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!)

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.

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/ Epub 2013 Oct 5. Review.

Physical Therapist's Guide to Diastasis Rectus Abdominis (May 2017) Retrieved from

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.

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:

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!

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

Friday, February 10, 2017

Running Safely as We Age

by Meredith Franczyk, PT
Running is one of the most popular types of exercise around the world. Since it requires very little equipment and can be done just about anywhere, people of all ages have found themselves lacing up their shoes and going for a jog. Running's many physical benefits - increases in aerobic capacity and skeletal mass, improvements in balance and cognitive function, and decreased chance of heart problems, to name a few - also make it an attractive option.

As our bodies age, however, we experience changes that can affect our ability to run. From the age of 40 onward, adults experience sarcopenia, or degenerative loss of muscle, losing between 5-8% of their muscle per decade. In addition, increased body fat percentage, decline in muscle thickness, decreased vertebral height, and joint stiffness can make maintaining any kind of workout a challenge. A more specific challenge that runners face is a decrease in type II muscle fibers with age. Also known as fast-twitch fibers, these fibers help us to move quickly in short bursts, and the decrease in these fibers diminishes our ability to sprint.

Biomechanics and stride pattern also tend to change as a result of our aging bodies. Achilles tendinopathy and calf strains have the highest incidence rates in older adults due to decrease in big toe mobility and altered biomechanics, so it is important to adapt a running program to one's body to avoid injury. To decrease these risks, older adults should do the following:

  • Cross-train more (bike, swim, etc.)
  • Run slower (to control altered biomechanics)
  • Change shoes more often (to help control stability)
  • Improve flexibility
  • Maintain range of motion
  • Improve quadriceps, calf and hamstring strength

When performed properly, running can absolutely be part of a healthy lifestyle for an older adult. As long as we make the correct adaptations to maintain healthy running form, we can hit the track with confidence even into our later years.

Conoboy, P. and R. Dyson. Effect of aging on the stride pattern of veteran marathon runners. British Journal of Sports Medicine. 40:601, 2006.
Cavagna, G.A., M.A. Legramandi, and L.A. Peyre-Tartaruga. Old men running: mechanical work and elastic bounce. Proc BiolSci. 275:411-418, 2008.
Chakravarty, E., H. Hubert, V. Lingala, E. Zatarain, and J. Fries. Long Distance Running and Knee Osteoarthrits: A Prospective Study. Am J Prev Med. 35(2):133-138, 2008.

Monday, January 9, 2017

Start 2017 Off Right!

by Sally Fansler, PT
The start of a new year is the perfect time to resolve to change something. As we all know, however, a New Year’s resolution can be difficult to stick to. In fact, University of Scranton research suggests that even with the best intentions, just 8% of people achieve their New Year’s goals. So why do so many of us fail at goal-setting?

Switch: How to Change Things When Change is Hard digs into the issue by looking into the human psyche to examine why we tend to resist change. In order to make a change, the authors pinpoint three things that need to be addressed. The first of these is the Elephant: our emotional side, the instinctive part of us that craves instant gratification. Often the Elephant is the first cause of failure because in the short term, it’s much nicer to sleep in or eat ice cream than it is to get up early to go to the gym or eat broccoli. The second component, the Rider, sits on top of the Elephant. The Rider is analytical and strategic, but often has difficulty controlling the emotional Elephant. The last component to successful change is to make a straight and clear Path. With that, the Elephant does not pull the Rider off course and the Rider can guide the Elephant smoothly along the Path.

