The topic of posture is something almost every patient inquires about during their PT stint. “What is good posture?” “Do I have bad posture?” “How do I build strength in my postural muscles?” While there isn’t exactly a “perfect posture” that will work for everyone, we have plenty of anecdotal and evidence-based research to safely say certain postures can contribute to pain in sitting, standing, etc. Since August is all about Back to School, we know this means back to sitting for 8 hour days for students. For many adults, sitting at work for long periods of time is inevitable. This is why addressing posture and building postural stability and strength is so important! 

Before we dive in to what good posture IS, lets first discuss what good posture ISN’T:

• Pulling your shoulder blades back and down
  • This creates tension/strain on your brachial plexus (the nerve network that runs from your neck to your arms)
• Standing with your butt tucked under you with posterior pelvic tilt
  • Thinking of your spine being straight will contribute to unnatural loading patterns for your vertebral column and your discs
• Keeping your neck held “straight” with a chin tuck
  • This will lead to military neck and loss of cervical lordosis and your natural curvature

Message from all of this? KEEP YOUR CURVES! Your spine is S-shaped and maintaining this is what good posture is all about! If you have worked with us at IP, you may have heard some expressions like: keep your ears over your a$$, pull your butt up to your blades, or  _________ . We aren’t saying these expressions for a laugh, but to cue to you to keep your natural lordosis and kyphosis (spinal curves). In the picture below, you see the anatomical plumb line. If maintaining good posture, this line should cross your earlobe, outside of the shoulder, outside of your hip, outer knee, and outer ankle in standing!

Think of maintaining these curves the next time you have to stand or sit for a prolonged amount of time to begin building postural endurance and strength! If you struggle with sitting or standing for prolonged amounts of time without aches and pain, consider scheduling your PT evaluation at IP!

Happy 4th of July! Summer has finally arrived in Colorado! This means more time spent outdoors doing your favorite activities, covering up with some SPF (see the last blog…), and of course, traveling! One of the biggest questions we get from our patients during this time of year is, “What exercises can I do while I’m gone so I don’t lose progress in my rehab?” Vacation and traveling don’t have to get in the way of a steady recovery as long as you stay consistent!

There are dozens of body-weight exercises that we prescribe our patients at IP, with our favorite being the Fire Hydrants. This sequence of four exercises works on stability AND mobility for the spine, hips, shoulders, knees, and wrists, need we say more?! Check them out below and try to hold each position for up to a minute! For added resistance and a more challenging workout, throw a pair of furniture sliders and therabands in your bag and you’ll be able to enjoy your vacation with a healthy body! 

Another concern with summer traveling is the increased stiffness and pain that comes from long flights or car rides. Below we are going to show some simple, yet easy ways to stay mobile while getting to your destination!

Seated Thoracic Extension/Flexion

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Lumbar Flexion/Extension

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Seated Figure 4 Stretch (Stay active by pulling knee open and keeping foot flexed)

Seated Thoracic Rotation (push your thigh out into hand for resistance)

Hip Adduction with Hand Resistance

Did you know that PTs are educated on skin care and the integumentary system as part of their coursework and that many PTs specialize in skin and wound care? As the weather starts to warm up (waiting for normal weather in Fort Collins…) and everyone starts to spend more time outdoors, taking care of your largest organ, your skin, is so important! You should have a head to toe skin check yearly to screen for skin cancer by your provider, as well as perform self-checks on larger moles, freckles, etc. regularly. Early detection is key to prevent spreading of lesions and treatment with excision. You can see Dr. John getting his #FatherhoodFitness on with Malaki, enjoying sunny Colorado and practicing safe skin care! Tag us on social so we can see those dad bods moving!

Here is what you should look for when performing a self-check:

The ABCDE’s of Skin Cancer

Asymmetry: If you draw a line through the lesion, the halves will be uneven
Border: Edges of the lesion will be uneven, crusty, or notched
Color: Uneven coloring, especially appearance of white and/or blue
Diameter: Lesions larger than a pencil eraser in diameter
Evolving: The lesion will begin to change in size, shape, or color or begins to bleed and scab

Summer Skin Care Tips

• Apply broad-spectrum, water-resistant sunscreen of 30 SPF minimum to all exposed areas of skin when spending time outdoors (and reapply every 2 hours!)
• Wear lightweight protective clothing to prevent prolonged sun exposure, especially between 10am and 2pm
• Avoid tanning beds and sunbathing
• EXERCISE! While it won’t protect you from skin cancer, working up a regular sweat is the best way to keep your skin healthy. Exercise increases circulation, delivers nutrient-rich blood to the skin, helps to flush out damaging free-radicals, and boosts skin cell turnover!

