider this surgical technique if conservative care such as physical therapy, walking aids (canes and/or walkers), or medications have not helped with pain or functional ability. Much research has been done on total hip replacements which shows decreased pain and increased ability to perform daily activities after surgery. The question that always remains in my patients' heads is, “How long will it take to recover?” Luckily, for the masses of people who have this question, there is new research from the Journal of Orthopedic and Sports Physical Therapy that just came out in April of 2011.

What did the study show us?

The study took 65 patients and followed them through their rehabilitation after total hip replacement. Recovery was measured by seeing how far the patients could walk in 6 minutes along with self reported problems with daily activities. Both measures were taken before surgery and at regular periods after the procedure. The study found that most patients had a rapid recovery in the first 3-4 months after surgery. After this point recovery continued but at a slower rate for up to a year.

My Advice

If you do not see a speedy recovery in the first 3-4 months after surgery or if you stop to see progress anytime during the first year, you would most likely benefit from a physical therapy evaluation to determine what treatment or additional exercise could help your recovery. Other past studies have shown decreased hip strength and increased risk of falls up to 2 years after total hip replacement surgery. The rapid recovery over the first 3-4 months can lead some patients to a false sense of good health and many may stop rehabilitation which can cause problems in the future. “For more information on rehabilitation following hip replacement, contact your physical therapist specializing in musculoskeletal disorders” (i.e. Hayashida and Associates)

Reference: 1. J Orthop Sports Phys Ther 2011;41(4):240. doi:10.2519/jospt.2011.0502

Hands-on Physical Therapy and Stretching Prove Effective for Treating Heel Pain

2011-05-24T18:18:00.000-07:00

The most common type of heel pain is plantar fasciitis. You may have this dysfunction if you have a sharp pain in your heel with your first few steps in the morning. The pain is usually worst when first standing up after sitting or resting and symptoms often decrease as you walk around. It is estimated that 2 million Americans acquire heel pain each year and that 10% of all people will have heel pain at one point of their life.(1) Luckily, for the masses of people who suffer from these symptoms, there is new research from the Journal of Orthopedic and Sports Physical Therapy that just came out in February of 2011.

What did the study show us?

The study took 60 participants with heel pain and split them into two groups. One group did a couple of calf and foot stretches while the other group performed the stretches but also had hands-on manual physical therapy. The manual therapy mainly consisted of hands on techniques to decrease the amount to trigger points or “knots” in the calf and foot. The researchers found better improvements in pain and function in those who were in the manual therapy and exercise group. This suggests that treatment from a licensed physical therapist along with self stretching is more beneficial that stretching alone when it comes to decreasing heel pain.

My Advice

If you have heel pain, a physical therapist can instruct you on the proper stretching techniques to perform. The physical therapist can also determine if you are a candidate for trigger point soft tissue techniques (like the ones used in this study) or other manual therapy procedures. For more information on the management of heel pain, contact your physical therapist at Hayashida and Associates Physical Therapy.

Reference: J Orthop Sports Phys Ther 2011;41(2):51. doi:10.2519/jospt.2011.0501

Exercise Machines That You May Want to Avoid

2011-05-10T20:32:00.000-07:00

There is often a general idea that if you go to the gym and use all the equipment you will have a great workout and avoid injury. This is comparable to going to the grocery store and expecting that anything you buy will be good for you and make you healthy. The grocery store analogy may be a little far off. We instinctively know 2 gallons of ice cream and a bag of potato chips is not a healthy choice and would not be nutritious to consume. But I would argue that roasted unsalted peanuts would be a healthy choice, so everyone should eat them, right? No, many people have allergies to certain foods. The gym is the same way. Many can get away with using whatever equipment in the gym that they would like but this general guide will allow you to make smarter decisions when it comes to your workouts. Some pieces of equipment that I would avoid include:

Seated Leg Extension – This machine does a good job at strengthening the quadriceps (the main muscle group on the front of the thigh). But this machine places increased stress on the patella (knee cap) since it makes you push a large amount of weight when in a disadvantaged position (90 degrees of knee flexion). To obtain good leg strength a better exercise would be doing one-legged body weight squats.

Seated Lat Pull-Down – This will confuse many of my patients since I give this exercise to almost all of them who suffer from neck, back or upper body weakness. The main aspect that is inappropriate with this machine is that in the gym it often forces you to pull the weight behind the neck which can cause neck and rotator cuff (shoulder) problems. This exercise can be completed better with a machine that allows you to pull to your chest. The best way to achieve strength in the upper back and biceps would be to perform body-weight pull ups, if able.

