What to Expect At Vestibular and Balance Physical Therapy

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As a physical therapist that treats persons with dizziness and balance deficits, I’ve come to realize that people do not know what to expect when they attend physical therapy (PT) for these issues. Due to the lack of exposure to this treatment and unfamiliarity with how it works, people come to their first session with trepidation and fear. So, let’s see what I can do to clear up some of your queries and give a more clear vision of what will occur in PT.

WHY DO PEOPLE GET DIZZY?

There are so many reasons! As I’ve previously mentioned in an earlier blog post, some of the reasons are:

• Inner ear dysfunction having to do with loose calcium deposits. This condition is called Benign Paroxysmal Positional Vertigo (BPPV)
• Nerve changes in the inner ear, often but not always associated with aging
• Fluid imbalance in the inner ear, called Meniere’s Disease
• Strokes in the part of the brain called the cerebellum
• On rare occasion, tumors
• Concussions

Each of these issues requires a different management strategy. Some are movements meant to shoo the calcium deposits out of the canals, and others are aimed at getting your brain used to, and less responsive towards, dizzying movements. That’s why it’s important to work with both your doctor and PT in an effort to maximize your success and initiate the process of understanding your unique scenario.

Vertibular Physical Therapy in New York CityI GUESS I’LL COME TO PT TO WORK ON MY DIZZINESS. HOW DO YOU KNOW WHAT’S CAUSING IT?

The purpose of the initial evaluation is to better understand the nature of your dizziness. Physical therapists can help illuminate what the cause is and how the symptoms might be made better. The therapist will do an ocular examination, motion sensitivity testing, postural awareness testing, and dynamic balance testing in an effort to tease out the cause and identify the most dysfunctional systems. Included as well is positional testing of the inner ear to identify if there are loose crystalline bodies in the canals. Suffice it to say, people are varied and so too is their dizziness. So the first visit, and maybe the second or third, is aimed at giving a more clear picture as to the nature of the problem.

I HATE FEELING DIZZY. WILL MY THERAPIST MAKE ME DIZZY?

Sometimes. The path to solving a problem means that we might provoke the symptoms to understand the cause. This unfortunately means that, at times, persons will experience their dizziness in PT. It is always my recommendation that a person plans to give themselves a few minutes of rest after their first PT visit, like for example sitting or lying with their eyes closed for 10 minutes prior to leaving the clinic. I also encourage that they don’t attempt to drive for the remainder of that first day. Have a friend or cab driver on standby! The good news is that, once the problem and triggers are understood, the therapist and patient can work together to build a treatment program that allows for progressive and tolerable movement forward into greater life participation and less discomfort. As with all PT, the patient should feel better over time, and therefore the dizziness provoked in the clinic should be gradually less and less.

HOW LONG WILL IT TAKE TO FEEL BETTER?

It depends! As I imagine you’d guess by now, different problems have different time frames of healing. Recovery from a stroke can take months, while some forms of BPPV can improve in one to two visits. It’s dependent on the individual. You’re thinking, “How vague?!” To this I’d respond, “I know!” The key is to get the process moving, and start the work of healing. To that end, I encourage anyone with questions or the desire to live without dizziness to contact your doctor and therapist.

 


Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS, MTC works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (read more)


     

School Backpack Safety

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As “Back to School” shopping begins, it’s important to do your homework to keep your child free from backpack related injuries.

Over 5 thousand emergency room visits a year by kids 18 and under are reportedly due to school backpack related injuries.  A major problem – kids carrying heavy loads in their school bags! Studies found more than half the students surveyed were carrying loads that exceeded the maximum safe weight for kids.  Finding the right sized school bag and teaching your child how to properly wear a backpack is just as important as lightening the load they carry to and from school each day.

TYPES OF INJURIES

A heavy backpack, or one worn incorrectly, can leave your child at risk for injuries like neck, back and shoulder pain. A school bag that is loaded up can significantly load the spine and surrounding joints. Wearing it improperly such as over one shoulder or sagging too low can place added stress on the vertebrae, discs, nerves, and muscles. It can also foster bad posture.

