Concussion Basics for the Non Athlete

Attention all those who have taken a dive this winter on icy streets, rusty once a year skiers and novice ice skaters- this post is for you. I’m also shouting out to those 20 something weekend warriors. There’s an injury epidemic out there that we, as medical professionals, are learning more about. IT’S TIME WE TOOK A HARDER LOOK AT OUR HEADS. Concussion awareness has become a topic of discussion among concerned parents of athletes and professional sports stars alike. But what about those of us that are neither of those things? What should we understand about brain health, concussion signs and symptoms, and rehabilitation? Without further ado, I’ll try to help fill in some of those knowledge gaps. Hopefully, it will inspire us all to get serious about protecting our noggins.

concussion brain injury physical therapyThe first jarring fact is that CONCUSSIONS ARE BRAIN INJURIES. They need to be treated as such, and one should not minimize their seriousness. A concussion must be followed by a thoughtful medical examination.  While concussions do not show up on CT or MRI, your doctor might use those tools to rule out more serious injury.  There is also a battery of tests that can be immediately done post injury to identify cognitive, balance, and visual issues and establish a baseline for recovery. In high school sports, doctors, therapists, trainers, coaches, parents, and athletes are working towards concussion identification and treatment.   However, I have found that those injured outside of athletics often go under treated.   I’m referencing those who slip and fall on ice, have had minor car accidents, etc. In my clinical practice as a PT, the patients I’ve treated for concussions often come in originally for other problems. Only after our examination do we discover that the fall that caused their back pain also caused their headaches, memory issues, and dizziness. In other words, they were concussed.

You might wonder how a concussion would go unnoticed. It seems like it would be obvious, right? Well, in truth, it might not be as evident as you think. One DOES NOT HAVE TO LOSE CONSCIOUSNESS to have a concussion. Concussions occur when your head moves uncontrollably in a forward/backward linear motion, or in a torsional motion. During this motion, the brain hits the undersurface of the skull. Often times, a whiplash injury associated with a car accident is the perfect mechanism to create concussive force. The person doesn’t even have to hit their head necessarily. Clinically, it is not uncommon to see whiplash patients in the office who, upon further investigation, also happen to have concussions. They might not have realized it if they didn’t loose consciousness or if the symptoms weren’t immediately apparent in the post accident melee.

So what are the signs and symptoms of a concussion? Below are some symptoms that one might see develop within the first 24-48 hours post injury:

• Headache

• Dizziness

• Fatigue/drowsiness

• Memory loss

• Concentration issues

• Light sensitivity

• Balance impairment or vertigo

If you happen to get a concussion and realize it immediately, it’s time to GO TO YOUR DOCTOR. Usually, the doctor recommendation is to let your brain rest for a few days until your symptoms resolve. That means limited activity, potentially including absence from work, reading, using the computer, and exercising.   This rest period is really important. If one gets concussed again while the brain is healing, even if the knock is small and seemingly innocuous, it can result in serious brain injury. For most people, symptoms of a concussion resolve in one to four weeks. Unfortunately, for 10-20% of individuals, the symptoms last beyond this point (Mucha 2016). This phenomenon is known as post-concussion syndrome. It is a relatively serious issue where a person may experience protracted headaches, dizziness, fatigue, concentration issues, memory loss, balance deficits, and anxiety. If a person has post-concussion syndrome, they need a team of people to help them medically manage their issues. This would include not only their primary care physician but also a neurologist specializing in concussion management, a neuro psychologist, possibly a neuro optometrist and otologist, and physical therapist. If the individual is a high school athlete, then school personnel like coaches and trainers would also be involved.

Our role as physical therapists is to help persons with concussions treat their balance issues, vertigo, endurance loss, and any orthopedic issues associated with the trauma. In other words, there is a lot we can do!!! With our athletes we may perform the role of helping decide when is appropriate for return to sport. Similarly, we may help the adult decide when is appropriate to return to work or recreational exercise. Before returning to full exercise or work, we want our patients to be symptom free at rest and during activity, without the masking effects of medication. The potential for recovery is really good, provided that the injury is treated with the seriousness it deserves. So, if you find yourself wondering if you or a loved one came away from that fender bender with more than just a sore back, it’s time to talk to a pro. Then you can set about the business of healing!


