It’s New Year‘s Eve.  The countdown begins and the ball is going to drop.  Don’t drop the ball on this one- a new year’s resolution.  It’s down to the wire, but I can finally cross it off my list, because I have a resolution.  Thanks to a friend, I’m joining a group of people who are #30min365: 30  minutes of exercise. Everyday. For one year.

Genius idea from Blake Samic for a new year’s resolution, if you’re still searching for one.  He did it in 2010 and can give you a few reasons why you should consider doing it with him and a few tips to stay committed.  Moderately intense exercise has been recommended 3-5 days per week in the past, but new exercise recommendations were made this year by the American College of Sports Medicine.

” The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d⁻¹ on ≥5 d·wk⁻¹ for a total of ≥150 min·wk⁻¹, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d⁻¹ on ≥3 d·wk⁻¹ (≥75 min·wk⁻¹), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk⁻¹. On 2-3 d·wk⁻¹, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk⁻¹ is recommended.”

As with any exercise including those your physical therapist prescribes for you, there will be times motivation is difficult.  Blake claims 7 days are easier than 5.  At first glance, I was skeptical, but as I started thinking about how I prescribe exercise for my clients, I think it makes sense.  In order to make a change in behavior, you have to make it a habit.  It’s easier when it’s routine and expected.  I frequently tell clients things like, ” every time you go to the bathroom, check your posture.”  ”Try fitting in your exercises each time before you eat.”  Perhaps knowing you need to exercise everyday, no exceptions, like eating or brushing your teeth, helps with compliance.

Time will tell on this one.  In the meantime I’ll be counting the minutes, days, and months until the next time I watch the ball drop.

Want to join Blake and others making the #30min365 resolution?  Check out his blog for more info.

Want to read more about ACSM’s exercise guidelines? Visit Medicine in Science in Sports and Exercise

©2012 Geaux to Physical Therapy. All Rights Reserved.

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.

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Since I cancelled my cable, I’ve been watching more Netflix.  Recently I was browsing through the “Suggestions for You” category when I found “Gotta Dance” a documentary about the first-ever senior citizen hip hop dance team for the New Jersey Nets.  It’s a story about people being active at any age and against odds… it’s scary how well netflix knows me.

The group was determined to show the world that just because you’re over 60, doesn’t mean you can’t dance.  A member said, ” age is a number I like to ignore.”  They even talked about the importance of exercise in keeping them “young.”  I have a discussion around the topic of exercise in older adults weekly with my clients.  Older people CAN get stronger and fitter.  Unfortunately, there are some that believe this is not possible and it usually takes some convincing on my part to get them on board.  Nothing is more convincing than hearing the stories of the people that joined this group.  Many of them talk about how they felt better, lost weight, and became more confident.

One of the members stated, “People over 60 CAN DO more than sit and watch TV.”  He’s absolutely right, however, if you’re over 60 and all you do is sit and watch TV… well that’s all you’ll be able to do.  Bodies in motion tend to stay in motion.  Find something you love doing or something you have an interest in learning, even if that something is difficult and challenging to your body and your mind.  I did a quick search in Milwaukee and found dance studios and recreation departments holding classes for adults to learn dance or return to dance.  One such company in Milwaukee is DanceWorks.  They have 50+ classes in ballet, tap, and yoga.  Communities should be offering more diverse options for older adults to stay active above and beyond chair exercises and water aerobics.  Although those are good classes and helpful to many, there are older adults who don’t want to slow dow.  Some want to continue to challenge themselves physically, such as those who joined the Netsationals.  The members of the Netsationals were new to hip hop dance, but they were willing and ready to learn something that was unfamiliar and out of their comfort zone.

Exercise is the key to aging gracefully.  Find something you like.  You can dance if you want to. If you know an older adult that falls into the “only sits and watches TV” category, have a discussion with them about exercise.  Life gets much harder for an older adult when their bodies are no longer in motion.  If you are having trouble staying physically active or if everyday tasks are becoming difficult or uncomfortable, the best person to see is a physical therapist.  Find one here.

©2012 Geaux to Physical Therapy. All Rights Reserved.

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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.

