Diastasis Rectus Abdominis

Diastasis Rectus Abdominis (DRA) is a condition that effects 3 million men and women each year. It is most common in pregnant women, in fact 2/3 of expectant mothers will experience related symptoms. DRA is when the 2 sides of the abdominal muscles separate due to the tissues connecting them becoming loose and stretching them apart. DRA is common in pregnant women because of the uterus expansion due to the growing fetus, and the stress around the surrounding structures. The rectus abdominis, specifically the linea alba (connective tissue connecting the right and left sides of the rectus abdominis), is the structure that is most effected. The constant stretching of the linea alba causes it to become weak which can eventually lead to a separation, especially during the second and third trimester due to rapid growth.

Risk Factors

  • Expecting mothers over the age of 35
  • Being pregnant with multiple children
  • Having multiple pregnancies within a relatively short amount of time
  • Strenous physical work
  • Obesity
  • Weightlifting
  • Frequent or rapid changes in weight

Symptoms:

  • Visible or palpable seperation of the rectus abdominis
  • Distended abdominal wall
  • Pelvic floor dsyfunction such as incontinence, leakage, or constipation
  • Low-back, pelvic, and/or hip pain
  • Poor posture
  • If you are experiencing any of the symptoms above reach out to a licensed physical therapist. An abdominal examination will identify the degree of separation of the core muscles, and a posture, movement, and muscle evaluation.

Quick Tips:

  • No sit-ups or push ups
  • No quadruped positions
  • No swimming
  • No yoga positions such as downward facing dog
  • No lifting of heavy objects
  • No front-loading baby carriers
  • Rolling to your side when you get up off the floor or bed
  • Lift the pelvic floor, engage abdominal core and bend at the knees and hips when lifting small objects

A physical therapist can help with DRA by addressing postural training, core activation, sequencing and coordination during functional activities and education. Bracing techniques can help to provide external support especially during the early stages of rehab and will provide proprioceptive feedback for the proper positioning of the midsection.

Don’t live in pain or shame if you are experiencing DRA. Seek help and regain function to improve your quality of life by visiting a physical therapist today.

Urinary Incontinence

A new born baby eliminates urine and feces at will. The bladder and bowel empty without thought or inhibition. At the end of life there often might be the same pattern. But between these two phases of life an important control function is toileting, releasing urine and bowel movement at the appropriate time and place. Day to day being dry and in control when urine or bowel movement is released is expected in our society. It is assumed that everyone is dry as they perform their daily activities at home and in the community. If an individual experiences leaking he or she often feels like “the only one”, “the weak one”, “the inferior one”. The truth is that 25 to 30% of adults 25-55 years old have experienced bowel and bladder problems at some time. 1-2 % of adults leak at night. 35-40% of community dwelling individuals have bowel and bladder problems. 10-15% of children 8-16 years old have night time wetting problems and 3-5 % have bowel dysfunction. Incontinence is twice as common in women than in men. Although, urine leakage is a very common problem it is not normal and should be addressed. 19.5 million dollars are spent on UI treatment annually but mostly on evaluation and not treatment.

Urine is stored in a muscular sac called the urinary bladder and passes out through a tube called the urethra. The bladder and urethra are supported by the pelvic floor muscles as well as ligaments in the pelvic cavity. The urethra has internal and external stoppers called sphincters that allow or prevent the passage of urine. When the bladder muscles contract suddenly or the sphincter muscles are not able to stop the flow of urine, is when involuntary leakage of urine occurs. Voiding mechanism is coordinated at several conscious and unconscious levels by the brain, spinal cord, nerves and muscles. At times when the pelvic organs like the rectum or uterus are displaced, they can start putting pressure on the bladder and lead to decreased ability to void or untimely leakage.

The most common type of urinary incontinence is stress incontinence which is increased abdominal pressure on the pelvic floor causing weakness and lack of support of the pelvic floor muscles which can lead to urine leaking during any type of physical activity (sports, laughing, sneezing). Stress incontinence can be caused pregnancy, labor, childbirth, episiotomy, an injury or trauma to the pelvic floor, organ prolapse, inflammation, infection, surgery or high impact exercise.

Urge incontinence is when a person suddenly has a strong need to pass urine or may leak before reaching the bathroom. This may be caused by the loss of coordination between the pelvic floor muscles and the urgency to urinate resulting in the inability to keep the urethra closed. Urge incontinence may also be caused my learned behaviors. For example, if you always go to the bathroom when you get home from work, your body may feel the urge to go to the bathroom on your way home before you reach your destination.

A combination of the above two problems is termed mixed incontinence.

