Thursday, November 15, 2018

Benefits of Activator Poles compared to the use (or in conjunction with) of Canes, Crutches and Walkers

Is there a more effective alternative to traditional passive devices such as canes, crutches and walkers for rehabilitation? The case for the ACTIVATOR Poles.

Specialized walking poles called Activator Poles are being internationally recognized as revolutionizing rehabilitation practices. The evidence-based Poles are being prescribed as a highly effective alternative (or in conjunction) to traditional passive devices such as canes and to reduce/delay the use of crutches and walkers (when appropriate) to improve outcomes for balance, core strengthening, off-loading and normalizing walking patterns.

Patients are also praising the Activator Poles for promoting the concept of Ability vs Disability associated with canes, crutches and walkers. Developed by a Canadian therapist, Mandy Shintani BSc (OT), MA (Gero), the Activator Poles have been the focus of presentations at the International 200 Years of Parkinson’s Disease conference, National Fall Prevention Conference and last month at the International Stroke Congress. They are prescribed in neurology, orthopedics, geriatrics, spinal conditions, pediatrics across Canada and now internationally. 

For the past 5 years I have consistently recommended the Activator poles for patients… they have been especially helpful for spinal stenosis patients who have undergone surgical decompression…. They have been instrumental in promoting an upright posture and a functional walking pattern compared to canes and walkers. In my opinion they facilitate rehabilitation and return patients to optimal function faster.” Dr. Charles G. Fisher MD MHSc FRCSC, Surgeon, Past President of the Canadian Spine Society

These photos below highlight some of the challenges associated with cane use with the stroke population including; trunk rotation, hip hiking, no arm swing of the affected arm, leaning to one side and limited weight-bearing on the affected leg (picture on left side). Canes provide a visual, proprioceptive and sensory cueing to the normal side however, rehabilitation modalities should be focusing the patient’s attention to the affected side. In comparison, Activator Poles promote bilateral cueing to the affected arm and leg, greater arm swing, weight bearing on the affected leg, upright posture and truck facing forward. The technique of using walking poles mimic the same pattern as normal walking, opposite arm and leg movement.

                Stroke client with Cane     Stroke client with Activator Poles

In 2005, Mandy Shintani discovered the concept of Nordic walking poles from her Swedish neighbour who indicated that the activity was very popular in Scandinavia by people of all ages and fitness levels. Recognizing that walking poles would be effective for the key goals of rehabilitation, she re-engineered the Activator Poles with design features for increase safety and stability for rehabilitation clients. They are backed by 8 recent/current research studies on reducing the risk of falls, balance, mobility, off loading on the knee joints and posture at the renowned Royal National Orthopedic Hospitals in the UK. Wendy Walker, UK neurological therapist comments on the patented Core Grip design which was developed for engaging core strengthening with each step, off loading and weight bearing for balance. The handle was designed without straps which are related to the highest rate of injury according to a German study by Knobloch et. al., 2006. 

"The Activator poles have a unique hand-grip which enables the user to stabilize their arm through the lateral border of the hand, thus providing a little more stability than standard walking poles as well as promoting a more neutral wrist posture.UK neurological therapist Wendy Walker, Physiopedia, Dec 2016 

While therapists initially prescribed ACTIVATOR Poles for gait retraining and mobility in Canada, they are now utilized extensively for innovative seated, standing and pre-gait exercises, with many of these exercises now found on the PT-Helper App. The Poles provide the same benefits for exercise including; promoting an upright posture, allowing greater ROM with bilateral support, sensory and visual cueing to the affected side. Core strengthening can be activated by applying a downward pressure on the ledge of the CoreGrip while exercising. Here are some sample exercises below.

The patented Activator Poles are now being launched into the USA. To learn more about the research, technique, use and contraindications of the Activator Poles, register for a 30-minute introductory webinar called Internationally Renowned Activator Poles on Wed Dec 5, 2018. With registration, you can receive a recording via email if you are unable to attend the live session. PT-Helper users can also use the coupon code of TRIAL2018 at to obtain the Activator Poles at 30% off*. For more information, videos on the adjustment and technique as well as research visit 

*one coupon code per rehab professional. Available until December 31, 2018.

Start your Free 30-day Trial of the PT-Helper CONNECT service for physical therapists and other wellness professional, to prescribe Home Exercise Programs.

Download the PT-Helper mobile app for patients and exercise enthusiasts to create your exercise program.

