Can Cold Weather Hurt Your Lower Back?

As we head into the holidays, the weather starts to change. As the temperature drops, aches and pains become a frequent occurrence. Without proper warm up and stretching, activities like snow shoveling and even prolonged standing can trigger low back pain, knee pain and other injuries. It is important to remember that blood flow to muscles and joints decreases as a direct result of reduced activity. In addition, the abundance of food during the holidays results in weight gain for most individuals. Therefore, it is crucial to stay active, keep the blood circulation going, and burn extra calories during the winter.

It is common knowledge that physical therapy helps in the treatment of injuries, but did you know that injury prevention becomes crucial during the winter? 

Injury Prevention 101 During the Winter:

If you are going to be lifting and moving things, shoveling snow or engaging in other forms of exercise, make sure to warm up and stretch before you begin. Start slowly and maintain the right posture as you increase the intensity of exercise over 10-15 minutes. Take short breaks and give your muscles and joints a chance to ‘adjust’ to the task. Your physical therapist will suggest that you use your knees rather than your lower back to lift heavy objects, avoid twisting movements and breath normally at all times.

Hold heavy objects close to the body to reduce strain on the lumbar spine. The feet should be kept wide apart to increase the base of support, and the knees must be slightly bent. Use your entire body to move objects rather than twisting your back. If you are shoveling snow, you must avoid twisting motions of the lower back such as throwing the snow over the shoulder behind you.

With the right combination of breathing, warm up and the correct technique, you can reduce the probability of injury significantly. If you have aches and pains that get worse during the winter, it may be time to see a physical therapist. Your therapist will assess your current activity levels and functional limitations. The therapist will discuss your short term and long term goals. All this information will be used to devise a plan of action to treat the underlying cause of pain as quickly as possible.

We Wish You a Healthy, Happy Holiday Season!

It is important to maintain strength and stability in the muscles of the torso and lower back, especially during the winter. As the snow melts to ice, the risk of slips and falls increases. Maintaining and improving balance and stability, especially for seniors is an important part of physical therapy and wellness.

We can educate you and your family about proper techniques to maintain posture, improve balance and prevent injuries. Some simple prevention techniques, combined with good old fashioned common sense will help you enjoy a healthy, happy holiday season. Winter is associated with a surge in the number of persons visiting the emergency room for snow shoveling and fall-related injuries, which is why prevention is so important.

As your physical therapists, we can help you stay safe and healthy. Give yourself (and your family) the gift of health and wellness. Contact us to learn more about how physical therapy can change your life this holiday season.

Everything you need to know before and after Total Hip Replacement Operation

Total hip replacement (THR) is a surgical procedure to replace a damaged hip joint with a new artificial/prosthetic implant. Physical therapy is essential before and after surgery in order to minimize complications. Therapy also reduces recovery time and restores hip joint function as quickly as possible.

Musculo-skeletal conditions that may require THR

An impaired hip joint can result in pain and motion restriction for daily activities like sitting, standing, walking and commuting. Some of the conditions that could potentially damage the hip joint include:

  • Trauma
  • Tumors
  • Osteoarthritis
  • Rheumatoid arthritis
  • Osteonecrosis

Signs and symptoms include moderate to severe hip pain and joint stiffness. Since the hip is a weight bearing joint, pain and discomfort in this region can interfere with the ability to walk and result in gait imbalances.

This can trigger several biomechanical adjustments in the lower body and lead to low back pain, knee pain and ankle pain. Over a period, this can cause several limitations in function. It is important to consult with a physician and detect hip joint abnormalities as soon as possible to prevent long-term damage.

Benefits of Physical Therapy

In the event of a scheduled THR surgery, physical therapy can speed up healing and rehabilitation of the hip joint before and after surgery.

Before surgery

A baseline measurement of the strength and flexibility is performed. The patient is educated about precautions to take prior to the surgery and positions / movements to avoid after surgery. Objects and furniture may need to be re-arranged to make sure important objects are within reach.

