Opioids Aren’t The Only Option For Pain.

By: Dr. Christine Stathes, PT, DPT, OCS

We live in a society that puts a premium on quick fix solutions to complex problems, for instance pain.  Pain is one of the many reasons to seek advice from a healthcare professional.  Pain is highly individualized and one of the most controversial and complex medical conditions to treat.

Since the mid 1900s, the health care system’s approach to pain management has been the pharmacological masking of pain.  This has resulted in a dramatic increase in opioid prescriptions, leading to misuse and addiction.  

In 2014, more than 750,000 people in the US were receiving substance abuse treatment for prescription opioids, and the number of those getting treatment for heroin was twice what it had been in 2002.  As of the latest statistics from 2016, more than 42,000 people in the US have died from an opioid overdose, with a growing percentage > 4 % of people addicted to prescription opioids transitioning to heroin.  

No one wants to live in pain and no one should put their health at risk, in an effort to be pain free.  Moving forward, the health care system needs to re-examine interventions for pain. In recent years, more and more evidence has shown that physical therapists may be the answer when it comes to managing pain. Physical Therapy is a dynamic profession that has been shown to be effective in managing pain and improving function.   For instance, a growing body of evidence has determined, physical therapists as a first line approach to those suffering from low back pain. Additional high quality evidence supports the effectiveness and efficacy of physical therapy interventions in preventing and minimizing pain for fibromyalgia, hip and knee osteoarthritis.  Using physical therapists as the first line approach has been proven to lower both healthcare related costs and the use of opioid medications ( 2015 BMC).

Physical therapists engage in a comprehensive examination and evaluation process that focuses not only pain but also the movement patterns and imbalances that contribute to painful conditions.  

Physical therapists play a valuable role in the patient education process helping you understand the mechanisms of and contributors to your pain.  Physical therapists can provide you with realistic expectations for recovery, with or without opioids.   With advanced understanding of how the body moves, and through targeted and patient specific individualized treatment plans, physical therapists can correct the causative factors contributing to your pain and abnormal movement patterns.

If you or someone you know is in pain, do not wait any longer.  Under NYS law Direct Access allows you to see a physical therapist for an evaluation and treatment without a physician’s referral.  In New York, a wide variety of insurances, allow treatment to be rendered up to 10 visits or 30 days, whichever comes first.  Please feel free to contact us, and our staff will be more than happy to verify your insurance plan is a participating provider with Direct Access. In addition to Physical Therapy, patients can get pain relief from other conservative healthcare services such as Chiropractic Care, Acupuncture, Massage Therapy, Active Release Techniques, and Graston Techniques. At ProClinix, we are able to provide these services and modalities to our patients as an integrative approach to care to eliminate pain as quickly and efficiently as possible.

Three Common Springtime Injuries For Runners & How To Prevent Them!

By: Rachel Amarosa, ATC

Are you taking your workout outdoors now that winter is over? Before you hit the pavement or trail, here are some injury prevention tips to keep you running outside instead of running to your doctor’s office.

Like with any new or “it’s been a while” workout, it is always best to progress gradually.  Even if you have kept up with your treadmill running over the winter, running outside has its own variables – specific elements that you simply can not train for while indoors such as uneven terrain, hills, and wind resistance.

So let’s get into it! What are the three most common injuries for runners? The answer is: Patellar Tendonitis, Achilles Tendinitis, & Plantar Fasciitis.  Patellar Tendonitis, also known as Jumper’s Knee, is a common injury or inflammation of the tendon that connects your patella (kneecap) to your tibia (shin bone). Patellar Tendonitis is an overuse injury that can occur in runners due to tight quadricep muscles (muscles on the front of your thigh) and / or from excessive running.  Signs and symptoms of Patellar Tendonitis include pain, swelling, and irritation. It may become more painful at the beginning of your run or after an intense workout, Eventually, it can be painful or difficult to stand up from a chair or to ambulate stairs. A comprehensive lower body stretching and strengthening program will help prevent this type of injury, making sure that your quadricep muscle and the other surrounding muscles have the right balance between flexibility and strength.

