- Your Bridge to Health -

Correcting Posture Is Hard Work That Often Requires Physical Therapy
July 27, 2021

By now, the many ways in which posture can influence the body and the importance of practicing good posture should be abundantly clear. If you’re interested in taking more control over your own posture, performing the exercises and techniques described in our last post is a great place to start, but they may not solve your issues independently.

Correcting one’s posture—especially if it’s been particularly poor for a long while—is hard work that doesn’t take place overnight. Truly improving posture usually requires a more sustained and hands–on approach, which is best provided by physical therapy. Physical therapists are perfectly positioned to correct posture, since their practice is based on evaluating the body’s mechanics—which directly contribute to posture—and then determining the best way to address any impairments or imbalances.

Whether a patient has a specific postural problem or a painful condition that may be related to a postural deficit, the physical therapist’s first step is always to perform a thorough screening examination. This involves the patient performing several everyday movements while the therapist observes the position of the spine, head, shoulders, and various other body parts in relation to one another. From there, the therapist will create a personalized treatment plan that focuses on correcting any postural faults and/or painful conditions present, which may include the following:

  • Strengthening exercises that target the muscles that attach to the shoulder blades and core muscles
  • Stretching exercises to increase the flexibility of the head, neck, and shoulders
  • Manual (or hands–on) therapy, especially if any neck, back, or shoulder pain is present
  • Posture tips and recommendations, such as setting frequent alarms to remind you to change your posture, working in front of a mirror, or using a foam roller
  • Evidence supporting physical therapy for posture correction

    Research on the use of physical therapy for posture is not abundant, but there are some key examples in the literature. In one high–quality study called a randomized–controlled trial, 99 adults aged 60 years and older with hyperkyphosis were randomly assigned to either a treatment group or a control group. The treatment group participated in three hour–long exercise sessions each week for six months. These sessions were led by a physical therapist and included various exercises that targeted muscle impairments that were known to be associated with hyperkyphosis, with a particular focus on strengthening and improving the flexibility of certain back muscles. These patients were also given training to help improve their posture. Patients in the control group attended an education session every month for four months and did not undergo any physical therapy.

    Results showed that patients who followed the physical therapist–led exercise program experienced several significant improvements compared to the control group. Most importantly, the angle of the curvature of the spine reduced by an average of 3.3° in the treatment group, compared to only 0.3° in the control group. In addition, the treatment group reported better self–image and satisfaction with their appearance after completing their treatment. These findings suggest that a treatment program consisting of spine strengthening exercises and posture training can lead to physical improvements in older patients with hyperkyphosis, which in turn appears to boost their confidence.

    Contact a physical therapist for any posture issue or pain you’re dealing with

    So if you’ve noticed that your posture is less than optimal or if you’ve been bogged down by pain that could be related to your posture, we strongly encourage you to see a physical therapist, preferably sooner rather than later. Doing so will help you address any issues before they progress further and reduce the risk for long–term complications

Proper Breathing Is Key To Posture And Pain
July 20, 2021

In our first post, we briefly mentioned how bad posture, neck pain, and respiratory function are all related. This relationship is worth a closer examination, too, as improving the way you breath is a key to better posture, reduced pain, and less stress.

A brief overview of breathing and posture

At first glance, posture and breathing may seem like separate bodily functions of the body. But when you understand how each one works, you can see that they are deeply interconnected, and that the health of one function can directly impact the other.

The diaphragm is the main muscle of respiration. It’s a dome–shaped muscle located between the chest and abdomen that contracts and relaxes during different points of the breathing cycle. When you take a breath in, the diaphragm contracts until it becomes flat to create room in the chest cavity for the lungs to expand, which lifts the ribs outward. Intercostal muscles, located between the ribs, also assist the diaphragm by elevating the ribcage to allow more air into your lungs. When you exhale, the diaphragm relaxes and assumes its full dome shape, while the ribcage contracts and returns to its original resting state.

Poor posture, especially when seated, keeps the diaphragm compressed and prevents it from opening fully when breathing. Similarly, rounded shoulders and a forward head posture can cause the muscles around the chest to tighten. This limits the ribcage from expanding completely and causes people to take more rapid, shallow breaths.

There is also potential for a vicious cycle to develop between posture and breathing. Breathing from the chest relies on secondary muscles in the neck and collarbone instead of the diaphragm, and when this breathing pattern occurs along with poor posture, it can weaken many muscles in the upper body and prevent them from functioning properly. Having weak core and upper back muscles makes it more difficult to practice good posture, and these two forces continue to impact one another in a cyclical fashion. Over time, this can lead to the development of many of the painful conditions we’ve described, such as neck, back, or shoulder pain.