After surgery

Several procedures and modalities can be used by the physical therapist to facilitate recovery after surgery. These include:

  • Ultrasound to heal connective tissue (tendons and ligaments).
  • Manipulative therapy that includes stretching and massage.
  • Resistance training to build muscle strength.
  • Cold compress and heat to relax muscle spasms.
  • Low-level laser use for muscle and connective tissue injuries.
  • Functional electrical stimulation to restore muscle strength.

The Importance of the Initial Evaluation

Your physical therapist understands that when it comes to your recovery, every little detail matters. That is the reason your therapist will conduct a detailed initial evaluation. This includes objective measurements of the strength, flexibility, and mobility of the hip jointsThe physical therapist will identify functional limitations of the patient and establish a gap between the prior level of function and intended level of function.

Once the physical therapist determines this gap and analyzes diagnostic tests like X-rays and MRI scans, an effective treatment program can be created. This consists of specific procedures and modalities.

Treatment for mild hip problems is generally conservative. It includes medications and physical therapy. Physical therapy can also help before and after THR surgery. After a brief period of hospitalization, the patient may need several weeks, potentially months of physical therapy to achieve full recovery.

If you or someone you know is complaining of hip pain, call our office today. We will do everything we can to help.

The Importance of Physical Therapy on Women’s health: All you need to know

Ever since the #1 New York Times bestseller entitled "Men Are from Mars, Women Are from Venus" by John Gray was published, more and more people have asked the question "What makes men and women so different?". Gray's use of analogies and metaphors to highlight key differences between genders has made the book a modern classic.

Although Gray's work was focused on relationships between spouses, it is important to understand that there are several physical and physiological attributes that are unique to women, and physical therapy plays an important role in women's health.

Three functions in particular are unique to women. These are menstruation, pregnancy, and lactation. These functions are intricately tied to complex hormonal patterns in women, which also influence behavior.

Some of the fundamental physical differences between men and women include:

  • Men have more muscle mass than women.
  • Women tend to have a higher proportion of body fat than men. This fat is generally stored in the breasts, hips and buttocks.
  • Men tend to have more body hair (especially facial hair)

Physical therapists understand the physical differences (and unique needs) of the female population and are uniquely qualified to assist women to live healthy, pain-free lives.

Healthy Aging for Older Women:

Specific actions need to be taken to ensure healthy aging for older women. Physical therapy can help identify (and eliminate) risk factors for falls and fractures. Regular strengthening and weight bearing exercise can slow down the reduction in bone density as women age. You may be asked to visit your physician to learn about the risks and benefits of hormone replacement therapy. Screening for calcium, vitamin D and vitamin B12 deficiency is also recommended. Pelvic floor dysfunction and incontinence can also be treated with physical therapy.

Here are some of the conditions (some of which tend to be more common among women) in which physical therapy can play an important role:

  • Osteoarthritis
  • Osteoporosis
  • Breast and other cancers
  • Rehabilitation following breast surgery
  • Lymphedema
  • Post-menopausal heart disease
  • Chronic myofascial pain
  • Patellofemoral pain syndrome
  • Hypermobility syndrome
  • Multiple sclerosis
  • Sacroiliac (SI) joint dysfunction
  • Fibromyalgia
  • Ailments unique to female athletes

Physical therapy helps reduce discomfort and recovery before, during and after pregnancy. Pregnancy related issues include heel pain (plantar fasciitis) and associated aches and pains.

Physical Therapy and Women's Health:

Exercises and techniques to treat issues specific to women include:

  • Muscle retraining – This creates body awareness (how you get in and out of your car, how you bend to pick things up, how you sit, overall posture, etc.) and improves movement patterns. Kegel exercises to strengthen weak pelvic floor muscles in addition to Pilates can be very beneficial.
  • Exercise Therapy – helps improve mobility, strength, and endurance. This also strengthens bones and joints.
  • Modalities – Application of heat and/or ice, electrical stimulation therapy, and massage therapy to reduce pain, stiffness, and swelling.
  • Manual therapy – helps improve joint and soft tissue flexibility and mobility by using repetitive and specific hands-on movements and motions.