There were a number of difficult, beautiful hills on the second day.  My muscles felt like rubber as I was puffing away up a hill yesterday when a rookie rider (shout out to the Power of the Patch team) passed me on the left and turned back to sputter out, “This kinda sucks.”   About a quarter-mile later, there was an even more challenging hill.  I puffed up that one and found “Power of the Patch” at the top resting and yelled out, “No, that kinda sucked.”  As I churned out the next few miles I reflected on the previous night’s speaker, Dan Erschen.

Dan has MS.  There are a few types of MS, his type is characterized by ”attacks.”  One of his attacks took away his ability to walk for a year and a half.  He says, “Believe it or not…I’ve had more good come out of having MS than I’ve had bad even though it hit me as hard as it did.”  Even though he is 50 years old and battling MS, he completed the 2010 WI Ironman in 14 hours and 41 minutes.  And you know what he has to say about it?  “It’s not a big deal.”  He went on to talk about some of the challenges he and others face who are battling MS stating after each one “That’s a big deal.” ….. building up enough endurance to walk to the mailbox for the first time, feeding himself without anyone’s help, buttoning his shirt, lasting 5 minutes on the elliptical machine.  These are usually the goals physical therapists help people with MS achieve.

As I kept puffing up the hills reflecting on his words as well as the courage and spirit of the patients I have worked with who have MS, I decided no matter what, I was doing the 150 miles.  I refused to walk my bike to get up a hill (even if that meant cruising at a mean 3 miles an hour at some points), because you know what REALLY sucks?  There’s no cure for this disease.

Please help Dan achieve his goal by donating to his cause- the MS Society.  If you really want to be inspired visit his page and read his own words.  Visit the Active MSers page for more info on staying active through MS.

Here’s Dan finishing the Ironman.

http://www.youtube.com/watch?v=8jt1JPnUELU

©2012 Geaux to Physical Therapy. All Rights Reserved.

Image by IronHide via Flickr

An article^[i] in the The Journal of Orthopaedic and Sports Physical Therapy (JOSPT) recently discussed a possible new hallmark of carpal tunnel syndrome – a stiff neck.  Carpal Tunnel Syndrome (CTS) is a condition in which a nerve in the wrist is compressed, causing symptoms of numbness, tingling, and weakness in the hand.  It can cause considerable pain and debility in the hand and many patients complain of it waking them at night or causing them to drop objects.  Carpal Tunnel Syndrome is most commonly thought to be caused by compression of the median nerve within the “carpal tunnel” in the wrist.  Or so we think.   In the JOSPT article, neck mobility was assessed in women with CTS and a second healthy group.   The research showed that women with CTS had less neck mobility, essentially a stiff neck, compared to the healthy counterparts.  The research also discussed previous studies that also found the presence of abnormal posture, arthritis, spinal stenosis, and pain in the neck and shoulder in individuals with CTS.   Apparently, CTS and conditions of the neck hang out well together like peas and carrots.  Hmmm.  One of my patients made a relevant comment this week, “You mean one part of the body is connected to another?!”

The carpal tunnel is a space within the wrist.  In this space lies a nerve, the median nerve to be exact, as well as 9 tendons.  If you can correctly comment below the names of the 9 tendons, you get a cookie, or maybe one of those mashed potato cupcakes.   During cadaver dissection, nerves look like little white strings.  The median nerve arrives from the brachial plexus, a bundle of nerves in the neck and shoulder region that look like a complicated braid.  The brachial plexus arrives from nerves that shoot off from the neck.  When you pull one side of a string, does it make the other side of the string move?  I’m simplifying something that is much more complex than that, but can you see how movement of the neck might affect a string or strings that come from it?

Physical therapists are trained to assess adjoining joints to get a more global picture of what might be contributing to a condition.  In a physical therapy evaluation of a patient with CTS, I screen range of motion and strength in the joints all the way up from the wrist and hand to the neck. I also assess mobility of the median nerve along its entire course from the hand to the neck, in what I like to call “flossing.”  Whatever impairments I find, treatments are incorporated to address them.  If CTS is not managed well with conservative treatments of physical therapy, splinting, and injections, then surgery may be suggested.  If you have or think you have CTS, be sure someone takes a look at your neck.