Deep breathing and other techniques to improve breathing patterns

Since breathing and posture are so closely intertwined, taking steps to improve one of these functions will likely have a positive impact on the others and lead to several other benefits as well. Keeping a slow, steady breathing pattern has been found to enhance core stability, improve tolerance to high–intensity exercise, and reduce the risk for muscle fatigue and injury. Paying more attention to your breath may also improve sleep habits and alleviate stress and anxiety, since breath focus is considered a common feature in several techniques intended to put one in a state of calm. Below are a few examples of breathing techniques and other exercises that can help you take better control of your breath and posture:

  • Deep breathing: sit somewhere comfortable, relax your shoulders and inhale slowly to fill your lungs completely; then exhale slowly, emptying the lungs completely
  • Pursed lip breathing: breathe in through the nose, then breathe out through the mouth with pursed lips while making the exhaled breath twice as long as the inhaled breath
  • Box breathing: breathe in through the nose for four seconds, filling the lungs, then hold the breath in the lungs for another four seconds; next, breathe out slowly through the mouth for four seconds, emptying the lungs fully, then wait another four seconds before breathing in again
  • Flexibility and resistance exercises: these exercises help realign posture and train the body to breathe better
  • Traditional quadriceps stretch: bend your right knee and reach behind to grab your right foot with your right hand and bring it to your buttocks; try to keep your knees aligned throughout this stretch
  • Head–to–hand neck release: in cross–legged position, bring your right ear toward the right shoulder, then lift your left arm to your shoulders and spread your fingers with palms facing up; place your right hand lightly on top of your head and apply slight pressure; retract the left shoulder blade toward the spine and hold the posture; repeat on the other side
  • Wall chest stretch: face a wall and place your hands on the wall at shoulder height; walk your feet and push your hips back so your torso is parallel to the floor; keep the toes pointed forward and the feet under the pelvis; you should feel a stretch in the back of the legs and chest muscles

In our next and final post, we’ll show you why physical therapy may be necessary to if you want to commit to improving your posture.

Answers To Your Frequently Asked Questions About Posture And Pain
July 13, 2021

In our last post, we introduced you to the concept of posture, explained what is meant by good versus poor posture, and offered a few examples of painful conditions and other dysfunctions that may be related to poor posture. But since this was only the introduction to the topic, there’s a great deal more to discuss when it comes to posture, pain, and how the two might influence one other.

To dive a bit deeper, in this post we take a closer look at posture by answering some of the most frequently asked questions about the topic.

Q: How common is forward head posture?

A: As we explained previously, forward head posture is when the head is positioned in front of the shoulders—by more than one inch—instead of directly over the shoulders. Also referred to as “text neck” due to its relationship with staring down at one’s phone too frequently, forward head posture is the most common of all postural faults, affecting between 66% and 90% of the population.

Q: How does forward head posture affect the body?

A: Forward head posture forces the muscles of the neck to work harder to hold up the head, and the further forward it’s positioned, the harder these muscles must work. Over time, overworking these muscles can lead to muscle imbalances as the body tries to adapt while figuring out other ways to hold the head up straight. Excessive forward head posture may also lead to reduced flexibility of the neck—particularly when rotating and flexing the neck—and have a negative impact on balance.

Q: What is hyperkyphosis?

A: Recall that the spine has three curves. The first curve (at the neck) and third curve (in the lower back) are forward curves called lordosis. The second curve, which runs from the shoulders to the bottom of the ribcage, is a backward curve called kyphosis. All these curves are necessary in the normal spine to balance the trunk and head over the pelvis, but in some cases, they can curve too far inward or outward. The normal angle of the second curve is between 20-40°, but when it increases beyond 40°, the condition is called hyperkyphosis, which is more common in older adults but can also occur in children and adolescents. Poor posture and excessive slouching are the biggest contributors to hyperkyphosis, and over time, it can cause a noticeable hunching forward of the back.

Q: What other painful conditions may be related to poor posture?

A: We already listed several examples of painful conditions that may result from or cause poor posture in the medical literature. Here are a few more:

  • Pain between the shoulder blades (interscapular pain), which can result from muscle strain due to leaning forward with prolonged sitting or standing
  • Shoulder impingement, which is the painful pinching of the shoulder’s muscles against surrounding bone from repetitive shoulder movements; slouching or hunching over can narrow an important space in the shoulder and cause tendons to become pinched and rub against other structures
  • Tight hamstrings: when the hamstrings are too tight, it rotates the pelvis backward, which can flatten the natural curvature of the back and cause poor posture while seated or standing
  • Tight hip flexor muscles can pull on the spine and lead to bad posture

Q: Do all experts agree that poor posture directly causes pain?

A: In short, no. Although there is an abundance of research that supports a connection between poor posture and various painful conditions—as we’ve shown—there is also ample evidence to show that there is no association between these factors, or that the association is not very important. For example, a powerful review called a systematic review analyzed 54 studies and found no evidence of a relationship between excessive curvature of the spine and health issues, including neck or back pain. However, it should be noted that the general quality of the studies included in this review was rated as low.

In our next post, we’ll explore how your breath affects your posture, and why working on improving one could also improve the other.

Consider The Mixed Evidence On Glucosamine And Chondroitin Sulfate
June 22, 2021

Osteoarthritis affects up to 31 million Americans, making it one of the most common conditions in the nation. The resulting joint pain can be devastating for these individuals, and the longer osteoarthritis progresses, the greater the disability becomes. It’s no surprise, then, that there is a plethora of treatments, medications, and products available that claim to alleviate pain related to osteoarthritis or even prevent it from progressing.