Every physical therapy program is different and is customized to the patient's needs. Women have unique physical and physiological attributes that physical therapists take into consideration. In fact, a section of the American Physical Therapy Association is dedicated to specialization in women's health.

Physical therapy can make a difference to every member in your family at some point. Give us a call today, and ask us about what we can do for you.

Can’t Get Comfortable In Your Chair? Here’s What You Can Do

Recently NPR ran an article on back issues related to chair design and it's evolution. Below is an excerpt of the article. We constantly talk about importance of proper posture whether sitting, standing or walking. This article focuses on sitting posture in modern chairs and three tips on how to get comfortable.

About a hundred years ago, something devious started happening in our homes and offices, in our cars and at restaurants — and our backs have never been the same.

For hundreds — even thousands — of years, chairs were made of wood. Maybe the seat was covered with cord or cattail leaves, and if you were rich, you could afford some padded upholstery, which began to take off in the 17th and 18th centuries.

But for most of Western history, people sat on chairs that were relatively firm, flat and proportioned for the human body.

Then in the 20th century, designers got their hands on new materials, such as steel, plastic and foam. And chairs started blowing up in size and softness.

"The 20th century was all about experimenting with technology and forgetting about the body," says Galen Cranz, who studies chair design at the University of California, Berkeley.

As a result, we've ended up with living rooms, offices and restaurants filled with chairs that are really bad for our backs, Cranz says. "It's shocking how poorly designed they are for our bodies."

"Now we need to use props and techniques to sit in chairs in a way that's good for our backs," saysJean Couch of Palo Alto, who is part of a growing movement on the West Coast to teach people to move and sit as they didin the past.

Almost every chair has one of two problems: They're too deep or too soft, Couch says.

"When a chair is too deep, the backrest is too far away from the edge and you can't put your legs [feet] on the ground without slouching," she says. "Else your legs stick out like a little kid."

And when chairs are too soft, it's almost impossible not to slouch. "The chair causes your hip bones to fall back and your spine bends into a C shape," Couch says.

Slouching a little bit every now and then isn't a problem, saysStuart McGill, who studies spine biomechanics at Waterloo University in Ontario, Canada. "But if you repeatedly expose your spine to this bending, it will become pain-sensitive in most people." Over time, you also run the risk of damaging the disks.

So should we all run out and buy new chairs?

"That's not necessary," Couch says. These three tricks can basically get you comfortable — with a straight spine — in any chair.

1. Sit on the edge of a chair.

"So if I walk into a room and see only soft and deep chairs, I will look for a chair with a frame," Couch says. "Then I'll sit on the hard, front part of the chair."

In other words, forget about the back rest and use the wooden frame of chairs as a firm support. That makes it easier to keep your pelvis from tucking under your spine and your back ending in a C shape.

And be careful how you position your legs, Couch says. "The big trick is to have your knees below the hip socket."

Most people think the knees and hips should be at the same level, Couch says, so that the angle between your torso and legs is 90 degrees.

But you'll be more comfortable — and less likely to slump — if that angle is bigger than 90 degrees, Couch says. "Something like 120 degrees," she says.

Astronauts' legs automatically take this angle when they're floating in the space station with microgravity. NASA calls it the neutral body posture because it's when the muscles are relaxed.

2. Build a perch.

"So I'm perched right now," Couch says as she sits down on her kitchen chair, which is clearly too soft. "Way too soft."

To fix it, she takes a firm pillow and places it a few inches from the chair's front edge. Then she sits down on the front of the pillow. So the pillow is tilting her pelvis forward a bit, and she's kind of elevated above the chair.

