Now that you have packed: carrying, pulling and lifting luggage:
Most people have luggage with wheels. Luggage with two wheels must be tilted and then rolled. The key to avoid strain to the shoulder and arm is to keep the bag close, avoid letting the bag trail behind because this causes stress to the shoulder and leads to a twist in the lower back. When the bag is heavy there is even greater pull and stress to the shoulder and neck. The bag with 4 wheels is easier on smooth surfaces however on carpet and cobblestones you often have to tilt to two wheels to prevent repetitive tipping due to catching of a wheel.
When lifting bend your knees, keep abdominals engaged and seek help. Putting a bag in the overhead bin can be tricky, especially if you are shorter due to the need to reach further overhead. Keep carryon luggage as light as possible and use both hands to lift.
Speaking from experience, as a person who has been hit in the head with carryon luggage another person could not manage, lowering a heavy bag down can be dangerous for you and those around you so be sure to have both hands on the bag before descending from the storage compartment.
Whether you travel for work or taking the vacation of a lifetime, stay healthy with a few tips from this physical therapist, who loves to travel and wants everyone to stay healthy.
The once perceived glamor of air travel in times past has evolved into long lines, safety checks, larger carryon bags, completely full flights and cramped seating. Throw confined space with recycled air, jet lag, change in diet and altered exercise routines and it is amazing anyone who travels stays healthy. Many of these travel complaints cannot be completely avoided however with a little planning you can at least arrive at your destination healthier and happier.
Part one- Packing list:
Unfortunately, you cannot prevent the woman or man sitting next to you who has not bathed in a while or is wearing too much cologne, or worse still, both. The screaming child or the talkative neighbor is the Russian Roulette of air travel. So, it is best to first pack your patience then a few essentials like toothbrush and ID. After that considering packing following items:
1. Empty refillable water bottle, fill up once you are past TSA. Hydration is important. Dehydration is one risk factor for deep vein thrombosis (discussed later in this series of articles)
2. Healthy snacks: it is hard to resist fast food when hungry and when there are reduced healthy options. Avoid heavy meals right before flying, you don’t digest well sitting in a cramped space and it makes the seat even more uncomfortable.
3. Prevent the spread of unwanted germs. Pack hand sanitizer to use when you are not near running water. Otherwise, wash your hands often be sure to rub hands together with soap for at least 20 seconds. This is about the time it takes to sing Happy birthday to You twice.
4. Pashmina, blanket or jacket. As someone who is always cold I never leave home without it, even when going to the tropics (at 35,000 feet the air is colder). It can always double as a pillow behind your back to improve spine support.
5. Relaxing music downloaded on your phone with noise cancelling headphones. Reduce stress and attempt to tune out the agitating noise that comes with public transportation.
6. Entertainment of choice: Not all planes have TV screens and these entertainment systems do not always work so bring your own. Old fashioned books have no battery to die but for long tips can add weight to your luggage. Tablets and e-readers are convenient, but you have to consider how you hold them and what position your head tends to be in when using these devices. The flight goes much faster if you can sleep or at least keep your mind occupied.
7. Workout clothes or at least one comfortable outfit and shoes that can be worn to go for walk and get outside when you reach your destination. Studies show, going outside around 2pm at your destination helps reduce jet lag and assists your body in adjusting to the new time zone.
We all know that sleep is important and that a good night’s sleep makes us feel better and can help us make better decisions, it is estimated that one third of the U.S. population struggle with sleepless nights. We at North County Water and Sports Therapy Center know all too well how lack of sleep affects our patients. Lack of sleep can impede progress in therapy. We see it often with the inability to get comfortable due to pain symptoms, or being woken up due to pain.
Sleep is our body’s time to rejuvenate. Sleep supports recovery of the cardiovascular system, neurologic system, immune function, tissue repair and pain modulation. Research shows that sleep regulates mood and is related to learning and memory functions which can help you to learn a new skill or stay on task throughout your day. Sleep also has benefits for weight control and energy level. “The CDC states that sufficient sleep ‘should be thought of as a ‘vital sign’ of good health.’”
We know that exercise can help protect you against heart disease, stroke, diabetes, obesity, and osteoporosis and can improve mood and stress management. Exercise can even help you with sleep. As little as 10 minutes of regular exercise can improve your quality of sleep. Physical activity can improve sleep quality and sleep duration. A good workout can give you energy for the day and speed up your metabolism while making you more alert. Experts say to avoid exercising right before bedtime in order to allow your body’s core temperature to return to normal which can take up to 6 hours. A low core temperature triggers your body for sleep2. Although this is true for the general population, little is known about the effects of exercise on quality of sleep in individuals with neurologic conditions. One study looked at sleep quality in patients with multiple sclerosis, and found that with a program of walking, aerobics and stretching patients had improved sleep quality.