WHEN YOUR CHILD’S BACKPACK DOESN’T PASS THE TEST

If that school backpack is creating some issues, your child may start to complain of different symptoms. They include:

• Pain while wearing the backpack
• Headaches
• Shoulder pain
• Low back or neck pain
• Tingling in arms or legs
• Red marks on your child’s shoulder where the straps are worn
• Stooped posture

backpack safety thrive physical therapy soho nycTIPS FOR WEARING A SCHOOL BACKPACK

• LIGHTEN THE LOAD!  Your child’s backpack should not exceed more than 10 – 15% of your child’s weight (ex: If your child weighs 100 lbs. the backpack should be 10-15 lbs.)
• Wear both shoulder straps that should be padded for comfort
• Waist belts can help distribute and support the load
• The size of the backpack should match the size of the child
• Backpacks should sit near your shoulders NOT above them
• Backpacks should sit in the contour of your low back
(Think of your belly button line and it should not fall more than 2- 4 inches below that level)
• Choose a bag that has multiple compartments. Place heavier items closer to body and lighter ones away. Also keep sharp objects in compartments away from the body
• Avoid placing child’s name on the outside of the bag
• Place a reflector on bag to allow cars to see your child at night

ALTERNATIVES?

To help lighten the load on your kids, speak with teachers to see if there are electronic versions of textbooks available or if you can purchase two textbooks – one to keep at home and the other to keep in the classroom. Some teachers send home lighter pamphlets to complete throughout the week which help avoid students having to lug a heavy book back and forth.

If you think your child is experiencing some discomfort due to a backpack – speak with your physician or physical therapist who can evaluate and determine if that is causing your child’s symptoms.  A physical therapist can also design a strengthening and flexibility program for students to help them tone up for toting those backpacks this semester.

Image above shows Thrive PT Amy McGorry demonstrating the proper way to wear a backpack. Image courtesy of Home & Family on the Hallmark Channel.


AmyMcGorry Physical TherapistAmy McGorry, PT, DPT MTC, is a senior staff physical therapist at Thrive PT in NoHo New York. She received her Bachelor’s of Science in physical therapy from SUNY Stony Brook in 1991 and earned her doctoral degree in physical therapy from the University of St. Augustine in 2011. In 2005 Amy, completed an advanced certification in Orthopedic Manual Joint Manipulation from the University of St. Augustine. In addition to her clinical skills, Dr. McGorry is a freelance news reporter for Channel 12 and contributes medical articles, short videos and slideshows to health and wellness websites. (read more)

     

Who Are Physical Therapists, What Do We Do, and How Are We Unique in the Medical Landscape?

Posted on Posted in All Posts, Let's Get Technical

Hello out there, Thrive loyalists.  To those of you who spend much time inside our clinic, you might find this blog topic odd given your familiarity with physical therapy.  That said, I have many times been asked, by persons I’m in process of evaluating, what IS physical therapy?  I grew up with a physical therapist (PT) as a mom, so for me the idea that one doesn’t know what we do is foreign.  I suppose I’ve always had proximity to the profession.  It has come to my attention that, while I’ve been in and around PT gyms forever, that’s not true for many.  So, I’m writing this to give some clarity to those out there who wonder what exactly we are qualified to do and how we fit into the wellness and rehabilitation realm.

physical therapy cervicalWHO ARE PHYSICAL THERAPISTS?

PTs are, by and large, persons with a passion for PEOPLE, science, movement theory, rehabilitation, and often times exercise.  All PTs graduated in the past 10 years have clinical doctorates (DPTs), making them Doctors of Physical Therapy.  This means that, including clinical internships, PTs go to school for roughly 7 years.  Prior to making the DPT the entry-level degree, persons graduated with a Masters Degree or Bachelors Degree, depending on when they were educated.  All PTs are licensed by our governing body and have to maintain that license with continuing education requirements.  The reason I share this is to clarify that, while there is variety and art in the practice of PT, there is also a rigorous set of scientific standards required to get and maintain a license.  This is good for the patient!  In most states, persons can go directly to an outpatient PT without a physician’s referral.  All this credentialing and schooling is a safeguard for the patient so that you can trust your PT as the first line of defense when you have orthopedic pain, and also trust that they know enough to know when they need to refer you to a doctor.