She says you can really use anything to build a perch — a wool blanket, a jacket, a rolled up yoga mat.

"I've sat on my wallet, a shoe, a folded sweater, but the best is a wedge," she says, as she pulls out what looks like an incline plane.

"It's a wedge-shaped pillow, and it's pretty dense foam," Couch says. "You want it as dense as you can get for it to really help."

Whether it's a wedge, a shoe or your husband's wool sweater, Couch says, these props help in two ways. First, they give you something firm to hold up your sitz bones (sitting bones). "When it's too soft, my hip bones fall back and then I'm in that nasty C shape," she says.

And second, the pillow raises your hips up a bit so it's easier for your knees to drop below and your legs to find that sweet spot of comfort — 120 degrees from your torso.

3. Build out the back.

The first two tricks work great for most chairs. But there's one situation in which sitting on the edge or perching on a pillow isn't a good idea: in the car.

"You definitely don't want to be sitting away from the backrest for safety reasons," saysEsther Gokhale, who also teaches posture and traditional movement in Palo Alto."You have to be up against the backrest and headrest or you could get whiplash in an accident."

But there's a big problem with the backrests in many cars and airplanes: They are shaped like C's. If you use them properly, they force you to slump and bend your spine.

"The only solution is build out the backrest so it's more planar," Gokhale says, so you turn the C shape into an I shape.

To do that, Gokhale says, grab one of your perching props. Take a firm pillow, a blanket or sweater and stick it right at your mid back.

"Then elongate your spine by gently stretching your back over the pillow," Gokhale says. And voila! You've turned a painful, slouchy chair or car seat into a comfortable one.

Click Here for original article.

Can physical therapy help people with temporomandibular joint (TMJ) dysfunction?

Do you ever find it difficult to chew or yawn due to pain, clicking or locking in your jaws?

A common source of many of these symptoms is the TMJ.

The jaw joint, medical condition referred to as the temporomandibular joint or TMJ, is made up of the bone below the mouth (the mandible, commonly referred to as the jawbone) and the bone just above the mouth (the maxilla). The lower jaw and is one of the most frequently used joints of the body.

Temporomandibular joint (TMJ) dysfunction affects more women than men and though generally affects people between the ages of 20 and 40; women especially between 18-44 years of age have the biggest increased risk of TMJ.

Risk factors include people who have a history of clenching and grinding their teeth (bruxism), dental work, trauma to the jaw or face, increased anxiety or stress, or poor posture.

Causes of temporomandibular joint (TMJ) syndrome include injury to the teeth or jaw, misalignment of the teeth or jaw, teeth grinding, stress, arthritis, and gum chewing.

Some kinds of arthritis, often osteoarthritis, can affect the TMJ and lead to pain when moving the joint.

“Researchers have estimated that 65%–85% of Americans experience some symptoms of temporomandibular joint dysfunction (TMD)”

Signs and symptoms of TMJ disorder:

Psycho social factors - Emotional stress (anxiety, depression, anger)

Facial pain, jaw pain tenderness of your jaw.

Pain in one or both of the  temporomandibular joints.

Aching pain in and around your ear.

Difficulty chewing or pain while chewing

Other Symptoms can include neck pain and joint pain

Help yourself with these TMJ pain relief tips:

  • Keep your face relaxed with your lips together and teeth apart.
  • Jaw Exercises
  •  Massage your jaw, cheeks, and temples regularly.
  •  Avoid grinding or clenching your teeth, and minimize chewy or hard foods in your diet and how often you chew gum.
  •  Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others),

Physical therapists and physical therapy help people with TMD ease pain, regain normal jaw movement, and lessen daily stress on the jaw. We can discuss possible causes and treatments of your problem.


Q: Can TMJ be cured?

A: TMJ May Not be Curable, But it's Treatable. treatments that can reduce your discomfort, lessen your symptoms, and help prevent worsening damage and pain.

Q: Does TMJ hurt?

