STAY IN THE GAME: KNEE PAIN WITH RUNNING

Posted on Posted in All Posts, Stay in the Game

knee pain in runnersRunning outside is a great way to stay in shape right now, for endless reasons. It will allow us to get fresh air, enjoy nature, boost our immunity, improve cardiovascular health, while also allowing for social distancing. However, we need to be able to manage and prevent injury at the same time.

Knee pain is one of the most common symptoms with running and accounts for about half of running-related injuries. If you are a runner who is experiencing knee symptoms or you are a runner who wants to prevent future injuries, there are several ways you can reduce impact or load on the knee joint.

One of the most common causes of movement impairment in running is lack of control or strength of the hip extensors, which can ultimately lead to knee pain. In order to facilitate use of the hip extensors and reduce demand on both the knee and quadriceps muscle, we can slightly increase our trunk flexion angle to 8-10 degrees. In a research study by Bonacci et al in 2013, they found increasing trunk flexion angle by 7.2 degrees resulted in 140% higher hip extensor energy generation in addition to a decrease in quads energy generation and absorption. Another reseach study in 2014 by Teng and Powers showed that a 10 degree greater trunk flexion angle also resulted in decreased peak stress on the patellofemoral joint.

We can also reduce forces on the knee during running by increasing our cadence. Bryan Heiderscheit et al (2012) found that increasing cadence by 10% can significantly reduce loading to the hip and knee. There are several metronome apps that you can use to record your current/preferred cadence, and you can gradually train yourself using a metronome in order to increase your cadence and make a permanent change. I would recommend trying the “fixed tempo” feature on the Weav Run App, which will play music that will guide you to run at a specific cadence of your preference. You can also keep it simple by recording your cadence using a Metronome App.

If these methods don’t work for you, we can also retrain your gait pattern from a rearfoot or midfoot strike pattern to a forefoot strike pattern. Research has shown that average load rates are reduced by 60% in forefoot strikers and lateral forces are reduced by 55% (Samaan et al 2014). A study by Wearing et al in 2018 also showed that habitual forefoot strikers have stiffer Achilles tendons, which are more resistant to injury.

These small changes in our running can create substantial improvements in symptoms as well as prevent future injuries, while also allowing us to stay active and healthy!

We currently offer running assessments at Thrive where we would watch you run in order to determine what type of motor pattern you are using and whether it is efficient or not. In combination with objective measures including functional task assessment, driver testing, muscle tests, and special tests we can create an individualized treatment plan for you with the goal of improving your form to prevent future injury and/or treat a current injury.

For more information on scheduling and insurance, you can email info@thrivept.com or submit your insurance information through our online portal HERE.

 


Morgan Locker, PT, DPT, MSCS, OCS, LSVT BIG Certified Clinician physical therapist NoHo NYC

Morgan Locker, PT, DPT, MSCS, OCS, LSVT BIG Certified Clinician, utilizes a combination of driver testing and functional movement analysis to specifically diagnose the cause of her clients’ symptoms. Her treatment approach includes a combination of manual therapy techniques and movement re-education in order for her patients to achieve symptom-free, optimal function.  Morgan is an adjunct faculty member at Dominican College’s Doctorate of Physical Therapy program, and she is currently pursuing a manual therapy certification through The North American Institute of Orthopedic (read more)

 

     

STAY IN THE GAME: Addressing Hip Pain with Physical Therapy

Posted on Posted in All Posts, Fitness, Let's Get Technical, Stay in the Game

 

Hello to the Thrive Community,

I’d like to bring some attention to one of my favorite parts of the body: the hip. The hips are a ball and socket joint that consist of the pelvis and femur, which is your thigh bone. As New Yorkers, your hips carry the responsibility of weight bearing during many of our daily activities, such as walking, running, or climbing stairs when taking the subway. Much like the other 250+ joints in our body, the hips are well supported by a number of ligaments and muscles to provide stability and mobility, respectively as we move.

treating hip pain and dysfunction in NYC with physical therapyEven with ligamentous and muscular support in place, the hip is a common area that is susceptible to pain and irritation. While there is no singular explanation for hip pain aside from direct trauma, we can point to a myriad of different causes associated with pain, such as faulty movement patterns, imbalances within the body due to underlying muscle weaknesses, or abnormal joint motion within the hip or neighboring areas of the body, such as the low back.