WHAT DO WE DO?

Lots! In seriousness, you may interact with PTs in an outpatient clinic (like Thrive), a hospital, a cardiac rehab center, and a child’s school.  PTs can specialize in women’s and men’s pelvic floor dysfunction, hand rehabilitation, and lymphedema management, vestibular issues.  We’re everywhere.  At Thrive, you are interacting with orthopedic PTs, meaning we are specialists in the management of musculoskeletal and neuromuscular dysfunction.   What’s that, you ask?  It’s basically any injury or dysfunction that influences the muscles and bones and the creation of movement and/or the coordination of those muscles via the nervous system.  If you’re now thinking, “That seems to cover a lot,” you’d be correct!!  That broad umbrella includes orthopedic post surgical recovery, back and neck pain, muscle and ligament strains and sprains, jaw pain, balance and fall dysfunction, etc.  It’s our passion and goal to return our patients to function, get them back to work or sport or whatever moves them.  We want to see our patients doing what they love without fear of injury or pain.

kinesio taping in room at Thrive SoHoHOW ARE WE UNIQUE?

PTs, by and large, get in the field because we are interested in people.  We talk to our patients, put our hands on them as a means to stretch and manipulate tissue, and problem solve as a team to get them moving.  It is physical and highly interactive work!  It affords us the great privilege of truly knowing the patient and serving as a resource for them.   It is my humble opinion that PTs are expert in not only the management of pain and rehabilitation from injury but also in its prevention.  Rather than coming to Thrive when your back has been hurting for 6 months, imagine the scenario where you come prior to pain for the ergonomic evaluation, stretching program, and hands on re-education that allowed you to function at your best.   I know that, for many, that’s impossible due to time and financial constraints.  So, instead consider coming in when your pain starts…get an early lead on the healing process.  Ultimately, whether you’ve had chronic pain, recent surgery, or want to problem solve out how to return to running after baby, PTs are ready to help you move forward towards achieving your goals!


Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS, MTC works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (read more)


     

Beyond the Nightguard: How Physical Therapy Can Help TMJ Pain

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The alarm clock rings waking you from sleep, you remove your nightguard, yawn, and instead of greeting the new day with excitement, you cringe and grab your jaw. Frustrated with the ongoing pain and soreness in your jaw, you wonder, “Why isn’t my nightguard working?”

jaw pain TMJ TMD physical therapy can helpSuffering from Temporomandibular disorder (TMD) or Temporomandibular Joint dysfunction (TMJ) can be frustrating. But what most people don’t realize is that it takes more than a mouth guard to address the underlying source of the dysfunction. That’s where physical therapy can help.

The Temporomandibular joint – the joint where your jaw and ear meet – can often be the site of pain and discomfort. Think of walking with one shoe on and one shoe off, eventually your back or hip will start to feel stress and irritated from the poor alignment of your joints. The same thing can happen with your bite when your teeth and jaw are not properly aligned. Typically, a mouth guard or bite guard, recommended by a dentist or orthodontist, is used to adjust the bite and jaw to a position that helps relieve some of the pain and discomfort associated with TMJ dysfunction. While a bite guard may provide some symptom relief, a physical therapist can help address the muscle imbalance and joint restrictions that can also contributing to tension at your jaw. This combination can typically help those who suffer from TMJ/TMD issues as well as headaches.