Functional incontinence is the intense urge to urinate with leakage before reaching the bathroom. It could be caused by factors unrelated to the bladder of pelvic floor which include confusion and dementia, psychological problems, using walkers (slows down movements), or environmental barriers, such as rugs or furniture, that block easy access to the bathroom.

Many people experience an urge to urinate in the middle of the night or may unconsciously lose urine at night-termed as nocturnal enuresis.

If you suffer from any the above issues, do not hesitate to reach out to your healthcare provider to seek the root cause and appropriate treatment. Talking about your problem and just not keeping it a secret anymore might be a big step. Physical therapists being musculoskeletal experts, will be a big part of a team that will be involved in your treatment process.

Your Physical therapist will take a detailed history to understand your condition, evaluate your musculoskeletal system including your pelvic floor muscles and design a plan of care according to your functional goals. Physical therapy treatment will involve gentle manual soft tissue or joint mobilizations, manual stretching, strength training with manual cuing, relaxation and breathing exercises, tips on appropriate nutrition and lifestyle changes, bladder retraining and functional exercises to incorporate timely engagement of your pelvic floor muscles during activities ranging from child care to sports specific exercises. The Physical Therapist might also refer you to other healthcare professionals per your requirements. An open communication among your healthcare team and your compliance with your treatment instructions, will be instrumental in a successful outcome like regaining control over your symptoms, reducing the need for pads/special undergarments, medications, and avoiding possible surgery.

Stay hydrated, minimize foods that irritate the bladder wall like caffeine, alcohol, milk products, artificial sweeteners, citric fruits, avoid constipation and foremost- stay in tune with your body.

For further information call Synergex Physical therapy today to schedule a free 15 minute telephone consultation to determine if Physical therapy is right for you.

Living Pain-Free with TMJ

Temporo-Mandibular Joint (TMJ) disorder is an altered functioaning of TMJ leading to pain in and around the jaw and facial muscles that control jaw movements. TMJ is more frequently used than any other joint in the body during talking, swallowing, and breathing. You can feel this joint in front on your ear, below the temples. It can produce between 134-190 pounds worth of force. Symptomns that you may have with TMJ include pain in the ear, face, jaw, or neck when you open and close your mouth. You may also experience heahaches and or dizziness. One or many factors can lead to TMJ issues- trauma to the face, teeth, jaw alignment, arthritis, muscle tension, faulty habits or postures, teeth grinding or TMJ disc disorder being some of them. Behavior, social, cognitive, and enviornmenal factors can also play a role in causing TMJ pain.

If you are experiencing the symptomns metioned above, there could be a solution to alleviate your pain. There are many ways to manage TMJ pain and prevent it from recurring. Consult your dentist if you expeirence teeth grinding to minimize it with a custome made night-time rigid mouth guard. Use an ice pack for sharp pain (usually joint related) or a heating pad for dull aches (usually muscular). Heat or ice should not be used for more than 20 minutes. Massage the muscles by the ears, inside the mouth, and on the side of the neck to release muscle tension. Try to keep the neck muscles as relaxed as possible by sitting up with the back well supported, not craning your neck during everyday activities, and not cradling a telephone between your shoulder and cheek. Altering your sleep positions can also help with decreasing stress on the TMJ.

Preventing TMJ pain starts with proper dental care. Make sure to see the dentist every 6 months, use a soft-bristle toothbrush or a sonic toothbrush. Have your dentist give breaks during long dental procedures to prevent TMJ from overstretching. In addition, you want to avoid prolonged chewing on gum or biting on hard foods like taffy. Certain habits like chewing on the inner cheek, lower lip, or your tongue can also stress your TMJ. Try to use molars on either side equally when chewing.

A physical therapist can offer significant relief from TMJ pain and help to restore the natural movement of the jaw. Posture education, manual therapy, pain-relief modalities like ultrasound, and different exercises will be utilized to treat your TMJ symptoms.

Don't let yout TMJ pain control your daily life, try these tips and seek help from your Physical Therapist today!

Vertigo, Imbalance, Dizziness

What is Vertigo?

Vertigo is caused by a inner ear disorder, in which a person experiences a false sensation of himself or the world around him spinning.  Common symptoms include spinning sensation, floating, imbalance, nausea, and light-headedness with quick head movements or- turning in bed. One of the most common types of vertigo is BPPV- Benign Paroxysmal Positional Vertigo. BPPV is a mechanical problem in the inner ear where tiny calcium carbonate crystals, otoconia, become dislodged from their natural placement within the gel in the utricle (balance organ than senses head tilt and linear motion). When otoconia accumulate in the semicircular canals(balance organ that sense angular motion), they stimulate the nerve endings in the inner ear as well as our eye muscles causing false sense of movement leading to imbalance and nausea.  