Hip pain or dysfunction can develop gradually over time, at times without awareness of our own deficiencies, until it starts to affect or alter the way we move. Case in point, over the course of the past year, I opted to use my time at home to partake in online high intensity interval training, which included different variations of squats. Within the exercise routine, I’d notice some discomfort along the front of my hip and an unsteadiness between my right and left leg, especially when performing high dynamic movements like a split squat. Following self analysis and a breakdown of my movements, it was apparent that I was experiencing possible hip impingement due to a lack of hip rotation range of motion and inefficient hip stability. I pivoted from my HIIT exercises to focus on restoring mobility in my hips while also retraining weakened hip muscles responsible for stability. A few weeks later, with improved joint motion and stronger supporting musculature, I felt more balanced and painfree when restarting my HIIT exercises.

As a physical therapist at Thrive, I see individuals with varying degrees of hip issues, such as hip bursitis, hip impingement, tendinitis, or arthritis. When it comes to treating some of these common diagnoses, much like I did on myself, it is essential to see how people move through movement analysis. With this initial step, I look for uncontrolled motions that are occurring, and the possible “driver” of your symptoms. The “driver” is the root cause of your hip issue that could stem from inflamed nerves, joint or soft tissue restrictions, or possibly poor muscle recruitment that is essential for optimal movement. Once we find the underlying cause, it will direct the treatment approach designed specifically for you. We can implement a combination of manual techniques, in the form of joint mobilizations or soft tissue release, and follow-up with specific exercises to strengthen underutilized musculature to retrain the body in order to re-establish a sound and efficient movement pattern.

For more information on scheduling and insurance, you can email info@thrivept.com or submit your insurance information through our online portal HERE.

 


Donny Chan Physical Therapist New York CityDonny Chan, PT, DPT, MSCS, CKTP, LSVT BIG Certified Clinician, utilizes a biomechanical assessment along with functional movement analysis to uncover faulty movement patterns in order to determine the root-cause of a client’s symptoms. His treatment approach incorporates manual therapy techniques and neuromuscular re-education to retrain areas of injury to restore optimal health and function to each client…(read more)

 

     

WHAT IS THE PELVIC FLOOR, HOW IS IT ADDRESSED IN PHYSICAL THERAPY, AND WHY YOU SHOULD CARE?

Posted on Posted in All Posts, Let's Get Technical, Reproductive Health, Take Control of Your Health

Hello Thrivers,

I’m writing today to clarify what it means to get “pelvic floor PT.”  It has come to my attention that people believe this is a service that applies only to postpartum persons seeking to stop urinary leakage.  And while that is certainly a reason to come to physical therapy, it is only a narrow facet of how PT can address pelvic floor dysfunction.  So, the intent of this missive is to offer clarity on what qualifies as pelvic floor dysfunction and when to seek care from your physical therapist.

First, “pelvic floor PT” is a flawed term.  Physical therapists are movement scientists trained to care for a body in motion.  We use our collection of skills to address dysfunctions in motor control, range of motion, strength, etc. with the intent to enhance function and improve our patient’s participation in society.  The pelvic floor is a group of muscles that, like every other muscle, contributes to our ability to function and participate in our chosen activities.  It is not divorced or separate from the rest of the body…we are not disembodied floating pelvises.  However, a physical therapist does have to train for enhanced examination and treatment skills to treat the pelvic floor.  Therefore, when you go to “pelvic floor PT,” you are really just seeing a physical therapist who has a collection of skills that allows them to integrate into the whole the assessment and treatment of the tissues of the pelvic floor.

pelvic floor physical therapy nyc
Pelvic Floor model by Marie Josee Forget (www.totalpelvichealth.ca)

As pictured, the pelvic floor consists of three layers of musculature.  These muscles do the following:

– Maintain bowel and bladder continence

– Allow for bowel and bladder evacuation

– Enhance sexual appreciation

– Support the organs of the pelvic basin

– Act as part of the postural core support mechanism

Given what we now know of the role of the pelvic floor muscle network, it would make sense that dysfunction could vary widely in presentation and that the avenues for treatment equally as numerous.  Direct dysfunction of these muscles can contribute to loss of bowel/bladder control, constipation, urinary and bowel urgency/frequency, pelvic pain, diminished sexual appreciation or pain with intercourse, pelvic organ prolapse, and lumbo-pelvic-hip control issues.  Additionally, these tissues are influenced by infection, hormonal changes across the lifetime, history of trauma, pain states, pregnancy, nerve injury (both peripheral and central), autoimmune disease, and much more. That is so much more than (but inclusive of) postpartum leaking!!

