Connect and Thrive with Telehealth Physical Therapy

Connect and Thrive with Telehealth Physical Therapy
How many times have you used technology in the past month to communicate with loved ones, co-workers or others in the outside world? Now, take yourself back in time 20-30 years and your answer to this question would likely have been very different. In this day and age, it goes without saying that technology has changed the way we communicate, collaborate, and connect with others. The medical field is no exception to this, and new methods of providing healthcare have begun to emerge in recent years. In the past, you may have used an online portal to check in with your medical provider or to obtain health information such as testing or imaging results. But what you may not know, or may not have known before COVID-19, is that you can also spend face-to-face time with your healthcare provider via virtual or online platforms. Telehealth, or telemedicine, is a term that broadly refers to the ability to communicate with and/or obtain healthcare services directly from your medical providers through telephone, video call, or other online platforms.

What is Telehealth Physical Therapy?
Connect with simple to use, real time video conferencing technology, and work with your musculoskeletal problem solver (aka your physical therapist) to develop and implement a movement and treatment plan specific to your goals.
For the purposes of this blog, we will be referring to “telehealth” as the method in which you engage in a virtual visit with your physical therapist through a video call from the safety and comfort of your own home. Telehealth physical therapy at our clinic includes one-on-one remote evaluation, consultation, education, and treatment of individuals with various musculoskeletal conditions. This occurs through a private video call, with a link sent to your e-mail which you can access from your phone, tablet, laptop, or computer. During these visits, your therapist will spend time asking you about your problem, assessing your movements, and creating an individualized care plan to manage your symptoms and improve your daily function – just like they would here in the clinic. Telehealth also gives your therapist an opportunity to virtually assess your home environment and address any challenges you may be having at home such as optimizing your home office or desk set up, navigating certain steps or stairs, or figuring out exactly where and how to perform your prescribed home exercises.

What are the benefits of Telehealth Physical Therapy?
Effective treatment to get you back to doing the things in life you want and need to do. The best part is that is convenient, saves time, saves money all from the safety and comfort of your own home.

Telehealth physical therapy services have been gaining popularity over the past several years, largely because it is convenient, private, safe, and cost-effective. Telehealth is ideal for those who would like to save time, money and energy spent on travel. It also provides access to care for those who are unable to come into the clinic due to transportation challenges or because they live in rural or distant areas. During this time in particular, telehealth physical therapy offers a safer option for receiving care that allows patients to stay at home while physically and socially distancing during the coronavirus pandemic. Another benefit is that telehealth physical therapy is also available via direct access, meaning you don’t have to have a referral from your doctor to get started.
New research has demonstrated reduced costs, improved patient outcomes, increased access to healthcare services, and higher patient satisfaction with the use of telehealth physical therapy. Here is a testimonial from one of our patients who has opted for telehealth physical therapy services at our facility:
“Working with skilled physical therapists using telehealth is just like being in person… without the commute! I’ve increased my physical therapy sessions to compensate for regular chiropractic, which cannot be conducted remotely, and it’s working great! Keeping up with physical therapy during this time is extremely important and very helpful for overall wellbeing. Given the recent changes in telehealth rules, all Californians now have access to the most competent physical therapists in our state and possibly our country, not just those who live in San Diego! Take advantage of it!” –Stacy

Physical Therapist talking with a patient

How do I know if Telehealth Physical Therapy is right for me?
re you wondering if telehealth would be right for your particular situation? To help decide consider the following questions:
1. Do I have access to internet and a smart device with a camera? Telehealth physical therapy visits can be accessed from any smart phone, tablet, laptop or computer that has a camera, as long as the device can be set up in a way that allows your physical therapist to see your full body during the visit.
2. Do I feel comfortable exercising in my home? It is helpful during telehealth sessions to have a little bit of space in your home where you can perform exercises and move around. Some situations may also require a caregiver or helper to be present during telehealth sessions to assist with certain activities and make sure you are safe.
3. Do I need hands-on treatment? Many patients benefit most from a physical therapist’s expertise through guided exercise, functional movement training, self-massage techniques and education regarding pain or symptom management strategies which can be done safely and independently in your own home. However, in some cases your physical therapist may recommend that you attend visits in the clinic in order to evaluate or treat you with hands-on methods.
Ready to sign up for telehealth? Call us at (858) 675-1133 or click the following link to fill out the intake form and we will get back to you right away: click to fill out basic information form

Still have more questions? Give us a call and our staff will guide you in finding the best option to get you moving again and back to doing the things you love.


Are you a New Year’s Resolution Newbie, Master or Flunkee?

Are You a New Year’s Resolution Newbie, Master or Flunkee?