Seated Hip Abductor Machine – Again, my patients are questioning me. I give hip abductor exercises to many patients with back, hip, knee, and/or ankle pain. This machine is supposed to strengthen the abductors (one of the gluteal muscles). My problem is that it does this in a very non-functional position since you are seated. It would be better to place a resistance band looped around your legs and do “lateral squat walks” (sidestepping about 15-20 ft in a partial squatted position).

Squats with Smith Machine – This machine restricts your movement during a squat that is supposed to strengthen your legs and chest. The problem is that the bar is attached to a track which alters normal movements of the body and leads to a linear movement. You body very rarely moves in linear movements. A safer alternative would be to do a weighted or body-weight squat without a rack.

Roman Chair Back Extension – I see many people at the gym doing this exercise with big weights across their chest, all trying to get “strong backs”. The movement of this exercise only places pressure on the spine and increases the risk of damage to the lumbar discs (the structures that are supposed to help with shock absorption for the spine). Other options for this would be the “bird-dog” or “quadruped reach.” Do this by being on all fours (hands and knees) and extend your right arm and left leg making sure your back does not shift or arch. Repeat 10x on each side.

Once again I will jump on my soap box and explain that exercises, like drugs, should be prescribed. Would you go to someone with 3 months of education for a prescription to a drug for your heart condition? This is equivalent to going to a trainer in your local 24 hour fitness and asking them what exercises you should do. See a physical therapist for exercises that are safe for YOU and tailored to what your body needs.

Posture and Sitting Series Article IV: Ergonomically Optimize Your Workspace

2011-04-20T20:37:00.000-07:00

In this article I hope to give you as much information as I can to help you set up your desk, whether it is at your home or office. As mentioned before your posture is a result of how you treated your body over the last 20, 30, or 40 years of your life. If you are like 80% of Americans, you sit 80% of the day whether it is for work or for surfing the internet; if you do this sitting activity incorrectly you will create postural deficits ultimately leading to pain. Let’s break down your desk space and see if we can make some changes.

Mouse and Keyboard:

Most people will take their mouse and keyboard and place it on the desk and think that is where it should be. Also, people like things to be centered and clean (most of the time) and this will make people place the keyboard right in the middle of the desk lined up with the monitor. In reality you should place your keyboard so the alphanumeric part is in the center; do not worry about the added number pad and arrow keys that are often to the right of the keyboard. The “B” key should be right in front of you when you are sitting at the desk. The mouse should be as close to your keyboard as comfortably possible. This will limit the amount you need to reach for your mouse. If you have a keyboard tray make sure the mouse is on the tray alongside the keyboard. The ultimate goal is to have your elbows bent at about 90 degrees when you are using your mouse and keyboard. This will decrease the amount of bend you will have to have in your wrist, decreasing overuse injures such as carpel tunnel syndrome.

Monitor:

It would be best if all of our monitors were adjustable or not attached to our keyboard in the case of the laptop. If your monitor is not adjustable you will need to get creative with books, monitor stands, or wedges to have your monitor in the correct position. There are many do-it-yourself (DIY) websites out there that have information on how you can accomplish this. Your first goal is to have the monitor at an arm’s length away from you. Secondly it is optimal to have your eye level to be about 2 inches below the top of the monitor. Even though this article is about ergonomics it would be smart to follow the advice of an ophthalmologist and look at an object far away from your monitor each 30-60 minutes to help “rest your eyes.”

Desk Height:

I can sit here and explain how each element of your desk should be set up but by the time I was done I would surely have a 20 page informational packet. Measurements of correct height of objects on your desk can easily be found with this informational website. Just enter your desk set-up (sitting or standing) and your height and the website automatically calculates desk height for you. It even gives you information on your chair positioning. Other chair information is to follow…

Your Chair:

You chair should have a pair of sturdy arm rests. Arm rest height is crucial so that you keep the correct length-tension relationships of your neck and shoulder muscles. The height of your arm rests should be at a height where your shoulders can be relaxed and your elbows bent at about 90 degrees. When looking at back rests on your chair you should have it forward enough so that you are not “slouching back” and it gives you support to sit up straight. The back rest should have some sort of lumbar support built in and if this is not the case, a relatively cheap low back support can be purchased online or at many local stores. Your low back should have a slight curve forward and this support helps you keep this position. “Do-it-yourself” (DIY) options are available. You can always roll up a towel and place it on your back rest to help support your lower spine. A semi-soft breathable cushion on your chair will make you feel more comfortable while sitting at your desk. If a cushion is too soft it can make your pelvis sit in an incorrect position which can put extra stress on your low back. When adjusting your seat height you should aim for a position where your thighs are parallel with the ground while your feet are flat on the floor. As you can see there are many different configurations and options for your chair. It is always best to have a physical therapist or certified ergonomist take a look at your setup. The information here is only a general guideline to your workstation.