STRUCTURAL ISSUES:

Imagine a stuck door hinge. The door can’t open fully if a hinge is “stuck” or not gliding correctly, nor can your jaw. It needs to glide properly to open and close. A manually trained physical therapist can evaluate your jaw and see how it is restricted. The joints in the upper cervical region (your neck) such as the atlas and axis vertebrae located just below your head, can get restricted from faulty postures or tight muscles. This can affect head, neck and jaw motions creating additional tension. Physical therapy for TMD/TMJ dysfunction includes manual joint mobility techniques to help the Temporomandibular move more easily. During your session your physical therapist will perform gentle muscle energy techniques or joint mobilizations to the neck to help restore proper motion to the vertebra. Soft tissue massage can also be performed, not only to the muscles along the neck and head, but also inside of the mouth. This helps to release tension in the muscles in your cheek near the TMJ.

THERE ARE STRINGS ATTACHED

upper cross lower crossThe saying goes “everything comes with strings attached” and it certainly applies to your jaw and neck. Certain muscles attach to the jaw to help you open and close it. The masseter, the pterygoids and temporalis muscles, among others, all must synchronize to help pull and navigate your jaw as it opens to talk, grind and chew throughout the day. Studies by Vladimir Janda, MD, show that muscle imbalances occur in the body can that affect the head and neck. Janda describes the upper cross syndrome where tightness of the upper trapezius and levator scapula (neck and shoulder muscles) occurs with tightness of the pectoral muscles (chest muscles). Weakness of the cervical flexors (anterior neck muscles) can be present along with weakness of the middle and lower trapezius located in your upper back near your shoulder blades.  This imbalance can create stress to your joints in the neck, and upper back and shoulders. This can all play a role with your posture and the way your jaw sits, opens, closes and the tension in the muscles that attach to your jaw.

 “TONGUE IN CHEEK”

Tongue position can play a role in your jaw pain. It is recommended that you rest your tongue up on the roof of your mouth as if saying “NO” or making a “clucking “sounds.  When your tongue is resting at the bottom jaw level you typically rest with the mouth open and this can “weigh your jaw down” and create tension of the muscles that attach to your jaw. Your physical therapist can teach you tricks to good posture and special exercises to perform gently with your mouth to help stretch tighten muscles and strengthen and stabilize that region fostering proper motion.

INFORMATION TO “CHEW ON”

Practicing stress relief techniques, avoiding difficult to chew foods in your diet and scheduling an evaluation by a physical therapist and dentist can help you address this painful situation. A physical therapist can play an integral part of your TMD/TMJ dysfunction rehabilitation by evaluating your posture and joint mobility. They will also work with you to develop a stretching and strengthening program to help establish a more neutral posture and alleviate stress at the jaw and neck joints.

 

References and links:
https://www.drweil.com/health-wellness/body-mind-spirit/stress-anxiety/breathing-three-exercises/
http://www.jandaapproach.com/the-janda-approach/jandas-syndromes/

Image of man with jaw pain by artur84 freedigitalphotos.net


AmyMcGorry Physical TherapistAmy McGorry, PT, DPT MTC, Received her Bachelor’s of Science in physical therapy from SUNY Stony Brook in 1991 and earned her doctoral degree in physical therapy from the University of St. Augustine in 2011. In 2005 Amy, completed an advanced certification in Orthopedic Manual Joint Manipulation from the University of St. Augustine. In addition to her clinical skills, Dr. McGorry is a freelance news reporter for Channel 12 and contributes medical articles, short videos and slideshows to health and wellness websites. (read more)

     

Instagram Insider: Physical Therapy Session at Thrive PT

Posted on Posted in All Posts, Stay in the Game

This week, on our Instagram, we followed along as Thrive PT Elizabeth D’Annunzio Shah, PT, DPT, OCS, MTC evaluated and treated our aide Katie in our SoHo clinic. Katie is a dancer and presents with hip pain when in the squat or single leg stance positions. We have assembled the Instagram story here for you so you can follow the journey from beginning to end and get a little behind the scenes look at what a physical therapy session is all about.

Evaluations at Thrive are different for each patient, but always begin with an analysis of movement as related to the individual’s specific complaints. Below, her PT Elizabeth is observing her move, palpating the joint, and deciding what to look at next!