Although this study points out that a stiff neck may be a common feature in CTS, more research needs to be done to see if this may indicate it contributes to CTS or if CTS contributes to neck pain and associated conditions.  We don’t fully understand our body’s nervous system.  I have a feeling it’s more than just peas and carrots.

Is all this talk of vegetables making you hungry?  Try this out.

©2012 Geaux to Physical Therapy. All Rights Reserved.

1. De-La-Llave-Rincon, et al. (2011). Women With Carpal Tunnel Syndrome Show Restricted Cervical Range of Motion. JOSPT, 41(5): 305-310.

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Since the news about the air traffic controllers a few weeks ago, it seems like the topic of sleep is being discussed everywhere. When I initially evaluate my patients I ask about their sleep habits and make recommendations on which positions might be the best and those to avoid.  The position in which one chooses to sleep can sometimes be the cause of the problem for which he or she is seeking treatment.  Though I believe sleep posture and appropriate positioning is important for treating certain conditions, I was curious to know if quality and quantity of sleep impacts a person’s outcome in physical therapy.  I value sleep personally and believe it does have an impact on how well someone can recover.  I looked at research to learn more about sleep and to see if this topic has been investigated as it relates to physical therapy.  I learned a few interesting things. 

The exact purpose of sleep remains elusive.  Our sleep cycle consists of periods of REM and non-REM sleep^[i] During sleep we alternate between REM (rapid eye movement) and non-REM (non-rapid eye movement) sleep with increased duration of REM sleep towards the end of the night.  A component of non-REM sleep is short wave sleep, which some researchers hypothesize has physiological restorative benefits.  This type of sleep diminishes as one ages.^[ii]  The amount of sleep one needs can vary with some people, “short sleepers,” only needing 4-6 hours of sleep per night versus others needing 7-9 hours.  Current research indicates that it is rare to be a true “short sleeper,” but many more people think they are one and are really depriving themselves of sleep.  One possible indication that you are not a “short sleeper”:  if you prefers to sleep in over the weekend versus only sleeping 4-6 hours per night as you might during the work week, then you are probably depriving yourself sleep during the work week.^[iii]

Sleep can have a positive effect on motor learning in young, healthy people, with a 60-90 minute nap improving performance.  Research has also indicated this same beneficial effect of sleep is seen in people recovering from stroke.^[iv]  Patients recovering from stroke often have to relearn many movements including things like walking, grasping objects with their hands, and getting up and down curbs.  Though research suggests the positive effects of sleep on learning motor skills and movements, which could benefit physical therapy, I also wondered what the negative effects would be of not getting adequate sleep.

Research suggests the negative effects of sleep deprivation include:

• increased risk of weight gain^[v]
• alteration of immune system^[ii]
• increased perception of anxiety and depression^[vi]
• increased inflammatory cells in the body^[ii]
• impaired memory and concentration^[vi]
• increase in muscle tone^[vi]
• muscle tremor^[vi]
• difficulty maintaining balance^[vi]
• increased sensitivity to pain^[vi]

58% of people with low back pain were found to have sleep disturbance.^[vii]  Sleep disturbance is also common in cases of rheumatoid arthritis.^[viii]   Although research shows that people with these conditions have disturbed sleep, I could not find studies that investigated the effect of sleep on the condition.  Based on the research of the effect of sleep deprivation, I would think that not having enough sleep would impact physical therapy outcomes, though I could not find much research on the effects of sleep deprivation on these conditions.

In summary, sleep does appear sleep has some positive benefits in learning motor skills in young, healthy people and in people recovering from stroke.  I was not able to find research that touts the benefits of sleep on outcomes in physical therapy.  From the few articles I did read, it seems that there are more negative consequences of sleep deprivation than positive effects.  I couldn’t find too many studies that investigated the effect of sleep deprivation on physical therapy outcomes.  However, many of the negative consequences mentioned in the research articles including weight gain, inflammation, impaired memory, and altered muscle tone suggest that depriving oneself of sleep could have a negative impact on the outcome of physical therapy.  As our lifestyles demand so much of our time, we can’t forget to take care of ourselves including saving adequate time for catching needed, restorative sleep.