Another common running injury is Achilles Tendinitis. The Achilles tendon is the band of tissue that connects the calf muscles at the back of the lower leg to your heel.  Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. Increasing your distance everyday and not giving your body enough time to adjust can lead to irritation of the tendon.  Other symptoms are pain, swelling and / or stiffness along the Achilles or back of the heel area. To prevent this type of injury, it is best to increase distance or intensity of your runs gradually and to warm up properly. A calf stretching and eccentric strengthening program will help prevent further and future injury to your calf and tendon.

Last but not least, Plantar Fasciitis.  Your Plantar Fascia is a weblike ligament that connects from the heel of your foot to the front of your foot, near the base of your toes.  The Plantar Fascia helps support the arch of your foot and generally experiences a lot of wear and tear in our daily lives by simply walking. Plantar Fasciitis is a common orthopedic complaint and occurs when the ligament becomes inflamed due to being overweight, high arches, flat feet, or running for long periods of time. Overtraining or neglecting to stretch your calf muscles can predispose you to having Plantar Fasciitis as well.  It can be characterized as having heel / foot pain, stiffness, swelling, or tenderness. Prevention techniques for Plantar Fasciitis include stretches for the plantar fascia, achilles, and calf, along with strengthening the lower leg and small muscles in your foot. In some cases, custom orthotics are recommended to take pressure off the Plantar Fascia and to help support the arch.

If you start to have pain and swelling in any one of these areas, it is recommended to see a healthcare professional, such as a Physical Therapist, to reduce the pain, swelling, and irritation. Your Physical Therapist would instill a comprehensive stretching and strengthening program and perform an assessment of your lower body alignment to see if you would benefit from orthotics.  At ProClinix, we will also integrate other treatments and healthcare services to ensure a complete and efficient recovery. Incorporating Active Release Techniques, Graston Technique, Massage Therapy, and/or Acupuncture with your Physical Therapy will help break up any scar tissue or adhesions, promote circulation, and realign the fibers for a faster recovery.

The best strategy to prevent these types of injuries is to go slow, incorporate a regular stretching and strengthening regime, plan out a modest / achievable running program, and to listen to your body!

Sciatica and Low Back Pain: Why Patients Should Choose An Integrative And Conservative Treatment

By: Dr. Alan Siegel, DC

With tens of millions of acute and chronic lower back pain and sciatica sufferers seeking relief in the U.S., it is important to educate this patient population on best treatment options to manage their condition. First, let’s discuss what the difference between acute and chronic conditions are. An acute lower back condition can be described as an initial traumatic or in many cases a non – traumatic incident occurs (ie tying ones shoes, sneezing or lifting up a window). Acute would be described as having zero or no pain to having significant pain in a very short period of time, upwards of 8 out of 10 or higher on a pain scale. Acute pain may or may not be due to a more serious underlying orthopedic or neurological issue, especially if trauma had occurred or significant neurological symptoms are present, ie; incontinence is present. It is important to always see a qualified healthcare professional to properly assess your condition.

Acute pain, if musculoskeletal in nature, can be treated very efficiently with combining care of a physical therapist, chiropractor, massage therapist and acupuncturist. Initially, using ice on the lower back can help reduce inflammation. Adding various modalities such as interferential and cold laser treatments, can significantly reduce pain and swelling within the first 48 hours of the flare up. Occasionally, using a lumbar support brace can also help stabilize the region to reduce pain with excessive movement and helps tighten up the core muscles around the spinal column. Once the acute pain has been reduced, patients will greatly benefit from continued soft tissue / myofascial release to the muscles around the spine and into the buttocks as these muscles tend to tense up during acute flare ups of lower back pain. Adding core strengthening and stabilization work would benefit patients for the long term and prevent a future acute episode. Most acute lower back pain should resolve or be significantly reduced, almost completely within 1 to 2 weeks if not sooner with conservative integrative treatment.

If your pain is lingering for 2 or 3 weeks, you may be in a more sub-acute or chronic stage. Chronic pain can be described as more persistent, moderate and a 5/10 or lower on a pain scale. Chronic pain may be due to an underlying orthopedic / neurological condition in the spine such as arthritis, a disc herniation/bulge, stenosis or a muscle related condition such as piriformis syndrome. For pain that is not improving, it is often recommended to get an MRI of the lumbar spine to determine if any of these conditions exist or any other condition is present in the lower spinal region. Even if diagnosed with a disc herniation or bulge, conservative treatment is still the best approach, especially if the pain is manageable and continues to improve through conservative care.