A: It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere.

Q: Can a Physical therapist help?

A: Physical therapists help people with TMD ease pain, regain normal jaw movement, and lessen daily stress on the jaw


US National Library of Medicine National Institutes of Health

What is Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is categorized as the stiffness of the shoulders resulting in immobility in the shoulder joints. It normally affects adults in their 40s to 60s, and women are affected most. There are several factors that may increase the risk of frozen shoulder, including certain medical conditions like tuberculosis, obesity, and even Parkinson's disease.

The common symptom of frozen shoulder is stiffness and limited range of motion in the shoulder. However, there are three phases that accompany this occurrence.

The first phase is the painful phase, which normally lasts for two to nine months. Pain and stiffness may gradually build up and worsen at night when lying on the affected area. The second phase the adhesive phase, lasting for four months to a year, is where pain may subside, but movement in the affected area is now limited. Rotation movements as well as overhead ones can be very excruciating. The last phase is the recovery phase where the shoulder joints are now recovered, and movements are back to normal.

What Causes Frozen Shoulder?

The real cause of frozen shoulder is yet to be discovered. It may gradually progress over time or be abrupt. However, when it does happen, the capsule in the shoulder joint is thickened, scarred or contracted. It is also most common in individuals who have had prolonged immobility of the shoulders, maybe due to a surgery or fracture.

People with diabetes also have higher risk developing frozen shoulder because of the collagen fibers accumulated in the linings of the joint resulting in limited capacity of the shoulders to stretch or move. Unfortunately, there has no available solution to prevent this, only compound treatments, including analgesics and anti-inflammatory drugs.

Dupuytren's contracture has also been found to cause frozen shoulder. It is a condition affecting the hands and fingers, where the connective tissues in our palms thicken forming nodule cords that pull the fingers bent towards the palm. And at some extreme case, these nodule cords can climb up affecting the shoulder joints.

Treatments for Frozen Shoulder

People with frozen shoulder may experience relief after 18 to 24 months. In severe cases, pain may persist over several years.

For individuals seeking an immediate solution, surgery may be required to loosen up the joint capsule bringing back its range of motion. However, those who do not have the resources may go for alternative treatments, such as injections of corticosteroids accompanied by massage and cold treatments, which will often do the trick to relieve frozen shoulder.

Over-the-counter medicines such as paracetamol and codeine are also first-line defenses against frozen shoulder. They are physician-approved painkillers and anti-inflammatory agents that can provide immediate relief lasting for six to eight hours.

There are also natural remedies. Massage, acupuncture, and spine sublimation, for example, have actually been proven very effective. Chiropractic treatments can provide relief for pain as well.

How to Prevent Frozen Shoulder

Since, frozen shoulder can be very troublesome for most people as it disrupts our daily lives, there are several ways you can try to prevent it.

To begin with, make sure you are on the right track towards good health. Maintaining a regular exercise routine will help keep your shoulders mobile. Your car is a perfect example of this theory. If you do not frequently use it, keep it tuned up or fill it with oil, eventually it will get rusty, and the same holds true with our body.

The shoulder joint is composed of several tendons and ligaments that we use for a variety of activities. But, once you keep them immobile, the body will not be able to supply them enough blood for nourishment, and thus poor blood circulation can tighten up the muscles and capsule joint.

Using proper body mechanics will also prevent frozen shoulder. Our shoulder is composed of a complex structure that includes our clavicle, shoulder blades, breast bones, upper back, and neck; all important to allow the shoulder to do its many jobs. However, if you go about your daily routines without proper body mechanics, these parts can be stressed. Over time this can cause a degree of discomfort or inflammation in the shoulder joints, which basically takes on most of the loads and impact when performing a task.