In conclusion, a good night’s sleep is the best for everyone. Check out the tips for a better night sleep below. By altering habits including a daily routine of activity you can improve your sleep quality and duration benefitting all body systems for healthy living.
TIPS FOR A BETTER NIGHT SLEEP
1. Go to sleep and wake up at the same time every day. This helps set your “clock”
2. Use your bed for sleep and sexual activities. Train the brain to recognize if you are in bed you should be sleeping. Avoid eating, workings, reading and watching TV. If you do not fall asleep within 20 minutes, leave the bed and return when sleepy.
3. Develop a relaxing bedtime routine.
4. Avoid moderate to vigorous exercise 2-3 hours before bedtime.
5. Avoid caffeinated foods and beverages at least 4 hours before bedtime.
6. Refrain from drinking alcohol or smoking 3-4 hours before bedtime, this can increase the number of times you wake up during the night
7. Create a relaxing environment, avoiding too much light and disturbing noises. Stop using light emitting electronics (computer, smartphone, TV) 30 minutes prior to bedtime as the blue light that is emitted can disrupt sleep by reducing melatonin production.
8. Do not take prescription or over the counter sleeping pills
9. To reduce heartburn, avoid eating a large meal or spicy food 2-3 hours before bedtime.
10. Talk to your doctor or healthcare professional if you are still having trouble sleeping.
References:
Adapted from PT in motion magazine, May 2017
Tips for a better night sleep from:
Siengsukon C, Al-dughmi M, Stevens S. (2017) Sleep health promotion: practical information for physical therapists. Physical Therapy. 97(8) 826-836
Health insurance is not only a hot button topic for most but can be extremely complicated. People may have difficulty knowing what services are covered, by whom they are covered, what office you can be seen at, and how much you might owe post visit. Most think and feel that since we may pay high premiums that all services thereafter should be covered 100% by the insurance company. Unfortunately, this is not true depending on the insurance plan you have signed up for. The best way to find out all the information is to contact your insurance provider prior to any medical visit to determine what your cost may be. At North County Water and Sports Therapy Center we take the extra step, before scheduling you for appointments, to verify your benefits and confirm what attending therapy might cost you. Insurance coverage explanation involves verbiage that you may not completely understand. Below is a list of terms you may encounter when speaking with your insurance company or our staff at the front desk that will help you understand your insurance benefits.
Deductible: A fixed dollar amount, usually a calendar year that the insured has to pay in full before the insurance company will pay for services. Plans may have individual and family deductibles.
Copayment (copay): A fixed dollar amount that the insured pays at time of medical services received. This amount may differ between your primary care providers versus a specialist, such as Physical Therapy. Some plans may require you to meet your deductible first before the copay applies.
Coinsurance: Requires the insured to pay a percentage of medical expenses after the deductible amount, if any, is paid.
Out of pocket max: A fixed dollar amount that the insured is required to pay each year out of his own pocket that does not include premiums, and depending on your insurance can be different for an individual versus a family.
Preauthorization: When an insurance company requires documentation prior to your first visit or after your first visit to determine medical necessity for treatment and visit allowance for episode of care.
Visit limitation: Some insurance companies put a limit of the number of visits a patient can have each year regardless of injury type or occurrences throughout the year.
Visit review: Some insurance companies allow you to have a certain number of visits, and after that number is reached they require a review of your case. In some cases they may deny any further treatment.
This is just a short list of terms that you may come across when deciphering your benefits for therapy. When you contact our office for an appointment we will do our best to answer any questions you may have regarding your insurance as it pertains to Physical Therapy.
Kettlebell Swing
Here it is; a detailed breakdown of how to perform the kettlebell swing with tips to keep in mind to facilitate better technique and avoid injury. Enjoy!
Step 1 – Starting position –Start with feet a little wider than shoulder width with kettlebell on floor approximately one foot in front of your body. Keeping spine straight, sit back hinging at hips, bend knees and reach forward with arms to grip Kettlebell handle with both hands.
Step 2 – Prepare to lift kettlebell – with a fairly tight grip on handle, activate core muscles by drawing belly button in towards spine and gently squeeze shoulder blades together. Tilt kettlebell handle down towards your body.