Spinal Decompression and Flexion Distraction are two techniques that can be very effective for conditions where a spinal disc has been compromised. These advanced treatment tables and techniques, often found in physical therapy and chiropractic offices, apply a gentle, even decompressive flexion or neutral force on the lower back with the goal to reduce the size of the herniated disc bulge or protrusion, through a negative pressure applied to the affected disc levels. The ultimate goal of this treatment is to take pressure off the spinal nerve roots that are causing ones pain. It is very important to integrate physical therapy and corrective spinal exercises when undergoing spinal decompression as the muscles around the spine will become slightly weakened / lengthened during this non-invasive procedure. These exercises will help stabilize the core muscles around the spine and will help prevent further injury to the area. Exercises will also help strengthen and stretch out other muscle groups below the spine such as the hamstrings, psoas and gluteal muscles which all need to be functioning well for a healthy spine.

In summary conservative, non-invasive to minimally invasive treatment is the best approach to resolving more than 90% of acute and chronic lower back conditions. Finding an integrative practice that provides multiple conservative treatments is highly recommended. Again, it is important to note that you should always be evaluated by a qualified health professional, as sometimes, back pain symptoms can be a sign of a more serious health problem that will not respond to conservative care.

Athletic Trainers (ATs) Are Healthcare!

By Justen Lopez, MS, ATC, NASM - PES

With spring right around the corner and outdoor sports starting up again, it is important to highlight the healthcare professionals on the fields and in the clinics who help keep athletes safe, Certified Athletic Trainers. March is National Athletic Training Month, and this year’s focus is on the numerous ways in which athletic trainers are involved in healthcare.

Athletic trainers are frequently thought of as fitness professionals who train athletes in strength and conditioning. However, the knowledge and responsibilities of an athletic trainer extend far beyond performance training. Athletic trainers are an integral part of the sports medicine team, and are usually on the front lines when it comes to injuries. They are trained in the prevention, assessment, and treatment of sports related injuries, and must go through an accredited program in order to become certified. The profession itself is currently undergoing changes from a bachelor’s degree to a master’s degree, increasing the knowledge of the students before going out into the field. In addition to the classes, students must complete over 1000 hours of field experience, emergency cardiac care and first aid, and sit for a national exam. Once certified, athletic trainers must then maintain continuing education and emergency cardiac care every two years.

In the last 15 years, there has been an increase in the number of athletic trainers employed at secondary schools and colleges, while also providing sports medicine coverage for non-scholastic sports of all levels. Their responsibility is to oversee the care of the athletes from their pre-participation exam through preseason training, to the occurrence of an injury through their recovery. Athletes generally have access to the athletic trainer after school in order to be evaluated for an injury, go through rehabilitative exercises, or to be taped up for their practice or game. Once this preparation is finished, the athletic trainer goes out to sit on the sideline of the practices and games, in case of any injuries. As injuries occur, the athletic trainer advises the athlete and coach on the appropriate next step. This takes tremendous pressure off of the coach, allowing him or her to focus on running the team, rather than worrying about trying to figure out an injury. That goes especially for concussions. Athletic trainers play a significant role in the management of concussions; as they administer baseline concussion testing, sideline post-injury assessments, proper referral to a physician, and facilitating the return to play progression once the athlete is cleared. Having this type of resource on the sideline is paramount to the safety of the players, which is why many sports leagues, such as USSoccer Development Academy, have required that an athletic trainer must be present in order for a game to be played.

Beyond providing healthcare to athletes on the field, athletic trainers are also utilized in physical therapy clinics and other outpatient clinics along side physical therapists and physicians. This relationship allows for a higher quality of patient care. Together, a physical therapist and an athletic trainer devise and implement rehabilitation programs to treat a vast spectrum of injuries and conditions. Many physical therapy clinics use physical therapy aides, which does not require any type of certification. However, the standard of care is often higher with athletic trainers due to the nature of their education and the types of therapies they are allowed to do within their scope of practice.