At Thrive, we care for persons with the following issues related to the pelvic floor:

– Urinary urgency/frequency

– Bowel urgency/frequency

– Bowel or bladder incontinence

– Bladder Pain Syndrome

– Chronic constipation

– Pelvic organ prolapse

Birthing preparation for the pregnant patient

Return to activity participation for the postpartum patient

Diastasis recti management

– Chronic pelvic pain

– Pain with intercourse

– Low back pain

– Hip pain

– Coccyx pain

As you can see, the list is varied and long.  You might also notice that the symptoms listed above might reasonably apply to LOTS OF PEOPLE!  Therefore, the question is less, Who is appropriate for PT with pelvic floor treatment? but rather, Who isn’t?

If you are interested in treatment options for any of the above conditions, please contact the office at info@thrivept.com or submit your insurance information and appointment request through our secure online portal by clicking HERE.

 


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. (more)

 

     

LET’S GET TECHNICAL: DRIVER TESTING, WHAT IS IT, AND HOW CAN IT HELP ME?

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

driver testing at Thrive Physical Therapy in downtown New YorkHave you ever experienced pain that either came out of nowhere or started immediately after a traumatic injury? Most people can respond YES to that question. Have you ever had physical therapy treatment for those symptoms, and was your physical therapy experience effective?

At Thrive, all of our therapists are trained in DRIVER TESTING, which is a unique approach that we use to figure out the root cause of each individual’s pain. Our method has been very successful in returning our patients back to their prior level of function, whether that’s being able to sit at a desk to work for 8 hours or being able to return to exercise or sport.

First, we have our patients perform a functional task that’s meaningful to them- and that can range from standing up from a chair, going down stairs, walking, running, Lotus position in yoga, doing a grand plié in ballet, etc.

During our functional task assessment, we look for areas of uncontrolled movement or a give.

Is the person’s knee giving inwards when they perform a squat due to a muscular imbalance at the hip? Is the person limited in motion at their ankle from a previous ankle sprain, which is leading to poor biomechanics at the knee?

We find the area that is moving too much or not being controlled well by certain muscle groups, and we retrain the muscular control or strength in that area to prevent that excessive movement. In the case of patellofemoral pain, we would retrain the core stabilizers of the knee, the Popliteus and Vastus Medialis Oblique.

We also find the specific areas of restriction that are leading to that excessive motion; we call this driver testing. When a joint is restricted, the body likes to compensate and adapt by moving more at other joints. For example, you can have a restricted hip joint and muscle imbalance at the hip that’s causing an excessive lateral glide or compression to the patella during activities that involve bending your knee. Maybe there are trigger points or knots in the quadriceps muscle or TFL, which need to be released and stretched in order to restore length in the muscle and improve mobility at the knee joint.

Habitual postures can also lead to muscle imbalances. A person may be sitting at their desk all day slouching forwards, which can lead to tight hip flexors and lengthened/weak glute muscles. Tight hip flexors can lead to a lack of hip extension range of motion, thus driving an issue at the back. Because the body likes to find ways around restrictions, this person might compensate with excessive mobility at the low back joints to make up for that lack of hip mobility. Over time, changes in these tissues structures can ultimately become a source of pain. However, this can be treated with physical therapy!

Our assessment is very specific so that we can individualize your treatment plan and address the root cause of your symptoms. Our approach at Thrive has been very effective and allows our patients to return to the activities that they enjoy doing every day.

Click HERE to request an appointment and get started.