Turning the page on the new year is a chance to wipe the slate clean—and to be better versions of ourselves. And when it comes to what we want to improve, goals that fall in the health and wellness arena top all other New Year’s resolutions. In fact, three of the top four resolutions in a 2018 YouGov poll were health-related: eat healthier (1), get more exercise (2) and focus on self-care, e.g., get more sleep (4). There are three types of people who choose a goal from the health and wellness category as a New Year’s resolution: the resolution newbie, the resolution master and the resolution flunkee. Let’s see which category you most identify with—and how focusing on the right strategy can help you get healthier in the new year.

Resolution Newbie. Maybe this is your first time making a commitment to your health and wellness. Good for you! Did a recent event like a health scare or loss of a loved one make you see the light? Or perhaps you want to be more active to enjoy activities with your grandchildren or to carry your own bag on the golf course. Whatever your goals are, taking that first step is a big one so you’ll want to be sure that you’re prepared for the challenge. Particularly when exercising for the first time or returning to an active lifestyle after a long hiatus, it’s important to have the proper information and tools to be successful. And that means tapping the healthcare resources available to you: Clinicians like nutritionists and physical therapists can make sure that your body is prepared to take on new challenges and work with you to a design a program that will help you achieve your goals.

Resolution Master. Perhaps you fall into a different camp: You vowed to get healthy in 2019 and you achieved it! For 2020, your resolution is to continue the work you’ve begun. After all, living a healthy lifestyle is a lifelong commitment; it’s not something you do for a while and then revert back to your former habits. As you prepare to embrace the new year, are there any small tweaks you can make to advance your goals? Maybe you’re thinking about training for and running a half marathon, but don’t know where to begin. A physical therapy evaluation is a great place to start—PTs are trained to assess your movement patterns and identify any limitations or weaknesses. Based on that information, the PT can design a personalized exercise program to help you safely and effectively prepare for the grueling half marathon course.

Resolution Flunkee. Let’s say your plan for 2020 is to get in better shape and improve your overall health (we support that resolution!), but this isn’t your first rodeo. Your 2019 resolution was pretty similar but it’s one year later, and you’re in the same place you were on New Year’s Eve 2018. What stood in your way—was it time? Affordable options? Access to healthy choices and activities? If any of these barriers sound familiar, then along with your resolution, you need an action plan. Without planning ahead, you’ll find yourself staring down the year 2021 with the same goal in mind. But let’s not focus only on the negative—what went right last year? Maybe you made sleep a priority, which in turn helped you to make better food choices at breakfast but by afternoon, you found yourself choosing to energize with a soda and candy bar when all you probably needed was an apple and a 15-minute walk. Take some time to think about the previous year—good and bad—and take with you what you need, and leave the rest behind. Afterall, you can’t plan where you’re going without understanding where you’ve been.

Which resolution type are you?

Do You Know Your Movement Vital Signs?

Do You Know Your Movement Vital Signs?
Most people think of heart rate or blood pressure when they think of vital signs. It is common to use numbers to quantify health and risk of disease. The American Heart Association encourages people to “know their numbers” referring to blood pressure, blood cholesterol, blood glucose, and weight. However, research is now showing the importance of moving properly for health. Let’s take a look at some of the numbers you can use to quantify your movement health:

Walking Speed
Walking speed has been called the “sixth vital sign” in medical literature recently. It is easy to measure, and takes into account strength, balance, coordination, confidence, cardiovascular fitness, tolerance to activity, and a whole host of other factors. It has also been shown to be predictive of future hospitalizations, functional decline, and overall mortality. Normal walking speed is considered to be 1.2 to 1.4 meters per second.

Push Ups
Push ups are popular to build strength, but a recent study found that they can show us a lot about your heart too. Researchers found that men who could do 40 or more consecutive push ups were at a 96% lower risk for cardiovascular disease than were men who could do less than 10. The push up test was also more useful in predicting future cardiovascular disease than aerobic capacity measured on a treadmill.

Grip Strength
Hand grip strength has been shown to be strongly correlated with health. The stronger your hand grip is, the less likely you are to suffer from cardiovascular disease, respiratory disease, COPD, and all types of cancer. In the study, muscle weakness was defined as grip strength <26 kg for men and <16 kg for women. Grip strength below these numbers was highly correlated with an increase in disease.

Standing From the Floor
If you can’t easily get down on the floor and back up your health might be in trouble, according to a study that looked at more than 2,000 people. The study asked people to go from standing to sitting on the floor and back up with as little support as needed. They found that if you need to use more than one hand to get up and down from the floor that you were 2 to 5 times more likely to die in the next 7 years than someone who can do it with just one hand, or even better, no hands at all.

Moving well is obviously important to overall health and longer life. These tests can give a snapshot of how you’re doing. If you’re having trouble with any of them, considering seeing a movement specialist – your physical therapist.