While dancing, Katie spends a lot of time in single leg stance.  In an effort to understand her right hip pain, Elizabeth looks at her in single leg stance, both with the right foot moving and right foot down.  She progresses from this parallel stance posture to single leg stance in first position.  It’s always necessary to look at the positions important to the individual!  The teacher has different physical behaviors than the dancer, the architect different postures than the electrician.  As such, all patients at Thrive receive individual attention and are asked to move in ways specific to their lifestyle.

It is discovered that Katie’s left hip is sitting anterior in the joint socket, and Elizabeth chooses to help glide the hip more posteriorly in the supine position.  There are many ways to accomplish this task, both by hands on manual therapy and active exercise.  Luckily, the 45 minute, one-on-one treatment blocks at Thrive allow for creativity and active problem solving between the patient and the therapist.

To the gym!  Katie is on the reformer, doing one exercise of many with an emphasis on folding at the hip joint.  From this parallel position, she moves to first position and then to second position, replicating in supine the postures she dances in daily.  (Of course, our Boomerang version is not as smooth of a movement as in real life, but you get the idea.)

Task specific practice is key!  At the session’s end, Katie practices folding over her left hip with a dance posture she regularly assumes.  She has no pain, and her session’s been gearing towards dance specific movement the whole time.  It is always the goal at Thrive to get our clients back to moving!  We want you to do what you love without pain.  While you might not be a dancer, your movement goal is no less important, and your journey will be no less specific.

We hope you enjoyed tagging along with Elizabeth and Katie on Instagram this week. If you’ve never been to physical therapy, hopefully this story has provided you with an idea of what to expect if you ever need to visit a physical therapist yourself.

Thanks for reading!


Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS, MTC works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (read more)


           

Staff Updates

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Join us in congratulating Thrive PT Elizabeth D’Annunzio Shah PT, DPT, OCS, MTC for passing her exams and becoming an Manual Certified Therapist. She has officially added a few more very meaningful letters to the end of her name.

Elizabeth D'Annunzio Shah Physical Therapist New York CityHere is a little more info about what that means:
The University of St. Augustine is a leader in the physical therapy field in manual techniques for the treatment of orthopedic patients. The university offers the opportunity for professional PTs to pursue a manual certification, during which time they take courses, hone very specific hands on skills, and refine those tools during a 6 day oral, practical, and written testing process. Elizabeth passed this test and is thrilled to be dubbed a Manually Certified Therapist (MTC). She hopes to use these skills to more efficiently and directly assess and treat her patients, and is looking forward to continuing to care for the Thrive community.

YAY LIZ!! We are thrilled to have such a smart and talented team supporting us here in NYC at Thrive.

     

Physical Therapy and Low Back Pain: What The New York Times Didn’t Say

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On February 13, 2017, The New York Times published an article saying to the world what physical therapists have known for years: medication should not be the first line of defense in low back pain management.  Specifically, it recommended “avoiding prescribing opioid pain killers and…that persons should stay active and wait it out.”1   The article further referenced interventions such as yoga, acupuncture, massage therapy, and physical therapy (barely) as strategies to help while the pain runs its course.

I read the title of the article expecting to be thrilled at its content, but found the information lacking a critical component of back pain management.  If we’re merely considering the wait and see method, it is true that pain subsides within 2 weeks for 80% of persons with low back pain.2 It is dangerous, however, to assume that just because the pain subsides that the person is healed.  As per Hides et al., we know that stabilizing musculature of the spine does not spontaneously recover its function following back pain resolution.3 Despite an improvement in symptoms, the person is at greater risk for re-injury without targeted exercise intervention.  That’s why, as we’ve seen play out time and time again, persons with back pain will tend to have pain that returns, each time larger and more severe in duration and intensity.  These persons miss out on work and leisure, and often cannot afford to passively “wait it out.”1

back pain physical therapyPhysical therapists are uniquely suited to help.  We are educated at the graduate level to partner with patients in the treatment of the musculoskeletal system.  It is our job to educate persons on safe exercise for tissue healing and movement correction, and to use our manual skills to improve joint motion.  Studies demonstrate that, for a subset of back pain sufferers that meet specific criterion, including having pain that occurred within the last 16 days, therapeutic manipulation has a 90% chance of reducing pain.4   It stands to reason, then, that the first line of defense in back pain intervention immediately upon onset of pain should be consultation with your physical therapist.  Luckily, all 50 states have some measure of direct access, which means persons can go directly to a physical therapist without a physician prescription.

