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Over the last month our routines have all changed. Our communities have responded by keeping in touch virtually, not just for work, but for just about EVERYTHING! Work, school, church, shopping, conferences, exercise classes, webinars, doctor and PT visits, social get togethers, even wine tasting parties… you name it and someone is doing it virtually. In one respect, I have welcomed the slower pace of not rushing place to place every day. We are so lucky to have this technology that is keeping up “together”, but I have certainly seen a physical cost. I like to call it “fanny fatigue”. And I mean that literally. I’m tired of sitting so much, and daily I’m hearing more and more stories from clients about pains that have started since increasing their computer time. On top of that, the change from crazy schedule to stay at home was so quick, that no one had a chance to set up their home office properly and ended up sitting in kitchen or dining room chairs that are not made for long term sitting. In my own house we have dealt with elbow pain, neck pain, and back pain. You can see why... 
So what is the best thing to do? Here is a short list of small changes that can make big improvements for your posture when working on the computer and avoid the aches and pains that come with prolonged sitting and repetitive movements. 1. Adjust the height of your monitor so that you can look straight ahead. Ideally, the top line of the text on your screen should be at eye level. You may need to be creative and stack some books for boxes to bring your screen up. Your monitor should be about an arms distance away from your face (20-40 inches away). 2. Support your low back with a back rest if your chair does not have one already. You may use a pillow or a towel roll to fill in the curve of your back. I tell my clients if you can slump down and roll your shoulders forward, you do not have enough back support. The back support will back it easier for you to sit straight and have your arms by your side instead of reaching forward. 3. Adjust the height of your chair or keyboard so you have a 90-110 degree angle at the elbow. This will allow your wrist to lay flat (neutral position). 4. Your feet should be flat on the floor to provide support for your back. After adjusting you chair to fit the desk or table height, you may find that you need a small stool or box under you feet to keep them flat. You need to have a small gap between the back of your knees and the chair seat.  Need some help figuring your space out?
Telehealth and virtual PT can make this super easy and convenient! With a phone camera (and some help in your house), a physical therapist can look directly at your specific set up and make recommendations to improve your positioning, relieve stress from painful joints, and exercises to get you back to work (or school, or wine tasting...) pain free!  It’s mid January, which is about the time that resolutions start to fall off. Some research suggests that by February each year, 80% of resolutions have already been broken. Making a new habit is hard enough, but especially hard if you have other challenges or pain to overcome.
Or maybe, you didn’t even make a new resolution because you are resigned to inactivity due to back pain? So far this year (and it’s only the first full week), I’ve had clients tell me that..
1. Get Your Joints Moving!! Movement is the key! Moving you to better health! These are phrases spoken in our clinic frequently. But when your joints are stiff, movement is often a challenge. It’s important to gain movement in the joints before strengthening, or else you will start compensating and create a whole new problem. Sometimes a hot shower is enough to get you moving, or maybe it’s getting back to a stretching program that has been helpful in the past. If you have a chronically stiff back, I recommend you see a movement expert (like a physical therapist) to learn a safe way to regain mobility before you start a strengthening program. 2. Pace Yourself! We all tend to get very excited about new goals and jump in full force. How many of us have felt SO motivated with a new workout and then couldn’t move the next day? (I did it last week). Even when you have a good, safe exercise plan, “overdoing it” will could cause muscle soreness, inflammation, or re-injury to the low back. Our muscles provide support around the spine, but with an exercise routine those muscles are not prepared for, they will easily fatigue and fail to provide the necessary support your body needs for optimal function. 3. Stay Hydrated One of the biggest mistakes that could be contributing to your pain and zapping your energy is being dehydrated. Dehydration can cause muscle aches, pains, fatigue, and dizziness. Recovery after a workout is delay with dehydration. Try to drink water throughout the day and avoid excess caffeine, including coffee, tea, alcohol. 4. Get Assessed by an Expert. Your first thought may be to see your doctor before starting a fitness plan. While that’s not a bad idea for medical clearance, not all medical doctors are fully experienced at evaluating back pain. Medical doctors will send you for imaging and look for serious problems, like broken bones, but they do not take the time to assess your movement in detail and look and muscle imbalances. A specialist physical therapist will assess you in detail and will be able to give you more specific information on how your pain may affect any exercise or activity that you want to start. A physical therapist can make recommendations of how to customize your plan, give you reasonable expectations, and send you off towards your new goal with decreased risk for injury. If you need help trying to figure out a way to start – click here to schedule a free discovery visit with me to create a resolution you can stick with. Happy New Year – Keep moving toward better health!!! 
