Picture of a Vintage Postcard from riptheskull on Flickr

Delivering holiday cheer, hope, and of course Christmas presents to all the good boys and girls of the world is an enormous undertaking.  As I was doing my last-minute shopping I started wondering about the physical demands of Santa’s job.  Physical therapists develop the best treatment plans when they have a good understanding of the activity of a person’s daily life.  In order to gain perspective on a client’s occupation, I ask clients to bring pictures of their work or sometimes I even make a visit to his or her workplace.  This allows me to make elements of a job more ergonomic.  Whether it be problem-solving with a client to alter the way a job is done or recommending equipment, we aim to decrease stress and strain to the body with an eye towards preventing injuries on the job or alleviating the pain of injuries already sustained.  Although Santa isn’t my client, he could very well be one day based on pictures and stories about his work.  I know it’s probably not possible to analyze Santa’s job at his workplace.  Although, Santa, if you’re reading, I can be ready in a flash.  This year in lieu of cookies, I am leaving Santa a few physical therapy tips to keep him moving and make his life a little more comfortable.

Dear Santa:

I thought it might be good to leave you a few physical therapy tips tonight to make your job a little less stressful on the body.  With all that travelling, your back and feet surely must be sore.  First, consider the seat of the sleigh.  Get a supportive pillow for your back.  This will maintain your back’s natural curve and promote a better posture.  I’m sure the reindeers don’t always provide the smoothest of rides and landings, so be sure to use a seat cushion to dampen the jolts and vibrations that are stressful to your spine.  Second, in order to reduce the swelling in your legs think about wearing compression garments.  This will also help to prevent development of blood clots on those prolonged sleigh rides.

I know it’s tradition, but why are you using the chimney to get into the house?  Trying to squeeze yourself and a large amount of presents into a dirty chimney isn’t ergonomic and climbing up a roof while carrying such a heavy item over your back is not recommended.  Landing on the roof seems dangerous anyway.  Why not have one of your magical elves open the front door for you?  Just a thought.

Speaking of elves, I know they help you throughout the year to make presents.  Consider taking a team with you on Christmas night.  They can help to unpack presents, carry the heavy gifts, stuff stockings, and keep the reindeer in line.  Many of my patients benefit from asking for help with the physical demands of household chores or even at work by getting the help of others.  Ask them to break up the gifts into more manageable loads or smaller sacks.  I know it’s inevitable that you will have heavier gifts to lift, so when you do, use good body mechanics by bending your knees to pick them up and ask the elves to help you.

Also, due to the repetitive nature of your job stuffing stockings and carrying objects, you are really setting yourself up for an overuse injury.  Have you ever had elbow or shoulder pain after the big night?  I’m sure there are tons of elves ready to help you with the lifting, carrying, and stuffing, so start asking!

Finally, We can’t deny that billions of cookies in one night is not good for your health.  Not to mention increased belly fat is associated with a whole host of physical ailments.  Also, excess weight places strain on your lower back.  Have you thought about saving the cookies and giving them to others or better yet, asking for veggies and peanut butter or lower fat options?  Many people depend on you Santa.  I hope with these tips you’ll be able to deliver good cheer and presents for many many more years.

Wishing you a stress-free night,

Sincerely,

Monique Serpas, PT

©2012 Geaux to Physical Therapy. All Rights Reserved.

Image via Wikipedia

October is National Physical Therapy Month (NPTM).  This year’s focus is on sports injury prevention through the lifespan. Staying active is important at every stage of life.   Sports are a good option for people looking to get exercise without hitting up boring cardio equipment like the “dreadmill.”  There are several options for staying active through sports by finding local sports clubs, the parks and rec department, or gym leagues.  Though sports are good for our bodies, injuries do occur, especially if a person isn’t properly trained or conditioned and ready for its physical demands.  What can start out as a nagging pain during sport can turn into a problem that takes a person away from a loved activity.  The best way to prevent sports injuries like these is to not ignore them and seek help from the right people.  Don’t give up and don’t stop moving!   A physical therapist can help you move, move again, and move better.

A physical therapist will not only treat your primary problem, but also other problems that may have contributed to the injury. Physical therapists are trained to find these deficits and give clients a customized exercise program to address them to prevent the injury from reoccurring.  If you would like to find a PT in your area to help you get back to sports or improve performance in sports, visit the American Physical Therapy Association’s (APTA) website.  To read more about NPTM, click here.