 


Morgan Locker, PT, DPT, MSCS, OCS, LSVT BIG Certified Clinician physical therapist NoHo NYC

Morgan Locker, PT, DPT, MSCS, OCS, LSVT BIG Certified Clinician, utilizes a combination of driver testing and functional movement analysis to specifically diagnose the cause of her clients’ symptoms. Her treatment approach includes a combination of manual therapy techniques and movement re-education in order for her patients to achieve symptom-free, optimal function.  Morgan is an adjunct faculty member at Dominican College’s Doctorate of Physical Therapy program, and she is currently pursuing a manual therapy certification through The North American Institute of Orthopedic (read more)

 

     

TAKE CONTROL OF YOUR HEALTH: PHYSICAL THERAPY AND PARKINSON’S DISEASE

Posted on Posted in All Posts, Let's Get Technical, Take Control of Your Health

Physical Therapy and Parkinson's Disease downtown NYC Thrive

Parkinson’s Disease (PD), also known as Idiopathic Parkinsonism, affects approximately one percent of the population over 55, with the percentage of people affected increasing with age. Though the etiology is unknown, genetic predisposition, familial history and head trauma have been correlated to an increased risk for developing PD. PD is associated with decreased dopamine within the basal ganglia of the brain. Dopamine may be decreased up to eighty percent before an individual begins to demonstrate signs and symptoms of PD. This delay is a tribute to the strength and versatility of the brain, but shows the importance of seeking treatment as soon as one is officially diagnosed. Diagnosis is made by a neurologist, with follow-up care being medication and physical therapy.

There are three things that I tell my clients on the first day of physical therapy:

1. PD is predictably unpredictable. No one can say for certain how the progression will occur. However, research does show that a combination of medication and physical therapy may help slow, stop or reverse the progression of the disease

2. Never say never. There are numerous myths out there about what you can and cannot do once diagnosed with PD. I have worked with individuals who have continued their careers as successful kickboxers, professors and mothers, all after being diagnosed. A fulfilling life will continue with PD.

3. Don’t single out the PD and neglect other health problems. You are only as good as your general health. The healthier and stronger your body is, the greater the benefit you will receive from treatment.

There are numerous Parkinson’s research groups that are dedicated to improving the lives of individuals with PD. Regardless of which Parkinson’s research group that you follow, be it the LSVT BIG group, the POWER group, etc., much of the research on Parkinson’s Disease points to the same conclusion: a target-specific exercise program may be essential in delaying the progression and deterioration of function that may develop with PD.

It is imperative that individuals participate in target-specific physical therapy program, beginning as early as possible. For individuals with PD who are unable to immediately participate in Physical Therapy, here are some guidelines that may assist you in improving your exercise program.

1. Stay active: Parkinson’s Disease does not make you weak. Individuals with PD usually lose muscle mass because they decrease their physical activity, once diagnosed. Keep up with your strength training. Keep up with your Pilates. Keep up with your yoga. If an activity becomes too difficult, find another activity that works. Whatever you need to do to stay active, do it.

2. Add aerobic activity to your program: Numerous research studies have shown that aerobic activity promotes brain health. With Parkinson’s Disease, the brain is the anatomical structure affected. The more we can do to promote brain health, the better.

3. Join a support group: Not many people know what it means to be living with a neurological disorder. But there are other people out there who do know. Being part of a support group will help you realize you that you are not alone is this process.

For individuals with PD who are able to participate in Physical Therapy, reach out to a physical therapist to set up an appointment as soon as possible. Early intervention is one of the key components to promoting a long and healthy lifestyle. If you are located in New York City, Thrive Integrated Physical Therapy is one of the few outpatient clinics in the city that has three physical therapists who are certified in the assessment and treatment of individuals with PD. Please reach out to us so that we can help create a program, that’s specific to your needs and goals!

For more information on scheduling and insurance, you can email info@thrivept.com or submit your insurance information through our online portal HERE. We are currently seeing patients in our downtown clinic and via telehealth, for those who prefer to see a therapist from the safety of their home. We look forward to partnering with you on your care.