At our house, we are almost through the first full week of school. Already, my high schooler has complained of her neck and upper back hurting. I'm sure there are a number of reasons: sitting all day, beginning swim practice, then sitting on her bed with her books in her lap. And then, there is her back pack. This year, the books are bigger, and she carries a computer. As a teenager, she will be able to adjust to the load with a little bit of strengthening, but what about the smaller, elementary kids? Have you seen your children or grandchildren with backpacks half their size, and to keep from falling backwards they have to bend over for balance? The American Academy of Orthopedic Surgeons official recommendation is that backpacks should weigh no more that 20% of your body weight. This is a good rule of thumb for adults, but for small children the backpack should ideally be be closer to 10% of their body weight. Tips to Lighten the Load 1. When choosing a backpack, look for lightweight, durable material. Leather or thick canvas backpacks can add weight before you even put a book in it. 2. Choose the smallest backpack that will fit the necessary books. If your child it like mine, he is particular about the color and design, but try to limit their options to the appropriate size. 3. Adjust the backpack to fit properly. Make sure the straps are tightened and the load is placed on their upper back, not sagging down on their low back. 4. Pack a separate lunch box and put in empty water bottles that can be filled once at school. 5. Use online resources or scan chapters. If the textbook can be read at home online or with a kindle, use those resources so the heavy textbook can be left at home. 6. Look for used textbooks. Sometimes you can find an inexpensive used copy of textbooks that can be left at home to alleviate carrying the heavy books back and forth. 7. Clean out backpacks frequently. Some kids are better than others in keeping organized. Make sure old water bottles, left over lunch items, and no longer used books are not getting lost at the bottom of the backpack . If you or your family member continues to have neck or shoulder pain after adjusting the load, download our Free Ebook "8 Easy Tips to Decrease Neck and Shoulder Pain" for other ways to relieve symptoms.  As I work with clients, I’m continually talking about their goals, not so much about how much they want to be able to bend. Instead, I’m asking questions like…
What do you want to get back to doing that you can’t do now? As treatment progresses, those answers change, get revised, clients have higher expectations as they start to feel better. Those are normal changes, and I’m happy when we can set the bar higher. But, every once in a while I get a surprise… When can I go to the water park? The first time this 74 year old woman (with rheumatoid arthritis and a recent spinal fracture from a car accident) asked me, I just laughed and didn’t answer. The next time she asked I thought “how cute, she wants to go with her grandchildren.” Then, I realized she was asking for REAL, for HERSELF. She’s never been to a water park and she wants to mark it off her bucket list. Talk about setting the bar higher… I had to think about my answer for while… of course, she can do whatever she wants, but what about the stairs, what about the impact at the bottom of the slide, what about the heat. Every negative about a water park ran through my mind. My goal is to keep people out of pain and avoid reinjury. But where’s the fun in that if there is no risk for something better? Movement and activity are essential for healing and recovery. Muscle strength, joint motion, and weightbearing are all integral parts of healing and returning joints to their proper movement patterns. Of course, there are times when rest is appropriate; but in general, you need to get moving to avoid weakness, stiff joints, and compensating for the injury. The opposite side of that is overuse and inflammation. I frequently tell clients “Quit while you’re ahead.” When you are at home, feeling good for the first time in weeks, you just want to tackle the world. Then the next day you’re hurting and depressed that you aren’t getting better. When we overuse a weak muscle, or strain a joint that doesn’t have enough support, we may experience irritation. Inflammation can cause swelling, redness, joint stiffness, and of course pain. So how do you balance movement and inflammation? To progress at home, I recommend you just add a little activity each day. Add a little more resistance, or just a few more reps to your exercise. Remember, quit while you are ahead. The right balance of activity and rest is different for each person, but we try to avoid “two steps forward, one step back.” As a trained therapist, I know when enough is enough which is why I repeatedly get asked “ When do I get to go to the water park? I know her goal, I know the bar is set high, and I know the work it will take to get there. But, as she continues to get stronger, I’m starting to believe this might actually happen. More importantly, she sees it too, which is why she keeps asking. Ultimately it will be her choice to weight the risks of inflammation and pain vs. the thrill of the water slide. We all have those choices, hopefully we will make smart ones. If you need help finding your balance, schedule a discovery visit in order to see how therapy or training can help you get back to YOUR bucket list item.
Do I need to get a MRI first??