In October, I’ll focus more on promoting physically active lifestyles, physical therapy, and its benefits.  In preparation for NPTM I’ve been doing free sports injury screenings at the Milwaukee Northside YMCA.  I’ll do my last one on Wednesday October 5th 4PM-6PM. I’ll also be giving out free information about injury prevention for runners, golfers, and bikers.  If you’re in the Milwaukee area, stop on by and help me celebrate NPTM!

©2012 Geaux to Physical Therapy. All Rights Reserved.

Image via Wikipedia

Tennis elbow is a painful condition in which pain is experienced on the outside of your elbow with lifting and gripping (especially when your elbow is straight) and can lead to weakness in the elbow and hands.  The condition can be attributed to poor technique related to tennis, however, more people suffer from tennis elbow than just tennis players.  If you’re reading this, you may fall into this category.  In fact, the condition is attributed to playing tennis in only 5% of the cases!

Tennis elbow commonly occurs in those who are middle-aged.  Although many believe tennis elbow (also known as lateral epicondylitis) is an inflammatory condition (“-itis” means inflammation, right?), research shows that in many cases little to no inflammation is present.  More recently, tennis elbow has been described in terms that do not suggest inflammation is present, such as tendinopathy, tendinosis, or lateral epicondylosis. These terms imply tendon degeneration, which research indicates is a cause of this condition.

Tennis elbow is caused by overuse and overload of the tendon beyond what it is capable of doing.  Overuse and overload can mean different things to different people.  It depends on how strong you are and what your body is capable of tolerating.  For some people, tennis elbow can be provoked by doing more household chores in one day than normal.  Others may provoke symptoms by participating in more sporting activities than normal (such as not swinging a golf club all winter and then taking a trip that includes playing 18 holes of golf 4 days in a row).

Overuse and overload leads to small tears in the tendon.  Under these conditions, the tendon may not be able to repair itself properly, leading to more small tears.  As part of the inadequate healing, the collagen fibers of the tendon, which give the tendon strength and support, become disorganized and weak and more “fibrotic” scar tissue is formed.  The tendon becomes thicker, inflexible, and is not very strong or resilient.   The improper healing of the tendon can lead to more pain and larger tears in the tendon and muscle.

Many of my patients ask about whether a cortisone injection would help.  Research shows that medication and cortisone injections can provide adequate short-term pain relief, but no lasting effects, and one study even noted that tennis elbow treated with cortisone injections had poorer outcomes after 6 weeks of treatment and increased recurrence compared to those who had physical therapy or even for those who took a “wait and see” approach.  Inadequate and or delayed treatment can lead to the problem becoming chronic.  For more info and my opinion about cortisone injections, click here.

Treatments for this condition will vary based on the stage of healing.  Physical therapists are trained to identify the stage of healing of tennis elbow and the appropriate course of treatment.  Physical therapists use specific manual therapy techniques and exercises to help reorganize the collagen within the tendon, promoting better healing and improving its strength.  If you think you may have tennis elbow, see a physical therapist.  You can find one through the APTA.

References

Clinical Evidence Handbook: Tennis Elbow – March 1, 2007 – American Family Physician. (n.d.). . Retrieved March 1, 2011, from http://www.aafp.org/afp/2007/0301/p701.html

©2012 Geaux to Physical Therapy. All Rights Reserved.

“I thought it would just go away on its own.”

I’ve had countless patients recount that their problems often start as small, nagging pains that eventually evolve to a level of pain that causes them to avoid physical activity all together.  Pain can start as occasional and progress to being there all the time and even at times when the aggravating activity is over.   Elbow or back pain that keeps a golfer from playing… knee pain that stops a runner in their tracks… back pain that keeps someone away from yoga… chronic ankle sprains that affect basketball players.  I’ve had patients in all of these situations.  I hope to see people when they are just “occasionally” having the pain with an activity, but I often see people only after they are in the chronic phase  (problem sticking around more than 6 months).  At this point they have usually stopped the aggravating activity all together.  Physical therapy can help someone in any phase of an injury: acutely (<6 months duration) or chronically (>6 months duration).  It’s best to get help right away, but maybe you didn’t know about physical therapy or who to reach out to… so now the problem is “chronic.”