Elizabeth D’Annunzio Shah, PT, DPT, OCS

Image(s) above courtesy of Stuart Miles at

Mucha A, Whitney S (2016). Concussion Basics: Assessment, Screening, and Risk Factors [Lecture Notes]. Retrieved from

Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS 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)

The Do’s and Don’t of Diastasis Recti

Hello all,

As a physical therapist, I have had a number of patients coming in with questions about their diastasis recti. As you may remember from my previous post, I recently had a baby and since then, the question of how to treat a diastasis recti has been on my mind. This seems to be an issue shrouded in concern and fear for many women, so let’s talk about it.

WHAT IS A DIASTASIS RECTI? Well, the rectus abdominus is a muscle that runs vertically along your abdomen from your lower sternum to the pubic area. It’s the muscle that creates the “six pack” aesthetic, if toned, in those with low amounts of abdominal body fat. It also functions to forward bend your trunk, and participates a bit in the stabilization of your spine (although it’s not the main player). A DIASTASIS RECTI IS WHEN THE CONNECTIVE TISSUE BETWEEN BOTH HALVES OF THE RECTUS ABDOMINUS STRETCHES OR SPLITS.  This happens commonly in pregnant women as their abdomens grow, with some studies suggesting that it occurs in up to 66% of women in their third trimester of pregnancy (Lee, 2011). It can also arise in people that exercise incorrectly or in men with large bellies.

diastasis recti
Typical abdomen vs a Diastasis Recti abdomen

Having a diastasis recti can contribute to lower back pain, pelvic pain, and incontinence. Therefore, treating it and correcting the loss of abdominal stabilization is important. In order to know if you have this issue, the test is pretty simple:

Lie on your back with your knees bent and place your fingers in the center of the rectus. Gently lift your head and shoulders off the ground and see how many fingers you can fit in the space between your abdominal muscles. You can test at the belly button, slightly above, and slightly below. If you can fit 2 or more FINGERS, you may have a diastasis recti.

If the test is positive, it’s time to go to your OBGYN or MD and get a referral to PT, or if you live in a direct-access state like New York, call your physical therapist office directly and make an appointment. We can help!

Now, if you have a diastasis recti, THIS IS NOT A CAUSE TO PANIC.  For women, a natural reversal of the separation will be seen at about 4 weeks post-delivery (Gilleard and Brown, 1996).   After that, the diastasis will typically not close further unless you do targeted activities to address it. So, if you have a diastasis recti and have delivered over 4 weeks ago, it would be a good idea to figure out some strategies to help improve generalized muscle activation and closure of the muscle. There are ways to diminish the size of the diastasis recti while also improving abdominal control. First things first: speak to a pro! Find a physical therapist or educator in your community who specializes in working with diastasis recti. For women, especially those who are pregnant or were pregnant, this might mean finding a PT that focuses on women’s health or works with women postpartum. At THRIVE, although we are not specifically a women’s health practice, all the therapists on staff are qualified to work with women pre-delivery and postpartum with this condition. We help our clients to work on abdominal activation, pelvic floor activation and relaxation, and movement re-education so that they can feel confident and strong with all movement and exercise tasks. We can also educate you on whether or not you might use a supportive brace to help with spinal support or prevention of increased separation.

YOU CAN ALSO START TO WORK ON THE PROBLEM AT HOME. Often times, the issue is not just the rectus abdominus muscle but a generalized abdominal activation problem. Specifically, you want to be sure that when rolling in bed, sitting from a reclining position, lifting, etc. that you are not bearing down on the abdominals for support but rather are gently drawing them in. A way to practice this at home is as follows:

• Lie on your side or back with your knees bent

• Start by working on breathing into your lower rib cage.  Put your hands on the sides of your lower ribs, and think about filling up that part of your ribs on the inhale, and then letting them gently descend towards mid-line on the exhale.  Don’t squeeze or push on the exhale, just check that movement is occurring as your ribs relax down.  Focus on your breathing for 3-5 minutes.