Athletic trainers are even being used in the industrial and corporate setting. Many companies are now working with athletic trainers and similar healthcare professionals to improve the health of their employees, while also decreasing the risk of injury. By having athletic trainers assist employees in how to be more ergonomically efficient, injury rates and costs to both the employee and company go down.

Sciatica: What Causes It And What Can You Do About It?

By Dr. James Cassell, PT, DPT

Sciatica is a very common symptom of injuries that brings patients into my physical therapy clinic. Sciatica is aggravation of the sciatic nerve, resulting in radiating pain from the low back, into the buttock and down the back of the leg. This symptom can be caused by numerous conditions, and I will go over a few of the most common injuries that I see on a daily basis: bulging/herniated discs, spinal stenosis and piriformis syndrome.

The first common cause of sciatica is bulging/herniated discs. Before explaining how this injury leads to sciatic, I will describe the spinal cord and how the injury can occur. The spinal column is an alternating sequence of a solid bone (vertebra) and a softer disc. This alternating pattern allows for the spine to bend, straighten and rotate. The sciatic nerve is composed of nerve roots from 5 different levels in the spine, which means that compression at any of those levels can cause sciatica symptoms. Bulging discs and herniated discs are very similar, in the sense that a herniated disc is a more severe version of a bulging disc. A bulging disc occurs when the soft material inside a disc is pushed backwards and compresses one or multiple nerves near where they connect to the spinal cord. The nerves that are compressed become aggravated and can give the patient pain sensations at any point along the nerve. Pain symptoms may manifest as shooting, tingling, numb or aching to name a few. A herniated disc also compresses on the nerves in the low back, though the soft material within the disc tears through the more supportive outer layer, rather than merely expanding it, as with a bulge. These symptoms are typically worsened when leaning forward or sitting, as this pushes the disc material backwards even more, increasing nerve root compression.

Another injury I frequently see cause sciatica in my patients is spinal stenosis. Spinal stenosis occurs when the nerve root is compressed by bone as it leaves the spinal column. The nerves travel through a hole between the vertebra above and below it, called a foramen. These foramen can become smaller, either from bone buildup, generally due to chronic overuse/injury, or due to the discs gradually wearing away and losing their height. The symptoms are similar to a disc issue, as nerve roots are still being compressed, however spinal stenosis tends to be aggravated with standing and leaning backwards, as this closes the foramen space even further. Patients with spinal stenosis tend to report reduction in their symptoms when leaning forward, as this increases foramen space, and reduces nerve compression.

The last common injury I’m going to discuss is piriformis syndrome. The piriformis muscle is a fan-shaped muscle that runs horizontally from the sacrum (base of the spine) to the top of the femur (leg bone). It runs deep to the gluteal muscles. The piriformis can cause sciatica, because the sciatic nerve runs just underneath the piriformis, directly through the piriformis or the piriformis muscle can sometimes split the sciatic nerve. If the piriformis becomes aggravated, it can compress on the sciatic nerve. The piriformis muscle is an external rotator of the hip and a hip stabilizer, it works in conjunction with the gluteal muscles. If a patient has weak gluteals, the piriformis may become overused and spastic/tight, causing sciatic nerve irritation. This can be differentiated from the aforementioned injuries, as piriformis syndrome doesn’t typically change with low back movements.

All three of the injuries described above can be treated conservatively with physical therapy, chiropractic and massage therapy. With disc bulges/herniations and spinal stenosis, treatment would focus on stretching and massaging any tight muscles, while strengthening the stabilizing muscles around the spine. Patients may also perform repetitive movements to try to push disc material into the correct location or to open the foramen further. Finally, piriformis syndrome is treated by stretching and massaging the piriformis and gluteals, while also strengthening the gluteals to reduce pressure on the piriformis.


Adding Strength Training To Your Exercise Routine Shouldn’t Be Overlooked!

By: Rachel Amarosa, ATC

For many people, improving one’s health is a common New Year’s Resolution. Two essential ways to achieve this goal is by implementing a new exercise routine or revamping an existing one. Adding regular physical activity to your weekly routine will improve your overall physical and mental health, help prevent chronic diseases, improve cardiovascular health, and decrease risk of heart attack, diabetes, and cancer – just to name a few. For some, an exercise routine will mainly consist of aerobic activities; such as walking, jogging, or treadmill work. Therefore, what is then overlooked is the value of strength building exercises.  By adding a strength training portion, it will help create a more well-rounded program that will add its own additional health benefits along with maintaining an independent lifestyle as we age!