This is a very frequent question that I get from clients, especially those with neck and back pain. Many clients think they need an MRI or Xray before starting physical therapy because “I don’t want hurt myself more”. Or, like my own mother said… “I don’t want to go to the doctor because they will make me get a MRI and I’m not going into that tube!” It’s normal to be anxious about your care, especially when you’re having pain shooting down your leg, or numbness in your arm. But don’t let those fears keep you from getting the care you need. The sooner you start addressing your symptoms the more likely you are to get relief without medication, surgery or injections. I can certainly understand why it’s tempting to get an MRI, especially when looking for an answer and cause of your pain. MRIs are an amazing advancement in technology that can easily diagnose abnormalities in the spine or joints, tumors, cysts or other tissue damage. However, MRIs, and Xrays too, can give a lot of false alarms, especially when talking about back and neck pain. What? False Alarms? You see, MRIs are so good at what they do that they find many problems and disc degeneration that most of us already have starting as early as our late 30’s. Just because you have degeneration, doesn’t mean you have pain. Multiple studies have shown that MRI results of stenosis, disc herniation, and nerve compression are positive, even on test subjects with NO PAIN! In addition, the radiologists reading the MRIs have no clinical context of what pain the patient is having, and they will address any degenerative changes they see creating a list of diagnoses that may have NOTHING to due with the cause of pain. Even if the MRI is detecting a problem that is the site of the pain, the MRI can not predict your own body’s ability to heal. I’ve had a few myself, but in the end, they have made no difference in my recovery. So how do I find out the ROOT CAUSE of the pain? Most people don’t realize that 70-80% of all spine and musculoskeletal problems are “mechanical”, which means the problem is related to the way you move. You could have muscle imbalances, tight muscles and joints related to bad posture, previous injuries, or general “wear and tear” on our joints. Many of these problems start to show up in our 40’s, 50’s, and 60’s due to years of bad movement patterns and compensation. The easiest way to find out about these “mechanical issues” is to ask a physical therapist. These movement and strength imbalances are best corrected with … Movement and Strengthening! Why not be over cautious and get an MRI anyway? If you have had a traumatic accident, a fall, or a long history of pain, then YES, seek medical advice and probably a MRI. But it you have a history of a nagging pain, that has recently gotten worse, or started to affect your ability to do the activities you enjoy, then seeing a physical therapist is a good idea. A physical therapist is a movement specialist and can determine if it is not a mechanical problem and if you need to be referred to a physician. A physical therapist may be able to save you money for the cost of the MRI and the anxiety of “going into the tube”. Here's another article that gives even more information about the overprescription of MRIs and how they can lead to chronic pain, use of medications, and higher disability scores. You can always download our Free E-Book 9 Ways to Relieve Back Pain without Taking Pain Medications or Missing the Activities You Love for tips to try and manage back pain at home. Physical Therapy: Common
Misconceptions Debunked Physical therapy has always been shrouded in mystery, and the truth is many people don’t really know what it is. Some think that physical therapists only stretch muscles, rehabilitate athletes, or use that electric stimulation machine. Others feel as though physiotherapy is an intense massage, or even just a way to avoid being stiff after a workout. As a physical therapist with many years of experience, I can honestly say that, despite all these conflicting ideas about physical therapy, one thing remains constant: most people believe we heal pain. And yes – we do heal pain, but what most people don’t understand is that physical therapy is NOT only about healing pain… it is about SO much more than that. Most patients come to see me wanting nothing more than for the pain to be gone. And that’s something we can all understand – pain is absolutely terrible. But the most common misconception about physical therapy is that ALL physical therapists do is take away the patient’s pain. That just isn’t true. Let me explain. If all a patient really wanted was for his lower back pain to be gone, or for her knee pain to disappear, then he/she would simply take a painkiller. And in my experience, many of the patients visiting my clinic have ALREADY done that. And the pain is STILL there when they first come to see us. So, getting rid of the pain isn’t the only issue the patient is facing. If pain relief is the only thing that’s required, the painkillers or the injection would have worked… but they haven’t. The unfortunate truth is that many people see pain as the problem, not the symptom. And it is this precise disconnect that defines what a physical therapist does: physical therapy finds the CAUSE, applies a whole body approach to heal the problem, thereby getting rid of the pain. The intensive physical therapy a person undergoes after a knee or hip surgery is NOT only so that he/she will not be in pain, but so that the root cause of the problem is healed, thereby promoting maintained health. Similar is true for someone suffering from lower back pain: physical therapy doesn’t start by healing the pain, but rather tackles the root cause in order to eradicate pain permanently. So, in other