• Now, work on gently engaging your lower core. This action should be very subtle, and should not involve pushing out the abs.  Instead, it is a gentle drawing in of your pelvic floor by lifting up and in on the area between your anus and pubic bone, and widening across the front hip bones.  Less is more, don’t overdo it!  Try this over 10 cycles of breaths, coordinating this action with the exhales.

You want to gently draw in your abs when rolling in bed, standing from a lying down position, and when lifting. Again, diastasis recti is made worse with a bearing down or pushing out action, so really tune into whether you notice that happening. There are also some positions to avoid while you await treatment. Don’t do sit-ups, planks, major lifting, or things that stretch out your front body like upward dog.

Diastasis recti is a common problem but one not often addressed with immediacy or correct techniques. EVIDENCE SUGGESTS THAT STRENGTH AND CONTROL CAN BE RESTORED ACROSS THE MIDSECTION WHEN APPROACHED WITH CARE AND GOOD INSTRUCTION. And for many, the closure can be reduced. Ultimately, the goal is being able to safely return to full activity without pain and without limits!

Elizabeth Shah, PT, DPT, OCS

1) Mombod Fitness: Fit Moms to the Core. Viewed 14 December 2015,
2) Lee, Diane. (2011). The Pelvic Girdle. Churchill Livingstone, Elsevier.
3) Gilleard, W, Brown M. (1996) Structure and function of the abdominal muscle in primigravid subjects during pregnancy and the immediate postpartum period. Physical Therapy, vol 76 (7), 750-762.
4) The Physiotherapy Clinic: Diastasis of the rectus abdominus muscles. Viewed 14 December 2015,

image via

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)

Musings From A Once Pregnant PT: Gearing Up For Delivery

pregnant woman physical therapy

Hello all,

This is Elizabeth Shah, staffer at Thrive, reporting from my home. I am on maternity leave after having recently welcomed our second child, and find myself reflecting on what I’ve learned through this pregnancy and delivery process. If you’re expecting a post on how to parent, stop reading. I don’t know what I’m doing and am, in fact, accepting suggestions. This is post about how my physical therapy background informed my pregnancy. I’m talking about the physical experience: what helped me to feel well during the process, and how might I apply these ideas to my patients.

I have been lucky during both pregnancies to be able to work until nearly delivery, to feel relatively well outside standard nausea and fatigue, and to be healthy as per the metrics relevant to my OBGYN (blood pressure, heart rate, etc.). I am extremely grateful for this good health, and think it linked directly to the body awareness and information available to me as a PT. What about being part of this profession contributed to my wellness, and that of the baby’s, during pregnancy? Here are some of the anecdotal things I believe to have helped:




Physical therapy is a movement-oriented job, and there is minimal time spent in the chair. While at times this is difficult, I believe ultimately this to be a benefit. My body is conditioned to tolerate standing, squatting, and load bearing activities due to my occupation, and the constant movement helped maintain a healthy cardio-vascular system and relative endurance. I think, anecdotally, that being upright during the day prevented some of the stiffness and postural pain that many pregnant women are well acquainted with. Now, does that mean that people with desk jobs are doomed to feel unwell during pregnancy? Certainly not! However, it is true that if your job requires you to sit in a chair, you will have to find the opportunity to stand and walk as often as possible outside of work. Additionally, as your center of gravity changes during pregnancy, one might find it difficult to maintain a healthy posture in sitting. A pregnant person might want to have some back support attached to the chair, in addition to having some gentle stretches to do both during the workday and after.

