Hot Topics in Physical Therapy: Caring for the Perimenopausal Patient

My journey towards becoming a pelvic health PT began with my own path towards motherhood.  I got pregnant and got curious about preventing injury in myself both during and after delivery.  Over time, I began to collect skills to serve pregnant and post-partum people at the clinic, and it became an area of specialty.  Those skills expanded to include persons without children with pelvic pain, constipation, erectile dysfunction, etc. but the vast majority of my patients in this space were under 40.  Then something interesting happened…I got older, and so did my clients.  

One of the gifts of being a physical therapist is forming relationships with people in your community, and serving as a care provider for them intermittently throughout their lifetime.  I noticed that the people I once cared for in the early days of parenthood were now corralling teenagers.  There was a group of clients returning to the office in their 40s and 50s with new symptoms and new concerns.  They were people entering the phase of life described as perimenopause, and they had questions.  As it happens, so did I.  

If menopause describes the phase of life when one no longer menstruates, perimenopause is the time that proceeds it.  Lasting on average for 4 years, it is a hormonal transition during which time estrogen and progesterone spike and dip.  This irregularity can cause a series of symptoms that can vary from person to person, some of which are listed below.

  • Irregular periods – they can be long, short, heavy, light and everything in between
  • Depression and mood disruption
  • Interrupted sleep
  • Hot flashes
  • Vaginal dryness and genital pain
  • Low libido
  • Cholesterol changes
  • Increased incidence of UTI

What struck me, as a clinician, is how undereducated I was about this part of life (especially given that it is experienced by ½ the population).  It also made me acutely aware of how little we collectively talk about symptom management during this period, with the expectation that the perimenopausal person should suffer through discomfort because it’s “natural.”  It’s hard not to interpret the lack of care for people in this age and gender demographic as a function of deeply held misogyny and ageism.  

What I now know is that caring for persons through hormonal transitions should be a group effort.  At the helm of the care team should be a gynecologist that can talk through the various treatment options with the intent to empower the patient to make decisions with a clear understanding of risk/reward profile for each medical intervention.  Just as we are not all the same, neither is the approach we take during this time of life.  A provider with the time and expertise to guide a person becomes particularly important, as interventions can range from oral birth control, estrogen based or non hormonal vaginal creams, IUD placement, hormone replacement therapy, and/or holistic management through diet, exercise, etc.

Physical therapy can be a very important tool in this period too, specifically for persons with pain in the vaginal region during intercourse.  As estrogen declines, the vaginal tissues dehydrate, atrophy, and become brittle.  This can lead to the sensation of burning and dryness during activity and pain during intercourse.  If left untreated, the experience of pain can cause a patient to protectively grip their pelvic floor muscles, making it difficult to tolerate sex.  This not only impacts the individual, but also partnerships, and it can be significantly distressing.  Physical therapists are well positioned to support symptom reduction via techniques to lengthen tight musculature, address habits associated with chronic gripping, and educate on the care of the tissues via moisturizers and lubricants.

Ultimately, this is an area of growing interest, and I am hopeful that as the public’s appetite for knowledge grows so too does our ability to have nuanced and thoughtful conversations in this space.  We at Thrive have multiple practitioners with experience in pelvic health and have cultivated relationships with gynecologists, acupuncturists, and nutritionists with expertise in this field.  We seek to support perimenopausal persons with the rigor and nuance they deserve, and look forward to answering your questions.

Elizabeth D’Annunzio Shah, PT, DPT, OCS, MTC is a board certified orthopedic specialist and a manually trained physical therapist through the University of St. Augustine. She has a special interest in pelvic health for persons across the lifetime and is committed to supporting all her patients in their pursuit of physical wellness.


Have you noticed an increased bulge in your lower abdomen?  You know the one…the lower belly pooch that won’t go away regardless of your eating or exercise habits?  You’re not alone!  We at Thrive are here to help explain why you’re seeing what you’re seeing, and how we can help.

The lower abdominal belly bulge is common amongst all persons regardless of gender or age, and is a sign of muscle coordination issues in the abdominal wall.  For the purposes of this blog, we are going to use toileting mechanics to illuminate common and treatable abdominal muscle dysfunction that contributes to this belly bulge.  Ultimately, bowel and bladder habits tell us a lot about pelvic floor muscles, the abdominal wall, and diaphragm function. For example, in order to eliminate liquid or solid waste, there needs to be a slight increase in abdominal pressure prior to evacuation.  This pressure signals to the pelvic floor that it should relax and allow the passage of stool from the rectum or urine from the bladder. This cycle should be fluid.   Ideally, one experiences a sensation that suggests that the bowel or bladder needs to empty, goes to the toilet, and easily eliminates waste.  It’s like turning on and off a faucet, and one should be able to feel fully emptied each time.

For some, this is not what they are experiencing! Many feel like they have to strain to go or are not fully evacuating their bowel or bladder each time. These symptoms often indicate that there is too much downward pressure coming from the abdomen, and this pressure does not allow the pelvic floor to relax. Some abdominal pressure is good, but more is not necessarily better! Those who have a long history of constipation and who develop forceful pushing habits will often disrupt and overstretch the structures that support the organs in the abdomen. Over time, this disruption causes the internal organs to descend.  This descent puts strain on the muscles of the pelvic floor and they tighten in response.  This makes it harder to relax the muscles for elimination!  From an abdominal perspective, this downward pressure contributes to the appearance of a lower belly bulge.