Step 3 – Pre-swing – Lift kettlebell off floor by gently pulling bell toward you and straightening knees but maintain hinge at hips with spine flat. Now allow kettlebell to swing between your legs with arms moving in a pendulum type movement until arms are resting against trunk and kettlebell is behind or under buttocks with bottom of bell facing behind you.
Step 4 – Hip Thrust – Rapidly extend hips standing up by contracting glutes, quads and hamstrings swinging kettlebell out in front of body without lifting bell with arms (while continuing to keep core muscles activated). Full extension should be achieved to where you are standing straight up, arms are near horizontal and bottom of kettlebell is facing away from you.
Step 5 – Drop / back-swing – Continue with pendulum type movement with arms straight and allow kettlebell to start swinging back towards body before bending knees. When Kettlebell begins to approach legs hinge hips allowing chest to bend forward towards floor and bend knees slightly until kettlebell completely between legs. At bottom of back swing knees are bent, back is flat, arms against trunk, hips are hinged and kettlebell is behind or under buttocks and bottom of bell facing behind you.
Step 6 – Keep swinging that iron. Repeat steps 5 and 6 for specified number of repetitions.
Tips to Remember
• Back flat / spine straight
• Core muscles gentle activated throughout movement
• Feet remain flat on floor
• Hinge / bend at hips and bend knees mildly
• Do not lift with arms
• Utilize legs for a hip thrust to power movement
• Maintain a pendulum type movement with kettlebell
**Recommend working directly with a professional trainer or physical therapist until you learn correct form.
The Kettlebell swing: Starting with a good foundation
To the weekend warrior or the general public when thinking about kettlebells the kettlebell swing usually comes to mind. The swing is not only the most well-known technique but also is the foundation for other Kettlebell exercises. When performed correctly the swing is very fluid beneficial exercise that will strengthen the glutes, hamstrings, quads and core muscles. The swing is a great exercise for building explosive power for sports, burning calories and improving cardiovascular endurance. Before jumping right in and swinging a 50lb kettlebell at your local gym or if you are returning to kettlebell lifting it is helpful to practice a few techniques that will prepare the body for the rigors of swinging heavy iron. The following exercises are great prerequisites before attempting or returning to the kettlebell swing. If you have significant difficulty or there is pain performing the following exercises then you need more time developing leg strength and flexibility before beginning the kettlebell swing.
Straight leg bridge feet on Physio Ball – this is a core and hip extension exercise which simulates a similar movement as the Kettlebell swing focusing on stabilization and control. Perform exercise 15 times
Push up Front plank – strengthens the core muscles to help maintain the neutral spine during the swing and helps build core endurance for high repetitions of the swing. Also simulates a similar position as the top of a swing. Hold position for 30 seconds.
Romanian Deadlift with Dowel Rod – this exercise helps practice hinging your hips with minimal knee bend while maintaining a neutral spine position which are both needed for a swing. Perform exercise 15 times.
We are bunch of live wires! Neuroplasticity of Human Beings!
Often the human nervous system is compared to electrical wires and circuits. It was once thought that after injury or at a certain age these connections were stationary and unable to regenerate. In 2000, American neuropsychologist, Eric Kandel was awarded the Nobel prize in neuroscience for his discovery that the brain’s neural connections can grow and strengthen throughout our lives.
This is good news, unlike the filaments in our electronic gadgets our nerves are not inanimate wires, they are alive with the ability to form new stronger connections with the right stimulation.
Neuroplasticity is the term used to describe the brain’s ability to create new connections throughout our lifespan. The benefits of these new connections include improved coordination, balance and physical skill, along with improved cognition and even mood. Ways you can promote the formation of these new pathways and increase your ‘brain health’ include:
Get physical exercise.
Our brains consume about 20% of the oxygen we take in. Physical activity increases the blood flow and oxygen levels to the brain for greater functioning.
Learn something new every day.
Water and feed your brain.
Stay hydrated and eat ‘brain healthy’ foods such as walnuts, green/ leafy vegetables, dark chocolate, foods with monounsaturated fat (olive oil), cruciferous vegetables, foods with omega 3, and lots of berries.
Manage stress/ learn meditation.
Excessive stress has been shown to reduce neuroplasticity of the brain.
Challenge your brain with intellectual activities and games.
Develop stimulating friendships: interact with others.
Laugh often.
Laughter reduces stress, releasing various chemicals, enhancing the efficiency of the immune system along with changing the brain wave activity towards what is called a “gamma frequency,” increasing memory and recall.