I continued to exercise during my pregnancies, although moderately. Gentle strength training and core/pelvic floor activation work is essential during pregnancy in preparation for childbirth and everything after. Additionally, it will help prevent back pain and difficulty with daily lifting tasks. THE BODY PREPARES FOR CHILDBIRTH IMMEDIATELY AFTER BECOMING PREGNANT, as hormonal changes allow for widening of the pelvis. Some are surprised to find that relaxin, the hormone that creates ligamentous stretching, is produced in large amounts as early as the first trimester. You might be thinking, “So what?” Well, with increased ligamentous stretch comes an increased risk for strains and sprains. In the interest of full disclosure, ligament and muscle changes can also lead to continence issues. Yikes. When connective tissue is no longer as taught and able to prevent injury, the muscular control system needs to be correctly engaged to prevent excessive movement. The diaphragm, abdominals, back, and pelvic floor musculature all contribute to stability and capability when it comes to movement and control. So do the muscles of the buttock and hip. Therefore, gentle muscle activation exercises are essential during pregnancy.

pregnant yoga physical therapyThe key to exercise during pregnancy is “portion control.” As mentioned earlier, the body begins to stretch so you can pass a baby through the birth canal. So, some stretching to relax the muscles of the pelvis to allow for this to happen is good. However, too much, as mentioned earlier, will lead to overstretch and injury. That’s why I think activity modification is important to some extent. “No pain, no gain” has no place during pregnancy. Personally, I practiced Iyengar yoga during my first pregnancy and Pilates during my second. I thought both met my needs with regards to postural strengthening and stretching. I should mention that, while I took group classes, I met with the instructors immediately upon finding out I was pregnant and received ongoing coaching throughout the experience to make sure I wasn’t putting myself at risk.

Targeted and specific activity is GOOD during pregnancy, and not to be feared. However, education is important. If you are exercising in group classes, make sure you seek out knowledgeable instruction. I  found success with Pilates and Iyengar yoga classes, but there are many options out there that fit all interests. Whatever you choose, be discerning and look for someone who’s an expert on working with pregnant women. ADDITIONALLY, YOU MAY SEEK OUT THE CARE OF A PHYSICAL THERAPIST. We can help if you’re curious about safe exercises, about how to help avoid continence issues or address ones that are developing, or if you are in pain. At Thrive, we work with pregnant patients all the time. However, if you’re reading this and unable to receive care from Thrive, seek out a PT in your area. Make sure, before attending, that you ask if the care is one-on-one, that the focus is on neuromuscular control, and that the therapist works regularly with pregnant patients.

Ultimately, after reading my post, it is my hope that you come away with one important concept: EXERCISE AND MOVEMENT ARE GOOD DURING PREGNANCY, and should be modified and tailored to the pregnant person. As always, ask a professional if you are unsure about how to proceed, need stretching or strengthening advice, or are already in pain. We look forward at Thrive to working with our pregnant clients, and growing our Thrive family (pun intended).

Elizabeth Shah, PT, DPT, OCS

Image(s) above courtesy of nenetus at

Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS 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)

Thrive Client Dances Again

We are always blown away when a former patient reaches out to tell how that they are still feeling great, but this patient has taken it to the next level by offering our patients and staff discount tickets to her upcoming performance. Please check out the flyer below for more information.

The details are as follows:

Date/Time: September 11th @ 7:30pm, September 12th @ 3:00 & 7:30pm
Where: University Settlement, 184 Eldridge St, New York, NY 10002
Price: $15
Where to buy:

Cornfield Dance Discount Tickets

What Is Vestibular And Balance Therapy, And How To Know If It Is Right For You

Today I’m going to write about a topic that many people don’t realize is covered by physical therapists. It’s a particular area of interest for me, and I believe an area of concern that is widely under-treated in general. It’s called VESTIBULAR or BALANCE THERAPY, and it has to do with helping those who feel dizzy, off balance, and/or are falling down.

First of all, there are many reasons why people get dizzy, nauseous, and light headed. Similarly, there are many causes that can lead a person to fall or have balance problems. The first step, before diagnosis, is recognizing the symptoms and knowing when to seek help.

THE FOLLOWING ARE A LIST OF SYMPTOMS THAT SHOULD LEAD ONE TO VISIT THEIR DOCTOR:can vestibular therapy help you with vertigo and blanace?