With Mother’s Day approaching, we thought it would be helpful to dive into a topic affecting the moms in our lives and in the IP community: Diastasis Recti. A woman’s body goes through incredible changes during pregnancy, delivery, and eventually post-partum. Typically these changes lead to overstretching and weakness of the abdominal wall and pelvic floor which can result in:

• Low back pain
• Sacroiliac Joint Disorder
• Difficulty with lifting child and performing functional activities

The good news is, these problems can be addressed and treated with physical therapy!

What is Diastasis Recti?
Diastasis Recti is a term that describes separation in the abdominal wall between the two sides of your rectus abdominis muscles (*think your 6 pack*) that leads to a bulging/herniation of organs when sitting up or increasing pressure throughout your abdomen. The dysfunction itself is typically painless, but the generalized weakness and loss of integrity of the abdominal wall can lead to low back pain, etc. Although this condition is most prevalent in post-partum women, this can affect people of all ages, gender, and fitness levels.

How do I know if I have it?

Lie on your back with your knees bent
Lift your head and shoulders off of the floor and reach your arms towards your feet
You will then feel for a bulging both slightly above and below the belly button
If the herniation is >2cm wide, it is a positive test for D.R.

How can I fix it?
Post-partum training of a muscle called the Transverse Abdominis (TrA) is crucial to closing the diastasis recti and strengthening the abdominal wall safely. This muscle wraps around your sides and pulls your waist in with the fibers pointing towards your belly button. To activate, start by lying comfortably on your back with your knees bent and think of “pulling in your corset” around the sides. Another way to activate is to imagine a string drawing your belly button towards your spine.Without having to hold your breath, you should feel your waist draw in and there should be no abdominal bulging. Hold this contraction and count to 10 while slowly breathing in and out. This can begin as soon as 4 days post-delivery.

Once you can successfully hold this contraction, you can begin a series of movements know as “Sahrmann Exercises” to place a higher demand on the TrA. Click the link here to follow along with these exercises.

As the diastasis recti begins to close, your physical therapist will continue to progress you to more demanding core stabilization exercises! If you or someone you know would benefit from these exercises and post-partum PT care, give us a call!

Challenge Your Core and Your Pelvic Floor with these Exercises!

Since April is “All About Adolescents,” we thought we would dive into an important topic that affects injury recovery in our young female population. Have you or an adolescent female you know had a difficult time recovering from an overuse injury? This young woman may be suffering from a phenomenon know as “Female Athlete Triad.”   This condition is the culmination of 3 main factors including:

Energy Deficiency

• Disordered Eating
• Decreased Caloric Intake
• Insufficient protein intake
• Disruption of hormone levels
• Decreased micronutrient levels (iron/zinc) = anemia

Disruption in Menstrual Cycle

• Irregular menstrual periods
• Amenorrhea: Complete cessation of menstrual periods

Decreased Bone Mineral Density

• Osteopenia
• Osteoporosis

HOW DO THESE TIE TOGETHER?

Low energy availability for a prolonged period of time will ultimately lead to a decrease in a person’s basal metabolic rate (BMR). This BMR reduction will result in higher levels of blood cortisol (stress hormone) and decreased levels of estrogen. This decrease in estrogen will lead to irregularity or complete absence of the menstrual period. The lack of estrogen and increased cortisol will finally result in decreased bone mineral density and ultimately osteopenia (osteoporosis in severe cases).

When this energy deficit becomes a chronic issue and leads to the other precipitating factors, the young woman may experience symptoms including increased fatigue, difficulty recovering from training, delayed healing, cardiac arrhythmia, difficulty gaining muscle mass, stress fractures, as well as difficulty concentrating and cognitive issues.

As physical therapists, we are trained to recognize the signs and symptoms of the female athlete triad and treat accordingly. As part of our integrative treatment approach, we may counsel the young woman on proper nutrition, incorporating adequate rest into the training schedule, and injury prevention methods. If your daughter, sister, friend, etc., may be suffering from the female athlete triad, have them schedule an appointment at IP to begin their road to a successful recovery!

