Friday, September 8, 2017

Good vs. Exceptional

by Sally Fansler, PT
Whether it is their first or their fiftieth time seeking physical therapy, patients want to put their health in the hands of a physical therapist that can help them achieve their goals. A good physical therapist has a solid education of the musculoskeletal system as well as training in biomechanics, neuroscience, physiology and kinesiology. Well-credentialed with a license in the state in which they practice is also a given requirement. But if you are seeking an exceptional physical therapist, there are some additional traits to look for in your provider.

Identifying a specific dysfunction takes natural problem-solving skills, and an exceptional therapist uses keen observations, deductive reasoning, and asking the right questions to get to the root of the issue. Any therapist can give a general exercise program to strengthen an area, but drilling down to the key problem to fix the issue takes a higher amount of skill and tenacity. For example, if a patient attends physical therapy with runner's knee, a program that exercises every muscle around the knee may hit the dysfunction, but it also may not resolve it. Using clear differential diagnosis skills and testing, the exceptional therapist will be able to address the exact cause of the pain, be much more specific, and ultimately much more successful. This allows the runner to return to training more quickly and efficiently.

Having the patience and proficiency to zero in on the source of a patient's pain is just one piece of the puzzle - the therapist has to be able to form a connection with the patient as well. The ability to establish rapport and a strong patient relationship early on is essential for the patient's success. A sense of understanding, empathy and sincerity helps patients feel as though they and their therapist are equal participants in their recovery. With a humble disposition, the exceptional physical therapist puts the concerns of the patient first and honestly wants to make a difference.

At Lakeshore Physical Therapy, our therapists average 12 years of experience (I did my share to elevate that average)! They are naturally gifted, but also take care to cultivate their talents to provide care that goes above and beyond rehabilitation. We realize that decisions about a patient's health should never be just another case or a job and we do our best to convey that every day.

Friday, August 4, 2017

Planes of Motion

by Meredith Franczyk, PT
We don't often think about it consciously, but as three-dimensional beings we naturally also move in more than one dimension. In fact, there are three distinct places of motion - sagittal, frontal and transverse - and all are required for our bodies to move with functional smoothness.

The most common plane of movement, the sagittal plane, divides the body into right and left halves. In this plane, we use the strength of our muscles to move forward or backward (flexion and extension). Key muscles such as the quadriceps, gluteals and biceps are typically worked in the sagittal plane: for example, a lunge forward or backward, which can be made more challenging by adding another sagittal exercise such as a bicep curl.

If we take an imaginary line and divide the body into front and back halves, this is the frontal or coronal plane. Movements in this plane are always sideways motions, called abduction (away from the center of the body) and adduction (toward the center of the body). Some of the muscles that work in the frontal plane include the middle deltoid, adductors (inner thigh) and gluteus medius. These muscle groups work as stabilizers to control the forward and backward movements in the sagittal plane. Sidestepping with a band around the ankles is an example of a frontal plane exercise.

The transverse plane, the plane most overlooked in exercise routines, divides the body into top and bottom halves. Movements in this plane are rotational in nature and critical in sports for pivoting, batting and golf swings. Common transverse plane muscle groups include the gluteal and adductor muscle groups and the rotator cuff. An example of an exercise in this plane would include a chop with a medicine ball.

(Left) Sagittal plane exercise. (Center) Frontal plane exercise. (Right) Transverse plane exercise.
A well-balanced fitness program should incorporate exercises along each plane of motion. By incorporating multi-planar movements in our warm-ups, strength training and stretching, we can reduce overuse injuries and muscular imbalances.

Friday, July 14, 2017

Building Core Strength: The Plank

by Stephanie Korso, PT
The plank is a common exercise with which most people are likely familiar: even if they have never tried to do a plank themselves, they have likely seen someone doing a plank at the gym or read about it in their favorite fitness magazines. But what is all the fuss about? Is it really such a great exercise?

Simply put, the answer is yes! The plank is a great way to improve core strength and stability. Research suggests that proper core strength and stability can help alleviate low back pain, prevent injury, improve balance, and enhance performance. When performed correctly, however, planks can do more than just work the midsection: they can work muscles from head to toe, improving limb strength and toning the entire body.

If the idea of performing one exercise sounds like it might not prove enough of a challenge, there are also many variations of the plank, making it easy to keep things interesting and modify or progress the exercise. A prone plank (face down), for instance, increases activation of anterior abdominal muscles, whereas a supine plank (face up) increases activation of back muscles and a side plank increases activation of the obliques. Adding arm or leg movements increases the difficulty of the exercise by further challenging core stability and increasing shoulder and hip muscle activation.

