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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.

Exercise Can Improve Your Health In Less Time Than You Think
May 4, 2021

If there’s anything the public knows about exercise, it’s simple: doing it is good for you. This association is undoubtedly common knowledge by this point, but what many people may not fully understand is just how far these benefits go. Research continues to pour in year after year showing that maintaining adequate physical activity levels is associated with a plethora of both physical and mental health benefits, and it can extend your expected lifespan as well.

This list is expansive and encompasses numerous fundamental areas of health, but some of the most notable physical benefits include the following:

HIIT: an important acronym for time–crunchers

Unfortunately, the problem for most individuals isn’t having doubts that exercise can improve their health. Many people simply struggle to find the motivation and/or the time to become physically active as regularly as they want to be or think they should be. One possible solution for those with busy schedules is to train more aggressively, but in shorter periods of time, which is the basis of high–intensity interval training (HIIT).

HIIT has been around for quite a while, but has been growing rapidly in popularity over the last few years. HIIT is essentially a training technique in which you give an all–out, 100% effort through quick intense bursts of exercise, which are then followed by shorter recovery periods. Since your body is working so hard during a HIIT workout, it increases your heart rate and helps you burn more fat in less time. HIIT workouts also increase the body’s need for oxygen during these extreme efforts, which, over time, will help increase your cardiovascular ability and strengthen your heart. In addition, HIIT can significantly bolster endurance, leads to fat instead of muscle loss, is quick and convenient—workouts can be completed just about anywhere in as little as 10 minutes— and usually does not require any equipment.

MCIT: a less intense alternative

Moderate–intensity continuous training (MCIT)—sometimes referred to as steady–state exercise—involves a sustained physical effort, but with no periods of rest in between. Compared to HIIT, MICT workouts are much less intense, with exercise performed at a moderate intensity over longer periods of time. This typically corresponds to 55–75% of one’s maximum heart rate, whereas HIIT typically involves about 80–85%. Similarly, MICT is performed at 40–65% of maximal oxygen consumption, while HIIT usually pushes individuals to 75–80% of this limit. MICT probably encompasses most types of exercise, and a good example is continuously cycling on a stationary bike at a constant pace for 20–40 minutes.

Both MICT and HIIT have their merits and are attractive for different reasons. Someone who’s short on time and in good shape may be interested in getting “more bang for their buck” with HIIT, while others who are not comfortable exercising at such a high intensity may prefer the more reasonable pacing of MICT. Research has also shown that both approaches to exercise are associated with similar health benefits. According to one study (the Generation 100 study) that evaluated more than 1,500 adults between the ages of 70-77 who regularly engaged in HIIT or MICT for five years, those who completed HIIT experienced greater health benefits and a reduced risk of dying compared to the MICT group. But another powerful study called a meta-analysis found that there was no difference between HIIT and MICT when it came to improving body composition and body fat percentage.

The long and short is this: HIIT and MICT are both great options for becoming and staying active that can lead to a variety of healthy benefits. What it really comes down to is how much free time you have in your schedule and your comfort level with intense exercise, but either way, it’s a win–win.

Read our next post for answers to some of the most common questions about HIIT and MICT.

Seeing A Physical Therapist Early Can Help With Long-Term Success
April 27, 2021

In our last three post, we’ve looked into the most common causes of low back pain and offered some tips on what to do if and when it strikes. Taking these steps and making other smart lifestyle changes–like moving more, sitting less, and improving your posture and sleeping habits–undoubtedly has the potential to significantly reduce low back pain levels. But even after making all the right changes, back pain will continue to be a problem for many patients.

For these individuals, a much more systematic and comprehensive treatment approach is needed that addresses the impairments present, and there is no other option that fits this bill quite like physical therapy. Physical therapy is predicated on first identifying any limitations or dysfunctions that can be contributing to a patient’s pain, and then developing a customized treatment plan to targets these faults with a series of movement–based interventions. While individual goals may vary from patient to patient, the overall goals of physical therapy are always to reduce pain levels, increase physical function, and prevent further recurrence of pain.