In dealing with chronic problems and pain, such as arthritis, you have two choices.  You can either stay moving or mobile to be healthy, or avoid activity all together because everything is “painful.”  As I’ve discussed previously, the benefits of exercise are widespread.  Every system in our body needs movement to stay healthy, especially the musculoskeletal system.  Inactivity results in thinning of a joint’s cartilage and it becomes less resistant to joint forces.  The right amount of activity stimulates cartilage and keeps it healthy.  The less active someone is, the faster his/her cartilage will degenerate, resulting in stiffer and more painful joints.  What develops is a painful cycle of inactivity leading to joint breakdown leading to more pain and more inactivity.

Out of those two choices, I think you know which one I’m for.  If you need help determining what activity you can do, what exercise will help you improve joint health, or what activities to avoid to improve and maintain joint health, see a physical therapist.

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©2012 Geaux to Physical Therapy. All Rights Reserved.

I applaud gyms that allow access worldwide. Making fitness more available helps us fight obesity by encouraging everyone to be active anywhere, anytime.

©2012 Geaux to Physical Therapy. All Rights Reserved.

1. Weak Back Muscles
2. Tight Hips
3. Loss of Balance
4. Low endurance
5. Weak Legs
6. Stiff Shoulders
7. Weak Hips

Most of the exercises below are yoga moves.  I incorporate yoga poses into many of my treatments.  Overall, it is one of the most multitasking activities out there, improving flexibility, strength, core stability, balance, coordination, and stress levels.  I highly recommend you make yoga a part of your workouts to improve health long term.

Chair Pose/ Squats

http://www.youtube.com/watch?v=Ur-W02QtIRU

Triangle Pose: This is great for not only hip flexibility, but also balance, especially when looking up.  Only reach down the leg as far as you can comfortably and without losing your balance.

http://www.youtube.com/watch?v=UVE5zW4RsK8

Child’s Pose: Do this one with your arms extended straight out in front to stretch your arms

http://www.youtube.com/watch?v=NwzE_J-3JOI

Clamshells: You can do this one without the band to start and work your way up to using resistance as you get stronger.

http://www.youtube.com/watch?v=njthA4SVOT8

Rowing: The person in this video gives some good variations on rowing, an exercise to strengthen the upper back muscles, by changing his standing position to incorporate balance.  Though, I would go much more slowly and controlled with the movements.

http://www.youtube.com/watch?v=1SgomK3sb98

Bridging: This previous post gives you lots of variations on the bridge exercise.  This exercise will strengthen the glutes and stretch the hip flexors, which can become stiffer as we get older.

To improve endurance, be sure to incorporate aerobic activities into your workouts.  In other words, exercise that will challenge the heart and increase your breathing.  Swimming and cycling are good activities to work on your endurance and they have lower impact on your joints.  Shoot for 15-30 minutes at least at a time and be sure you feel like you are working hard, though not so hard that you can’t talk while doing it.

When you are designing your anti-aging exercise program it is important to do them regularly, 3 times a week minimum.  Yoga and strength exercises should be done in 3 sets of reps of 8-15 with a good 5-10 second hold for the yoga poses.  It’s also important to make sure that your exercises are a real challenge, because challenging yourself is what will ultimately bring about the changes your body needs.  Don’t just be active, be active in the right ways with the right exercises to avoid mobility problems like inability get out of a chair or step up and down curbs.  If you need more tips on exercises, find a good personal trainer that is in tune with exercising for prevention.  Or you could ask your physical therapist for a good recommendation.

Thanks to ClevelandSGS on Flickr for the picture.

©2012 Geaux to Physical Therapy. All Rights Reserved.

As we age our muscles lose elasticity and strength.  Our joints become stiffer and compacted.  We develop arthritis.  These are things that are inevitable and cannot be changed, however, you can decrease the speed at which these events occur and improve or maintain your mobility throughout life by staying active, strong, and limber.  Did you know that you can improve your strength at ANY age?  Even if you’re 90 years old you can get stronger by doing resistance exercises and lifting weights, even as age is taking strength away!

http://www.youtube.com/watch?v=fTrUrFdepuQ

As a physical therapist, I’ve noticed that there are certain areas of the body that tend to lose flexibility and strength as we get older.  Here’s a breakdown of the most common age-related mobility problems I have noticed in my evaluations.