Back pain, like any other type of injury or illness, does not come out of nowhere.  Often there are habits, postures, faulty exercise, and mechanical patterns that contribute to spinal wear and tear and ultimately pain.  Identifying why one is in pain should hypothetically improve the pain itself and direct an individual to make ergonomic, lifestyle, and exercise change.  Additionally, having a therapist educate one on how to correctly retrain stabilizing spinal musculature makes re-injury less likely.  I applaud the recognition that medication is not the most effective means to encourage healing and should not be our first recourse, but I encourage The New York Times to go further.   We need to educate the public that there are researched, empirical, scientific strategies to assist healing and hasten the return to work and leisure activity available through physical therapy care.  We, as New Yorkers, are notoriously solution oriented and engaged.   Let’s apply this same rigor to include participatory management of spinal pain.
 
Reference(s):

  1. Kolata, Gina (2017, February 13). Lower Back Ache? Be Active and Wait It Out, New Guidelines Say. The New York Times. Retrieved from http://nytimes.com
  1. Paris, S, et al. (2011). S2: Advanced Evaluation and Manipulation of the Pelvis, Lumbar and Thoracic Spine. St. Augustine, Florida: University of St. Augustine for Health Science.
  1. Hides, JA, et al. (1996). Multifidus Muscle Recovery is Not Automatic After Resolution of Acute, First Episode Low Back Pain. Spine, 12 (23), pp 2763-2769.
  1. Flynn, T, et al. (2002). A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine, 27 (24), pp 2835-2843.

Image courtesy of stockimages at FreeDigitalPhotos.net


Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS, MCT works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (read more)

     

Campaigning For Healthier Ribs and Better Breathing

Posted on Posted in All Posts, Stay in the Game

With all the media hype about Democratic Presidential Candidate Hillary Clinton’s walking pneumonia, I felt the need to discuss how breathing, and our ribs, affect certain movements and even our speech!

When reported recently that Hillary Clinton was suffering from walking pneumonia, I had many patients asking me what it was, and how it affected the candidate. Walking pneumonia typically occurs as a result of a lung infection from a bacterial microorganism called Mycoplasma pneumoniae, and of all the types of pneumonia one can contract, it is the least worrisome. Quite often, people who have walking pneumonia don’t even realize they have it and feel like they just have a bad cold. They are rarely bedridden and are able to continue their daily activities feeling a bit “under the weather.

stuck ribs and better breathingThis conversation brings up the topic of breathing, however, and when we think about the act of breathing, it’s important to note the correlation between our ribs and taking a breath. Healthy rib movement is essential, not only for breathing, but for everyday movements such as lifting your arms overhead, or twisting. When an illness like pneumonia, or bronchitis, causes coughing or shallow breathing, the muscles surrounding our chest get strained. Our ribs then can become compromised, making certain movements painful. Breathing and speech can also become altered – certainly not what a political candidate wanting to portray strength and power during speeches wants to deal with.

As the Political Campaigns Roll On- So Do The Ribs!

Different movements require your ribs to roll certain ways. Straightening up, and standing tall to deliver a speech, for example, requires the ribs to move backward. Bending over, or leaning in, to shake hands with voters requires the ribs to move forward. Twisting at the waist to turn and greet voters causes the ribs to rotate in two directions at once. For example, turning the shoulders to the left causes the ribs on the right side to rotate inward and the ribs on the left to rotate outward (and vice versa). Ribs also move in a pumping motion, like a bucket handle, to allow the chest to move in and out as you breathe.