Take Home Tips for Understanding and Managing Your Pain

Hurt Does Not Equal Harm: Take-Home Tips for Understanding and Managing Your Pain

Pain is a common experience shared by all human beings. It’s the body’s natural alarm system which is produced by the brain and occurs in response to a perceived threat. This means that pain is not only normal, but necessary for survival. However, as most of us know, suffering from pain has the potential to be very disruptive to daily life. But what many don’t realize is that pain, especially pain that persists for long periods of time, is extremely complex. Factors that impact pain include physiological stress (i.e. muscles, bones, ligaments, and nerves), emotional and psychological stress, sleep hygiene (i.e. amount of sleep, quality of sleep, and regularity of sleep pattern), past experiences with injuries or pain, and beliefs about pain and recovery. For this reason and many others, everyone experiences pain differently and will have different ways to manage pain for different situations.
As you may have heard in the media, the U.S. is currently in an opioid epidemic as a result of increased prescription and abuse of pain medications. This is because opioids have been found to be highly addictive which can lead to overdose and death if used improperly. Luckily, there are many ways in which pain can be managed without using pain medication. Your physical therapist can help you better understand and manage your pain. Here is a testimonial from a previous patient about her experience with managing her painful condition at our facility:

“Over the past 20 years, I have suffered with painful lower back pain, sciatica and shoulder issues. I have sought treatment from countless physical therapists and orthopedic surgeons. Along with the enduring physical pain, I developed a fear to pursue activities that I enjoyed; I was worried that exercise could worsen my condition. At the evaluation appointment, I expressed fear, hopelessness and skepticism about undergoing more physical therapy treatment. However, soon it became clear to me that this experience would be different because Tori was different than what I’ve ever experienced. She was patient, encouraging and pushed me beyond what I thought I could accomplish. I’ve never been treated and taken care of with so much one on one care. I’ve never been consistent or motivated with PT exercises, however, this time I was. I benefitted from being educated on correct lifting techniques and form applied to my weight training at the gym, backyard gardening, lap swimming, daily living activities, and even mastering stairways! I am for the first time in many years finally not fearful of pursuing my preferred active lifestyle.”

– Emma

You, too, are capable of taking back control of your life with pain management strategies individualized to you. Below are some take-home tips to help you get started.
1. Understand that pain does not always equal harm or tissue damage. As previously mentioned, pain is complicated. And in many cases, it isn’t a direct reflection of the health of our body’s tissues or structures. Your physical therapist can help you identify various factors that may be contributing to your pain experience and can help guide you through movements that will help you get back to your daily life. If you’re feeling stuck or are interested in learning more about your pain, your physical therapist may introduce you to the “Why Do I Hurt? Workbook,” an interactive and evidence-based booklet created by Dr. Adriaan Louw, PT, PhD, that can further help you understand and lessen your pain. The following quote is from a previous patient who utilized the workbook:

“Dr. Tori Williams helped me work on a painful hip problem that had been preventing me from exercising and interfered with sleeping well. The physical therapy did the trick, however at one point I felt like progress had stalled and I was frustrated. I was getting stronger and could move much better, but the pain kept flaring up. Tori suggested that the Why Do I Hurt Workbook might give me some insight on the problem. The Workbook provided the missing pieces of the puzzle. It helped me put it all together and move past the pain cycle. I learned that the tissue problem is only one part of the equation. My history, emotions and attitudes were me keeping me in the pain cycle. Once I began to work on some of those things, combined with the PT and exercise I was able to easily move forward and move out of the pain cycle”

– Pat

Another patient who has used the workbook had this to say about what he learned:

“It helped me understand how personal emotions and the fear of pain can cause pain. Now I realize how physical activity can help mitigate the pain and strengthen me both physically and mentally. I don’t focus on the pain when I am physically active and the book taught me the importance of that.”
– Steve

2. Find your favorite relaxation techniques. As previously mentioned, pain occurs in response to a perceived threat. This can come in many forms and can be compounded by physical, emotional, and mental stress. Relaxation techniques such as deep breathing, meditation, listening to music, and soft tissue massage can be helpful in managing stress and turning down the body’s natural alarm system. Taking as little as 5 minutes of each day to devote to relaxation can be beneficial to decrease pain and stress over time. One evidence-based strategy for calming your nervous system is using the 4-7-8 breathing technique which involves breathing in through the nose for 4 seconds, holding for 7 seconds, and exhaling through the mouth slowly for 8 seconds.

3. Keep moving. Research has shown that just a single bout of light aerobic exercise increases the production of the natural opioids produced by your body, called endogenous opioids. These are well-known to reduce anxiety, enhance mood, and aid in pain relief. So if you are able to move around, it’s always a good idea to work up a little sweat by going for a walk, jog, bike ride, or participating in other physical activities that you enjoy. If you’re concerned that movement might make your condition worse, your physical therapist can provide reassurance and help you determine which exercises and at what intensity and duration are appropriate and individualized to you. Movement is medicine!