Thursday, November 8, 2018

Exercises Before & After Hip Replacement Surgery

Hip replacement surgeries have grown in the United States from 138,700 in 2000 to 310,800 in 2010. The growing elderly population has contributed to the rise in these numbers where 2.3% of adults 50 years and older have had a hip replaced. By 80 years of age, 6% of this population will have had a hip replaced.

Improvements in joint replacement surgery has reduced the risk as well as shortened the recovery time resulting in improved lifestyle of the patient. A significant component to regaining mobility after surgery includes physical therapy.

Prior to surgery, you can start doing hip exercises to build strength to help your recovery. Possibly more importantly, doing exercises prior to surgery establish the practice and routine of doing your exercises that you will need to continue post-surgery. This is particularly important if your hip pain has prevented you from maintaining an active lifestyle.

Fortunately, hip exercises pre- and post-surgery are very similar.

The American Academy of Orthopaedic Surgeons has provided a “Total Hip Replacement Exercise Guide” which has many of the same exercises recommended by Allina Health in their “Before Surgery Exercise Program”. You can find these exercises within the PT-Helper mobile app.

Reminder: Please consult your physician or physical therapist before engaging in any physical activity and stop if you experience pain or discomfort.

Some of these recommended exercises can be found below:

  • Ankle Pumps - While sitting or lying down, pump your ankles up and down.


  • Quad Sets - Lie on your back with one knee bent and the other leg straight. Tighten your thigh muscle on the straight leg and push the back of your knee against the ground. Hold. Relax.

  • Short Arc Quads - Lie on your back with one leg over the bolster and the knee bent. Tighten your muscles on the top of your thigh and straighten your knee. Hold. Slowly lower to starting position while keeping the bottom of the knee resting on the bolster.

  • Straight Leg Raises - Lie on your back with one leg bent and the other leg straight. Tighten the front of your thigh of the straight leg. Keeping the leg straight, raise the leg off the floor or bed no higher than 45 degrees. Keep thigh muscle engaged on the way down too!

  • Knee Extension (sitting) – While sitting, raise your leg by straightening your knee fully while contracting your quad. Slowly lower your leg. Weights may be placed around your ankle.

  • Hip Abduction - Standing straight, keep both thighs tight. Kick out to the side keeping toes straight ahead and both legs straight, then return to starting point.

Reminder: Please consult your physician before engaging in any physical activity and stop if you experience pain or discomfort.

Start your Free 30-day Trial of the PT-Helper CONNECT service for physical therapists and other wellness professional, to prescribe Home Exercise Programs.

Download the PT-Helper mobile app for patients and exercise enthusiasts to create your exercise program.

Thursday, October 25, 2018

Preventing Falls in Seniors with the Otago Exercise Program

Preventing falls in older adults can save them from significant health consequences. A study revealed that more than 1 in 4 adults over 65 years of age had a fall in 2014. From those falls, 27,000 adults died because of their falls and 2.8 million were treated in emergency room departments for fall-related injuries.

According to the Centers for Disease Control and Prevention, some conditions that are more likely to cause older adults to fall include lower body weakness, difficulties with walking and balance, as well as foot pain or poor footwear. 

The Otago Exercise Program was developed in New Zealand and has been shown to reduce falls between 35-40% for frail older adults. Research at the University of North Carolina at Chapel Hill School of Medicine and Center for Health Promotion and Disease Prevention has shown statistically significant improvement in as little as 8 weeks.

The Otago Exercise Program can be found in the PT-Helper exercise library inside the Geriatric category. Some exercises from the program are shown below:

  • Ankle Pumps - While sitting or lying down, pump your ankles up and down.


  • Seated Marches - While seated in a chair, lift one knee up and return it to the ground. Lift the other knee up and return it to the ground. Repeat.


  • Hamstring Curls with Support - Standing with good posture in front of a solid table, bench or kitchen sink. Look straight ahead. Rest your hands on the bench. Start with your legs together. Lift one heel up bringing your foot towards your bottom. Then bring it back down. Repeat. (If you lose your balance, grasp the table, bench or kitchen sink to regain your balance.)

The Otago Exercise Program is meant to be delivered in the home and doesn’t need any special equipment to complete.

Reminder: Please consult your physician or physical therapist before engaging in any physical activity and stop if you experience pain or discomfort.

Start your Free 30-day Trial of the PT-Helper CONNECT service for physical therapists and other wellness professional, to prescribe Home Exercise Programs.