Shallow breathing can cause the muscles around the lower ribs to tighten up. This can cause ribs to “get stuck” out of their proper (aka neutral) alignment. Certain muscles shorten or lengthen to adapt to this new posture, which prevents the muscles from doing their job efficiently. Voice Projection during a speech may be affected as the rib expansion gets compromised. A jarring cough can compromise rib motion in the same way that a harsh hit in football, or an awkward reach for an object on a high shelf can. Endurance may become affected as the ability to take a deeper breath becomes inhibited by tight muscles.

Stuck Ribs and Shallow Breathing Don’t Rock My Vote

Stuck ribs also reduce lung capacity, which can have a big impact on public speaking or voice projection, for that matter. If your ribs aren’t moving properly, you can’t take deep breaths. When we take air into our lungs, the air vibrates as we speak. This produces a power to our voice. Too shallow of an inhale doesn’t allow the diaphragm (a muscle just under your rib cage) to efficiently move air into our lungs. This typically prevents the speaker from sustaining strong speech.

Studies also show that the body’s response to acute stress — sometimes known as the fight-or-flight response — slows down when a person breathes deeply, helping you feel calmer. Injured ribs interfere with deep breathing can therefore inhibit the much needed de-stressing on the campaign trail.

Not to forget, insufficient breathing can also lead to a decrease in the oxygen supply to your muscles, which will leave you feeling sapped of energy.

Campaigning For Healthier Ribs and Better Breathing

A good rehabilitation program can help fix ribs that get stuck out of alignment and help you promote better breathing.  The goal of the following exercises is to strengthen and loosen up the many muscles that affect the ribs, such as the pectorals, serrati, and abdominals.

While a full-blown strengthening and flexibility program is recommended, these at-home exercises can help get you started:

            Belly Breathing

  1. Lie with your back flat on the mat with knees bent and feet flat
  2. Place your hands on your lower ribs
  3. Place tongue up and slightly behind your upper front teeth as if to make the “N” sound as in “NO”
  4. Take a deep breath in through your nose trying to raise the ribs into your hands.  Breathe in for 4 seconds.
  5. Hold breath for 7 seconds.
  6. Now breathe out for 8 seconds through your mouth and breathe out 5 seconds.  Do 4 repetitions

Side stretch

  1. Stand up tall with arms overhead
  2. Lean to one side. Breathe for an added stretch.
  3. Hold 30 seconds. Do 2 repetitions on each side

Side twist on all fours

  1. Get on all fours
  2. Lift your L arm sideways and up to the ceiling.
  3. Turn your head to look at your hand. Breathe!
  4. Hold 5 seconds repeat on other side. Do 5 times.

As always, be sure to check with a physician prior to beginning an exercise program.
 
Image of rib cage courtesy of renjith krishnan at FreeDigitalPhotos.net


AmyMcGorry Physical TherapistAmy McGorry, PT, DPT MTC, Received her Bachelor’s of Science in physical therapy from SUNY Stony Brook in 1991 and earned her doctoral degree in physical therapy from the University of St. Augustine in 2011. In 2005 Amy, completed an advanced certification in Orthopedic Manual Joint Manipulation from the University of St. Augustine. In addition to her clinical skills, Dr. McGorry is a freelance news reporter for Channel 12 and contributes medical articles, short videos and slideshows to health and wellness websites. (read more)

     

Let’s Get Technical: Ankle Sprains

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At some point in your life you may have rolled and sprained your ankle. It’s the most common athletic injury in the U.S. with an estimated 30,000 sprains occurring each year. Whether your sprain is due to tripping in a pothole (my specialty), cutting and pivoting to hit a tennis ball, running, or falling in high heels, it’s essential to completely rehabilitate your ankle to avoid a progression to chronic ankle instability (CAI).