4. Establish healthy sleep habits. Sleep is crucial for daily functioning and has been shown to have effects on how your body processes and perceives pain. This means that if you don’t get adequate sleep, you may experience increased pain, reduced quality of life, and a whole host of other negative effects. Try going to bed and waking up at the same time every day to help set your body’s natural biological clock. You should also try to block blue light before bed, which has been shown to disrupt the ability to fall asleep and stay asleep. This includes the light from your cell phone, television, or tablet. (Tip: Most smart devices now have blue light screens/off switches which can be manually or automatically turned on at night.) Lastly, make your bed a sacred sleeping place; try not to do anything in your bed other than sleep and sexual activities.
If you are struggling with pain, know that you are not alone and there is hope. Our qualified physical therapists at North County Water and Sports Therapy Center can help you establish an individualized plan to manage your pain.

Tori Williams, PT, DPT

1. Louw, A. Why Do I Hurt? Workbook. Orthopedic Physical Therapy Products; 2016.
2. Goyal M, Singh S, Sibinga E, et al. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. Deutsche Zeitschrift für Akupunktur. 2014;57(3):26-27. doi:10.1016/j.dza.2014.07.007.
3. Hannibal KE, Bishop MD. Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy. 2014;94(12):1816-1825. doi:10.2522/ptj.20130597.
4. Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Practice & Research Clinical Rheumatology. 2015;29(1):120-130. doi:10.1016/j.berh.2015.04.022.
5. Siengsukon CF, Al-Dughmi M, Stevens S. Sleep Health Promotion: Practical Information for Physical Therapists. Physical Therapy. 2017;97(8):826-836. doi:10.1093/ptj/pzx057.
6. Louw A, Puentedura EJ, Zimney K, Schmidt S. Know Pain, Know Gain? A Perspective on Pain Neuroscience Education in Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy. 2016;46(3):131-134. doi:10.2519/jospt.2016.0602.

“You are what you eat!” Nutrition and Injury Recovery

We have all heard it… “You are what you eat.” But did you ever realize that what you eat can actually affect your body’s ability to heal after an injury? Your body has a natural recovery system with a set timeline as to how long it takes for certain tissues to heal. Without even knowing it, you could be fighting against that system by giving your body the wrong fuel, either by eating foods that increase inflammation in your body or by not eating the foods that naturally reduce inflammation. Why are we as physical therapists so concerned about inflammation? Well, we are so happy you asked…

As we mentioned above, your body has a natural recovery system when injury occurs to the tissues. Did you know that inflammation is actually the first step in that recovery system? Most people have heard about the importance of reducing inflammation after an injury but it is actually your body’s natural response to injury. Inflammation is characterized by swelling, redness, heat and pain. The swelling is due to damage to the tissues and vessels in the area of the injury causing an accumulation of fluid in the area of the injury. The redness and heat is due to increased blood flow to the injured area as well as the increase in cellular activity necessary for starting the healing/rebuilding process of the tissues. The pain can be due to the initial damage to the tissues, the increase in pressure on the tissues due to the swelling, and/or the chemical irritant of the tissue healing cells that come to the injured area. So, inflammation is normal and necessary for healing, but we need to make sure that the inflammation does not get out of control, or to the chronic stage, where it can become more of a hindrance than a help to injury recovery.

Where does the food come in? We could spend hours talking about nutrition and the science behind it all but, in the interest of simplicity, we will just lay out the basics. Everyone knows that high fat diets probably aren’t the way to go for healthy living, but you have to consider the type of fats to include in your diet (or exclude from your diet). Saturated fats, trans fats or fats rich in omega-6 should be limited as they can increase inflammation in your body. This means you should limit processed foods high in saturated or trans fats and vegetable oils like corn, safflower, sunflower and soybean oil. Instead, include monounsaturated fats that are rich in omega-3 such as fish, olive oil, and avocados, as they can help to reduce inflammation. Mixed nuts, flax oil, ground flax and other seeds can be beneficial as well. Diets with high omega-6 to omega-3 ratios can result in a decrease in collagen production, which can negatively affect healing as collagen is important for tissue healing. Therefore, aim for a balance with more omega-3 rich foods compared to omega-6 foods to help support healing.