• Dizziness, including spinning (vertigo), nausea, light headed sensations, and difficulty focusing the eyes

• Frequent falling or tripping, with or without provocation

• Difficulty focusing the eyes on the computer for long periods without getting headachy, dizzy, or noticing trouble reading

• Difficulty staying upright while walking in crowds

• Difficulty focusing your eyes while driving

• Recent hearing loss or ringing in the ears

• Recent head trauma, concussion, or suspicion of concussion

The list could go on from there, but essentially the gist is this: falling, dizziness, and post-concussive confusion can get better! THE FIRST STEP IS SO SEEK HELP.

When you go to your primary care physician, the process is often multi-layered.   Make sure you ask about physical therapy. Some will refer you to vestibular physical therapy right away. Others will recommend you go see a specialist first, either a neurologist or an ENT that focuses on vestibular disorders. Eventually, you may end up in the care of a PT.

At Thrive, it is a core value amongst the staff that we treat all our patients as individuals and do a thorough evaluation to determine the cause of their symptoms. This is true if you’ve sprained your ankle, or woken up with the spins.   When a person comes in for a vestibular or balance evaluation, it is our job to weed out what their specific goals and needs are based on their presentation. I first like to know why my patient’s have come: are they dizzy, do they seem to be tripping often, or have they bumped their head and are now struggling to focus at work? The way the patient presents helps form a hypothesis as to what might be wrong.


•  Sensation loss associated with age or diabetes that make it hard to feel where you step

•  Weakness of the muscles that hold the trunk upright

•  Joint motion loss

•  Nerve changes in the inner ear, often but not always associated with aging, that signal to the brain where your body is in space

•  Balance impairments related to a concussion, stroke, or neurologic impairment like Parkinson’s Disease


•  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

As surprising as it may seem, most of these things can be made better. While we may not be able to fix sensation loss in your toes, for example, we can improve your strength and positional sense to compensate for that loss.   Similarly, while BPPV feels like sea-sickness on steroids, there is actually a very effective way to treat it. The most important thing to do is call your doctor or PT and get the ball rolling! If you are already a patient at Thrive and have been noticing some of the things discussed in this post, be sure to ask your PT about it. We treat many vestibular disorders in house. And, if your problem is beyond our scope, we will be happy to refer you to the appropriate professionals.

Looking forward to helping you stay upright and moving in the future!

Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS 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)

Stability vs. Mobility

Have you ever taken an apple from the produce section at the grocery store and caused an apple avalanche to tumble all over the floor? Or loosened your belt to the point where your pants fell down?

All moving things, our joints included, require a certain amount of tension and stability, if they are too loose they can cause a ripple effect of problems. In the case of our joints, bones and muscles, this ripple effect isn’t as incidental as an embarrassing grocery store incident or sagging jeans. The results can be severe, long lasting, and far reaching to other parts of the body. After all, our body is an intricate system of hinges and pulleys – all sensitive to each others tensions.

manual orthopedic release of scapulaStretch and massage feels wonderful! It can also create some beneficial space in our joints so we can regain movement. However, stretch and massage alone is NOT the answer to the rehabilitation of a body part. Sometimes a muscle has tightened up to offer stability, doing release work without stabilization and re-education can create instability.

Physical therapy and true physical fitness involves the mobilization and stabilization of joints, and re-education of the muscles and central nervous system to produce efficient and graceful movement, free of impingement, instability and compensations.

So, next time you’re at the nail salon and you’re craving a shoulder massage, tell the manicurist to tread lightly. Bringing blood to the muscles via gentle massage is a good thing, but affecting the muscles deeply can potentially lead to other issues. And if and when you do require physical therapy, remember that your experience is more than just muscle release. Stability is the only thing that can lead to true strength and true strength is the answer to a happy, pain free body!