Download the PT-Helper mobile app for patients and exercise enthusiasts to create your exercise program.

Tuesday, October 16, 2018

How to Create a HIIT Program on PT-Helper

After attending the National Strength and Conditioning Association’s 2018 Personal Trainer conference, it has become obvious that there is an incredible array of exercise options that personal trainers or wellness coaches can recommend to their clients. Variations include weight training, suspension trainers, kettlebells and many others. High Intensity Interval Training (HIIT) continues to be a very popular approach to improving athletic conditioning in a short period of time.

This blog will show how to easily create a HIIT program in PT-Helper CONNECT that you can prescribe and customize for each client.

We will use this article “The Ultimate HIIT Workout For Weight Loss — No Equipment Needed” as a reference guide to our HIIT program. To simplify this how-to, we will only include 3 exercises into the HIIT program: high knee skips, plank jacks, and lateral bunny hops.

When creating a HIIT program within PT-Helper, it is best to define the Hold time to correspond with the high intensity anaerobic interval period while the Rec. Time (within PT-Helper) would correspond with the low intensity recovery periods within the HIIT. With this in mind, you would add the exercise pictures to the program in the following manner:

You will want to add your exercise pictures in a similar order of rest (or starting position), interval, recovery, interval, recovery, …. The program will follow the sequence of images from left-to-right and top-to-bottom.

In the example above, the program will start with high knee skips, recovery, plank jacks, recovery, and lateral bunny hops, and recovery. If there is more than 1 repetition specified for the program, the sequence will repeat after the recovery following lateral bunny hops. Then the program will start the second repetition with high knee skips.

In the article, the author recommends 30 seconds intervals and 30 seconds recovery times. Following this recommendation, the exercise parameters would be set to

If you are following a Tabata regiment, you would set Hold Time to 20 seconds while Rec. Time would be set to 10 seconds.

The number of Reps represents how many times your client would repeat the HIIT sequence.

For the demo video below, we have set Hold Time to 6 seconds while Rec Time is set to 4 seconds to keep the video short.

 HIIT Demo Video

If you have any questions on how to create exercises within PT-Helper CONNECT, please contact us at

Tuesday, October 9, 2018

The Path to Exercise Adherence

I had the wonderful opportunity to attend Dr. Mike Israetel’s presentation “From Inspiration to Passion” at the National Strength and Conditioning Association’s 2018 Personal Trainer conference. I believe that the points he made are also valid from the perspective of getting physical therapy patients to adhere to their home exercise program.

Dr. Israeltel’s presentation addressed adherence in diet and fitness clients. He highlights that the client’s desire to adhere to the plan will fluctuate over time and psychological states. He identifies six constructs that clients/patients go through that coaches/therapists can utilize to maintain exercise compliance.
  1. Inspiration
  2. Motivation
  3. Intention
  4. Discipline
  5. Habit
  6. Passion
Inspiration: Inspiration represents the patient’s first step towards recovery. For PT patients, an illness, injury, significant pain, or functional mobility issues are the typical sources of inspiration to visit you, the physical therapist. Unfortunately, inspiration doesn’t last long and can quickly disappear when the patient realizes that you actually want them to exercise to get better and can’t wave your magic wand or give them special pills to suddenly make them better.

To help inspire your patients, you can educate them about the benefits of home exercise and provide them with relatable success stories.

Motivation: Motivation is the desire to do something about a goal and begins after inspiration. It is a less intense emotion compared to inspiration but longer lasting. Motivation will rise and fall but is not dependable in the long term.

From a physical therapist’s perspective, recognizing that your patient’s inspiration may end before the completion of their initial evaluation, you need to start helping them activate their motivational emotions by helping them set specific and realistic goals in their first visit.

As motivation will fluctuate, it is important to add another layer of structure to overcome the periods when motivation is low.

Intention: Intention is a commitment to actually do something and can give your patient the impetus to fill in the adherence gap when motivation is low. Intention develops within days of beginning the program and is especially important in the first month of the program.

To help develop intention in your patients, you can help them create a plan to execute their exercises to achieve their goals. Plan details don’t matter nearly as much as having a plan.

Discipline: When your patient’s motivations are low, they need discipline to fulfil their intentions. Your patients can use willpower to execute the plan.

You can help your patient by cultivating their discipline. You can remind your patients that motivation will wane and sometimes it will be tough to get through their home exercises. Remind them that it will get better but they have to continue with their plan.