Duane Grell, PT, DPT, NCS, OCS, CMPT, MSCS, CSCS, LSVT BIG Certified

Duane Grell, PT, DPT, NCS, CMPT, MSCS, CSCS, LSVT BIG Certified, centers his treatment approach around driver assessment and movement analysis, addressing any underlying movement dysfunctions or arthrokinematic issues that may be causing the musculoskeletal dysfunction. When working with clients with neurological impairments, Duane follows an ICF (International Classification of Functioning, Disability and Health) based approach, identifying and addressing the specific body function or movement that is causing the activity and participation limitations. (read more)

     

HEALTHY WORK FROM HOME HABITS

Posted on Posted in All Posts, Take Control of Your Health

With COVID-19 drastically changing the lives of millions, Americans everywhere had to make a quick transition to the “work from home” lifestyle. Many New Yorkers were not given much notice for this change, leading to apartments all over the city being converted to Work From Home (WFH) spaces. There are both positives and negatives in regards to WFH, when it comes to our health. And since it's seems like the transition to a home office environment is here to stay for a while, we thought it would be a good idea to share a little practical advice.

POSITIVES

Being able to take breaks to stretch
No longer being in the office allows for people to more readily insert stretching breaks throughout their days (without feeling judged from co-workers). Patients often tell PTs that they only feel comfortable stretching when heading to the bathroom or behind closed doors in an office setting. Being in the privacy of your own home, allows you to stretch whenever and wherever you’d like!

Changing to different areas
Another benefit of working from home is being able to alter your workstation as often as you like. This is in contrast to being in one chair and desk all day at work. For example, when you’re home you can go from your dinning table, to a couch, to your favorite chair, to your bed, and repeat. By changing the surfaces you sit on, your body is being put in different positions which allows for more distribution of forces/loads into your joints.

CHALLENGES

Working in non-ergonomic set ups
Many people were not given advanced notice to set up their home. Therefore, many of us are sitting in non-ergonomic set ups. At work, you may have had a sit-to-stand desk with an ergonomic chair and now you are siting at a dinning table or a chair with minimal back support. Making sure our workspaces are working for us is paramount at a time like this.

Decreased activity
Even though you may think that one would be more active when there is more freedom to move, many times working from home leads to a more sedentary lifestyle. Many New Yorkers would usually take public transit to work which includes: walking, standing, negotiating stairs, and improving both balance and proprioception while riding the subway. No longer having a commute and not regularly having to stand and walk to go to a coworker’s desk or conference room leads to decreased overall activity in the day unless you make a conscious effort to move.

Increased Screen Time
With digital platforms being the main form of connection during this time, we are constantly in-front of screens. The many negatives of excess screen time can include: straining the eyes/ headaches, disruption of sleep patters, and having negative effects on our posture as we continue to hunch forward as the day progresses.

WHAT TO DO

So how can we make this situation work for us? Here are some tips to improve the quality of life while working from home: Make your home work station as ergonomic as possible.

You might not have an office set up, but you can make a situation better with items that can be found in your home. For example, if you are working at a dinning table, scoot in and allow the table to support your arms. That way, you can adequately use the back rest and avoid having your elbows dangling (which can put more strain on your neck and shoulders). Place books underneath your screen to bring it to eye level.

If you are at a couch or recliner, use pillows behind the small of your back to allow for low back support. Try to avoid the “slouched” position for long periods of time (for example working from your bed). Although, initially it may feel comfortable to be in this position, it places increased strain on your lower back and neck. It’s okay to sit in this position for short periods of time, but if you are like this all day you body will start letting you know that you need to make some changes (difficulty sleeping secondary to pain, back feeling constantly “stiff,”and an increase in “aches and pains”.

Take conference calls standing up. This allows to you to avoid bad sitting posture.

Incorporate these changes to allow for more neutral postures throughout the day.

Also, try to increase your activity levels to avoid being sedentary, which will allow working from home to work for you.

Also, you might consider scheduling a TeleHealth session to review your home office setup.  Asking a physical therapist specific advice on how to make sure your work from home set up is working for you and learning ways of how to alleviate pain and tension from home is just one of the many patient concerns we can address with TeleHealth. Send an email to info@thrivept.com to find out more.