Other areas you can spice up your diet (yes, pun intended) and promote healing is with dietary spices, herbs, and extracts. Tumeric and garlic have long been used to reduce inflammation. Bromelain, a plant extract found in pineapples, and Boswellia can help in reducing inflammation as well. Flavonoids found in cocoa, tea, red wine, fruits, vegetables, and legumes can assist in reducing inflammation due to their antioxidant actions. Now, remember what we said about the inflammatory phase being a normal part of the healing process? We want to control inflammation, not completely obliterate it, so eating only foods with anti-inflammatory properties is not recommended either. A well balanced diet with proper balance is the goal, making sure to stay hydrated to assist in flushing the body of any toxins or waste products from the injured tissues. Be sure to check with your physician to ensure any of these dietary changes are safe, as individuals and circumstances vary.

While nutrition can assist in the healing from injury, it is only part of the equation. At North County Water and Sports Therapy Center, our therapists work one on one with the patients for the full hour of the treatment session. This allows the therapist ample time for measuring and monitoring for signs of inflammation both before and after treatment in order to make sure that your body is responding well to treatment. We utilize manual therapy for reduction of inflammation to maximize the healing process. We can utilize modalities including (but not limited to) cold therapy, electrical stimulation, and KinesioTape to assist in the reduction of inflammation and its associated pain and swelling. We provide supportive techniques and exercises for the patient to perform independently to assist in the management of inflammation so that the healing process and tissue repair continues between treatments with your therapist. This attention to detail and individualized approach to treatment helps our patients successfully move out of the inflammatory phase of healing, and progress through each of the phases of healing, ultimately getting back to the activities they love to do.

Nutritional information in this blog is from Dr. John Berardi, PhD at Visit his website for further information about the effects of nutrition on injury recovery.

Choosing Physical Therapy over Opiates for Pain Management

Choosing Physical Therapy over Opiates for Pain Management

116 million Americans suffer from chronic pain1. Historically, opioids were thought to be a safe and effective way to manage acute and chronic pain. However, more recently, we have become more aware of the serious consequences that have evolved from overutilization of these drugs. Potential side effects of opioid use include depression, overdose, addiction, and withdrawal when stopping use2. Additionally, opioids have not been found to significantly improve long-term health outcomes. Opioids are a classification of drugs that includes hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), tramadol, oxymorphone (Opana), fentanyl, and methadone, which are commonly prescribed for varying severities of pain.2

Overutilization of opioids for pain management has become a very concerning issue in our country. The National Survey on Drug Use and Health has reported that the number of first time abusers of opioids increased from 628,000 in 1990 to 2.4 million in 2004.3 According to data published by the US Department of Health and Human Services, at least 2 million Americans have disordered opioid use involving prescribed medications, and about 90 Americans die each day from opioid overdose (including prescribed and non-prescribed substances)1. “The quantity of opioid prescriptions in the United States is staggering, with the CDC reporting 259 million prescriptions written in 2012, enough for every single American adult to have a bottle of pills.1”

When appropriate, doctors prescribe opioids to treat pain because they interrupt pain signals to the brain, inhibiting the perception of pain in the body. In proper doses, opioids are an appropriate pain management tool in some cases, most commonly utilized to get through a short duration of severe pain, as in after surgery or injury. However, they have not been found to be an effective tool for long-term pain management, and the CDC recommends other approaches like physical therapy in most cases. While pain medications reduce pain by masking it, physical therapy can help to alleviate pain by addressing the cause or source of the symptoms, without the harmful side-effects

In a recent randomized controlled trial involving 240 patients with moderate-severe chronic back, hip, and knee pain, treatment with opioids was not found to be superior to non-opioid treatments.1 In another study, receiving physical therapy as the first intervention after onset of low back pain reduced the likelihood of receiving an opioid prescription by 87% compared with patients who never received PT services.3 Physical therapy treats pain through movement, utilizing internal pain relief mechanisms and retraining the body to improve or maintain mobility and quality of life. We utilize education, hands-on care, and movement-based interventions. Due to overwhelming evidence, the CDC now recommends nonpharmaceutical approaches for treatment of chronic pain, such as physical therapy.1

Physical therapy is one of the safest and most effective alternatives to drugs for pain management. Management of acute pain is key to avoiding the progression to persistent pain. Addressing pain quickly can be an important factor. In a study about work-related injuries, same-day access to physical therapy after injury led to faster recovery, lower healthcare costs, and less time away from work.1 As physical therapists, our job is to educate people about their current condition to reduce fear and apprehension, and help them to address and manage their symptoms to prevent symptoms from becoming chronic or recurrent.

78% of Americans surveyed prefer drug-free pain management to opioid-based treatments1, and we agree! There is a better way. Try PT first!

1. Mintken PE, Moore JR, Flynn TW. Physical Therapists’ Role in Solving the Opioid Epidemic. JOrthop Sports Phys Ther 2018;45(5):349-353.
2. “Physical Therapy vs Opioids: When to Choose Physical therapy for Pain Management”. Move Forward PT. APTA, 2018,
3. Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions. Experiemental and Clinical Psychopharmacology. 2008;16(5):405-416.
4. “Health Center on Opioid Use for Pain Management: Physical Therapist Services to Avoid Opioids”. Move Forward PT. APTA, 2018.