Is treatment available?

Yes. One of the treatment methods used to target the symptoms of vertigo is the Canalith Re-positioning Maneuver- Epley , Liberatory or the Apiani, depending upon which semi-circular canal is affected. A PT trained in treating these conditions can perform some specific and quick tests to match the right procedure to your condition. In this method, a trained therapist will treat a patient using a specific series of head and neck movements. The motion in this maneuver aims to displace the tiny crystals of calcium carbonate, to their original location within the inner ear. Proper placement will prevent these crystals from sending false signals of movement to the brain, thus restoring balance and alleviating motion sensitivity. 

What other Vestibular conditions PT’s treat…

Physical therapists can treat a variety of vestibular and balance disorders including concussion, labyrinthine dysfunction, vestibular neuritis, post-surgical conditions dizziness. Vestibular rehabilitation therapy (VRT) can alleviate your symptoms and help you to return to your normal level of activity. VRT is a method that uses habituation exercises, eye muscle exercises, and balance and proprioception training exercises to improve balance during functional activities. A physical therapist will assess you to identify the root of your balance deficits  and address these through educations, individualized home exercises and home exercise program to help you resume your prior activity level.

Winter is Around the Corner!

Tips to help you have a Safe Holiday Season

Given the changing weather conditions during this time of year, it is important to be cautious of winter conditions such as snow, ice, and the cold temperature. 

Most common winter Injuries & how we can avoid them: 

1.       Falling on snow & ice

  • Making sure your winter shoes have good traction is important. When purchasing winter shoes, pay close attention to the material and tread pattern on the soles of the shoes. Plastic or leather shoes are not optimal slip-resistant materials, a good tread design on the sole of a shoe is one that is spread out and has depth. 
  • While proper footwear is helpful, it is equally as important to be conscious as you walk outdoors in the winter, because black ice can be present. Instead of only looking down as you walk, try to glance in front of you to detect uneven surfaces that are in your direction.
  • Keep your arms and hands close to your body and take small steps like a penguin when walking- ankle is positioned under the hip. If you take big steps, placing the heel of your foot too far ahead of you, and the rest of your weight is shifted backwards, you are more prone to fall.

2.      Experiencing muscle strain from shoveling snow/ scraping ice

  • Muscle contraction is directly affected by temperature. Oxygen is carried into your body through hemoglobin. In colder temperatures, oxygen is bound to hemoglobin more tightly which impedes the rate at which oxygen reaches the muscles. For this reason, you should always warm up before engaging in physical activity including activities like shoveling the snow. By warming up, more oxygen will be available to the muscles to allow for a stronger force of contraction.  
  • Muscle strain can occur in an instant, or over time. Acute muscle strain can be a result of a slip/ fall, or heavy lifting; chronic muscle strain may arise from long-term harmful repetitive movement.  Acute strain can be minimized by being cautious of your movement, and avoiding strenuous activities. If you do not feel physically fit, shoveling heavy snow yourself may not be the best option. Look into finding an alternative by asking a neighbor/ friend, or hiring a snow cleaning service. Chronic muscle strain can be avoided by being aware of your form when you’re engaging in physical activity.
  • Some tips to keep in mind when shoveling snow is to find your balance before beginning to shovel the snow. Keep your feet wide and shift weight to the front foot when digging into the snow. When pulling the snow-filled shovel upwards, shift weight to the back foot and be sure to use the strength in your arms not your back when lifting. When throwing the snow, turn your body in the direction of the shovel instead of twisting at the waist.

3. Accidents while playing winter sports and activities

  • As we should do during all times of the year, wearing proper protective gear is key to having a safe athletic experience!
  • Be adventurous, but dive into it slowly. Trying a sport for the first time can go two ways, it may be a very enjoyable or a very frightening experience. While it may be very tempting to try new tricks, or experiment free-style, having the proper initial training is critical. With guidance from a professional, you can learn critical skills such as how to stop, slow down, and change directions. This basic training will help you have a safe experience.
  • Be mindful of barriers! Especially in popular winter sports, such as skiing and snowboarding, facilities will mark safe areas to be in. The cones, flags, and other barriers that are blocking off certain ground is placed for your safety. Do not venture off past marked trails. 

A Parent’s Guide to Concussion in Sports

According to the NFHS, National Federation of State High School Associations, it is estimated that over 140,000 high school athletes across the United States suffer a concussion each year. As a parent of active children, being aware of symptoms of a concussion is important. While many believe that concussions only occur when an athlete loses consciousness, in actuality, a concussion can occur even when symptoms are not as apparent.