Another thing you can consider preventing shoulder pain is to maintain a healthy diet. Foods rich in Calcium and Vitamin D can strengthen the bones surrounding the shoulder joints. The same is true by eating foods rich in Vitamin B complex, where veins and ligaments are properly nourished to their full potential. Sticking to a healthy diet every day will not only help prevent frozen shoulder, but by far all the unnecessary conditions you may experience and suffer as a result of it.

Article Source:

The benefits of Massage Therapy for Anxiety

The human body was designed to react to danger in a manner that shows up as “fight or flight” behavior. When fear or anxiety are present; cortisol (stress hormone) levels increase to keep our muscles ready to respond to a real or perceived threat. When this happens, the immune system becomes suppressed and blood sugar levels increase in addition to cortisol levels. A long-term condition of stress and anxiety creates an unhealthy environment in the body.

According to, about four million adult Americans suffer from General Anxiety Disorder during the course of a year. GAD is the abnormal functioning of certain nerve cell pathways that connect particular brain regions involved in thinking and emotion. It is characterized by excessive ongoing worry and concern that is not within the control of an individual. GAD can cause overthinking to the point of possible worst-case scenarios, indecisiveness for fear of making decisions in error, difficulty concentrating and the inability to relax. GAD becomes an interference and in some cases a barrier to daily life.

Common symptoms associated with General Anxiety Disorder are:

  • Fatigue
  • Trouble Sleeping
  • Headaches
  • Muscle Tension
  • Irritability
  • Nausea
  • Unhealthy thoughts

An alternative and proven treatment for these symptoms associated with anxiety is massage therapy. Massage therapy manipulates the muscles with various pressures in ways that improve circulation, increase flexibility, decrease heart rate, and help to manage the “fight or flight” response. Massage also helps to improve levels of serotonin. There is a direct link between effective serotonin levels and the impact on positive thinking, increased energy, and reduced irritability. In addition, serotonin release enabled by massage therapy can result in deeper sleep as it helps to regulate the sleep cycle. Keep in mind that no different than with other forms of treatment, massage therapy requires more than one instance to provide significant relief. Massages should be scheduled on a regular basis to provide a notable impact on anxiety symptoms and overall health long-term.

Ways to Relieve Tight Muscles

Muscle tightness can happen for a variety of reasons. They can range from fatigue to stress to dehydration. Whatever the cause, muscle tightness leads to pain. Below are some ways to help relieve tight muscles.

  • Ice: The coldness of ice reduces inflammation, a potential source of muscle pain.
  • Heat: This can help a tense muscle relax into a non-stressed state.
  • Stretching: Keep it in a pain-free range.
  • Massage.
  • Hydration: Drink more water
  • Medical intervention: If the above strategies fall short, seek medical help.

If your pain is constant or severe, seeking out medical help is advised. A physical therapist or doctor can help you discover the root cause of your muscle pain and plan a course of treatment accordingly.

Early Physical Therapy Intervention for Low Back Pain Has Many Benefits

Low back pain is a major public health concern. Americans spend upwards of 100 billion each year to try and ease aching backs. Low back pain is also a leading cause of disability in the U.S. Since low back pain is such a problem, there has been research into ways of dealing with it more effectively. A recent study has shown that early intervention with physical therapy yields positive benefits.

This study examined 150,000 health insurance claims filed in the U.S. from 2009 to 2013. Researchers specifically checked the files of patients who were newly diagnosed with low back pain. They looked to see if there were any differences between people who got physical therapy first or those who received physical therapy later. The results showed a lot of benefits to early therapy.

These befits included an 89% lower chance of needing an opioid prescription, a 28% lower chance of needing advanced imaging, and a 15% lower chance of making one or more trips to the emergency room. They also concluded that the average person who got physical therapy first saved $500 on average. This is when compared to people who did not get physical therapy early.

If you are having issues with low back pain, remember, we are here to help. We can meet with you and create a treatment regimen based on your specific issues and needs.

Source: Frogner, Bianca K., Kenneth Harwood, C. et. al., “Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs.” Health Services Research. 23 May 2018.


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