Moreover, the plank is generally a safe exercise because it is isometric, meaning that muscles maintain a constant length as they contract and body parts do not move. This is easier on one's joints than other types of exercises in which the body changes position, such as sit-ups. The plank requires minimal time and can be performed without any equipment, making it easy to sneak in anytime, anywhere.

Consider mixing up your routine by trying out some of the variations below! As with any type of exercise, remember to breathe throughout and stop if you have pain. It is recommended that you consult your physician or physical therapist before beginning a new exercise routine.

  • Forearm plank
  • Straight arm plank
  • Side plank
  • Side plank with twist
  • Supine plank
  • Plank with alternating shoulder taps
  • Plank with alternating hip extension
  • Plank with legs elevated on stability ball
  • Plank with forearms supported on stability ball
References:
Escamila RF, Lewis C, Pecson A, Imamura R, Andrews JR. Muscle activation among supine, prone, and side position exercises with and without a Swiss ball. Sports Health. 2016; 8(4): 372-379

Calatayud J, Casana J, Martin F, et al. Trunk muscle activation during different variations of supine plank. Musculotskelet Sci Pract. 2017; 28: 54-58.

20 ways to do a plank. Health Magazine. http://www.health.com/health/gallery/0,,20813896,00.html. Accessed May 17, 2017.

Friday, June 9, 2017

More Than Trivial: Working Memory and Pain Management

by Lauren Sweeney, Office Manager
Knowledge of American history, popular music or sports may not be the first thing someone might be thinking about when they begin physical therapy, but our patients have come to expect that, when they walk through the door, they will be greeted by a Question of the Day. This rotating slate of various trivia and logic puzzles delights and challenges our patients so much that often a patient will end a phone call or email by asking, "What's the question today?"

While it may seem just a simple distraction, engaging the brain in recalling information or cracking a puzzle can serve a more useful purpose: pain management. Working memory, the part of short-term memory that takes on immediate cognitive tasks and processes language, also manages attention, meaning it is to a degree responsible for what we perceive and experience. When that working memory is engaged in a task, then, it can do so to the exclusion of other stimuli, such as pain. In a study conducted at the University Medical Center Hamburg-Eppendorf, participants were given a painful stimulation which was then followed by a cognitive task. The more complex the task, researchers found, the less pain the participants reported. And it wasn't all in their heads - MRI data showed a decreased neuronal response as well, meaning that fewer pain signals were making it to the spinal cord.

All that said, there's no evidence that working memory engagement is helpful in alleviating chronic pain, and it's certainly no substitute for seeing your doctor or setting up an appointment with a physical therapist. It may, however, lower pain just enough to start off a physical therapy session on the right foot. On that note, I'll leave you with my favorite riddle: A man lies dead, surrounded by 53 bicycles. What happened? (Feel free to answer in the comments below!)

Reference:
Sprenger, Christian et al. Current Biology, Volume 22, Issue 11, 1019-1022.

Friday, May 5, 2017

Diastasis Rectus Abdominis: Dealing with the Post-Partum Bulge

by Katie Hopkins, PT
While many women notice differences in their bodies after giving birth, some experience an extra bit of abdominal bulge that has nothing to do with baby weight. Diastasis rectus abdominis (DRA) is a separation of the two muscle bellies of the rectus abdominis muscle. Commonly referred to as the "six-pack" area, it is the main and largest abdominal muscle on the front side of the body. DRA most often occurs in women during pregnancy: the expanding uterus stretches the abdominals, which can cause a separation in the line alba (the connective tissue between the two sides of the muscle). While it can also occur in men and non-pregnant women due to inappropriate loading and pressure within the abdominal and pelvic regions, it is rare.

DRA is characterized by a visible and palpable separation of the rectus abdominis. This gap, assessed by contracting the muscle in a specific fashion, is measured in finger widths. While the separation of the rectus abdomens itself is not always painful, it can lead to other painful dysfunctions. Patients can experience a feeling of weakness in the abdominal muscles, pelvic floor dysfunction (urinary and bowel problems), low back pain, pelvic pain, hip pain, poor posture and sexual pain as a result of DRA, and the risk for separation increases with each delivery or being pregnant with multiples.


To treat DRA, a physical therapist can help develop an appropriate exercise program to strengthen the abdominals and decrease the separation. This program usually consists of a combination of transverse abdominal training, pelvic stabilization and postural training. Physical therapists can also tell you what exercises - such as crunches, sit-ups and twisting with weight - should be avoided, as they may exacerbate the separation. New mothers, or those who have older children that still like to be picked up and held, may also benefit from reviewing proper lifting mechanics: it is important to stabilize the abdominal and pelvic region, as well as lift properly, to avoid additional stress on the diastasis. Taping has also been shown to be effective for DRA.