Physical therapy is associated with a host of benefits that will save patients time and money while putting them on a path to positive long–term outcomes, and the earlier a patient sees a therapist, the greater the benefits will be. To give you a clearer idea of what physical therapy can do for your low back pain, here are four of its most notable evidence–based advantages over other approaches to treatment:

The top 4 benefits of early physical therapy for low back pain

  1. Reduces the need for additional care
    • Many patients with low back pain see their primary care physician as their first point of contact with the healthcare system because it’s usually the easiest approach, but doing so can actually lead to delays in receiving appropriate treatments
    • By seeing a physical therapist first, on the other hand, patients can start their treatment program right away, which will usually include various strengthening and stretching exercises, manual (hands–on) therapy techniques, and other pain–relieving interventions; according to one study, early physical therapy reduces the need for additional treatments in the future, and the earliest initiation of therapy was found to be associated with the lowest need other interventions
  2. Leads to similar outcomes compared to surgery and helps patients avoid it
    • Due to the high costs, various risks, and extensive recovery period, surgery should only be considered as a last resort for most cases of low back pain, after all other options have been exhausted; still, some patients will choose to undergo surgery much earlier, either because they have abnormal MRI findings, want a “quick fix,” or for other reasons
    • But research has shown that physical therapy can lead to outcomes that are just as good as surgery; in one study of patients with spinal stenosis who were candidates for surgery, no differences in painful symptoms or physical function were identified in patients who underwent surgery compared to those who followed a course of physical therapy
    • Research has also shown that early physical therapy can help patients avoid surgery
  3. Helps patients avoid opioids
    • Opioids are powerful pain–relieving medications that should prescribed with extreme caution in only rare cases of low back pain–if at all–due to the high associated risks for abuse, dependence, and overuse
    • By seeing a physical therapist early, patients can significantly reduce the likelihood of being prescribed opioids in the future; according to one study, patients who consulted with a physical therapist earlier in the course of their care had lower rates of opioid prescriptions compared to those who saw a physical therapist late or never
  4. Results in lower overall costs
    • For patients with low back pain, getting treatment right away, undergoing fewer additional tests and treatments, and avoiding surgery and opioids also equates to lower overall healthcare costs
    • Many studies have shown the cost savings associated with early physical therapy are substantial, with one study finding that costs for those who started physical therapy within three days of being diagnosed with low back pain were just under $3,000 over one year, while for those who waited 29–90 days to do so, costs were more than double, at nearly $6,400

With such a clear set of benefits, it’s easy to see why physical therapy is regarded as the safest and most logical choice for low back pain. So if you’re dealing with any persistent or chronic pain, we strongly recommend making an appointment with your local physical therapist to get started on a path to less pain, better function, and greater enjoyment of the things you love.

Following A Plant-Based Diet Could Help Alleviate Lower Back Pain
April 20, 2021

Low back pain is more complex than it might appear on the surface. Many conditions can be responsible–as we discussed in our first post–and there are also numerous potential factors that could play a role in the development of pain, some of which are known and others that are still being investigated. But one variable that is known to definitively contribute to low back pain is inflammation.

Inflammation is a sign that the immune system is working effectively and protecting the body from potential threats. But too much inflammation could be a sign of other issues at work, and it can lead to a variety of damaging effects when it continues unabated, one of which is pain. For this reason, taking certain supplements and eating foods that are known to fight inflammation is not only a great approach for overall health, but it may also be an effective weapon for alleviating your low back pain.

With this in mind, here are some anti–inflammatory nutritional supplements and food items/groups that you may want to consider adding to your diet.

Anti–inflammatory nutritional supplements

  • Omega–3 fatty acids: these chemicals, which are found in fatty fish and an abundance of other foods, are regarded as one of the best fighters of excessive inflammation in nature; for those who don’t like to eat fish, fish oil or omega–3 fatty acid supplements can be taken instead, and research has shown that these supplements are effective for reducing disc degeneration
  • Devil’s claw: devil’s claw is an herb derived from native African plant called Harpagophytum procumbens; the active ingredient in devil’s claw, harpagoside, decreases swelling and inflammation, and one comprehensive study called a Cochrane Review found that taking it on a daily basis can reduce back pain and the use of pain medications
  • Bromelain: bromelain is an enzyme found in pineapples that has been used for its medicinal purposes for centuries; studies have shown that strong anti–inflammatory properties, which could translate to less back pain
  • Capsaicin and comfrey: capsaicin is the chemical responsible for the sensation of heat in hot peppers, while comfrey is an herb derived from a flower; both are available as topical creams and are believed to alleviate pain through mechanisms other than fighting inflammation; research has shown that both comfrey and capsaicin may be effective for tackling back pain

A plant-based diet is best for lowering inflammation and reducing back pain

Nutritional supplements may be a helpful tool to fight inflammation and reduce your low back pain, but they are called supplements for a reason. To effectively manage your inflammation levels, you need to also adhere to a diet that’s loaded with anti–inflammatory foods while avoiding foods that increase inflammation as much as possible. One of the easiest ways to accomplish this is by following a diet that is based primarily on plants, as fruits and vegetables–especially those that are dark in colors like green, red, orange, and blue–is extremely effective for reducing inflammation.