Image courtesy of Ambro at

Elizabeth Houchins Personal TrainerElizabeth Houchins has been involved in fitness since childhood, participating in multiple team and individual sports. She became a certified personal trainer in 2007 through NASM (National Academy of Sports Medicine) and also completed certification courses in Schwinn Cycling (Spin Instruction), Group Exercise Instruction, NASM Stretch and Release and Annette Lang Pre and Post-Natal personal training


Stay in the Game: Tennis Injuries

Summer’s here and tennis is literally in full swing! Tennis athletes should train in a specific manner to both improve their performance and reduce their risk for injury.

tennisTennis has become more physically demanding game than in the past, so proper and specific conditioning is required to generate the power to hit the ball harder and at faster pace. Players need to move quicker and more explosively than ever before. Advancements in racquet technology have enabled players to hit serves at over 150 on the Men’s tour and if you are Serena Williams you consistently hit at 125 mph. Tennis players are now playing more of an aggressive baseline game taking balls earlier to reduce their opponent’s time between strokes and and utilizing an open stance that allows for harder more aggressive strokes. As a result there has been a recent increase in tennis related injuries.

Tennis injuries can occur in players of all skill levels, from the pros to the recreational player. One of the main causes of injuries is the inability of a body part to withstand the demands placed on it, which often results from either a lack of training or the converse, over training.

Tennis injuries can be categorized into 2 types: Traumatic and Overuse Injuries.

According to the USTA (United States Tennis Association), traumatic injuries account for 1/3 of all tennis injuries and include muscle pulls, ligamentous sprains and fractures. Overuse injuries run the gamut of lower back pain, muscle strains, tendonitis etc. They can occur anywhere in the body, and may often be related to player technique or diminished and improper conditioning.

Tendonitis is one of the more common overuse injuries, often seen at the elbow, shoulder or knee. Tendonitis is due to overuse of the muscle or excessive stress on a muscle and tendon. Often this excess strain is a result of poor technique. Tennis elbow is usually seen in novice players, as opposed to advanced players; it is likely to be caused by either improper technique or equipment. A tennis player’s technique may breakdown due to muscular strength and lack of endurance and conditioning. Limited joint mobility, decreased power and decreased flexibility can also contribute to poor form.

How can Physical Therapy Help?

A physical therapists evaluation will address specific parameters to help prevent injury and return the tennis player back to their game. Assessing flexibility, strength, power, and control is critical to developing a specific program to restore optimal performance. Utilizing the guidelines developed by the USTA strength, flexibility, control and stability and movement patterns are evaluated.

Physical therapists also perform biomechanical evaluation of the serve, strokes, form, and playing technique, assessing faulty movement patterns. This enables the therapist to identify the cause or contributing factors to pain, injury, or poor play. In addition, they can work with one’s tennis professional to tie their evaluative findings with the player’s injury or poor performance and collaborate on a scientific and effective approach to injury prevention, appropriate conditioning and performance enhancement.

Still have questions… call us today and set-up an appointment with a physical therapist where they will evaluate your condition and answer all of your questions.

Image courtesy of Carlos Porto at


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)


Sidelined: the ACL

Anterior Cruciate Ligament (ACL) injuries is often referred to as the “Mother of all injuries”. It can knock athletes out for a season and leave them hesitating from pivoting ever again. Skiers, basketball, football, lacrosse and soccer players shutter at the sound of this three letter word knowing a 6-9 month rehab is following this injury. ACL tears usually occur after an awkward landing or a pivoting motion on a planted foot. Hard hits also contribute to this injury but nearly 80 % of ACL injuries are caused by non contact. Training the muscles to fire properly in the legs and working on form can hopefully keep ACL’s from sidelining you.

runnerWhen ACL Is a Pain
The anterior cruciate ligament is a fascial band in the knee that connects the thigh bone (femur) to the shin bone (tibia) . It provides stability to the knee, controls rotation, and along with the hamstrings keeps the tibia from translating too forward on the femur.

Studies show the ACL is under more stress when the knee is straight or bend 5 to 20 degrees and is exposed to an inwardly directed force. (Think “knocked knee position”). If the force exceeds the tensile strength of the ligament a tear can occur and the knee loses its stability. Grinding and excessive motions occur, leading to wear and tear on the joint surface and meniscus. It can also strain surrounding ligaments and tendons.