DRA can be treated before and after pregnancy. Although it is rare for diastasis to close during pregnancy, treatment can help to minimize the gap and potential symptoms that occur after delivery. If you have recently given birth, talk to your doctor about when it may be appropriate for you to start treatment after delivery. Even if it has been a while since you've given birth, it's never to late to get treatment - separation can be decreased and improvements can be made no matter how old your kids are.

Resources:
Benjamin, DR, van de Water, AT, Peiris, CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar; 100(1):1-8. doi: 10.1016/j.physio.2013.08.005. Epub 2013 Oct 5. Review.

Physical Therapist's Guide to Diastasis Rectus Abdominis (May 2017) Retrieved from http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=f8a7ad12-eadf-4f42-9537-e00a399c6a03

Tuesday, April 11, 2017

Swing Into Spring

by James Bansberg, PT
Spring is finally here, and it's time to get on the green. It's been a long time since your last round, though, and your golf clubs aren't the only things gathering dust - your joints and muscles have also hibernated all winter. It's time to get everything back into golfing shape and hit the ground swinging!

Physical fitness has become a top priority for professional golfers in recent years, and rightfully so: many golfers, such as Davis Love III, contribute their lengthy, successful careers to proper conditioning, strength and flexibility. This doesn't mean you need to start deadlifting heavy weight like McIlroy, however - many basic strength and flexibility exercises can be done in the comfort of your home and don't require you to break a sweat.


Flexibility
Though stretching is one of the hardest things to get golfers to do consistently, proper flexibility will not only improve swing mechanics and speed, it will also lengthen your golfing career by reducing stress on joints. Including a stretching routine in your usual workout or signing up for a weekly yoga class can address this. (If you're not sure hoe to get started on your own, we've included a link to a basic flexibility routine at the bottom of this post.)

Core Strength
The core acts as a bridge between upper and lower limbs. When core stability is weak, the body compensates and channels unnecessary pressure and motion through vulnerable areas, leading to injury. With greater core strength and stability, we gain better trunk control. Improved core strength also translates to improved power - studies show there is a relationship between driving distance, swing speed, ball speed and muscle strength.

Warm Up
After a long, cold winter without golf, it can be incredibly tempting to step out of bed, up to the tee, and just swing away. Do yourself a favor, however, and resist that temptation. Head to a driving range first to work out the kinks, get a feel for your swing, and get those golf muscles working optimally. Start with your wedges and work up from there, only grabbing your driver once you feel back in the "swing" of things.

Golf Stretching Routine: http://www.stretching-exercises-guide.com/golfing-stretches.html

Resources:
Torres Ronda L, Sánchez-Medina L, Gonzáles-Badillo JJ. Muscle strength and golf performance: a critical review. J Sports Sci Med. 2011;10(1):9-18.

Thursday, March 16, 2017

Customer Service - Giving 100% With Every Step

by Joni Modaff, Office Coordinator
In my 5 years of experience working at Lakeshore Physical Therapy as an Office Coordinator, giving my best to customers (or in our case, patients) has always been my top priority. As the first point of contact - whether by phone or in person - my interactions set the tone of the office experience. Because our patients often walk in the door with physical challenges or in pain, I strive to make each visit a welcoming and positive one.

While the term "customer service" means something different to each individual, I have found that these 5 Best Customer Service Tips to help achieve customer satisfaction:

1. Anticipate the Needs of the Customer - put their best interest first
2. Greet with a Smile - a friendly handshake or greeting goes a long way
3. Make Time for the Customer - prioritize their needs
4. Make Customers Feel Comfortable - address by first name and get to know their expectations
5. Be Accountable when Mistakes Occur - rectify situation quickly, professionally and with an apology

In any type of field or career, the above tips will help build a strong relationship with customers that will keep them coming back. I had the opportunity to see how much of a difference strong customer service made from the other side of the desk when my ailing uncle needed to go into a nursing home. We had to a find a place that would be best for all his needs, as well as make sure we felt comfortable with the various staffing personalities. The place we chose made my uncle feel right at home with their warmth and exceptional service. Needless to say, I would recommend the facility.

Referrals are the best compliment an individual or a place of business can receive, and I take pride in creating an environment that makes people comfortable to suggest their friends and family receive care from us. We do our best to incorporate all of these tips at Lakeshore Physical Therapy and continue to make our customer experience one that won't be forgotten!

Reference:
CSM - The Magazine for Customer Service Managers and Professionals by Ian Miller