In physical therapy, we consistently encourage our patients to set realistic goals and make changes. A change in posture can alleviate neck pain. A change in hip strength can improve running speed. A change in overall fitness level can reduce daily fatigue. Pain can be a motivating factor in the beginning, but by changing a habit, we remove conscious deliberation from the situation, which helps us on a healthy path. Here are a few tips:

  • Make your goals clear and concise. “Lose weight” is unclear and easily compromised. “Lose 10 pounds in 90 days” is measureable and specific.
  • Set small, easy steps to motivate the Elephant. Many people quit because their goal feels like too much at once.
  • Establish some accountability by setting up someone to report to and share in your progress.
  • Celebrate small successes rather than waiting until the goal is complete.
  • Focus on the present. Right now, what can be done to help move forward toward your goal?
Change is a continuous process and must be sustained over a long period of time for the results to be clear. A combination of a solid goal, a dose of motivation, and a supportive environment are the best ingredients for success.


Heath C, Heath D.  Switch:  How to Change Things When Change Is Hard, Random House Inc., (New York: 2010).

“New Years Resolution Statistics,” Statistic Brain (2016), data from University of Scranton Journal of Clinical Psychology.

Tuesday, December 13, 2016

Arthritis and Exercise

by Katie Hopkins, DPT
It’s one of the most common causes of disability in the U.S., according to the CDC, and about 1 in every 5 adults is diagnosed with it. Two-thirds of those diagnosed with it are under the age of 65.

Would it surprise you to learn that I’m talking about arthritis?

It is a common misconception that arthritis is an ailment only for the elderly. In fact, arthritis can describe a variety of conditions, including rheumatoid arthritis, osteoarthritis, lupus, fibromyalgia, and gout. Of these, the two most common types of arthritis diagnosed are osteoarthritis (OA) and rheumatoid arthritis (RA). While both have symptoms that include swelling around the joints, those with osteoarthritis tend to experience more joint pain, stiffness and achiness while rheumatoid arthritis sufferers experience more muscle stiffness, achiness, fatigue and weakness.

Due to weakness and fatigue, patients with RA often have difficulty lifting items over 5 lbs., climbing a flight of stairs or walking more than 1/4 of a mile. In fact, studies show that people with RA are anywhere from 33% to 55% weaker than healthy controls. An aggressive exercise regimen is often recommended to combat muscle atrophy and fatigue, as this keeps patients functioning at a higher level in their daily lives. Research shows that patients with RA benefit from both short-term and long-term aerobic capacity and dynamic strengthening programs to produce and maintain higher levels of function.

Conversely, patients with OA tend to suffer from more joint pain and stiffness affecting their range of motion and muscle function. Hips and knees are two joints commonly affected by OA, and OA in these joints tend to lead to the most functional limitations and greatest decrease in quality of life. Research studies indicate that resistance training - along with aerobic exercise - lead to the most changes in patients with OA in their knees. While there has not been as much research done specifically on hip OA, preliminary studies do show that therapeutic exercise programs are as effective for the hip as they are for the knee. Perhaps one of the most notable factors in osteoarthritis research is that long-term results tend to diminish when a prescribed exercise program is not updated or a patient does adhere to the same levels of exercise independently.

The research supports the effectiveness of an individualized physical therapy program in treating symptoms of arthritis. A physical therapist can help you to determine what specific exercises are best for you and your joints and how to manage your symptoms long term.


Farr JN, Going SB, McKnight PE, Kasle S, Cussler EC, Cornett M. Progressive Resistance Training Improves Overall Physical Activity Levels in Patients with early Osteoarthritis of the Knee: A Randomized Controlled Trial. Phys Ther. 2010;90(3);356-366.

Fernandes L, Storheim K, Nordsletten L, Risberg MA. Development of a Therapeutic Exercise Program for Patients with Osteoarthritis of the Hip.  Phys Ther. 2010;90(4);592-601.

Iversen MD, Brandenstein, JS. Do Dynamic Strengthening and Aerobic Capacity Exercises Reduce Pain and Improve Functional Outcomes and Strength in People with Established Rheumatoid Arthritis. Phys Ther.  2012;92(10);1251-1257.

Lin CC, Taylor D, Bierma-Zeinstra S, Maher CG. Exercise for Osteoarthritis of the Knee. Phys Ther. 2010;90(6);839-842