Over the past 20 years, glucosamine and chondroitin sulfate have emerged as two of the more popular products that claim to resolve osteoarthritis–related issues. But what are glucosamine and chondroitin sulfate, and what does the research say about their effectiveness? In this post, we try to answer these questions and help guide you towards an informed decision about whether taking these is right for you.

Nutritional supplements are not FDA–regulated

Glucosamine and chondroitin sulfate are naturally occurring substances that make up many connective tissues throughout the body, including the cartilage that protects the ends of bones in joints. Glucosamine is a major building block of large compounds called proteoglycans, which contributes to the elasticity of cartilage, while chondroitin sulfate is a larger molecule that also plays a key role in the elasticity and function of cartilage. Either of these chemicals can be extracted from the tissue of certain animals and then packaged in pill form—either individually or combined—to be taken as a treatment for joint pain related to osteoarthritis. The typical dose is about 1500 mg for glucosamine and 1200 mg for chondroitin sulfate, taken once daily.

However, it’s important to note that products containing glucosamine and/or chondroitin sulfate are labeled as nutritional (or dietary) supplements rather than approved medications. Status as a nutritional supplement means that these products are not subjected to the same aggressive regulations as prescription medications and claims regarding their indication or effectiveness have not been evaluated by the U.S. Food and Drug Administration (FDA). Glucosamine and chondroitin sulfate supplements typically claim to alleviate joint pain from osteoarthritis and help to slow or prevent the breakdown of joint cartilage, which is the major underlying cause of osteoarthritis pain. But do they deliver on these supposed benefits?

Loads of research both for and against

The short answer: possibly, but it’s difficult to say with certainty. Evidence to support glucosamine and chondroitin sulfate supplements for osteoarthritis has been mixed, with some studies suggesting that one or both chemicals can relieve pain and others identifying no clear benefits.

For example, a key analysis of multiple studies published in 2010 called a meta–analysis concluded that glucosamine and chondroitin—both independently and in combined formulations—did not reduce joint pain or have any impact on the narrowing of joint space. Another study published in 2016 that administered combined glucosamine and chondroitin sulfate to half the patients and placebo to the other half had to be stopped early because those taking the supplement reported worse symptoms than those taking placebo.

On the other hand, a 2008 study found no statistically significant improvements in knee pain overall for patients with knee osteoarthritis taking glucosamine and chondroitin sulfate supplements, but a group of patients with moderate–to–severe knee pain did experience some improvements. A 2014 review concluded that these supplements may lead to a small but significant reduction in joint space narrowing, while another key 2018 meta–analysis found that chondroitin sulfate alone was more effective than placebo for relieving pain and improving function in knee and/or hip osteoarthritis, and glucosamine was found to reduce stiffness.

Although most guidelines from professional societies do not currently recommend glucosamine and/or chondroitin sulfate for osteoarthritis, some experts believe that newer supportive research could lead to some future changes in these guidelines. But as you can see, the jury is still out on these supplements. It’s possible that the evidence is so mixed because some patients do truly experience benefits—possibly from the placebo effect, which is a real benefit nonetheless—while others do not.

Consult your doctor before making a decision

Therefore, a clear–cut answer on the therapeutic value of glucosamine and chondroitin sulfate for osteoarthritis may be difficult to reach, but should you still consider taking these supplements? Since answering this question is out of our scope as physical therapists, we strongly recommend talking to your doctor and evaluating the potential benefits compared to the risks involved. These supplements are generally considered to be safe, but some side effects have been reported, including diarrhea, abdominal pain, heartburn, drowsiness, and headaches. If you and your doctor agree that the benefits outweigh the risks, it’s probably best to try a short trial of one or both supplements, and if you don’t experience any notable improvements after a designated period, consider discontinuing their use. And as always, keep realistic expectations and understand that these supplements can only go so far. Proper care for osteoarthritis also requires regular movement and exercise, and as physical therapists, we can help you get there with a comprehensive, customized treatment program.

Physical Therapy Is The Best Way To Address Shoulder Pain
June 15, 2021

As we explained in our last post, there are several steps you can take to reduce your risk for shoulder pain, but even if you follow these measures to a T, pain may still develop for reasons that are partially out of your control. If you do begin noticing pain in your shoulder or start struggling to perform certain overhead activities, you might be wondering what to do next.

For frequent episodes of pain that interfere with how you function in daily life, we strongly recommend taking a proactive approach and seeing a physical therapist as soon as possible. Physical therapists are movement experts whose goal is to guide patients back to full strength and function with a multifaceted, evidence–based approach. Rather than wait and see if the pain progresses or improves on its own, physical therapists teach patients how to modify their movements and engage in behaviors that reduce strain on the shoulder right away, which will ultimately reduce their pain levels.