Too much downward abdominal pressure causes dysfunction not just in the bathroom, but also in other facets of life.  Poor pressure dynamics can make the pushing phase of child delivery difficult and long.  It can also disrupt healthy mechanics in weight lifting practice.  For those who breath hold and bear down while lifting, I’m looking at you!!  These habits transmit load downward into the pelvic floor and lower abdomen via the obliques, and make it harder for your body to maintain appropriate tension in the lower portion of the abdomen.  Over time, the lower abdomen becomes unable to contract properly, and “the bulge” is born.  One will often see the tightness in the upper abdomen and the appearance of a little pooch in the lower belly.  If this describes you, and/or you notice a line going across your belly button when you contract your abs, it’s a sign your muscles are out of sync.

Ultimately, if you notice difficulty with bowel evacuation, lifting mechanics, or have questions regarding baby delivery strategies, Thrive is here to help!  Abdominal pressure mechanics influence many parameters in our life, and a multi-factorial and personalized approach to care is important.  You can make a lot of small changes that have large scale impact, and your pelvic floor PT is uniquely positioned to help.   If you don’t have any symptoms, but think you might have abdominal control issues, prevention is the best medicine!  Book a session today to get a pressure biomechanics assessment and stop problems before they start.

Dr. Escudero, PT, DPT

Dr. Daniela Escudero received her Bachelor of Science in Kinesiology from Skidmore College and her Doctorate of Physical Therapy from Dominican College. Her interest in movement science and physiology sparked her interest to pursue a career in physical therapy- she loves exploring and learning about the interconnectedness of movement. She is a therapist at Thrive with expertise in both orthopedic and pelvic health clients.


Schroth Three Dimensional Scoliosis Therapy was developed by the German educator and rehabilitation specialist Katherina Schroth in 1921. Discouraged by the lack of conservative care in the management of her own scoliosis, Katherina systematically developed a functional approach that combines both neurophysiological and musculoskeletal elements to produce exacting affects on spinal alignment. This work became a forerunner in the field currently known as Scoliosis Specific Exercise. 

Understanding that respiration is inhibited in the concavities of the spine and inspired by a balloon, Katerina devised the technique of orthopedic breathing to expand the collapsed aspects of the curvature. This ingenious approach makes use of the long lever arms of the ribs to produce corrective affects on the spine, promoting symmetry and altering alignment. Deep and specifically directed inhalations expand the ribs and produce mobilizing affects on the soft tissues and joints of the concavity. Slow resisted exhalations produce both strengthening and stabilizing affects that promote a posture that approaches the mid line. Specific reverse muscle actions of the limbs are performed during exhalation to produce corrective and stabilizing forces on the spine.  The affects of the breathing exercises are carried forward into daily life through increased postural awareness and enhanced correction of alignment. 

Schroth breathing exercises are performed in a variety of positions to vary the affects of gravity and weight bearing in facilitating a postural change. The spine is positioned in a fashion to mirror and reverse the scoliosis, at times over correcting as appropriate.   Set up of the breathing exercises involve correcting each of the three dimensional aspects of scoliosis. Particular attention is given to elongation of the spine to build stabilizing forces against the compressive affects of gravity. After lengthening the spine the participant learns to make finely tuned motor control calibrations to reduce rotational affects of scoliosis. The orthopedic breathing of Schroth becomes highly impacting in conjunction with all of the prescriptive corrections that are made in setting up each exercise. 

Scoliosis is the sum of the structural boney changes within the spine and the flexible,  adaptive changes in postural alignment. The flexible postural aspect of scoliosis can be altered by positioning and exercise. Bringing posture closer toward the midline through active control and passive positioning can support the boney deformity in a way that diminishes curve progression. Schroth retrains the altered perception of posture that occurs with deviation in the center of gravity of the body that accompanies the shifting of the spine in scoliosis. The neurophysiological aspects of the Schroth exercises produce a brain training affect that retrains the true orientation of mid line. This is highly impacting in reducing the body’s shift into more scoliosis. 

The physical therapy goals in the conservative management of scoliosis include halting curve progression and preventing surgery, addressing spinal pain syndromes, managing respiratory dysfunction, improving aesthetics and body image. In addition to Schroth physical therapists employ an array of manual techniques including joint mobilization, myofascial release, soft tissue mobilization, crainosacral therapy, visceral mobilization and neuromuscular stretching techniques.  

To get started, you can email or submit a request through our online portal HERE.


Scott Teagarden, PT, SSPT physical therapist NoHo NYC

Scott Teagarden, PT, SSPT, is passionate about physical therapy and is continually inspired by the adaptive and restorative capacity of the body. He employs a dynamic, innovative and tailored approach in finding the root cause of dysfunction. Scott is a Schroth Certified Scoliosis physical therapist and has advanced training in spinal and extremity care. He has a BS from The Ohio State University and has had clinical concentrations in neurological, orthopedic and catastrophic illness based rehabilitation. (full bio



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 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. 




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 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)



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 (

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 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)



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.



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 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)


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.


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.


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.


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 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. 



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 and ask for Elizabeth.

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)