Athletes often complain of a “popping” sound when the injury occurs and swelling and pain follows.

Why You Are Sidelined
It’s like the Perfect Storm when an ACL injury occurs – a few factors simultaneously hit, washing out an athlete’s season. Consider landing from a rebound in basketball with the knee fairly straight in that 5-20 degree knee bending zone where the ACL is stressed. Add sluggish hamstrings, and “rolling in” of the knee from a weak glute and the ACL is stressed even further. Suddenly POP!

Players participating in sports involving sudden stops, jumps and pivoting motions are more at risk for ACL injuries. Female athletes are 6-8 times more at risk compared to males. Studies say it could be due to delayed hamstring firing compared to male athletes, structural issues like hip/ knee alignment, or hormone levels.

Regardless of your gender, if your buttocks are weak, you can develop that “knocked knee position”. If your hamstrings are weak they can’t efficiently stabilize the tibia. The ligament is then subjected to more force, increasing risk of injury when landing or cutting and turning during your sport.

How to Stay In The Game
FORM! Our favorite four letter word when it comes to avoiding injury. Watch your form and build proprioceptive awareness of where that knee and foot relationship is while you are playing your sport. Besides overall core and quadriceps strengthening be sure to strengthen the hamstrings and gluteal muscles to help support the ACL.

Try these exercises:
Side to Side Shuffles

• Don’t allow knee to cave in!
• Start with slight bend at knees
• Leading with right foot sidestep pushing off with the left foot
• When you drive off with the left leg, be sure the hip/knee/ankle are in a straight line.
Do 30 seconds then switch direction 3 sets

Scissor Jump
• Start in lunge position right leg forward with knee over ankle
• Push off from your right foot and bring your left leg forward into lunge position.
• Don’t let knee roll in or out keep it in line with ankle
• As you land the weight should be accepted on the ball of your foot and knee should be bend slightly
Do 3 sets of 10 repetitions

Glute Sidelying
• Hips stacked lie on your side
• Lift leg up and SLOWLY lower down
• Don’t let leg come forward
3 sets of 10 repetitions

As always, be sure to check with a physician prior to any exercise program.


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. 


Ready, Set, Spin!

intor to spin calss

Taking a new class can be a bit intimidating, but it doesn’t have to be. If you have never taken a spin class before, arrive early and find the instructor, they’ll be happy to help get you set up properly.

A spin bike allows you to adjust for seat height, position and handlebar height, to create the perfect fit, ensure a great ride experience, and minimize the risk of injury. Here are a few how-to tips for setting up your spin bike like a pro.

Seat Height: With proper bike set up you minimize the risk of injury. When clipped in, or if you place your feet in the toe cage rotate the pedals so that at the bottom of the pedal stroke your leg should have a 25 to 35 degree bend at the knee.

Fore-Aft Seat Position: The seat will adjust forwards and backwards to ensure that your knees are properly aligned relative to your feet. Sit on your bike with your hands on the handlebars and ball of your feet over the center of the pedals. Then position your pedals so that they are level with each other and parallel to the floor. Using the forward leg to check alignment, the seat is in the right position when your knee cap is directly in line with center of the pedal.

Handle Bar Height: Adjust the position so that you don’t have any neck tension or back strain.

Foot Position: Make sure that your cleats are properly aligned so that the ball of your foot is positioned on the center of the pedal. This is the firmest widest surface of your foot and most efficient and comfortable foot position.

Spin Shoes are recommended: They are designed to snap the cleat into the peddle so that you foot is attached to the bike, this allows you to both pull up using your hamstrings and gluts as well as pushing down. Without the cleats you risk Achilles and anterior tibialis tendonitis.   If you do spin regularly these shoes are recommended. If you are spinning regularly you may want to buy your own pair, but most facilities will either lend you a pair or rent you spin shoes.


Tamar Amitay Physical therapist NYCTamar Amitay, PT, MS, Founder and Principal of Thrive Integrated Physical Therapy, Tamar Amitay 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)