Strength training, or also known as “resistance training,” are exercises that require you to resist against an opposing force.  Strength training exercises are designed to engage one or more major muscle groups in your legs, hips, back, core, chest, shoulders and/or arms.  Using machines, free weights, resistance bands, kettlebells, vests, or by simply using your own body weight (like when performing squats or pushups) – are all forms of resistance training exercises. Whichever type of resistance you decide to use, the most important factor is maintaining good form! Focusing on form and biomechanics will help you get the most out of your workout, avoid injury, and help to build a strong and necessary foundation for progression.

What are the benefits? – The benefits of strength training become more critical as we age. An article by Harvard Medical School states that as we enter our 50s, strength building exercises are essential in preserving our ability to perform daily activities, allowing us to maintain an active and independent lifestyle. Other benefits include – strengthening of bones and muscles, improving balance, controlling blood sugar, boosting cardiovascular fitness, improving cholesterol levels, helping maintain a healthy weight, and helping relieve pain associated with arthritis.

How often should one incorporate strength training? – The American College of Sports Medicine (ACSM) guidelines recommend 30 minutes of exercise 5x/week as the minimum effective dose to experience the benefits of exercise.  Furthermore, 150 to 250 minutes per week of moderate to intense exercise will yield more health benefits and weight loss. This equates to about one hour of exercise, 5x/week. If you’re going for the full five days a week of either 30 minutes or an hour of work; three days should focus on strength training, two days for cardiovascular training and two days of active rest.  Active rest days are just as important to help your body recover, build new muscle, restore energy systems, and prevent injury. All workouts, whether aerobic or strength focused, should also include a 5 to 10 minute warm up (of dynamic stretches and activities which get the body ready for exercise)  and a cool down (which consists of stretching and/or foam roller work). Determining the appropriate amount of repetitions, sets, and resistance/weight can be a little bit of trial and error. Generally, strength training routines will consist of 2 to 3 sets of 8 to 12 repetitions of several different exercises, with a brief rest in between. The trick can be choosing the appropriate amount of resistance/weight.  You know you have the right resistance if you can complete a set with effort that wasn’t to the point of needing to hold your breath, with excessive strain, or with compensation of form.

When you are ready to start, start slowly and listen to your body! A beginners strength training workout can be as little as 20 minutes. Remember when instituting a strength training routine, good form (slow and steady motions) and working within your means is paramount! After four to eight weeks, you will experience noticeable gains in strength and performance due to your hard work! If you haven’t produced the results you expected by that two month mark, then you may need to consider the assistance of a qualified healthcare or fitness professional for additional help (such as a physical therapist, personal trainer, or nutritionist).

We hear it all the time…“New Year, new you” – I say accept that challenge and up the ante by saying “New Year, BETTER you!” In 2019, work towards that better you by investing your time and effort into your own health and fitness, and get the results you want to see!

A Winter Without Pain: Healthy Ways To Manage The Snow

By Chelsea Brooks PT, DPT

Bundle up with your heavy coat, hat, gloves and a hot cup of tea because winter is coming! Winter is a time for family, friends, and holiday cheer but can sometimes bring about a host of seasonal problems. One winter problem we can’t ignore in New York is the weather. It graciously gifts us with frigid cold temperatures, icy driving conditions, and mounds of snow. These conditions cause us to rely on little things such as salting the front steps to prevent falls or leaving yourself an extra ten minutes in the morning to defrost the car. But one thing we can all agree on is that getting rid of the mounds of snow can be a big pain, literally!

Snow shoveling in particular can be a dangerous undertaking. Due to the strenuous nature of snow shoveling as a physical activity, it can often lead to injury, hospitalization, or even death.  Snow shoveling involves forceful and exertive movements of major muscle groups that challenge both the cardiovascular and musculoskeletal systems.  Research has shown that just two minutes of snow shoveling by sedentary males can increase heart rates enough to exceed recommendations for aerobic activity.  Combine that with freezing cold temperatures, which cause blood vessels to shrink in diameter thereby increasing the workload of the heart, snow shoveling can become quite a vigorous shock to the system.  Possible cardiovascular incidents from shoveling your lengthy driveway can be serious and potentially life threatening.  Therefore, it would be wise to seek medical attention if you start to experience any feelings of fatigue, dizziness, lightheadedness, chest pain, palpitations, and pain throughout the upper extremities.