Recognizing Symptoms:

A critical step you can take to ensure your child is having a healthy athletic experience is to be aware of warning signs of a concussion. You may notice changes in your child’s behavior or thinking, or your child himself may complain about cautionary symptoms.

Symptoms:

Thinking

  • Feels confused
  • Appears dazed or stunned
  • Not thinking clearly
  • Slow process of thinking
  •  Concentration/ Memory problems

Physical

  • Nausea/ Vomiting
  • Headache
  • Dizziness/ Imbalance
  • Blurred vision
  • Sensitivity to light/ noise
  • Diminished energy

Emotional

  • More emotional
  • Anxious/ nervous
  • Easily upset/ angered

Sleep

  • Changes in normal sleep pattern
 When one or more of these symptoms are evident, it is important to
1.       Stop sport/ activity                           2. Seek medical evaluation

When Can An Athlete Return to Play?
No athlete should return to play on the same day.
All athletes who sustain a concussion must undergo an evaluation by a healthcare provider and must be clear of all symptoms during physical testing. Even if it appears that your child is symptom free, healing my not be complete. For this reason, ample rest is required for complete recovery.

  • Following medical clearance, a return to play schedule should be followed to allow the brain to re-adjust to exertion. This schedule should be enforced over time allowing your child to be asymptomatic for each step for a period of time prior to progressing. 

Step 1: Light exercise, including walking or riding an exercise bike. No weight-lifting.
Step 2: Running in the gym or on the field. No helmet or other equipment.
Step 3: Non-contact training drills in full equipment. Weight training can begin.
Step 4: Full contact practice or training.
Step 5: Game play.

When Can An Athlete Return to Learn/ School?

  • Just as a child should gradually increase physical activity post-concussion, all cognitive activities should slowly be reintroduced after a period of rest. By consulting your doctor, you can create the optimal return to learn schedule for your child similar to the one presented below. 

Step 1: Post concussion take a rest from cognitive activities. 
Step 2: Slowly reintroduce light cognitive activities for short periods of time (coloring, drawing,                        listening to audio books, and watching television).
Step 3: School-specific activity can be increased gradually (up to 30 minutes). 
Step 4: Allow your child to return to school under a modified schedule. This means fewer classes, or                providing extra time to complete activities when needed. 

* Note: If symptoms worsen at any time, allow your child to rest until symptoms improve. When they improve, the child may return to class. 

By having a deeper understanding about concussion identification & care, you will be able to help your child live a healthier lifestyle. 

Physical Therapy: A Beginner's Guide

Physical Therapy

A Beginner's Guide.

Who are Physical Therapists?
Physical Therapists (PT's) are movement specialists who treat individuals of all ages who have health related conditions that limit their ability to move and perform functional activities in their daily lives. They can work with patients to offer preventative care or even to develop fitness programs to promote healthier living.

What qualifications do PT's have?
PT's are required to receive a graduate degree from an accredited PT program. As of 2015, all accredited PT programs are Doctor of Physical Therapy (DPT) programs in which a student will receive a doctorate after successful completion. In order to practice, students must pass a national licensure examination. A PT must also acquire state license in each state he or she wishes to practice in. There are several areas of practice that PTs can specialize in, such as Neurology, Orthopedics, Pediatrics, Women's Health, Geriatrics etc. Seeing a specialized clinician can ensure effective and efficient care.

Where do PT's Practice?
You may encounter PT's in a variety of settings. From inpatient facilities, tofree standing outpatient clinics, to schools, or even at workplaces. PT's can be found working with a large population base to help promote wellness.

What can a PT assist me with?
PT's are qualified to help treat patients with a range of conditions. From working with a patient prior to surgery for preventative care, to helping a patient after the surgery to assist with healing, a therapist helps promotes well-being, and maintenance of functionality. Commonly, PT's work with patients who experience joint or muscle pain, loss of balance, feelings of dizziness, difficulty with gait, spasticity, concussions, and lymphedema.

How can I find the right PT for me?
Most importantly you should know that in all 50 states in the US, you can use some form of direct access to visit a PT without a physician's referral. You have the freedom to choose your PT! Here are a few tips to help you find the right PT for you:

·         Make sure you find a Licensed PT. Always make sure you are receiving care from a qualified professional.

·         Do some research to find a PT who specializes in the area you need care in. 

·         Find out if you will be receiving care from a PT or a PTA. PTA's are licensed therapy assistants who provide care under the direct supervision of a licensed Physical Therapist.

·         Check with your insurance plan if your PT facility is in network with them, as they will offer you services at a lower contracted cost than out of network providers.