With injury, illness and lack of activity not only do the muscles and joints lose function but the connection from the body to the brain becomes altered. These connections do not return automatically and can lead to limitations in the future if not restored. In rehabilitation, we utilize techniques to promote neuroplasticity with varying a task or exercise. Adding cognitive challenges or additional physical tasks to a simple exercise helps the brain learn to think and act at the same time. This skill is essential in not only in sports but maintaining balance and navigating through our daily lives. For example, we might have a person stand on one leg while throwing a ball requiring the brain process both input from the lower extremity to keep balance but also the upper extremities and eyes to catch a ball. To increase the challenge, we could then ask the person to count backwards by three requiring the brain to engage in a cognitive task.
At North County Water and Sports Therapy Center we have a couple of additional tools to improve neurocognitive efficiency.
Fitlights are a series of programmable discs with various colored lights that can be set up to illuminate in a random or specific sequence with the goal of turning off the light by tapping or reaching toward the correct light. The software program allows us to keep track of reaction time and success rate as a way of demonstrating progress. In fact, Steph Curry of the Golden State Warriors works with his trainer utilizing this technology to stay on the top of his game.
fitlights, random pattern with different colors
Biodex Balance System is a computerized force plate with feedback screen. You can think of it as the fancy Wii fit game providing both testing and training capabilities working on balance and postural control.
Working balance and stability with feedback from the Biodex SD
The best part about neuroplasticity and being made up of ‘live wires’ is that although it may happen faster and to a greater extent in the young it possible to train your brain not matter your age.
Go outside, take a walk. Better yet walk with a friend, try a new trail and discuss the latest book you have read, tell a joke. Your body and your brain will thank you!
References:
Cramer, S. C., Sur, M., Dobkin, B. H., O’Brien, C., Sanger, T. D., Trojanowski, J. Q., … Vinogradov, S. (2011). Harnessing neuroplasticity for clinical applications. Brain, 134(6), 1591–1609. https://doi.org/10.1093/brain/awr039
Fuchs, Eberhard, and Gabriele Flügge. “Adult Neuroplasticity: More Than 40 Years of Research.” Neural Plasticity 2014 (2014).
Pelletier R, Higgins J, Bourbonnais D. Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskelet Disord. 2015;16(1):25.
Smith, G. S. (2013). Aging and neuroplasticity. Dialogues in Clinical Neuroscience, 15(1), 3–5.
As an outpatient orthopedic and aquatic therapy clinic, we primarily get referrals from primary care physicians and orthopedic surgeons. Imagine our surprise when we started getting regular referrals from a dermatologist.
Imagine, you go to your dermatologist complaining of an itch on your arm that just will not go away. Maybe it is on your shoulder blade. The more you scratch it, the worse it gets, and pretty soon you have scratched yourself raw. Being in the sun tends to make it worse. Ice seems to be the only thing that helps but it always comes back. The dermatologist does their exam and tells you that you that there is nothing wrong with your skin (raw patches aside) but in fact the itching is coming from a problem in your neck and writes a referral for you to see a physical therapist. I know what you are thinking… WHAT?!?! The problem is the itch on your arm, you don’t even have neck pain so how can physical therapy help you???
To understand this, you first must understand a little bit about the anatomy of your neck. Your spinal cord travels from your head down to your low back region, and at each level of your spine, nerves come out of the spinal cord and travel to the limbs. In the neck, or cervical spine, those nerves travel to your arms, and in the low back, or lumbar spine, those nerves travel to your legs. These nerves have both sensory components, which send information to your brain about sensation of the limb (touch, tickle, pressure), and motor components which give the muscles in your limbs the message to contract. When there is any sort of compression on these nerves, either due to prolonged positions or degeneration of the joints of the spine, then the function of these nerves can become impaired. The muscles in the limb may not work as well and the sensation of the limb may be compromised. This compromised sensation commonly presents itself as numbness or tingling, but it can occasionally present as itchiness in the limb. These conditions are called Brachioradial Pruritus when the itchiness is on the arm and Notalgia Paresthetica when the itchiness in in the shoulder blade region.
How exactly can physical therapy help?
Well, since the problem is compression on the nerves coming out of the neck, we start there. Often people with either of these two conditions have a history of neck pain or tend to have poor postural habits. After a comprehensive physical therapy evaluation, we can determine the potential cause of the compression of the nerves, address any joint or muscles restrictions that may be contributing to the compression, and educate the patient on postural exercises so that they learn how to hold their spine in the optimal position to avoid further compression on the nerves. How cool is that?
So, if you have an itch in your arm or shoulder region that just won’t go away, and a medicine cabinet full of creams, discuss the possibility of physical therapy with your physician or dermatologist. Better yet, call our office and find out about seeing one of our physical therapists through direct access, no referral necessary.