Typical physical therapy treatment programs for common shoulder conditions

Most treatment programs will involve some combination of pain–relieving interventions, flexibility and strengthening exercises, manual (hands–on) techniques administered by the physical therapist, and education on how to avoid future shoulder issues. The specific approach used will vary depending on what condition is present, its severity, and the patient’s abilities and goals, but most treatment plans for shoulder pain share several features in common. Below are a some of the more frequently used interventions for various shoulder conditions:

  • Rotator cuff/shoulder tendinitis
    • Stretching and strengthening exercises, including external and internal rotation, forward flexion shoulder raises, pendulum exercises, and scapular squeezes
    • Education on how to improve posture and avoid habits that will further aggravate the shoulder
  • Rotator cuff tear
    • Passive treatment like ice, heat, and ultrasound to alleviate pain
    • Strengthening exercises that target the pectoral and upper back muscles
    • Education on how to avoid positions and movements that can further aggravate the shoulder, like sleeping on the side and carrying heavy loads
  • Shoulder impingement syndrome
    • Stretching and strengthening exercises that target the rotator cuff and scapular muscles
    • Manual (hands–on) therapy, which typically includes soft–tissue massage
  • Shoulder bursitis
    • Stretching exercises like Codman’s pendulum swings and active range of motion exercises
    • Strengthening exercises that target the scapular and core muscles
    • Ultrasound and other pain–relieving modalities
    • Posture education
  • Frozen shoulder
    • Treatment for frozen shoulder depends on the current stage of the condition, from stage 1 (pre–freezing) to stage 2 (freezing), stage 3 (frozen), and stage 4 (thawing)
    • The bulk of treatment consists of manual therapy and stretching and strengthening exercises, which increase in
    • intensity with further stages of the condition; activity–specific training is usually added at stage 4

There is an abundance of research showing that these interventions are effective for many shoulder conditions. For example, a recent review of studies called a systematic review found that stretching exercises, strengthening exercises, mobilization, and several other physical therapy techniques were found to reduce pain and improve range of motion and functional status in patients with frozen shoulder. A 2018 systematic review identified moderately strong evidence to support the use of exercise therapy for full–thickness rotator cuff tears, while a 2015 systematic review and meta–analysis concluded that surgery was no more effective than conservative treatment for shoulder impingement. Similarly, a 2019 guideline recommended that patients with a shoulder condition shoulder impingement avoid surgery and instead pursue nonsurgical treatments like physical therapy.

So if you’re dealing with a new case of shoulder pain or a lingering problem that just won’t seem to improve, physical therapy may be your best bet for a safe and successful outcome. Contact us today to learn more or schedule an appointment.

Our Top 4 Tips For Preventing Shoulder Pain
June 8, 2021

Shoulder pain can be an extremely bothersome issue to deal with. Although you may not realize it, you use your shoulder on a frequent basis throughout most days, since it permits many of the movements that involves your arms. So if a problem arises that leads to pain and prevents your shoulder from moving normally, it can become a major burden to your daily life.

As we discussed in our last post, there are many conditions that can produce shoulder pain. In some cases, the cause may be a single, traumatic event like a hard fall to the ground or sports-related injury (eg, rotator cuff and SLAP tears). Other patients will experience a gradual onset of shoulder pain due to repeated damage from overhead activities, which is often the case in rotator cuff tendinitis, shoulder impingement syndrome, shoulder instability, and bursitis.

If you’re concerned that you may develop shoulder pain—perhaps because you play an overhead sport or have a job that involves overhead movements—you may be wondering if there’s anything you can do to reduce your risk. The good news is that yes, it may be possible to avoid some types of shoulder pain. There is no single, foolproof way to stop all shoulder pain from occurring because many variables are involved, but there are several steps you can take that will lower your chances. Each tip addresses a different aspect of shoulder use, but the underlying message is that you should modify and improve how you move your shoulder to reduce potential stress and strain.

4 Tips To Prevent Shoulder Pain

  1. Modify your workstation: working at a desk may not sound like a big risk factor, but you could be aggravating your shoulder if your workstation is not set up properly; below are some important ways you can modify and improve your workstation ergonomics to reduce shoulder strain
    • Use proper posture: sit with your feet flat on the ground or on a footrest, with your lower back supported, shoulders relaxed, and hands and wrist in line with your forearms
    • Take regular breaks: aim for a 30 second “micro-break” about every 30 minutes to shake out your arms and hands, plus longer breaks to give your shoulder a rest every few hours
    • Rearrange your desk: keep supplies that you use regularly within easy reach, so you don’t have to twist or stretch to reach them
    • Invest in a headset: if you’re on the phone frequently, strongly consider adding a headset
  2. Limit overhead activities and/or improve your form
    • If your profession does not involve regular overhead movements, try to avoid performing these types of activities too frequently in your spare time; when you do, be aware of how you move your shoulder and try not to overreach regularly
    • If your profession does involve lots of overhead movements, learn to use proper form during these activities (your physical therapist can help with this), take frequent breaks throughout the day, and switch your arms as often as possible so that the load is more evenly distributed; also try to avoid straining your shoulder when reaching for objects
  3. Increase shoulder strength: strengthening the muscles that support the shoulder will increase its stability and reduce the risk for pain; below are two helpful examples of shoulder strengthening exercises
    • Scapular stabilizing exercise: lie face down with a pillow under your stomach and place your forearms on the floor with your elbows bent at 90°; slowly raise your arms up off the floor as high as possible and hold for 5-10 seconds; slowly return to the starting position; repeat up to 10x
    • Doorway stretch: stand in an open doorway and spread your arms out to your side; grip the sides of the doorway at shoulder height, and while maintaining your grip, lean forward until you feel a light stretch in the front of your shoulder; slowly return to starting position; repeat up to 10x
  4. Improve shoulder flexibility: the more you stretch your shoulder, the better its range of motion will become, and keeping these muscles flexible will in turn help you avoid pain and injury; below is one great shoulder stretch example
    • Sleeper stretch: lie on a firm surface on your side with your shoulder under you and your arm extended out; bend the extended arm up into a 90° angle with your fist in the air; use the other arm to push the bent arm down (forearm towards the floor) and stop pressing down when you feel a stretch in the back of your shoulder; hold this position for 30 seconds, then relax your arm for 30 seconds; repeat 4 times, 3x/day