Pilates and Rehab a perfect match!

“Change happens through movement and Movement Heals”

Joseph Pilates and the Pilates Method

What is Pilates?

Pilates method was originally created in the early 1900s as a series of exercises based on connecting the body, mind and spirit. Joseph Pilates designed this comprehensive program with focus on elongating and strengthening the body, using specific movements and resistive equipment.

Why is Pilates right for you?

1. Build lean muscle and improve strength.

Pilates focuses on quality movements performed with control and precision. The exercises balance strength with flexibility, to build lean muscle while developing foundational strength for your spine and limbs.

2. Restore balance and efficiency of your muscles.

Believe it or not, you have certain muscles that you use more than others. Over time this imbalance leads to back/neck pain and injury. Pilates helps to balance your muscles so that you use them all together instead of one muscle doing the job of 3 or 4. Now, doesn’t that just sound more efficient?

3. Competitive edge.

There are some beastly young NFL guys out there doing Pilates. Why? Because it helps to improve flexibility, balance and strength. Supplementing your normal strength-based gym routine or sport with Pilates as cross training helps stretch, strengthen and lengthen key muscles that give you the extra power for your desired sport.

4. Better posture

We are fight the same battle: Us vs. Gravity. Our jobs have us hunched over our computers, our kids have us hunched over to pick them up. The best way to win the battle against gravity is a Pilates routine, to strengthen the muscles that naturally help to elongate and stabilize your spine. Human 1, Gravity 0…

5. Positive Mindset

Pilates improves circulation, oxygenating the blood and replenishing cells throughout your body. This increase blood flow to the brain, helps you focus and improves your mental outlook.

6. Working through Injury

Whether you have some crunchy shoulder pain or a recent surgery, Pilates is a safe, low-impact alternative to heavy weight lifting or high impact activities. With a solid balance of stretching and strengthening, Pilates is a great way to restore your body during injury while still receiving a fantastic workout!

Pilates is just like any other commitment. It takes an investment of time and energy. But, if you commit to a few times a week for a few weeks, you’ll notice the results for your mind, and body. Pilates isn’t just for a select few athletes, celebrities and dancers. Everyone can benefit from Pilates!

“You will feel better in ten sessions, look better in twenty sessions, and have a completely new body in thirty sessions.” Joseph Pilates


One of the Pilates principles is flow – performing movements with precision without a lot of energy expended. The core stabilizers of your spine are just the starting place for a Pilates session. Once the spine is strong and the core muscle are turned on, the Pilates client is challenged with dynamic movements of the arms and legs while at the same time maintaining a stable core. This makes Pilates not only good for mothers and women, but for athletes to older adults. It helps tune up all those smaller muscles that help stabilize your legs and arms during sport, work and everyday activities to prevent injury.

Are there different types of Pilates?

There are different apparatuses and accessories that can be used to challenge the client during a Pilates session. Most people are familiar with mat Pilates, which is done entirely on a mat, utilizing gravity and the weight of your own limbs to challenge stability and build strength.

The reformer is Pilates machine that utilizes a moveable carriage attached to a series of springs that can be modified to increase or decrease the challenge of the exercise. The reformer is one of the best places to start for a client who has never tried Pilates, or for the rehabilitation patient who is getting back into physical exercise and building strength. The reformer allows the client to be challenged through increasing resistance while maintaining a safe, supportive environment for their spine.

Using the reformer for dynamic hip flexor stretching.

Is Pilates the same as yoga?

While Pilates and yoga have some similarities, Yoga typically focuses on flexibility, balance, and prolonged holds of certain positions; the focus of Pilates is on control, precision, mindfulness, breathing and alignment to build stability in the spine and strength in the extremities. Pilates focuses on decreasing the tension in tight muscles, and intentionally strengthening the weak muscles. Each movement is focused on a deliberate execution with precise movement. Mindfulness and functional breathing helps the client execute each movement with control. Pilates movements should never be sloppy and should always be challenging. The core control utilized during Pilates should be focused on using as much energy as necessary, but as little as possible.

Beginner’s Pilates exercises:

Wherever you are reading this, notice how you’re standing. Chances are that the lower part of your ribcage is flaring out this very moment. Just a simple adjustment in your ribcage position can build your core strength. Here’s a step by step:

  1. Lie on your back with your hands resting on your ribcage
  2. Draw your ribcage down so that your stomach is flat.
  3. Draw in your belly button to hold the new position.
  4. Now, breathe in deeply without allowing your ribcage to change position

Excessive arch in the lower back.

Performing the exercise by engaging abdominals and lowering rib cage.