References and further reading:
https://www.mdedge.com/cutis/article/67624/contact-dermatitis/brachioradial-pruritus-case-report-and-review-literature
Brachioradial Pruritus: A Case Report and Review of the Literature.Lane JE McKenzie JT Spiegel J Cutis. 2008 January;81(1):37-40
Application of Kinesio Tape to the shoulderKinesio Taping
Kinesio Taping® Method is a modality developed in 1979 by Dr. Kenzo Kase, a chiropractor. He recognized that while his manual treatments were effective, they were usually temporary and he began looking for a treatment that his patients could utilize between treatments. He developed a tape that would support the joints of the body, and their surrounding soft tissues, but still promote normal joint movement, this was in contrast to the therapeutic tapes on the market at that time which primarily restricted joint motion. Kinesio Taping® Method can be used to treat patients with a variety of impairments, including but not limited to muscle imbalance, postural insufficiency, soft tissue (ligament and tendon) and joint injuries, and neurological conditions. Kinesio Taping® has gained popularity here in the USA as many athletes have used the tape during their sports competitions, including Lance Armstrong, David Beckham, Serena Williams and Rory McIlroy. Today, most physical therapy clinics utilize Kinesio Taping® on a regular basis with their patients.
Kinesio® Tex Tape, the tape developed by Dr. Kase for the Kinesio Taping® Method, is a latex-free, 100% cotton tape that is skin friendly for all ages and can be worn for multiple days. This allows patients to benefit from their physical therapy treatments between visits, which can help to improve the outcomes of their rehabilitation. The tape is water resistant which allows the patient to swim, sweat and shower while wearing the tape without compromising the effectiveness of the tape. While most people are familiar with the tape due to having seen its use with athletes, 85% of the applications for the tape are for the non-athletic population. While Kinesio Taping® Method can be very beneficial for the majority of our patients, it is important to recognize that there is a skill involved with the application and removal of the tape to ensure only positive results. There are certain medical conditions in which the application of Kinesio Tape ® would not be recommended such as with blood clots, over infections or open wounds. Other medical conditions would at least warrant the approval of the patient’s physician, some of which include diabetes, kidney disease and congestive heart failure. For this reason, it is important to find someone who has been properly trained in the application of the tape.
Here at North County Water and Sports Therapy Center, our therapists have many years of experience in the application of Kinesio Tape® and one of our therapists, Dr. Ryann Caciotti is a Certified Kinesio Taping Practitioner. In our clinic we use the Kinesio® Tex Tape that was designed specifically for the Kinesio Taping® Method. If you have any questions about how Kinesio Taping® Method may help you, please feel free to contact our office and set up a free 15- minute consult with one of our therapists.
For more information about Kinesio Tape®, and to see some research supporting its use, visit their website at https://kinesiotaping.com/research/published-research/.
References:
www.kinesiotaping.com
KT1 & 2: Fundamentals and Advanced Concepts and Corrective Techniques of the Kinesio Taping Method Course Manual
Clinical Therapeutic Applications of the Kinesio Taping Method. Kenzo Kase, Jim Wallis, Tsuyoshi Kase. 2003.
We walk daily for regular activity and function. A regular walking program can be very helpful in improving wellness, whether it is returning from an injury or helping with chronic pain. There are numerous reasons why it is beneficial to establish a walking program. On average, an individual may walk anywhere from 2,500- 5,000 steps each day. Setting a goal to meet each week is a great way to keep track of your walking. Whether you keep track of your steps or just track how long of an afternoon walk you take each day, try to reach and progress past your goal. An effective walking program should be performed 3 to 4 times per week and gradually increasing intensity to improve endurance, strength and avoid injury. Walking can help to maintain bone mass, tone muscles, and reduce stress. Walking is good for cardiovascular endurance, improving circulation, lowering blood pressure, improving balance, and improving sleeping habits. Make sure you keep safety in mind with your walking program. Use walking sticks or assisted device as needed, drink plenty of water, walk at cooler times of the day, and wear supportive shoes.
Walking is one of the simplest and most beneficial exercise routines that majority of people can participate with no special equipment. However, please consult your doctor prior to starting a walking program to make sure exercise is safe for your current health condition. If you have concerns about a current injury or chronic pain symptoms please consult your physical therapist or contact our office to make an appointment to assess condition of your injury.
d while maintaining a neutral spine position which are both needed for a swing. Perform exercise 15 times.
fitlights, random pattern with different colors