Although following these tips is likely to help, shoulder pain can still develop for a variety of reasons. In our next post, we’ll show you why seeing a physical therapist is the best decision you can make in these situations for safe and quick relief.

Answering Common Questions To Understand Painful Shoulder Conditions
June 1, 2021

The shoulder doesn’t always get the recognition it deserves. As the only major joint that can rotate a full 360°, the shoulder is the most mobile and flexible joint in the body, and this flexibility allows you do things like throw a baseball, reach for faraway objects, drive a car, hoist a child above your head, and complete countless other complex movements. This wide range of motion, however, also makes the shoulder one of the most common locations for pain.

Shoulder pain ranks only behind back pain and knee pain as third most common site for musculoskeletal pain in the body. Assessing its prevalence is difficult because the definition of shoulder pain is not clear cut, but some studies have found the annual prevalence to be as high as 47% and the lifetime prevalence to be as high as 67%. There are many conditions that can lead to shoulder pain and disability, which can arise from a variety of causes. To help you better understand what can cause shoulder pain and how it might feel, we’d like to provide you with answers to some of the most frequently asked questions about shoulder anatomy and common painful conditions.

Q: Is the shoulder a single joint?

A: Although the shoulder is often referred to as one joint, it technically consists of four joints, with the acromioclavicular and glenohumeral joints being most important for movement. The acromioclavicular joint is a gliding joint where a part of the shoulder blade (scapula) called the acromion and the collarbone (clavicle) meet, and it allows forces to be transmitted from the arm to the clavicle. The glenohumeral joint is what most people think of when visualizing the shoulder, and it’s responsible for the shoulder’s extremely wide range of motion. It is a ball-and-socket joint consisting of the head of the upper arm bone (humerus) as the ball and the glenoid, a shallow cuplike part of the scapula, as the socket.

Q: What other structures make up the shoulder?

A: Connecting the bones and muscles of the shoulder are several ligaments, tendons, plus several other important structures, including the following:

  • Rotator cuff: a group of four muscles that run from the humerus to the scapula; the tendons of these muscles form a cuff around the head of the humerus, and all the muscles work together to allow movement and stabilize the shoulder
  • Deltoid: the largest and strongest muscle of the shoulder, which provides the strength to lift the arm
  • Bursa: a fluid-filled sac that acts as a cushion between tendons and other structures of the shoulder
  • Labrum: a ring of cartilage surrounding the glenoid that creates a deeper socket for the ball to stabilize the joint
  • Joint capsule: a fibrous sheath the encloses the structures of the shoulder joint

Q: What’s the difference between rotator cuff tendinitis, shoulder impingement, and a rotator cuff tear?

A: Any of these structures can be damaged in an acute or overuse injury, but most shoulder conditions about 85%  involve the rotator cuff. Of these, rotator cuff tendinitis, shoulder impingement, and rotator cuff tears are most common.

  • Rotator cuff tendinitis (shoulder tendinitis): the most common cause of shoulder pain, this condition results from irritation or inflammation of any of the rotator cuff tendons occurring gradually over time; the main symptoms are pain and swelling in the front of the shoulder and side of the arm, usually while raising or lowering the arm
  • Shoulder impingement syndrome: a condition in which the bursa or any rotator tendons are trapped (or impinged) by the humerus and the acromion, which is usually due to an outgrowth of bone (bone spur); symptoms include shoulder pain and weakness, and difficulty reaching up behind the back
  • Rotator cuff tear: a tear results when one of the rotator cuff tendons detaches from the bone, either partially or completely; these injuries can occur either traumatically due to a single incident, or gradually over time, which is usually the case in older patients; the most common symptom is pain that is most noticeable when lying on the shoulder or lifting or lowering the arm

Q: What is a SLAP tear?