Predisposing factors that can lead to an increased risk of sustaining a lateral ankle sprain include:

• A past history of ankle sprain
• Poor running technique
• Inappropriate footwear
• Tight, weak calves
• Poor hip stability
• Poor ankle balance

Recent studies suggest that a simple ankle sprain is not as benign as previously thought.  Ankle sprains can have a substantial effect on how well and how far we move later in life. Study subjects were shown to have moved less, less well, and with a significant impact on their balance.

In addition to chronic instability, many patients will develop proprioceptive deficits in which they lose some of their ability to sense the position of the joint in space and fire the appropriate muscles. These muscles normally protect and prevent the ankle from rolling over will fire inefficiently, which increases the likelihood of a re-sprain.

It’s estimated that 30% of people who sustain lateral ankle sprains will advance into CAI, involving persistent ankle re-sprains and multiple episodes of the ankle giving way. CAI is believed to be the result of deficits in muscular strength, power and endurance, impaired , and ligamentous laxity.  A large number of these patients can develop post- traumatic ankle arthritis.

Ankle ligaments surround the ankle joints to provide passive stability, fluid motion and balance. They run bone to bone, are highly innervated, and provide feedback to our brains automatically letting us know where our foot and ankle are in space. The most commonly injured ligaments are the anterior talofibular and the calcaneal fibular. Less likely to be injured is the posterior talofibular ligament.

ankle sprainHealth care practitioners use functional and anatomic classifications depending on the severity of the ligament injury that provide a timeline for recovery.

Grade 1: Stretch the lateral ankle ligaments, but the patient is able to walk and can fully weight bear and usually takes 1-2 weeks to recover.

Grade 2: There’s a partial tear of one or several ankle ligaments, functionally one can walk but with a limp and takes 6-8 weeks to recover.

Grade 3: There’s a complete rupture of ligaments, and the patient is unable to walk. Rehab is going to take several months to completely recover, usually 8- 12 weeks.

It’s important to reduce the swelling early on to decrease further overstretch of the ankle ligaments. The RICE protocol (Rest, Ice, Compression, and Elevation) is used in the post-injury phase. A compression ice wrap should be applied 2x per day and the ankle should be protected with either an ankle brace or CAM walker to expedite healing, protect weight bearing, and guard the vulnerable ankle. Thereafter, progressive weight bearing is guided by symptom tolerance.

Physical therapists are mindful of developing appropriate treatment programs to prevent an ankle sprain from becoming the gateway to a continuum of disability. Researchers currently believe that CAI may be due to injury of the nerve receptors around the ankle and weakening of the lateral ankle ligaments following a sprain. If you have sprained your ankle in the past, it’s a good idea to have your balance tested by a physical therapist. Evaluating balance is one method of assessing sensory deficits after injury.

Acute rehab should focus on protection of the ankle ligament immediately after spraining, regaining ROM and initiating strengthening. In the intermediate stage of rehab it’s crucial to restore the sensory motor function of the ankle. A series of progressive balance or proprioceptive exercises should be incorporated. The last stage of ankle rehabilitation focuses on sport specific exercises and progresses strengthening and power to pre-injury levels.

A physical therapist will utilize modalities such as cold laser, electrical stimulation and ice, to control inflammation, manual therapy such as therapeutic massage and joint mobilization, and will structure an individualized exercise program to strengthen and restore balance and agility.

If you twist and injure your ankle consult a doctor or physical therapist about diagnosis, treatment and rehab. Rehabbing with a physical therapist will assure that you are literally back on your feet and more active than ever.

Note: ankle illustration courtesy of praisaeng at freedigitalphotos.net


Tamar Amitay Physical therapist NYCTamar Amitay, PT, MS, Founder and Principal of Thrive Integrated Physical Therapy, is a highly regarded physical therapist recognized within the New York City medical community as a remarkable clinician, diagnostician and healer. Graduating in 1986 with academic honors from New York University she has over 28 years of clinical experience in rehabilitation and outpatient private practice and working at NYU Rusk Institute, JFK Medical Center. (read more)