words, though physical therapists love to get rid of pain, we do so in a way that treats pain as a symptom, not the problem. Our goal is to provide lasting health, not temporary comfort. That’s why seeing a physical therapy involves a hands-on, thorough evaluation, and recommendations usually for multiple sessions. I see the same thing happening in my practice all too often, that is, after a session or two with a physical therapist the patients feels great – his/her pain has dissipated, and life is back to normal. The problem is, he/she then stops coming to physical before completing the recommended number of sessions, healing the root cause of the pain, and the pain returns. It is this common scenario, too, which casts physical therapy under a cloud of misunderstanding. As we do not deal with the management of pain so much as the HEALING of the problem, patients often assume that if their pain is gone there is no need for further treatment. Or when pain returns, it is assumed the physical therapy didn’t work. The truth is, physical therapy isn’t a painkiller – and thank goodness for that. Though a session or two might ease the pain, it’s imperative to continue seeing a physical therapist for the suggested duration of your treatment in order to attain PERMANENT health and a pain free life. Unlike pain medicine, physical therapy is the most effective way of healing the CAUSE, and the happy truth is that, along the way, the pain will dissipate. So, based on the above, here are some things that a physical therapist actually does:
Physical therapy is, of course, useful for eradicating pain. But the truth is, a common misconception lies is precisely HOW we do that. We do not offer temporary solutions to a permanent problem, rather we tackle the root cause of the problem so as to heal the patiently effectively. So, there you have it: the most common misconception about physical therapy, namely, that physical therapist only treat pain. We do so much more than that, and with the proper, hands on, unique treatment that physical therapy provides, a patient who does the required sessions, and commits to the therapy prescription, will ultimately maintain a pain free, active life. Stop the painkillers, stop the injections, and stop the visits to the physician: physical therapy is by far the most effective way to achieve and MAINTAIN a pain free, active life.  As the holidays approach, my family and I did some cooking baking this weekend. It's become a tradition that we all look forward to, both the baking and the eating of the cookies. When taking break from washing pans and cleaning up frosting from the floor, I came across this cartoon which made me laugh. Not just because I was tired from baking and sore from standing so long. No, this is funny to me because it is what my husband says I went to PT school to learn. "Just put some ice on it."
That might be what he frequently hears from me when says his knees hurt after running. Possibly because he tells me in between making dinner and doing laundry, and I don't have time for the long answer. But the truth is, cold packs or ice can be very helpful for pain and inflammation relief after an initial injury or a challenging work out. High level athletes have learned the benefits of cold therapy after a game or practice, which is why they leave the training rooms with packs of ice wrapped around their knees or shoulders. Ice tubs/ice baths are also popular in training rooms, and you may see them in some gyms now too. But ice can also help us regular people who are sore after starting to exercise again, or standing too long at the festival, or even after lifting a box that was too heavy. Cold packs will contract blood vessels, significantly reduce inflammation of joints, tendons or muscles, and thus reducing pain. The cold temperature can also slow the nerve activity rate, decrease muscle spasm, and decrease the perceived pain. Cold therapy (formally called cryotherapy) is most effective in the first 48 hours after the strain or injury. By controlling the inflammation initially, you can return to activity sooner and avoid falling into a chronic inflammatory state Cold or ice can be use in different forms: gel packs, ice packs, ice baths, or ice message. A bag of frozen peas also works just as well. It is most effect used for short periods of time, 10 - 15 minutes, multiple times during the day. It is important not to place ice directly on the skin or leave for longer than 20 minutes to avoid any risks of skin damage. While some people love to use ice to control pain, it is NOT for everyone. Clients with arthritis often feel very stiff after using ice packs. Diabetics with any type of neuropathy will not tolerate the cold temperatures and will find it very uncomfortable. Ice packs are also not the best option for those with poor circulation. If you find ice helpful in managing pain and swelling, then great! But if your symptoms continue past 48 hours you need to see a professional for care to avoid any further injury or chronic pain. I promise, I have learned more from PT school and 20 years of practice than "Just put some ice on it!" Every week I hear many patients ask us the same question: “how can I keep active even