What body part is treated most in our clinic behind the low back and neck? If you guessed the shoulder you are correct! Recent studies show that shoulder injuries and disorders make up roughly 15-25 percent of all outpatient physical therapy visits. Of these patients, we are typically diagnosing and treating conditions that include:

• Impingement Syndrome (subacromial, subcoracoid, internal)
• Labral Tears (SLAP, bankart)
• Adhesive Capsulitis
• Degenerative Arthritis
• AC Joint Disorders
• Scapular Dyskinesia
• Bursitis
• Rotator Cuff Tendonopathy
• Rotator Cuff Tear (Partial and Full Thickness!)

When people hear or see the word TEAR, the first knee-jerk reaction is, am I going to need surgery? While surgery is an option for some severe cases, our goal at IP is to get our patients out of pain and back to their functional and recreational activities without going under the knife! With the right PT protocol, conservative treatment can be just as successful, if not more successful than surgery.

If you have been to IP for a rotator cuff tear, we most likely have provided you with an article that discusses the non-surgical approach to treatment. In this study, done by Kuhn et al. in 2013, they found that of the 452 subjects with full-thickness rotator cuff tears, 75% recovered successfully with physical therapy. With customized, appropriate therapeutic exercises, manual treatment, and compliance with our home exercise program, these outcomes are very realistic!

Another non-operative approach and adjunct to physical therapy treatment is PRP (Platelet-Rich Plasma) stem cell injections. Dr. Abrahamson of Integrative Sports Medicine can diagnose a rotator cuff tear using diagnostic ultrasound and perform either of these techniques on-site at 2020 if he deems the procedure is appropriate. This, along with the appropriate rehab protocol can significantly reduce recovery time! Read more on these procedures here:

If you’ve been told surgery is your only option for a shoulder injury (or any musculoskeletal injury), consider trying a conservative approach first! We will design a customized, evidence based plan of care to get you back to optimum performance faster!

https://www.ncbi.nlm.nih.gov/pubmed/23540577

We’re Bringing Function Back.

Back pain. Most of us have experienced or at least know someone who has been affected by the dreaded sciatica, SI, disc herniation, or general low back pain. In fact, did you know that up to 84% of adults will experience an episode of low back pain at some point in their life? With that in mind, it is important for you to know that most back pain, whether acute or chronic, can be treated conservatively with PT. In this post, we’re going to debunk some of the most common misconceptions about low back pain.

MYTH: I should rest after a low back flare up or acute injury.

FACT: Light movement, walking, and restorative PT exercise will help to “pump” out the inflammation your body has produced in response to the initial injury. Laying in bed all day will lead to inhibition of lumbar and core stabilizers and overall exacerbation of symptoms.

MYTH: If I have a disc herniation (PSA: discs don’t “slip”), I am going to need an injection or surgery.

FACT: Through our use of active traction, exercise, and manual treatment, disc herniations can become asymptomatic

MYTH: I’ve been dealing with this pain for years, I doubt it’s going to improve.

FACT: At IP, we treat many patients who have dealt with chronic, severe low back pain and made huge improvements to their overall function and quality of life!

IP Exercises to Address Back Pain:

Supine Windmill: Great exercise for back pain, increased mobility and shoulder stability! Pro-tip – keep both shoulders on the ground and look in the opposite direction.

Prone Rudder: Another great home exercise to address low back pain and improve posterior chain activation! Pro-tip: Keep both elbows on the ground and knees and feet squeeze tight together throughout the motion

In our last post, we discussed the importance of SMART goal setting and ways you can prevent yourself from ditching your New Year’s resolution before Valentine’s Day. If you have been wondering what goals we have set for ourselves at IP, we are going to flip the clinic upside down! John, Alex, and Jen all want to practice their variations of headstands and handstands!

Why you ask? Here are some of the benefits of practicing a form of inversions:
1) Increased core and cervical stability
2) Trains your vestibular system
3) Increased blood flow to the brain to improve concentration
4) Decreased lymphatic pooling in lower extremities
5) Builds humility through regular mistakes and practice
6) It’s FUN!

Not convinced you want to try yet? It doesn’t have to be a scary as it sounds. At IP, we have dozens of ways to modify and add assistance to various inverted poses for you to receive the therapeutic benefits of “inverting your perspective.”

Welcome to 2019!