A: A SLAP tear, which stands for superior labrum, anterior to posterior, is a common injury to the labrum. More specifically, the top (superior) part of the labrum is torn from front (anterior) to back (posterior). SLAP tears can result from a single incident, such as falling on an outstretched arm or shoulder, or from regularly doing lots of overhead activities. Sports like baseball and tennis, and professions that involve lifting heavy objects can all increase the likelihood of a SLAP tear. Typical symptoms include a sensation of locking, popping, or catching, pain with many movements of the shoulder, especially lifting heavy objects overhead, and reduced shoulder strength and range of motion.

Q: Which other shoulder diagnoses are common?

A: Here are four other common shoulder conditions:

  • Shoulder bursitis: a bursa is a fluid-filled sac that acts as a cushion to prevent structures from rubbing against each other; the subacromial bursa in the shoulder is the largest bursa in the body, and when it becomes inflamed, often from regularly performing too many overhead activities, he result is shoulder bursitis; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
  • Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, another structure that helps to keep the shoulder stable; this causes the shoulder capsule to thicken and tighten around the shoulder joint, which means there is less room for the shoulder to move normally, eventually causing it to freeze.  Symptoms include pain and stiffness that makes it difficult or impossible to move the shoulder
  • Shoulder dislocation: an injury in which the humerus pops out of the glenoid; this is typically due to a forceful motion, and the dislocation can be either partial or complete; symptoms include pain, swelling, and difficulty moving the shoulder
  • Calcific tendinitis: a condition in which small deposits of calcium form within the tendons of the rotator cuff; calcific tendinitis is most often seen in individuals between the ages of 30 – 60 years, and the reasons it occurs are not entirely understood; in most cases it does not cause symptoms, but can lead to severe pain if the calcium deposits get bigger or become inflamed

Q: Am I at risk for frozen shoulder?

A: Frozen shoulder affects up to 5% of the population, but it’s not completely clear why it develops. There are, however, certain factors that may increase one’s risk for getting it, such as not moving the shoulder for a long period of time, a recent injury, surgery, pain, being between ages of 40 and 60, female, or having arthritis, diabetes, or cardiovascular disease. Therefore, your risk could be higher if you fit into any of these categories, but predicting whether you will get frozen shoulder is difficult.

In our next post, we’ll provide some simple strategies you can follow to reduce your risk for all causes of shoulder pain.

A Physical Therapist Can Help You Overcome Exercising Barriers
May 25, 2021

As we discussed in our first post this month, most people are aware that exercise is good for you and is recommended for achieving and maintaining optimal health. Yet still, a significant portion of the population doesn’t do it. We mentioned in that post that lack of time and motivation—or both—are two common explanations given for why people don’t exercise, but these certainly aren’t the only reasons.

Many other individuals, particularly middle– and older–aged adults, very much want to exercise, but may be unable to do so on account of physical limitations. Poorer balance, reduced flexibility, and weakened muscles all tend to become more likely through the aging process, but perhaps the most common ailment in older populations is joint pain. Issues like osteoarthritis, bad backs, sore shoulders, and knee and hip pain all increase in frequency the older we get, often making simple functioning throughout the day more difficult. Together, each of these issues can serve as a major barrier that prevents adults with physical limitations from exercising.

What you need to understand is that nearly every one of these barriers can be overcome, and one of the best ways to get there is by seeing a physical therapist.

Finding exercises that are perfectly suited for you

If you happen to be dealing with joint pain of any sort, you may think it’s best to avoid any activities that strain the injured area so that you don’t aggravate it any further. For a long while, this was believed to be the best approach for joint issues, but the prevailing logic has since changed, dramatically. Research over the past 30+ years has shown that physical inactivity is one of the worst things you can do for joint pain, as it leads to weaker muscles, less flexibility, and poor heart and lung health. In effect, too much rest will prolong one’s recovery or even make the condition worse over time.

Instead, current recommendations strongly promote frequent exercise for those with joint issues because it increases flexibility, bolsters strength, and promotes healing by increasing the flow of blood to the injured area. Strong and healthy muscles can more effectively protect bones and joints, which is one reason regular exercise significantly lowers the risk for future musculoskeletal injuries. And over time, higher physical activity levels will increase stability and reduce the risk and number of falls in older adults as well.

But knowing this, getting from point A (physical inactivity) to point B (regular physical activity) often requires some guidance for many adults, and this is where physical therapy come in. Physical therapists are movement experts that are trained to assess any limitations or impairments that may be affecting one’s mobility, and then address these issues with a personally tailored treatment program. If a patient comes in who wants to exercise more but doesn’t think they can do so because of joint pain, poor balance, weakness, or any other potential barrier, a physical therapist will work with this individual to find forms of exercise that are feasible for their specific physical abilities. From there, the physical therapist will continue to monitor your progress and then introduce ways to help you gradually advance to more intense forms of exercise once you’re ready. Each exercise program can be modified regularly based on your response, so you’re never falling out of your comfort zone.

Ultimately, it doesn’t matter how old you are, if you’re out of shape, or if you have any other physical impairments. Your physical therapist will find a way to help you become more physically active in a manner that’s safe, comfortable, and effective for your unique goals.

If you’re interested in learning more about how physical therapy can help you safely increase your activity levels and introduce exercise to your life, contact us today.