General Rule:

You could have the best, most expensive, perfect set up and still fail when it comes to sitting correctly at work. The most important piece to the puzzle is your brain. It is imperative that you recognize how you are sitting at your desk and constantly fine tune your posture. The human body is an amazing “cheater”. Your body will find a way to slouch at your desk no matter what kind of equipment you have. Set an alarm on your watch, computer, or calendar to remind you to think of your posture every 20 minutes so that you can correct any problem areas that may have arose when you were busy typing an email or talking on the phone. It is also a good idea to get up every 40 minutes and take a short walk. Patients always tell me “I can’t just get up and walk around; my boss would fire me.” I can understand this. At the very least you should stand up every 40 minutes to “re-set” your body.

As you can see there are many factors to think about as you begin to change your desk setup.

If any major problems arise or you need professional help with your set-up be sure to see your local physical therapist for the proper set up or treatments if necessary.

Reference: http://lifehacker.com/#!5755870/how-to-ergonomically-optimize-your-workspace

Posture and Sitting Series: Article III – How to Correct Your Posture

2011-03-20T13:50:00.000-07:00

As we have been talking about your posture we can see how prolonged sitting especially with poor posture can lead to aches and pains in your legs, back, shoulders, and neck. It can be hard to change these seated and standing postures; the way you sit or stand today is a product of years of incorrect muscle use. The key is to be in positions that decrease the strain put on your body. "Good posture involves training your body to stand, walk, sit and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities."¹ Lets look into a couple ways we can do this.

The first key is to understand what needs to be changed. This is hard to do. It is difficult to see your posture and to be able to understand how it may be leading to your aches and pains. The best way to understand changes would be to see a physical therapist for a biomechanical screen and receive a prescribed treatment plan. Others may be able to have their friends or family observe their static or dynamic posture.

I will break down my advice by first looking into standing posture and then educate you on sitting posture.

STANDING POSTURE

While standing your shoulders should be slightly back. Many people have the tendency to lean forward. While standing place your hands in your front pockets. Feel how your shoulders start to gravitate forward; this position will lead to strain on the shoulders, neck and chest. We should also have our feet at about shoulder width apart.

SITTING POSTURE

While sitting we need to make sure that we have support to our low back (commonly referred to the "small of your back"). When your low back is in the correct position the rest of your spine will line up correctly. Secondly make sure that you don't begin to gravitate towards your computer screen, this will place increased stress on your shoulders, upper back, and neck. Make sure to keep your eye level even with the top of your monitor.

As mentioned before seeing your physical therapist is the optimal way to make changes to your faulty posture. Your physical therapist can use passive techniques to correct your posture including the use of McConnell® or Kinesio® Taping techniques. An extensive and personalized exercise program can be prescribed to help with your postural problems. Along with this, your physical therapist can apply manual techniques to loosen your stiff joints, stretch your tight muscles while strengthening your weak ones. Many people think this would be the job of a Chiropractor, but many chiropractors do not address the muscles and will not give out preventative exercises, so their patients will need constant care to feel better.

1. http://lifehacker.com/#!5732064/how-can-i-improve-my-posture

Posture and Sitting Series: Article II – Sitting Too Much May Kill You

2011-02-27T17:59:00.000-08:00

Posture and Sitting Series: Article II – Sitting Too Much May Kill You

As we have pointed out many times in this blogs history, it is important to meet certain requirements in order to be considered an active adult. We can recognize that if a person is to work out for 45-60 minutes each day they receive many health benefits including but not limited to controlling weight, decreasing blood pressure, and relieving physical and mental stress. But the question that remains is "What are you doing the other 14-16 hours of the day?"

In the past we used to judge ones fitness level strictly based on the amount that they worked out. "In simple terms, if you were exercising for 60+ minutes/day, you were considered physically active. If you were exercising 10 minutes/day, you were sedentary."¹ And by association those who were physically active where healthy and those who were sedentary sat too much throughout the day which made them unhealthy. But in the true meaning, sedentary means any time that you are sitting. So that person that is working out 60+ minutes/day may be sedentary if he or she is sitting for the other 16 hours of the day. "Thus, to quote researcher Marc Hamilton, sitting too much is not the same as exercising too little."¹ This is a very important statement.

Multiple studies have shown that sitting too much, disregarding the amount of physical activity one gets can kill you. A study by Katzmarzyk et al. (2009) showed that those patients with common illnesses who sat the most throughout their day were 50% more likely to die upon follow-up even when controlling for many factors such as smoking, age, and physical activity levels. Another study by Genevieve Healy et al. (2008) found that "The greater the number of breaks taken from sedentary behavior, the lower the waist circumference, body mass index, as well as blood lipids and glucose tolerance."¹

Many more studies on this subject can be found at Scientific American.