Cardiovascular incidents may be the most serious and adverse response to snow shoveling, but acute musculoskeletal injuries account for more than half of snow-shovel related injuries. Do you ever wake up with soreness the next morning after a snowstorm? It’s probably in your lower back, which would be due to the shear and rotational stress on the spine after repetitive bending and lifting with your heavy snow shovel.  Not to mention this repetitive bending and lifting is often performed incorrectly.

There are a few simple things that you can do to prevent some of the cardiovascular and musculoskeletal risks that occur from shoveling this winter. Here are some recommendations to prevent injury:

A PROPER WARM UP AND COOL DOWN: Warm up with 5-10 minutes of some light activity prior to going outside to prepare your muscles for exercise. This can include exercises such as arm circles, jumping jacks, push-ups, air squats, or stair climbing. It is also important to continue to move after you are finished shoveling. A sudden cease in activity will cause heart rate and blood pressure to drop rapidly. A proper cool down ensures that the systems of the body reduce gradually.

TAKE FREQUENT BREAKS: Who said that the driveway has to be spic and span in under 30 minutes? Try shoveling your driveway frequently so that you are managing less amounts of snow at a time and reducing the stress placed on your body. Don’t forget to hydrate during you break periods!

WATCH YOUR FORM:  A tendency is for people to lift with their back. That will lead to a lot of associated low back pain. Get a little bend in the knees and keep your hips back just as if you were going to sit in a chair. Keep your back nice and flat and activate your core by drawing your belly button towards your spine. Now you are in a better position to lift! If you feel your form breaking, take a break yourself!

CHECK YOUR SHOVEL: Technology is always changing and so are snow shovels! Find an ergonomic snow shovel with an adjustable shaft that can fitted to your height. This will limit the need for excessive flexion of the trunk and therefore minimizing risk of injury.

Please consider these helpful recommendations before heading out the door this winter. There is plenty to enjoy outside such as the winter sports favored here in the Northeast. Following these simple but useful tips can ensure a safe and fun-filled season without any aches or pains.

Can I Avoid Surgery? How Physical Therapy Can Help Relieve Pain and Restore Function Without Surgery

By Dr. Brittany O’Rourke, PT, DPT, CSCS

You were just diagnosed with a meniscus tear and told you may need surgery. You are worried about how many other things you have going on and how you don’t have time for surgery right now. So what now? Have you considered physical therapy? Recent research shows that physical therapy can be considered as an alternative to surgery for individuals with meniscus tears that are non-obstructive as well as degenerative full thickness rotator cuff tears and superior labral tears of shoulder (SLAP tears). These are a few of the many injuries that can be addressed with physical therapy alone to help relieve pain and restore function!

According to an article in the International Journal of Sports Physical Therapy, there is substantial evidence to support physical therapy as the first line of management, especially in individuals >60 years of age with chronic, degenerative full thickness rotator cuff tears.

Further evidence from an article about clinical outcomes of non-operative treatments states that non-operative treatments were extremely successful for the outcomes of middle-aged patients with symptomatic SLAP lesions, where surgical intervention was not required.

Other evidence from an article about knee injuries suggests that people who went through physical therapy with nonobstructive meniscal tears had better outcomes after a 24 – month follow up then patients that underwent an arthroscopic partial meniscectomy.

What does all this mean? You CAN avoid surgery by trying physical therapy!

How does PT work? For injuries in the knee including meniscus tears and osteoarthritis, it is important to reduce strain on the weight bearing surfaces of your knee. This can be done by improving strength of the muscles that support your knee and restoring full range of motion to increase available surface area and decrease pressure on the injured area. Impaired mechanics with walking, squatting, and going up and down stairs can increase strain on your knee and contribute to pain. Working on correcting muscle imbalances and retraining your muscles to move through the correct patterns can help decrease strain on the injured area. For example, if you are getting out of a low chair and your knees are collapsing inward because you lack the hip strength to control this and are unaware of correct mechanics, this can increase strain in multiple areas of your knee. It can increase joint compression on the outside of your knee, create abnormal tracking of your knee cap within its groove, increase strain along your IT band, and put important hip muscles at a disadvantageous muscle length making them weaker. In turn these imbalances can make functional activities more difficult and painful.