• Inability to Stand Up Straight/ Increased Thoracic Kyphosis
  • Another term people use is a “hunched” back, where the upper part of the back is rounded more than normal.  This is in part due to poor posture and prolonged positioning, which can lead to a permanent change in spinal and shoulder alignment.  Most clients with this problem mention they have to sleep with 2 or more pillows at night due to this change in the spine.  This can worsen over time and cause problems at other areas including the neck, shoulders, and low back.
• Inability to Raise Arms Overhead
  • Maintaining the ability to reach for things in your cupboard or get a pullover on without straining your shoulder requires good range of motion and flexibility
• Difficulty Getting out of a Low or Soft Chair
  • As leg strength decreases this activity gets harder and harder and most people start to rely more on their arms to push themselves up, or to unsafely use momentum to propel themselves up.  Also hip inflexibilities can make getting out of chairs much more difficult.
• Waddling Gait
  • This may also look like a limp and may be related to arthritis, but when our hips get weak they start to cause a waddling gait which places undue stresses on the hips, knees, and low back
• Feeling unsteady
  • As strength, flexibility, and reaction time declines, so does balance, though balance can be improved through exercise.  Falls is a serious problem among the elderly, so we should all be working on our balance from an early age to combat the risk of falling as we age.
• Inability to take the stairs or get up a curb
  • Weak glutes, hamstrings, and quads in particular will make this activity much harder.  Although there should always be a ramp, some places do not have one or it is not conveniently located, so it’s important to maintain this skill to stay safe and prevent falls.
• It’s hard to walk long distances
  • Aerobic conditioning is very important to maintain through the golden years to maintain endurance for walking, whether it be for several hours to shop or to get all your errands done in one day.  Many of my clients who have this problem have to sacrifice efficiency and plan for much more time to get everyday chores done due to low endurance.

These are the most common problems I have seen in physical therapy related to aging and prolonged inactivity.  The good news is with physical therapy I have helped clients overcome these obstacles through customized exercises to improve quality of life and independence.  If you have one of these problems, find a physical therapist to get a customized plan to make improvements and prevent disabilities!  If you’re looking to prevent these problems and maintain your quality of life, check back next week.  I’ll post exercises and tips to help prevent these commonly-seen problems and help you get started on a plan to maintain your independence and mobility for as long as possible!

©2012 Geaux to Physical Therapy. All Rights Reserved.

Link to knee anatomy.  Note all of the muscles surrounding the knee to give it stability.

Video showing the knee joint, including the muscles surrounding it, and arthrosis (degenerative arthritic changes).

http://www.youtube.com/watch?v=l9sS4wfD-AU

©2012 Geaux to Physical Therapy. All Rights Reserved.

Sustained Positions Self-Check

1. During the course of a day, try to be consciously aware of the positions you put yourself in- start from the bottom up: feet, knees, hips, back, shoulders, neck.  Are you forward, backward, bent in any certain position for a prolonged period?
2. Make a note of your preferred and comfortable postures.  Do you tend to slouch?  Does your back round?  Do you jut your head forward?  Is your head turned one way or the other?
3. When you are seated do you always cross one leg?  Do you feel weight on one buttock versus the other?  Do you prefer to prop yourself up on one elbow versus the other?
4. Do you have a preferred sleeping position?  Do you always lie on one side?  Are your back and legs rotated? If you sleep on your belly (not a good sleeping position and not recommended by me) do you always have your head turned left or right?
5. When you have to stand for a long time in one spot where do you place your weight?  Are you more on one leg versus the other?  Do you put more pressure on the balls or heels of your feet?  Are your feet rolled inwards or outwards?

If you find certain asymmetries, for instance you always sleep on your right side or when you stand you feel most of your weight on your heels, try to correct them.  The goal here is to keep the body balanced.  If you always sleep on your right side, try to sleep on your left side sometimes.  If you feel more than 50% of your weight on your heels, try to shift your weight on your feet so you feel equal weight between the balls of your feet and the heels.  Our bodies have subtle preferences such as these that over time can lead to musculoskeletal problems.  If you can catch them now and do something about them, you may be able to prevent a painful condition down the line.

©2012 Geaux to Physical Therapy. All Rights Reserved.