The Best Diet For You Is The One You Can Stick With
May 18, 2021

Dieting can be overwhelming. With new research constantly emerging, new diets seemingly popping up every week, and experts regularly claiming to have discovered the magic bullet to weight loss or nutrition, it’s difficult to even keep track of what’s out there these days, let alone determine which type of diet is best for you.

Physician Peter Attia has recognized this problem and attempted to simplify the process of understanding how diets work by using a basic nutritional framework that consists of three parameters:

  • Dietary restriction: what you eat or don’t eat; in other words, if you’re focusing on only eating certain types of foods while avoiding other types, the diet would fall into this category
  • Caloric restriction: how much you eat; this means counting the number of calories you consume and aiming for a specific target range
  • Time restriction: when you eat or don’t eat; intermittent fasting, in which you only eat during a predetermined period each day and fast for the remainder, is the best example of a time–restrictive diet; we’ll explain this in more detail later

In Dr. Attia’s framework, each of these restrictions represents a lever that be plotted on an x–y–z axis. If you eat whatever you want, whenever you want, and as much as you want, you’re not pulling any of these levers. Instead, you’re following what’s called the standard American diet, which consists of lots of sugar, refined carbohydrates, saturated and trans fats, and is associated with high rates of obesity, diabetes, and other health issues. To break out of the standard American diet, Attia recommends pulling at least one of these levers. Pulling two, or possibly three, is even better.

Just about every diet that has ever been developed is structured on pulling one or more levers by regulating what, how much, and/or when you eat. All diets claim to help individuals lose weight or improve other aspects of their health by adhering to these restrictions, and many do have the potential to be beneficial—so long as it’s followed on a long—term basis.

Now that you have a general understanding of this framework, we’d like to describe a few of the most popular diets out there currently and explore what restrictions they recommend and the health benefits associated with each one.


Vegan and vegetarian diets are similar, but there is one key difference between them. A vegan diet consists only of plant–based foods and no foods derived from animals whatsoever. A vegetarian diet, on the other hand, does not include any meat, but may include other animal products like eggs (ovo vegetarian) or dairy (lacto vegetarian). Pesco vegetarians eat seafood, which doesn’t technically fit the definition of vegetarian, but oftentimes they are still classified together.

As you can see, vegan and vegetarian diets clearly pull on the dietary restriction lever of Attia’s nutrition framework. They do this by avoiding consumption of meat and possibly other animal–based products (depending on the specific type of diet). Vegans and vegetarians may also do indirectly do some caloric restriction by eating less high–calorie foods, but this depends largely on their food choices within each diet. Health benefits that have been identified with these diets include the following:

  • A vegan diet can lower high cholesterol levels, mainly by eliminating lots of saturated fats and completely eliminating dietary cholesterol that’s only found in animal products
  • Vegan diets are also associated with has anti–inflammatory effects in patients with heart disease and have been found to improve lipid and glycemic control in type 2 diabetics, which are two important parameters for these patients
  • A vegetarian diet reduces the risk for heart disease and death related to heart issues
  • Caution: a vegan or vegetarian diet isn’t automatically healthy, since potato chips, soda, and vegan ice cream all technically fit this classification

Ketogenic diet

The ketogenic diet—or keto for short—places a strong emphasis on rich sources of fat (like meat and dairy), while limiting the consumption of foods high in carbohydrates (like fruit, whole grains, beans, and some vegetables). Moderate servings of protein are also allowed, but fats account for most of the calories consumed.

As with the vegan and vegetarian diets, the keto diet also pulls the dietary restriction lever by limiting the amount of carbs and protein while focusing on lots of fats. If the ketogenic diet is being followed for the primary purpose of losing weight, it can also pull the caloric restriction lever, but this is not always the case. Some of the health benefits associated with this diet include the following:

Intermittent fasting

One of the most rapidly emerging dietary trends is intermittent fasting, which involves only consuming meals within a strictly defined period. The most popular variations are the 16/8, 18/6, and 20/4 time–restricted feedings. This means an individual will fast for 16 hours and then eat only within an 8–hour “nutritional window” (or 18 hours of fasting followed by 6 hours of eating, etc.). A more aggressive approach includes alternating a 24–hour fasting period with a 24–hour eating period, two or three times a week. During eating periods, individuals do not have to be selective about what they eat, but healthy foods will lead to better results.

Intermittent fasting is clearly different from the other diets in that it focuses almost exclusively on pulling the time restriction lever. Some individuals who follow intermittent fasting will combine it with some other diet to also the types of foods they consume, but this is not a requirement. Intermittent fasting has been associated with several health benefits, including the following:

  • Reduces blood pressure and prevents hypertension
  • Can lead to weight loss
  • Improves glucose metabolism and increases sensitivity to insulin in diabetic patients
  • Caution: intermittent fasting can be difficult to sustain long–term, and it may also lead to negative side effects like mood swings, chronic tiredness, headaches, dizziness, and nausea; it’s also not recommended for those with hormonal imbalances and pregnant and breastfeeding women

Each diet clearly has some attractive qualities and could be good for your overall health if done properly. So ultimately, if you’re thinking about trying a new diet, the main question you should be asking yourself is this: which one can I stick with in the long term. Most diets fail because dieters are only able to maintain the restrictions for a few weeks or months. But enacting real change requires adopting a diet that you can maintain for the long haul, at which point it transitions from a “diet” to just the way that you eat.