Jari Haile, DPT, OCS, ATC, PES, is able to pinpoint faulty mechanics and movement patterns that contribute to pain. She incorporates skilled manual therapy to elongate shortened tissues, stretch tightened muscles, align the spine and decrease compression on the body’s joints. She then taps into the body’s neural pathways to “retrain the brain” how to move properly and finally break the pain-producing cycle. 

 

     

PHYSICAL THERAPY’S ROLE IN PREPARATION FOR LABOR

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

Hello Thrivers,

Over the course of my time at Thrive, I’ve written a number of blogs about how physical therapy can help people recover and return to function after having a baby. We’ve also talked about physical therapy’s role reducing pain and maintaining function during pregnancy. We know, as validated by studies, that pelvic floor muscle education prior to childbirth reduces the likelihood that people will experience incontinence after birth¹.  However, it recently occurred to me that our Thrive clientele might benefit from further understanding how physical therapy can improve the actual birthing experience.

physical therapy and child birthThe genesis for this blog occurred after I attended a birthing preparation course taught by Ashley Brichter at Birth Smarter. This organization has virtual and in person childbirth education classes for expectant parents and professionals.  Despite being 5 years removed from having children myself, I found the educational review helpful for my professional practice.  It reminded me that understanding the anatomy of a vaginal childbirth can gift the expectant parent with tools to improve the birthing experience.  In the spirit of that education, let’s talk a bit about the pelvic floor muscle mechanics during childbirth.

It’s intuitive and correct to say that pelvic floor muscles stretch during vaginal delivery. It also understates the truth…these muscles grow between 1.5 and 3 times their original length². This can seem really scary to an expectant parent, but ultimately these muscles are designed to move! In normal, daily life, they get shorter and longer in response to given tasks.  When they function to maintain continence, they gently tighten so that we don’t urinate or have a bowel movement when we don’t want to.  Alternately, when we go to the bathroom, they relax and get longer to allow the passage of fluids.  I tell you this to illuminate the point that pelvic floor muscles are designed to change shape and length.  It’s just the magnitude of the change that’s specific to childbirth.

One can learn to increase muscle awareness and improve the ability to relax and lengthen the pelvic floor for birthing. This is exciting, and is where physical therapy comes in! By partnering prior to birth with a skilled PT, one can:

-Improve pelvic floor muscle awareness
-Engage in mindfulness techniques to enhance the relaxation and lengthening of the musculature
-Understand and practice laboring positions that more easily allow the pelvic floor to lengthen and the bony anatomy to open
-Learn what pushing positions and strategies are best for one’s body
-Increase tactile stimulation and stretch tolerance to the pelvic floor tissues via perineal massage (a technique which is proven to reduce incidence of episiotomies)³.

These skills give the birthing parent more agency over the experience. One becomes more prepared, more flexible, and more able to access available tools so that the pelvic floor can do its job!  I would love to tell you that the birthing experience will then be perfect.  The messy truth is that there is no such thing!  That said, it does create the potential for a more informed and empowered experience.   In the best case scenario, physical therapy is prescribed both before baby’s arrival and after.  At Thrive, we are passionate about partnering with birthing parents and their partners to enable a more empowered delivery and aide in the recovery that follows.

If you are curious is this type of rehabilitation would be good for you, schedule an appointment and speak with your physical therapist. For appointments please call (212) 254-7750 or email info@thrivept.com and ask for Elizabeth.


References:
¹ S Woodley, R Boyle, J Cody, S Morkved, E Hay-Smith. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women, Cochrane Database Syst Rev (2017; 12).
² G CAllewart, M Albersen, K Janssen, MS Damaser, T Van Mieghem, CH Van Der Vaart, J Deprest. The impact of vaginal delivery on pelvic floor function – delivery as a time point for secondary prevention. BJOG: An International ³ Journal of Obstetrics and Gynaecology (2016: Volume 123; Issue 5), pages 678-681.
³ MM Beckmann, OM Stock. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev (2006; 1).