Related articles

• Tired Neurons Caught Nodding Off in Sleep-Deprived Rats (nlm.nih.gov)
• Memory lapses linked to napping brain cells (cbsnews.com)
• Short sleep is linked with premature death (bhls.wordpress.com)

©2012 Geaux to Physical Therapy. All Rights Reserved.

1. Siengsukon & Boyd. (2009).  Does Sleep Promote Motor Learning? Implications for Physical Rehabilitation. Phys Ther. 89: 370-383.
2. Ranjbaran, Keefer, Stepanski, Farhadi, & Keshavarzian. (2007). The relevance of sleep abnormalities to chronic inflammatory conditions. Inflamm. Res. 56:51-57.
3. Beck, Melinda. “The Sleepless Elite.” Wall Street Journal, Apr 5, 2011.
4. Siengsukon & Boyd. (2009). Does Sleep Promote Motor Learning? Implications for Physical Rehabilitation. Phys Ther. 89: 370-383.
5. Orzel-Gryglewska. (2010). Consequences of sleep deprivation. International Journal of Occupational Medicine and Environmental Health; 23 (1): 95-114.
6. Orzel-Gryglewska. (2010). Consequences of sleep deprivation. International Journal of Occupational Medicine and Environmental Health; 23 (1): 95-114.
7. Alsaadi, S., Mcauley, J., Hush, J., & Maher, C.. (2011). Prevalence of sleep disturbance in patients with low back pain. European Spine Journal, 20(5), 737-743.
8. Ranjbaran, Keefer, Stepanski, Farhadi, & Keshavarzian. (2007).  The relevance of sleep abnormalities to chronic inflammatory conditions. Inflamm. Res. 56:51-57.

©2012 Geaux to Physical Therapy. All Rights Reserved.

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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.

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The Combined Sections Meeting of the American Physical Therapy Association (APTA) kicked off yesterday with a presentation on Healthy People 2020 and how physical therapy can help America achieve its goals in health and wellness.  Healthy People 2020 was developed by the US Department of Health and Human Services as a ten-year plan to improve the nation’s health.  The APTA is part of the Healthy People Consortium, a group of organizations and partners that have agreed to be active participants in helping to achieve the goals of Healthy People 2020.  As we move towards these goals, physical therapists will advocate for healthier, more active lifestyles, and provide rehabilitation and recommendations to ensure all Americans can start or return to being physically active for health.

The second course I attended was on the biomechanical factors impacting running injuries.^[i] As America strives towards its Healthy People goals, more people will be taking up new activities for exercise.  A popular and relatively cheap endeavor for someone looking to stay active for health is running.  As the presenters discussed each running injury and the contributing biomechanical factors, some information popped up which I thought you(either the beginner runner or experienced) might find useful.

• 79% of runners will be injured and 46% will have recurrence of the problem
• If the alignment of your trunk, pelvis, and legs are off, you’re at increased risk of sustaining an injury.  Not only that, the presenters did not mention this would impact your performance.  Bad alignment = inefficiency
• It is possible to have good alignment and still be at increased risk of injury due to inability of the muscles to absorb shock.  When the body’s active shock absorbers (muscles) are inadequate, it starts to rely on passive shock absorbers (bone and cartilage).

Many of the factors that contribute to running injuries can be corrected with instruction in better form, safe training guidelines, and strength training.  Number one on my list is strength training the hips.  More info on my recommendations can be found here.

Physical therapists can help turn an unhealthy and injured runner into a healthy and happy one.  A comprehensive physical therapy running evaluation consists of gait analysis, strength training, movement analysis, flexibilty, and ROM.  It will not only feel good to have the pain gone, but the runner will likely improve performance as a result.

©2012 Geaux to Physical Therapy. All Rights Reserved.

1. Powers, C & Davis, I (2011). “Biomechanical Factors Underlying Running Injuries: Proximal and Distal Factors” presented February 10, 2011 at the Combined Sections Meeting of the American Physical Therapy Association, New Orleans, LA.