Now just sit there for a second (no pun intended) and think about your daily activities. Let me guess, you sit most of the day. You are not alone, western society sits most of the day, it's how our lives are formed. We sit at work, sit in our car, sit to read and write emails, and I bet your are sitting right now to read a blog on how sitting too much can kill you. So for now, get up and move around. You life depends on it.

1. http://www.scientificamerican.com/blog/post.cfm?id=can-sitting-too-much-kill-you-2011-01-06

Posture and Sitting Series: Article I - Avoid Computer Hunch

2011-02-07T16:47:00.000-08:00

In the upcoming months I plan on bringing you a series of blog entries focused on how sitting and posture can affect your body and health. Many patients who I see in the clinic could have avoided their injuries and/or dysfunctions if they would have listened to their elders who always preached “sit up straight.” The majority of the population sit for prolonged periods of time either for their job or to unwind in front of the television. While we are sitting or standing many of us have incorrect posture which increases stress on our joints leading to degeneration and pain. So stay tuned over the next couple months for all the information you can handle on sitting and posture corrections. As with any exercise program make sure to talk to your physician or physical therapist to be cleared for these types of exercises.

Step 1: Avoid the dreaded “computer hunch”

You just adjusted your posture didn’t you?” Whether it’s your primary task at work or your favorite way to pass the time, hunching over the computer can cause a gamut of hip, back, neck, and shoulder problems. I myself sit at the computer to do patient documentation and then sit longer to do online shopping, read the news and write blog articles for you. It takes a lot of will power to maintain good posture during all of this; completing some relatively easy stretches throughout your day will help avoid “the hunch”.

1. 1. Shoulder Blade Squeezes – This exercise will help avoid having “rounded shoulders.” Sit up straight, engage your abdominal muscles as if you were bracing for a punch. Make sure your shoulders are relaxed and that your shoulders are not shrugging up to your ears. Squeeze your shoulder blades together and down. Hold for 5 seconds. Repeat 10x each hour.

2. 2. Chin Tucks – This exercise will help reduce “forward head posture” where your head is sticking forward toward the monitor; this posture can increase strain on the neck. Tuck your chin straight back as if you were making a double chin. Hold for 5 seconds. Repeat 10x each hour.

3. 3. Wrist Circles – Ok, this one won’t correct your posture but it will keep you from getting stiff in the wrists and decrease your chance of getting a repetitive use injury. Turn your wrists in one direction 10x, repeat in the other direction. Repeat every hour.

4. 4. Chair Twist – Begin by sitting in a chair with good posture (looking straight ahead and with your chest up). You back should be against the back rest and you should be sitting "tall". Reach with one arm around you to the back rest. In this tall posture twist using your arm to help you pull. Hold for 20 seconds and then repeat on the other side. Repeat this for both sides every hour.

5. 5. Back Extension - Standing, place your hands on your lower back. Squeeze your gluts (your bottom) tight to stabilize your pelvis and then lean backward. Only go as far as is comfortable and not into painful ranges. Hold for 5 seconds and repeat 5 times every hour.

It is important to do these exercises throughout the day if you are sitting at a desk. It is recommended that you perform these exercises for 5 minutes for every hour that you are sitting in your desk. If any pain or complications should occur make sure to talk to you physician or physical therapist before continuing.

Reference: http://lifehacker.com/#!5715136/avoid-succumbing-to-computer-hunch-posture-with-these-easy-stretches

Should I Exercise When I Have a Cold?

2011-01-27T18:08:00.000-08:00

More and more people I have come into contact with this past week have been coming down with colds or other seasonal illnesses. Now I know we have talked extensively in previous posts that exercise can reduce the risk of getting sick but are there times where we should stop exercising secondarily to having a cold? The die-hard runners would say that running helps them feel better and gives them more energy. This is because exercise can help increase the release of endorphins which are chemicals that help you “feel good”. But are you prolonging your sickness by working out? Here are a couple tips on when you should avoid exercising and when it is okay to partake even when battling a cold:

Generally it is okay to continue to workout if your symptoms are above the neck. The “neck check” includes¹:

· Runny nose

· Nasal congestion

· Sneezing

· Sore throat

In other cases where you have symptoms below the neck it advised that you hold off from your exercise regimen. The “below the neck check” includes¹:

· Chest congestion

· Hacking cough

· Nausea or upset stomach

· High fever

· Fatigue

· Body and muscle aches

Working out with congestion in your lungs or with a fever can exacerbate your symptoms. On the other hand the endorphins released from cardiovascular workouts can actually help reduce nasal and head congestion. Be smart about your exercise routine; workout to reduce the chance of getting sick but be sure to know when to stop as well.

Reference: http://adventure.howstuffworks.com/outdoor-activities/running/health/run-when-have-cold.htm