while I’m recovering from an injury?”. I get it.... you’re fed up of resting the problem area in the hope that things will get better. Is this you? Keep reading! We often find that the general advice given by doctors (and sometime even the internet!) is that ‘rest’ is the best thing for an injury. In the hope of healing faster, the patient then rests the problem area for prolonged periods of time. Later, though, once he/she attempts to get back to his/her activities, the pain is still there and often it’s even worse than it was at the start. There are two major flaws in the ‘rest your problem’ strategy. The first issue is that an active person finds the idea of prolonged rest to be almost impossible, if not unbearable. Secondly, resting the area for long periods of time can actually be even more harmful – but, more on that later. Let’s take a look at a fairly common scenario I encounter with my clients on a regular basis. Quite a few of the patients I treat are generally active adults, and though they may not be professional athletes, they do enjoy running or cycling over the weekends. I often find that once an active patient sustains an injury – like a leg or groin injury in a runner – he/she finds it difficult to swallow the doctor’s “rest” pill. In fact, all those kind of patients want to know is when they can start running again! And I absolutely love hearing that question! In fact, I dislike the “rest” prescription as much as the actual patient! Here are the two major problems I always try to make our patients aware of: Firstly, rest almost NEVER actually fixes anything. Think about that for a moment. Our runner has injured his leg and is advised to rest it. What happens when he does? Well, the root cause of the problem isn’t addressed – in fact, it is often hidden behind painkillers. The problem with this is that the real healing just cannot begin. It’s as though the patient is, really, just wasting valuable time. Secondly, resting the problem area for prolonged periods of time results in what is called “whole body de-conditioning”. That is to say, just because the patient experiences pain in the leg does not mean his/her entire body is incapable of staying active. Here’s the problem with a full-body rest-up: the entire body loses strength, power, endurance, and flexibility. Once this happens, the recovery time needed practically doubles! Remember, healing the problem area – and SUCCESSFULLY addressing and fixing the root cause of the problem – is really only possible when the muscles surrounding the issue are strengthened. This strengthening helps with support and flexibility, ensuring that the muscles in the affected area no longer overcompensate and create pain. Not strengthening these critical surrounding muscles only aggravates the issue at hand. The key is to adapt the patient, that is, to ensure that he/she keeps active in a safe/sustainable way – always building back up to the run, the walk, or the cycle. Doing this keeps the patient motivated, strong, and gives him/her the best possible start on their journey to health. So, if you’re resting because you’re injured, but you only find more pain at the end of the day, then it’s time to make a change. Here at Blue Wave Physical Therapy and Wellness, we can help you. Our team will help you get back to the activities you love in no time at all. With custom-made exercises suited to your routine and recovery, we aim to heal the root cause of the problem. If you heal the root cause of the problem then you are sure to create a strong foundation for the MAINTENANCE of a pain free life. This means that running, walking, or any activity you love will no longer cause anxiety or worry. We want you to get back to doing what you enjoy! If you’re ready to finally sort that pain out, to get off of the sofa and back out running or doing what you love, give us a call TODAY. We look forward to helping you get back to health safely, quickly, and effectively.  I know that when I’m hurting, the last thing I want to do is get moving. But I also know that’s what I need to do. That’s one motivation for me to get to the pool in the mornings. Our bodies are made for movement. When we don’t move, we get weaker and lose flexibility, our circulation slows down as well as our digestion. Frequently, our lack of movement and inability to do the things we want to do can lead to symptoms of depression and anxiety.
Apparently, a lot of Americans are hurting due to injury or disease. I’m sure you have heard that Americans are in the middle of an “Opioid Epidemic” from pain medications such as Vicodin, Lortab and Oxycontin. According to the Center for Disease Control (CDC), 11% of American experience pain on a daily basis. In 2012, 259 million prescriptions for opioids were dispensed, and 1 and 4 of the people receiving those prescriptions already struggle with addiction. Another study of Medicaid patients showed that 61% of opioid related deaths were related to chronic pain diagnoses. That’s why the CDC released a new set of guidelines in March 2017 with safer alternatives for long term- pain management. Physical therapists can play a key role in those alternatives. A physical therapist is trained to guide a person through movement to improve the pain instead of masking it with medications. The “side effects” of physical therapy include improved mobility, increased independence, decreased pain, and prevention of other health problems through movement and exercise. As part of their new guidelines, the CDC cited “high quality evidence” supporting exercise as part of physical therapy treatment for familiar conditions like low back pain, hip and knee osteoarthritis, and fibromyalgia. Before starting an opioid pain medication, talk to your physician or consult your physical therapist for information about alternatives and realistic pain management goals. Blue Wave Physical Therapy and Wellness helps those with chronic pain by using manual therapy techniques, specific stretching, education of safe movement and body mechanics, and gentle progression of movement. |
We help active adults get back to exercising, feeling fit, and participating in the activities they love without medications, injections, or surgery.
Catherine Courtney, PTSpecialist Physical Therapist Categories
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