Most people don’t know how to move their spine independently. For most people it just moves like a brick, and this can subject your body and spine to injury

  1. Lie on your back.
  2. Beginning at your pelvis, press it down against the floor.
  3. Begin to peel your spine up off the floor as you lift your sit bones off of the floor.
  4. One vertebrae at a time, try to feel each vertebra as it separates and peels off the floor
  5. At the top of the movement, reverse direction of the spine as you lower back down to the floor. You should be able to feel each vertebra individually as your spine returns to the floor.

Using abdominal muscles to curl spine and gluts to lift hips, keep spine aligned and avoid over arching of the lower back

Many people don’t know how to activate their core muscles. This is a good exercise to start with if you’re having trouble.

  1. Begin by lying on your back with your feet flat.
  2. Put your arms straight out in front of you, with your fingers pointed toward the ceiling. Take the resistance band in your both hands as shown in (picture).
  3. Gently pull on the band to create a small amount of resistance, but maintain straight arms and straight wrists.
  4. Hold this position for 10 seconds.
  5. You should begin to feel your core muscles turn on!

Hold and breathe

Advance the exercise by bringing legs into table top position, make sure back stays in contact with the floor


Coming Soon…

Foam Rolling….Does it Work?

Foam Rolling… Does it work? By: Jordan Levine, PT, DPT

Foam rolling and other Self-Myofascial release tools (hand held rollers) have gained popularity in the fitness and wellness world for decreasing pain, improving range of motion, decreasing muscle soreness and enhancing recovery. The physiological effects of these tools are mostly theoretical and are still being researched. There has been a variety of claims of these tool benefits but there is no consensus on optimal application for best results.


  •  Foam rolling improves ROM – when performed for as little as 30sec and for up to 5 mins it has shown to have short term benefits (less than  10 mins) for increasing joint ROM in hip, knee and ankle joints.
  • Stretch after Foam rolling – ROM improvement from foam rolling has better effects when static or dynamic stretching is performed immediately following the foam rolling.
  • Decreased effects of post exercises muscle soreness – Foam rolling after high intensity exercise helps to decrease delayed onset muscle soreness (DOMS).


  • No effect on performance – Foam rolling does not negatively or positively affect performance when performed prior to activity.
  • More is not better to improve ROM – Performing for longer than 5 mins on one area has not shown to have more benefit than shorter duration.
  • Breaks up scar tissue or breaks up myofascial adhesions. There is no current research that supports these claims.


  • Altered Viscoelastic and thixotropic properties of fascia. Foam rolling helps fascia to return to more a gel like state causing the increased ROM of joints.
  • Increased Blood flow to tissues – Foam rolling brings increases intramuscular temperature and blood flow causing the increased ROM of joints and decreased DOMS. Decreased DOMS likely due to the effect of blood lactate removal, edema reduction and oxygen delivery to muscle.
  • Stimulation to joint muscle receptors – alters muscle spine length and/or stretch perceptions to allow increased ROM of joints.

TIPS 1. Foam Roll targeted area for 30sec – 2mins prior to exercises. 2. Start at one end of the muscle and slowly move to the other end by visualizing rolling down 2 inches and back up 1 inch for the entirety of the muscle. 3. Stretch immediately after foam rolling. Performing either static stretching of targets muscle for 20-45 sec holds, or performing dynamic stretching / Active ROM of joint for 10-15 reps to maximize effectiveness of foam rolling. 4. Do not exceed 20-30 mins of rolling total when rolling entire leg and hip muscles when performing to avoid post exercise soreness.

Foam rolling Calf / Calves. Start out with foam roller placed at the calf region close to the back of your knee supporting yourself with arms allowing pressure to be applied to calf muscles. Begin rolling slowly moving roller down two inches then back up one inch until you have made your way to Achilles or just before reaching ankle. This whole process should only take from 30 seconds to 1.5 minutes. Rest your buttocks on ground intermittently as needed if arms begin to get tired. To make this more aggressive try crossing one ankle over the other with targeted calf against foam roller and perform same method of rolling down two inches, up one inch. As with all foam rolling it is important to stretch muscle that was rolled and use new range of motion immediately to help maintain new range of motion. In this case stretch the calf muscle following foam rolling the calf.

Stretching Calf muscles – start in staggered stance with back leg straight and front knee bent with arms supported on wall. Make sure to keep big toe in a straight line with heel of the same foot. Keep your trunk in an upright position with pelvic bone tucked under (posteriorly tilted) and bend front knee bringing belly button closer towards the wall until a stretch is felt in the back of the leg. Hold moderate stretch sensation for 30-60 seconds, repeat for 2 sets on targeted leg.
Examples of using your new range of motion – seated toe taps, walking on heels, full squats, calf raises with heels off step allowing heels lower down past toes etc.