Several studies have also found that clogged arteries supplying blood to the spine could be another important factor that likely contributes to several low back pain conditions. Since clogged arteries and some other blood conditions are known to be related to one’s diet, it’s been suggested that following a plant-based diet can help address these issues and alleviate some causes of low back pain in the process. Thus, a plant-based diet could be doubly effective for treating low back pain.

Plant–based diets can be easily customized depending on your tastes and preferences, but here are a few suggestions to consider:

  • Aim to eat lots of dark green vegetables, which are all great at fighting inflammation, especially kale, spinach, and broccoli
  • When selecting other fruits and vegetables, always remember that darker usually means more anti–inflammatory properties; some great options include carrots, beets, sweet potatoes, cherries, berries, and pomegranates
  • Add lots of herbs and spices to your food, particularly basil, cinnamon, ginger garlic, oregano, and onions, all of which are anti–inflammatory
  • Cook with olive oil and or add it to your foods
  • Try drinking herbal and green, white, and oolong teas
  • Try to avoid processed foods, fast foods, foods high in saturated fats, which increase inflammation (eg, white bread, pasta, and rice, and sugary drinks and snacks)

Diet is a major component of good overall health, and taking control of it could make a difference in your back pain, yet some pain will persist even when following an optimal diet. Read our last post of the month for a look into what physical therapy can do for low back pain that fails to improve.

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

Performing This Exercise Can Strengthen The Back And Alleviate Pain
April 13, 2021

If you have low back pain, you’re far from alone. Tens of millions of Americans are affected by it, with some only being bothered occasionally and others burdened on a nearly constant basis. Regardless of where you fall along this spectrum, there’s a strong chance you’ve probably searched for remedies to quickly alleviate your pain.

Just as there are tons of people with low back pain, there are also tons of treatment options out there that claim to be a solution. Many are probably not worth your time, but one of the easiest and most effective things you can do for your back is to bolster the strength and increase the flexibility of the structures that could be contributing to pain. This can best be accomplished by staying physically active on a regular basis and by performing specific exercises that target the lower back, abdominal, and core muscles.

How to perform the basic bridge exercise

One exercises we strongly recommend for your low back pain is called the basic bridge, which is also known as the glute bridge or hip raise. The basic bridge exercise primarily stretches and strengthens the gluteus muscles of the buttocks and hamstring muscles in the back of the thigh. And when done correctly, it also targets various muscles that support the abdominal, lower back, and hip regions. As a result, regularly performing this exercise will lead to greater strength in these muscle groups, which will improve your posture and can help alleviate lower back pain. Even if you’re dealing with chronic low back pain, properly executing the basic bridge can lead to reductions in pain.

Here’s how to do the basic bridge exercise (click here for a video demonstration):

  1. Lie on your back with your hands at your sides, knees bent, and feet flat on the floor under your knees
  2. Tighten your abdominal and buttock muscles by pushing your low back into the ground before you push up
  3. Raise your hips to create a straight line from your knees to shoulders
  4. Squeeze your core and pull your belly button back toward your spine
  5. Hold for 20–30 seconds, and then return to your starting position
  6. Complete at least 10 repetitions
  • Cautions: Two of the most common mistakes that people make when performing the basic bridge are raising the hips too high, which can strain the lower back, and allowing the hips to drop while trying to hold the position. Try to avoid this mistakes and keep good form throughout, as it’s better to hold the correct position for a shorter time rather than an incorrect position for a longer duration.
  • Modifications: If the basic bridge starts to feel too easy after doing it regularly over time, you can increase the difficulty by adding an exercise band, dumbbell, or exercise ball. From there, you can even try to single-leg bridge, which is a variation on the basic bridge in which you keep the same form, then raise one of your legs off the ground about 10 times, and then repeat with the opposite leg.

While the basic bridge is a great starting point, it may not completely eradicate your low back pain on its own. For persistent or chronic pain, a comprehensive treatment program prescribed by a physical therapist may be needed, and we’ll take a closer look at the benefits of physical therapy in our last post this month.