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. (more)

 

     

COVID-19 ROAD TO RECOVERY: IMPROVING LUNG FUNCTION AND MOBILITY VIA TELEHEALTH

Posted on Posted in All Posts, Sidelined, Telehealth

As a medical professional, I’ve watched with great concern as front-line medical personnel have taken the brunt of exposure to COVID-19. Recently, my physician, a man so full of life he practically sprinted down the hospital hallways, was struck down by the virus. After returning home from the hospital and a stint in the ICU, this once energetic man was unable to ambulate without the aid of a walker or take 20 steps without gasping for breath. Instead of seeing patients, his days were filled with home nursing visits, nebulizer treatments and walking exercises that were not improving his overall health. As a friend and colleague I asked myself, what techniques could I, as a physical therapist, utilize to help this patient recover? As it turns out, a lot.

When breathing becomes compromised as it does with COVID-19, patients not only have damaged lung tissue from the virus, but the muscles, diaphragm and ribs don’t operate properly making breathing even more difficult. Respiratory distress can prompt the muscular systems to overcompensate when trying to get air into the lungs. Muscles in the neck, like the scalenes, become overworked and the pectorals in the chest wall tighten, leading to poor posture. This results in a feedback loop where tight muscles then facilitate other muscle groups to weaken.  Additionally, the extended period of bed rest that accompanies recovery further weakens muscles in the chest and intercostals (between your ribs). The result: stiffened, weak muscles and reduced movement of the diaphragm, which is responsible for a significant part of inspiration, or breath intake.

TeleHealth for COVID-19 recoveryAs a physical therapist working with a variety of cardiac and pulmonary patients, there are a number of treatment options we can deploy to help our patients recover from the severe impacts of this disease.  Our treatments focus on getting the diaphragm, ribs, and the vertebrae in the spine to move better by instructing the patient on self-release techniques to gently mobilize stiff joints. We instruct patients on how to perform soft tissue releases and stretching of tight muscles, which allow the chest wall to expand and the diaphragm to move more effectively.  We can then guide the patient to perform movement reeducation of the shoulder blade, thorax and core muscle recruitment. Coupling these techniques with guided breath work will then allow the patient is able to draw in and expel more air in with each breath.

Fortunately, all of this can be accomplished without the need for physical contact, limiting the spread of the disease. Working with my fallen hero via daily TeleHealth sessions I was able to guide him through self-administered rib and soft tissue stretches to release his diaphragm. Our daily exercises included diaphragmatic breathing to address stretching, strengthening and coordination of the upper neck and chest muscles. As the treatments progressed, he began to take more efficient breaths and his oxygen saturation rate improved from 89 to 96 percent at rest, with less supplemental oxygen.

Three weeks into his TeleHealth sessions, his lungs no longer “crackle” during examination. He is now able to walk the halls in his home, mostly without his walker. He can sit for hours in a chair and, with his oxygen by his side, he is doing modified yoga poses.  Although he has a long road ahead, the gains he attained though physical therapy have been significant. He now says he is taking a deep breath and staying positive.

If you or someone you know is recovering from COVID-19, the team at Thrive Integrated Physical Therapy may be able to help with regaining lung function and mobility. Our Dynamic TeleHealth COVID-19 Program is available from all of our providers – please email us at info@thrivept.com for more information.


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. 

     

THE UNANTICIPATED BENEFIT OF VIRTUAL PT

Posted on Posted in All Posts, Telehealth

Hello All,

Tonight I write you from my home in Manhattan, it is 7pm and the clapping has begun.  This apartment has historically been my family’s refuge.  It is now also my exercise studio, my children’s school, my husband’s office.  All this in 850 square feet.  The disruption of normal life has made me pensive…my day to day was once large, it is now small.  There is an absence of shared community, in the physical sense, and I’ve had time to reflect on it’s value.  Specifically, I’ve thought much about what it means to go in to work at Thrive.

I have always loved my job at Thrive.  I’ve worked there since 2014, and have been aware that I am one of the lucky who like going to work everyday.  Physical therapy is a natural fit for a curious, chatty extrovert.  However, I was unaware of how deeply I relied on the community fostered there until I was no longer among it.  In times of strife, it has been a balm to see familiar faces of the staff, our patients, the other tenants in the building, and shop owners in our neighborhood.  It made the big city feel manageable.  How scary can Manhattan be if Carol at the coffee shop knows me by name?  We at Thrive have grown with one another over many years, and have been a witness to one another’s healing, growth, fragility, and humor.  I have realized that “job” does not describe, for me, what I do there.  The work is more shared, more communal than that word implies.  We, patients and staff alike, are part of a collective.  It is our purpose as employees to foster and serve that community.  In turn, our patients have nurtured our curiosity, propelled us towards growth, and provided comfort in human interaction.  WOW!

virtual pt telehealth teletherapySo, in recognition of our loss, temporary though it may be, what is there to be gained?  What can we learn about ourselves as we transition to work online?  How can we continue to support one another as a community if not sharing physical space?  How can we, as physical therapists, help our patients maintain their health and wellness virtually?