References Cheatum SW, et al. The Effects of Self-Myofascial Release Using A Foam Roll Or Roller Massager On Joint Range Of Motion, Muscle Recovery And Performance” A Systematic Review. IJSPT. 2015; 10(6):827-838.

alf raises with heels off step allowing heels lower down past toes etc.[/caption]

References Cheatum SW, et al. The Effects of Self-Myofascial Release Using A Foam Roll Or Roller Massager On Joint Range Of Motion, Muscle Recovery And Performance” A Systematic Review. IJSPT. 2015; 10(6):827-838.

Can I return to Golf after joint replacement surgery?

Can I return to golf after a total joint replacement?

The main reasons individuals chose to undergo a total joint replacement surgery (either shoulder, hip or knee) is to reduce pain and get back to doing the things they love. For 26 million Americans, golf is the sport they love to do. Many questions arise when golfers who happen to be our patients have a joint replacement surgery.

Two of the most common questions are:
Can I return to golf?
How soon can I return to golf?

The answer depends greatly on type of surgery, the surgeon and compliance with rehabilitation.

Looking at the research many golfers who had a total joint replacement return to golf. The average time to return to golf depends on which joint was replaced and the activity level prior to surgery. The average time frame ranges from 4 to 8 months.

Unique rehabilitation challenges present themselves depending on the joint involved.

For total shoulder and reverse total shoulder replacement good range of motion and strength are essential. This takes time, communication with the surgeon and especially patient and therapist working as a team to safely and effectively progress through basic rehabilitation to a golf specific exercise routine.

There are different surgical approaches to hip replacement. The approach will dictate any precautions after the surgery. Once basic healing and strength are achieved, gaining rotational control components at the hip and pelvis are necessary for return to golf.

With knee replacement surgery, initial rehabilitation focuses on range of motion. Returning to golf after getting a new knee, lies in gaining stability at the knee and of course strength and mobility of the hips, trunk and shoulders.

So the answer is YES you can return to golf. The better shape you are in before the surgery the more likely you are to return to golf. After the surgery, you will need to be patient and allow the body to heal. Exercise is necessary as you recover to regain your endurance. Golf requires you to use your whole body. Meaning while you are protecting the joint that was replaced you can be doing golf specific exercise at other joints to keep and tune up the rest of the body. Making it easier to return once the involved joint is ready to go.

How many steps to you think the average golfer takes when walking the course? 11, 000 steps! For that reason, when you do return we recommend using the golf cart for the first year after surgery reducing undue stress. Even if you had a shoulder replacement a cart prevents you from having to carry your clubs.

We can’t guarantee you will play better after surgery but as physical therapists and movement experts we can get you moving better and back in the game.

Celebrating Twenty Years

Where were you in 1997? J.K. Rowling released the first Harry Potter book, Titanic won eleven Oscars, the Pathfinder landed on Mars and Madeleine Albright became the first female Secretary of State in US history. North County Water and Sports Therapy Center opened its doors in October of that same year. Twenty years has brought many changes in healthcare but not, how WE treat patients.


When asked, “Why did you start your practice?” the short answer is, “to continue to do what I love, my way!” The late 90’s shift in healthcare included reducing reimbursement for physical therapy services. Which required treating more patients in less time to make a profit. I became frustrated at the reduced contact time with my patients, and began researching going back to school to become an architect, if this was the way healthcare was going. Instead of returning to college again, I seized the opportunity to start North County Water and Sports Therapy Center.


In the words of Marilyn Monroe, “Ever notice that “what the hell” is always the right decision? “ I did not do everything right, I made a lot of business mistakes along the way. The frustrations from insurance reimbursement while trying to stay in business has not eased over the years. Yet every time we face challenges as a small independent practice, I remind myself of why I started in the first place: the patient. We are now using electronic medical records and online/video home exercise programs, but we still treat patients the old- fashioned way, one on one, getting to know the person, not just the injury.


First, I would like to say how happy I am I built this practice. I would have made a lousy architect. Secondly, I did not make it twenty years without the love and support of my family, the understanding, patience and skill of our team, and of course, all the patients and physicians who have placed their trust in us over the last twenty years. I enjoy a keen sense of gratitude.


Hard work, and long hours are still part of my daily practice but so is laughter, joy, and satisfaction in a job well done. I am thankful that I still get to do what I love with an amazing, talented team.   Future predictions for the next twenty years: continue to learn and grow as a therapist; integrate the advancing technology which will deliver more tools to assist in providing care and weather inevitable changing healthcare polices.   The one thing that won’t change is our philosophy; providing patient first, hands on therapy, and education and exercise to help our patients achieve their greatest potential. Where will you be in 2037? I plan on continuing to do what I love and love what I do!

With gratitude and hope for the next twenty years,