Disclaimer: Physical therapists are not licensed to provide nutrition recommendations. This post is intended for informational purposes only.

You Have Questions About HIIT And MICT And We Have Answers
May 11, 2021

In our last post, we explored a few of the many health benefits associated with regular physical activity and discussed two popular approaches to exercise that are worth considering: high–intensity interval training (HIIT) and moderate–intensity continuous training (MICT). Since HIIT has now become something of a buzzword and MICT is essentially the type of exercise most people do—often without knowing its technical name—it’s likely that there are some unanswered questions out there regarding how to go about these types of training and what’s right for you. In response, in this post we’ll answer some of the most frequently asked questions about HIIT and MICT.

Q: What is aerobic exercise?

A: Also known as endurance or cardiovascular exercise, aerobic exercise is any form of physical activity in which oxygen is heavily involved. This is most clearly evident by noticing an increase in your heart rate and by breathing more deeply during these activities, which are signs that your body is maximizing the amount of oxygen in the blood to help you use it more efficiently. HIIT and MICT are both considered forms of aerobic exercise, while other examples include walking, jogging, swimming, biking, jumping rope, and playing basketball. Over time, performing aerobic exercises can significantly improve the function and performance of the heart, lungs, and circulatory system, leading to various benefits, such as better heart health, sleep patterns, weight regulation, and metabolism.

Q: How do I calculate my resting and optimal exercise heart rate?

A: Since all types of aerobic exercise increase the heart rate, it’s important to understand how far you should be pushing yourself to make sure getting the most out of your workouts but staying safe while doing so. Your resting heart rate is the number of times your heart beats per minute (bpm) when you’re at rest, and it’s an indicator of your physical fitness level. Many fitness trackers and smartwatches measure track your heart rate automatically, but if you don’t have one of these devices, you can measure your resting heart rate manually by taking your pulse at your wrist or (below the base of your thumb) over 60 seconds (or for 6 seconds and multiplying by 10, 15 seconds and multiplying by 4, etc.). An average adult heart rate is 60–100 beats bpm, with the lower end indicating good overall fitness and the higher end generally associated with health problems like metabolic syndrome.

The next step is to calculate your maximum heart rate, which can be done by using one of several formulas, the easiest of which is subtracting your age from 220. Once you know your maximum heart rate, you can choose from aerobic activities that range from very light (under 57% of maximum heart rate) to maximal (96–100% of maximum heart rate). If you’re new to exercise, it’s best to start in the low range and gradually work your way up until you find your target, or optimal heart rate zone.

Q: What are some examples of HIIT programs?

A: If you’re just getting started with HIIT, here are a few examples of single–exercise workouts that are great for introducing you to this type of training:

  • Bike: pedal on a bike as hard and fast as possible for 30 seconds, then pedal at a slow, easy pace for 2–4 minutes; repeat this pattern for 15–30 minutes
  • Jog/run: after jogging to warm up, sprint as fast as you can for 15 seconds, then walk or jog at a slow pace for 1–2minutes; repeat this pattern for 10–20 minutes
  • Squats: Perform squat jumps as quickly as possible for 30–90 seconds, then stand or walk for 30–90 seconds; repeat this pattern for 10–20 minutes

You can also find a multitude of free HIIT programs on YouTube and other fitness websites. One great website for free videos is Fitness Blender.

Q: What are some examples of MICT programs?

A: Remember that MICT is performed at a moderate intensity but for longer periods of time than HIIT (MICT exercises are typically completed at 55–75% of one’s maximum heart rate, while HIIT hits at around 80–85% of maximum heart rate). Following our last examples, you can modify a biking or jogging HIIT workout and make it an MICT workout instead by reducing the intensity, eliminating the rest periods, and extending the duration. In other words, a bike ride at a moderate pace for 20–40 minutes or a jog at a moderate pace for 20–30 minutes.

Other examples of MICT activities include any of the following, performed at a moderate pace for at least 20 minutes:

  • Swimming
  • Brisk walking
  • Playing a pick–up game or practicing basketball, soccer, or football
  • Hiking
  • Kayaking

Q: Is HIIT safe for older adults?

A: In most cases, yes, but this depends heavily on your current fitness level. One of the most attractive features of HIIT workouts is that there are practically endless modifications that can be made to the types of exercises, durations, and rest periods to suit your activity level. If you’re interested in HIIT but aren’t already physically active, we strongly recommend consulting a doctor or a physical therapist, who can give you a fitness test and provide you with guidance to get you started.

Q: How can I start a HIIT or MICT program?

A: As we mentioned above, physically active individuals can get started on their own, but if you’re new to moderate– or vigorous–intensity exercise, talk with your doctor or physical therapist first to clear you for activity and help move on the right track.

In our next blog, we’ll look at the role that various diets can also play in reducing the risk for various health conditions.