In a broad sense, I have been amazed at the continued support that the Thrive staff has provided and received since our physical closure.  I find myself in regular communication with my patients, and am bolstered each time I hear from them.   They have emailed me: recipes, educational websites for children, mindfulness apps, yoga flows to calm you down, yoga flows to pump you up, books for when you’re sad, books for when you’re happy, books for when you’re too tired to read hard books, podcasts, TED Talks, and no less than 50 assorted Netflix suggestions.   They’ve emailed to talk about their medical issues, but also their  musings on this weird ride we’re on.  Truly, this experience is universal.  As such, our need for connection is.  At least for me, my connection to the Thrive community is alive still, just moved to a more virtual platform.

As an individual, what can  be gained from virtual PT?  Perhaps surprisingly, quite a bit.  An interesting shift has happened.  When conducting a virtual session, the therapist has the benefit of visual assessment, verbal feedback, movement screens, etc.  That said, there is no tactile intervention.  We cannot over the computer feel what muscle you are using.  Nor can we help release that muscle or alter it’s function with manual intervention.  Instead, we ask the patient, “What do you feel?  What can you do to change this muscle tone?”  Absent of the manual PT feedback , the patient becomes arbiter of success.  It requires and fosters a deeper understanding of one’s own movement.  A more introspective, movement aware, and in control patient emerges.  This empowerment of the patient can only be good, and these tools are indefinitely theirs to own.  I find myself hoping that PT’s will continue, after quarantine is long over, to use what we are learning to enable our patient’s independence and confidence. A silver lining in an anxious time…

I count the days until we are physically together, when we can charge forward in our new normal and rebuild something beautiful.  Until then, our community is alive and well.  We as staff are here for you, the patients.  It is our pleasure to check in, to field your emails, to help you navigate TeleHealth, and to be part of your team!  In turn, you have bolstered and nurtured us with your inquiries, energies, and support.  We are so grateful.

 


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. (more)

 

     

TELETHERAPY SERVICES: CONTINUE CARE IN THE SAFETY OF YOUR HOME

Posted on Posted in All Posts, Telehealth

WHAT IS TELETHERAPY?

TELETHERAPY SERVICESTeleTherapy is a way for you to connect and continue to work one-on-one with your physical therapist through a secure, HIPAA compliant online platform. The evaluation and treatment sessions are similar to what you would receive in the clinic. The most noticeable difference between online and in person sessions is no hands on care from your therapist. The feedback from our patients is that TeleTherapy sessions are quite effective and meaningful.

While these visits are not a replacement for the level of hands on treatment that you have come to expect from us, they are the best way to assure that you continue to receive the professional guidance and treatment that is needed to advance your care. TeleTherapy can include a physical screen of what is truly meaningful to you, as well as “real time” feedback and guidance as to self release, exercise progression and exercise modification as needed. It allows the education component to continue in regards to tips for daily living, postural adaptations and other concerns that you may have. It is a platform that will allow us to work together to advance your rehab program and meet your goals and expectations for physical therapy during this difficult time.

WILL MY INSURANCE COVER THIS?

We know this is an uncertain time and finances are a concern for all. The team at Thrive has been hard at work staying abreast of  the latest developments in patient billing for TeleHealth services. Many insurance companies are rising to the occasion and eliminating hurdles so that their members can continue to get quality care without having to incur higher than expected out of pocket expenses. As insurance policies differ from person to person, we are calling to check benefits individually for patients who are interested and advocating for coverage for everyone.

To find out what your coverage options are and for pricing on TeleTherapy sessions please email info@thrivept.com and one of our staff will be in touch with more information.

Together we will get through this.