Time for your newsfeeds, timelines, conversations, etc. to be filled with hopeful New Year’s resolutions and the clichéd “New Year, New Me” mantra. Did you know that 80% of these resolutions fail by February? You don’t have to be part of this statistic! At IP, we want to help you reach your health related goals this year. Whether you want to lose those 20 lbs you’ve been struggling with, perform your favorite activities pain free, or simply start a daily walking program, we have some helpful tools to help get you started!

First things first: Set a SMART goal

S-Specific
M-Measurable
A-Attainable
R-Realistic
T-Timely

Bad Example: I want to start working out so I can lose weight.

Good Example: Starting today, I want to walk a minimum of 10,000 steps a day and lose 10 lbs by our vacation in April.

In the “bad” example, the goal does not have a definitive timeline. How many times have you said to yourself or heard someone say, “I need to start working out.” If you do not give yourself a start day, it may never come! The first goal also does not have any measurable, specific details of what “working out” may mean. If a person has been leading a sedentary lifestyle, starting a strict exercise regimen can be daunting and lead to failure before the person even starts! By setting an achievable goal of 10,000 steps (which can be tracked with their phone, fitness band, or pedometer), the person is increasing their activity level which can eventually lead to an overall healthier, more active lifestyle and losing the 10 lbs and not just “weight” in general. Finally, make your goals realistic by keeping them smaller and setting milestones towards a bigger goal.

Setting successful goals takes practice and recognition that these goals will continue to evolve with you! Exercise and leading a healthy life is not something that is achieved and then checked of the list. Figure out what methods work for you and most importantly, find something that you will maintain! Ask your team at IP how we can help you reach your 2019 SMART goals!

IP Exercise:  Invert Your Perspective
This exercise is great for neck stability, balance and is a progressive step towards handstands! You get all the benefits of inverting while being accessible to most people. Stay tuned for handstand modifications for any level!

What is Differential Diagnosis?:

In the physical therapy setting, differential diagnosis involves comprehensive screening for systemic disease that may mimic musculoskeletal or neuromuscular conditions.

Why PT Should Be Your Go-To For Primary Care:

At Integrative Physiotherapy, we ensure that each patient is given a clear diagnosis and plan of care following their initial evaluation. Our therapists take a thorough, comprehensive history and perform evidence-based special tests to determine this diagnosis. If clinical red flags are suspected and your symptoms are not appropriate for physical therapy services, our team will help direct you to the appropriate healthcare practitioner and coordinate your plan of care. For confirmation of an injury or to rule out a systemic cause of musculoskeletal pain, John and Alex may also order imaging.

Some diagnoses that have been referred out for medical care include:

• Cardiac distress
• Kidney Stones/Kidney Infection
• Multiple Myeloma
• Lyme Disease
• Gallstones
• GERD/Stomach Ulcers

Medical management, along with our holistic treatment approach can get you back to feeling your best FASTER!

Case Example of Differential Dx at IP:

Santa sits a LOT in his sleigh. In this year’s sleigh preparation, he’s occasionally experienced a dull ache in his right shoulder.  Sometimes it wakes him during the night and he notices it when prepping presents or following a big snack of cookies and milk.

After treating it with ibuprofen and seeing his primary care physician, who ordered imaging that came back negative for a shoulder injury, Santa’s symptoms got worse…the pain intensified, he’s started having headaches a couple times a week and he felt pain more often with daily activities.

Santa then called to see Dr. John.

Dr. John got a comprehensive history; asked about Santa’s symptoms (the how, when, where and what), collects range of motion/strength measurements and does evidence-based ‘special tests’. Santa left with a clear diagnosis of cervical stenosis contributing to shoulder pain and headaches as well as gallstones… Santa was sent back to his PCP for medical management of the gallstones.

This story has a happy ending, thanks to the comprehensive differential dx process and after a few weeks of PT, Santa recovered successfully with IP’s patient-specific plan of care to strengthen and provide neuromuscular reeducation for improved posture in both sitting and standing. He was discharged pain free with a plan for how to keep the problem from returning and with appropriate medical management of his gallstones.

Although his symptoms may have indicated a possible shoulder injury, Santa was rehabilitated correctly thanks to differential dx and the IP experience, just in time for the holidays!

IP Exercise: Show Your ‘Presence’

This exercise tests your balance and give your inner ear fluid a workout (as well as your shoulders!). Stand on 2 bosu balls, holding medicine balls in each hand. Arms should be in a goal post position. Close your eyes and shake your head side to side for as long as possible while keeping your balance. Stop in the clinic to “Show Your Presence” this month for a chance to win a month free gym membership!