Unfortunately, willpower is exhaustible and can be consumed by other aspects in your patient’s life. If your patient is experiencing high level of stress or other demands on their life, they may not have any willpower left to apply to do their home exercises.

Habit: After more than a month, activities soon start to become habits. The longer your patients regularly do their home exercises, the stronger the habit becomes. Maintaining a habit requires less discipline resulting in better compliance.

An exercise plan that suits your patient’s preferences are more likely to become habits. Understanding your patients and creating a home exercise plan that is sustainable and convenient for them is more likely to become a habit. Asking non-active patients to suddenly allocate an hour a day towards home exercise is likely not going to become a habit.

Passion: Passion is a deep love for the process of exercising.

Most physical therapy patients will not be under treatment long enough to develop a passion for exercising. However, physical therapy can lead a patient towards a passion for wellness and fitness that they pursue with a health and fitness coach.

Recognizing what your patients are passionate about may help you motivate them to exercise to get back to doing what they love to do.

Tuesday, October 2, 2018

Making Exercise A Habit In Your Kiddo

Guest blog by Richa Kohli

Like many other moms, it was also my concern that my kid is not involved in any outdoor sports or do any kind of exercises. Kids nowadays are very much involved in video games and mobile games that they refuse to go out of the house to play. During a recent visit to the doctor for a routine checkup, I came to know that my 8-year-old is overweight. That was the time when I decided to search for smart ideas to keep my kid engaged in fitness activities.

  1. Set a goal – Setting up a goal can be really motivating. Set small goals, not unachievable ones. Once your kid is capable to reach for small goals, raise the bars.
  2. Let’s dance together – Enroll in a dance class together as dancing is a very good exercise and fun too,
  3. Park trips – Take them to the park and play with them. This will increase your fitness and is good for your kid as well.
  4. Bike buddies – Be a bike buddy with your kid. It is a good cardio exercise.
  5. How about a work out video – Do the exercises together while watching a fitness video. Choose the one who does not have complicated exercises. Go for the simple one so that your kid can also do it. You can take a consultation with board-certified physical therapists at TheraNow.
  6. Get competitive – Get competitive in a healthy way. This can act as encouragement in kids and the kid tries to give their best.

Encouragement plays a very important role while you are trying something new with your kids. Do not get angry or scold them. Be patient, talk and tell them to know the importance to stay fit, what you are trying to do is good for them. Analyze your kid and see what are all their area of interest and how you can use them to incorporate fitness into them. You also share a special bond when you spend quality time with your kid while exercising. You should also monitor that your kid does not overdo anything as this can lead to injury. You can give rewards on the achievement of conquering a short-term goal. This will keep them encouraged and they will try to give their best every time.

Richa Kohli, CEO of TheraNow, is a young female entrepreneur and innovator with a vast knowledge of Physical Therapy field. Richa has a vision of making physical therapy services digitally available for everyone in the USA, provided by board certified and experienced therapists, ensuring convenience, effectiveness and lower cost of treatment. She is an avid healthcare blogger and also loves traveling the world.

Thursday, September 27, 2018

PT-Helper's September Blog Posts for Physical Therapists

Concussions and Neck Exercises
Published On September 18, 2018
Neck strength is being recognized as a prevention and rehabilitation strategy for concussions. Strong neck muscles can help control the motion of the head and control the brain motion inside the skull during an impact. PT-Helper has collaborated with Iron Neck to put their neck strength and mobility training exercises in our neck exercise catalog providing therapists with additional resources to avoid and rehab concussions.

Published On September 13, 2018
Therapists may customize an exercise based upon their own experiences or the restrictions and capabilities of their patients. Creating a new exercise within the PT-Helper mobile app is a simple way to add customized exercises to your Favorites program ensuring that you have all of your exercises with you. Using the built-in camera feature adds pictures and videos to help you remember how to do the exercises correctly.

5 Reasons Why Your Back Pain Keeps Coming Back

Published On September 4, 2018

By guest writer Dennis Treubig PT, DPT, SCS, CSCS.
80% of the population will experience back pain at some point in their lives. Dr. Treubig identifies the 5 most common reasons from his 10+ years of treating athletes and active individuals that cause recurring back pain.

Subscribe to the PT-Helper Blog here so you don’t miss these helpful compilations and BONUS, you’ll receive Our Secret Guide, unveiling the secrets your patients are keeping from you.