“Tobacco use, particularly cigarette smoking, is the leading cause of preventable illness and death in the United States”

Everyone has heard about the negative effects of smoke, second-hand smoke, and now even third-hand smoke.  How does smoking impact physical therapy?  Smokers actually take longer to heal than nonsmokers, thus more time is required to rehab an injury.  Most people have to quit before any elective surgeries for this reason.  Less likely to heal = more complications.  Smoking also affects your heart and lungs, making exercise more difficult.  Below I share a few facts about how smoking affects the body, its risks, and the benefits of quitting.

About one-third of all cancers are due to cigarette smoking.  Also, cigarette smoking increases the risk of stroke by approximately 50%.  Stroke is an interruption in blood flow to the brain that results in brain damage.  It is the leading cause of adult disability, and the third leading cause of death in America.

The Cardiovascular System

• Smoking exacerbates circulatory problems leading to peripheral vascular disease, which limits the body’s ability to heal. This can lead to foot amputation in those whom have diabetes.
• Smoking increases your risk of developing coronary heart disease which increases your risk of having a heart attack.
• Nicotine increases the LDL receptors of blood vessels, contributing to high cholesterol.
• Tobacco products elevate the heart rate and lead to high blood pressure.
• Buerger’s Disease, a vasculitis affecting peripheral blood vessels is  associated with smoking.  This compromises circulation and healing.

The Digestive System

• Smoking weakens the lower esophageal sphincter.  This causes stomach acids to reach the esophagus, which leads to heartburn and esophageal damage.
• Smoking increases the risk of infection from a bacterium, H. pylori, which is responsible for causing peptic ulcers.  Further, the ulcers may heal slowly or not at all.
• Smoking can cause liver disease, harming the liver’s ability to process toxins.
• Smoking increases the risk of developing Crohn’s Disease, swelling deep in the lining of the intestine, which causes pain and diarrhea.
• Several studies show that smoking may increase the risk of developing gallstones.

The Pulmonary System

• Cigarette smoking is the greatest risk factor for lung cancer.
• Smoking is the major factor for developing emphysema, a disease that destroys lung tissue.
• Irritants such as cigarette smoking can cause chronic bronchitis, an inflammation of the lungs that obstructs air flow and increases mucous production.

The message is out there that smoking is bad for you.  What exactly are the benefits of quitting?  Below it’s broken down into benefits from as little as 20 minutes after quitting to 15 years later.

Photo Credit: Quinn Dombrowski

Immediate and Long-term Benefits of Quitting

20 minutes later… blood pressure, pulse, and body temperature return to your baseline normal level
8 hours later… oxygen levels increase, carbon monoxide levels decrease in the body
1 day later… your risk of heart attack decreases
2 days later… you will be able to smell and taste better, nerve endings begin repairing
2 weeks to 3 months later… improved circulation and lung function, reduced shortness of breath, improved ability to exercise
1-9 months later… Reduced coughing, sinus congestion, and fatigue; increased energy
1 year later… Risk of coronary heart disease is reduced to one-half that of a smoker
5 years later… Risk of lung cancer is reduced by 50%, reduced risk of stroke, risk of oropharyngeal cancer decreased to one-half that of a smoker
10 years later… Lung cancer death rate corresponds to nonsmoker’s rate
15 years later… Risk of coronary heart disease equals that of a nonsmoker

Of course, every rose has its thorn.  To get the benefits of quitting you actually have to give it up.  Nicotine is addictive and overcoming such an addiction is no bed of roses.

Guidelines for Quitting

• Don’t go it alone and don’t quit cold turkey!  Your body has developed a dependency on nicotine and you need to carefully wean yourself from this drug.  Seek the advice of your physician.
• Use a medication approved by the FDA
• Nicotine replacement therapy: gum, inhaler, nasal spray, patch
• Nonnicotine pharmacologic aids:  consult with your physician

Feel free to share this with others!

References and Resources

Office on Smoking and Health Nat’l Center for Chronic Disease Prevention and Health Promotion (www.cdc.gov/tobacco)

National Cancer Institute’s Smoking Quitline (1-877-44U-QUIT)

www.smokefree.gov

www.stopsmoking.org

Boissonnault, W.G., Fuller, K.S., & Goodman, C. C. (2003). Pathology: Implications for the Physical Therapist (2nd ed.). Philadelphia, PA: Saunders.

©2012 Geaux to Physical Therapy. All Rights Reserved.