For injuries of the shoulder including SLAP tears and rotator cuff tears, it is important to decrease strain on the shoulder joint by correcting posture and biomechanics. This is done through addressing shoulder range of motion, strength of the muscles that control the shoulder and shoulder blade, mobility through the upper back and neck, and motor control. Many of us sit or stand with a slouched posture for prolonged periods of time. When in this position, the area in your shoulder joint gets smaller. Your rotator cuff tendons pass through this area and when you lift your arm with this smaller joint space, it increases the risk of pinching one of these tendons, otherwise known as “impingement”. Overtime, this can contribute to tendinitis and micro-tears. If you already have a tear, this repetitive impingement can contribute to continued inflammation affecting the shoulder’s ability to heal.

It always important to address the entire body even when treating a localized injury and a strong core is key. For example, it is recommended to include hip range of motion, hip strength, and core exercises in shoulder rehabilitation programs especially in the throwing athlete. Unfortunately, surgery won’t make your core stronger, but physical therapy CAN help with this.

Surgery is necessary with many injuries, but there are many cases in which you may be able to avoid or postpone it by training your body to work with optimal mechanics. Even if you still need surgery, despite trying PT, you are now stronger and better educated about proper posture and biomechanics. This can help you in the long run by making your post-op rehab easier and by reducing the risk of another injury.

Most Common Shoulder Injuries: Diagnosis, Management, and Treatment Strategies

By Andrew Levine, MS, ATC, CSCS, PES

Among common orthopedic injuries that one may suffer, complaints about shoulder issues are some of the most common. The glenohumeral joint (ball and socket joint in the shoulder, GH joint for short) is the most free-moving and mobile joint in the human body.  This is a great attribute when considering all of the different actions and motions that can be performed by the joint in both an ordinary and athletic environment. The caveat is that this increased mobility can make the GH joint very unstable and vulnerable to injury relative to joints like the knee and hip, especially if all of its structures are not working effectively and in-synch.  The purpose of this article is to discuss some common issues that occur in the shoulder and to help you understand some different treatments and management strategies before making the leap into more invasive procedures that can potentially be painful, debilitating, and expensive.

Shoulder Impingement/Rotator Cuff Tendinopathy/Bursitis:

Sub-acromial impingement, or impingement of the rotator cuff and/or bursa sac underneath the acromion process of the scapula, is commonly referred to as shoulder or rotator cuff impingement.  The tendon of the rotator cuff muscle called the supraspinatus runs through a small space (imagine a small tunnel) between part of your scapula (“shoulder blade”) and the head of your humerus (forms the “ball” portion of the GH joint and is part of the long bone that runs between your shoulder and elbow).  When this tendon becomes inflamed and swollen due to overuse or injury and becomes too big for its “tunnel”, friction/compression can occur on the bone above and cause pain and loss of function. This compression also commonly results from poor posture causing abnormal alignment of the “ball” inside the “socket” and subsequent friction on the tendon. Overtime the repeated friction to the supraspinatus tendon can cause chronic inflammation, commonly referred to as tendonitis, or a tear in the tendon.  Tears due to chronic compression are often present as micro-tears or partial rotator cuff tears, whereas full-thickness rotator cuff tears often occur due to acute trauma such as a fall with the shoulder in a compromised position, lifting a heavy object, or a dislocation/subluxation episode.


If there is one silver lining to having and injury such as this, it’s that treatment and management could be as easy as fixing your posture!  While this ailment is often seen in athletic populations who are using their shoulders for lifting weights, blocking, shooting a basketball, etc., it is also very common in the average person, especially if they are hunched over at a desk for a living.  If this sounds like it may pertain to you, start by following these simple steps and see if you notice any relief.

Start by fixing your standing/sitting posture.  Sit and walk with your shoulders back, chest high, and head back so your ears are over your shoulders.  Pulling your belly button back into your spine and engaging your core while walking and sitting will also help keep you upright.  Modifying your daily tasks may also be beneficial. If you are sitting at a desk, rearrange it so that everything is close to you and you don’t need to reach for your keyboard, mouse, or phone.  Also make sure that your computer monitor is positioned directly in front of you so you don’t need to keep your head/neck turned to one side for prolonged periods to look at it. The same goes for driving; adjust your seat and steering wheel so that you are not reaching for the wheel for long periods of time and taking some stress off of your shoulders. The other side of management and treatment will likely involve some degree of medical professional, be it a medical doctor, orthopedist, physical therapist, or athletic trainer.  Conservative management by any of these disciplines or any combination will likely include an initial evaluation and diagnosis followed by rehabilitative exercise and activity modification.  Supervised exercises and mobility programs will serve to strengthen weak muscles in the upper back and rotator cuff and provide mechanical balance/alignment to the joint, allowing for restoration of function and reduction of pain.  This conservative course of action can be followed for any range of previously mentioned injuries, from mild impingement to rotator cuff tears.

If conservative treatment of these ailments fails, other more invasive options may be considered to ease the patients discomfort and restore function.  Different types of injections into the area have both been shown to provide relief in some cases, most notably corticosteroids (or cortisone) or platelet rich plasma (PRP).  If conservative management with therapeutic exercise and/or PRP injection still do not provide relief for the patient, they may want to consider surgical intervention to correct the problem.  This may come in the form of a complete re-attachment of the tendon to the head of the humerus, or a procedure to trim and smooth out the torn section of tendon called a debridement.

Everyone’s body is different and reacts differently to different treatments!  This piece was meant to be strictly informative, so please be sure to consult with a physician, physical therapist, or athletic trainer for further information or referral before beginning any rehabilitation or course of treatment.

What is Active Release Technique (ART) & How It Can Help You.

By: Dr. Ivana Monserrate, DC

Are you a runner with severe knee pain that is preventing you from training for a marathon? Or are you a mother who can’t lift your new born because of low back pain? If so, you are not alone. Millions are agonizing from similar conditions as a result of repetitive stress or acute injuries.  A solution for this pain and suffering is Active Release Technique (ART).

What is ART?

ART is a muscle stretching technique used to resolve issues involving the muscles, tendons, ligaments, nerves and fascia. It is performed with the provider’s hands to reduce fibrous adhesions and restore proper motion and function. Many symptoms may not be a result of a direct injury and instead are the result of a repetitive stress. With these micro-injuries, tearing of the muscle and soft tissue occurs gradually over time. The body then responds with inflammation and eventually repairs the small tears with adhesions and scars. These adhesions then begin to accumulate causing the muscle to become tighter and eventually weakener, leading to a decrease in performance. The overall goal of ART is to break down these adhesions over time and restore the texture and function of the soft tissue.

Who can benefit from ART?

With over 500 protocols, ART can be helpful in various conditions such as headaches, shin splints, plantar fasciitis, tennis elbow, muscle strains/pulls, frozen shoulder, IT band syndrome and even general low back pain. ART can also be performed to release any nerve entrapments in injuries such as sciatica, carpal tunnel syndrome, etc.

What to expect during an ART session?

ART sessions are comprised of examination and treatment. The provider begins by using their hands to evaluate the texture, tightness and movement of the soft tissue along with searching for adhesions and attempting to reproduce the main complaint. Once the abnormal tissues are identified, a tension is applied with the provider’s hands to the area and the patient is directed to move their body part in a certain position. This is then repeated a few times. Retesting after treatment is then performed to assess the specificity of the treatment.  Each ART session is unique and specific to each patient given the nature and severity of their condition. After being treated with ART, patients typically respond rapidly with decreased pain and increased flexibility and mobility. A few sessions may be needed depending on the tissues response to each treatment.

Other Benefits?

ART is not only used to treat specific injuries once they occur. By incorporating ART into any training regimen or daily life can prevent injuries from wear and tear we apply on our bodies, it can reduce recovery time and help with overall maintenance. Routine ART treatments prevent accumulations of scarring in the tissues and stress on the joints, tendons and ligaments leading to reduced risk of acute or overuse injuries.