Thursday, January 10, 2019

Do You Use Your Patient’s SmartPhone to Prescribe Exercises

One of the more interesting responses that we get when we ask physical therapists “how do you prescribe exercises to your patients?” is “I use my patient’s phone and record them doing their exercises”. In many ways this is a great example of the therapist using the available tools to inform and individually customize their patient’s exercises.

With this behavior in mind, we have added the ability to add pictures and videos taken on the patient’s phone to prescribed exercises in the PT-Helper mobile app.

The PT-Helper mobile app provides a quick and easy way to view and select exercises from our library. From the app home page, select “Exercises by Category” to view the available categories of exercises. Select the appropriate category, in this example Shoulder, to view the list of available exercises.


Scroll up and down the list to select the appropriate exercise, such as Bilateral Shoulder External Rotation. Then select Add To Favorites. Once any exercise is added to Favorites, you can use the camera symbol located at the top left of the screen to take pictures or videos. You can take videos of your patient doing their exercises while giving verbal cues on how to do it properly. Since these pictures or videos are not exported by PT-Helper, they will remain private on the patient’s phone.

 
In the scenario where an exercise doesn’t currently exist within the library, you can easily create a new exercise within the app by selecting Create An Exercise and then adding photos or videos to the new exercise.


As long as they have their smartphone, your patients will have access to their prescribed exercises.  No more excuses of losing their exercise sheets. PT-Helper mobile app also has up to 3 daily reminders so that your patients don’t forget when to exercise.

Watch the short how-to video below to learn how to add pictures or video to the PT-Helper mobile app.



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, January 3, 2019

Low Back Stretches

By guest blogger Joane Chamberlain, PT, MOMT

The most effective things that you can do at home to decrease low back and neck pain is to do the back stretches and strengthening exercises that align your spine and level your pelvis.

The muscle that pulls the left side of your spine and pelvis out of alignment and causes left sided back pain (and may radiate into your left leg) is the quadratus lumborum muscle. It attaches to your lowest rib, lumbar spine and top of your pelvis (iliac crest).

In order to stretch it you need to stretch your left arm over your head and lean to the right, this stretch is demonstrated in the DVD, “The Missing Link to Neck and Back Pain Relief.” This stretch can help relieve left sided low back pain and sciatic pain in the left leg.

The muscle that pulls the right side of your low back and pelvis out of alignment and causes right sided back pain (which may also refer into your right leg) is the right hip flexor, the iliopsoas muscle. It attaches to all of the lumbar vertebrae, lumbar discs and then runs forward to attach to the front on your hip bone (femur). The iliopsoas muscle when tight and spasmed is very powerful for compressing your lumbar spine, pulling the right side of your pelvis out of alignment and contributing to herniated discs. It is commonly shortened in many of us because we tend to sit too much. This muscle is stretched with a lunge stretch by kneeling down, placing your left leg in front of you and leaning forward, keeping your shoulders up. This is a common yoga pose. This stretch is also demonstrated in the DVD,”The Missing Link to Neck and Back Pain Relief.” It can relieve right sided low back pain and sciatic or radiating pain into the right leg.

When you have pain that is centered in the lumbar spine you probably need to do both of these stretches. Stretching the right quadratus lumborum muscle or the left iliopsoas muscle will not hurt you, but will not help to relieve your pain. One needs to stretch the left quadratus lumborum and the right iliopsoas muscle to relieve pain and align the spine and pelvis.


Modalities like hot packs and cold packs will only treat your symptoms temporarily. If you are in the middle of herniating a disc (an acute disc disruption) a hot pack can actually hurt you, why is that? The nucleus pulposus is the jelly fluid that leaks out of your disc and herniates through the outside layer (the annulus fibrosis). The nucleus imbibes (attracts) fluid to itself so that under normal conditions the discs can hydrate and stay plump. However, when the disc is herniating and leaking through the outside layer of ligamentous tissue this imbibing action can cause the herniation to grow and increase the chances of nerve pain, etc. It is always safer to stick to cold packs.

If you have pain that is radiating past the level of your buttocks, it is best to be evaluated by a professional to make sure you are not herniating a disc, as it may not be safe to do any back stretches at that time.

About Joane Chamberiain, PT, MOMT (Master’s Orthopedic Manual Therapy)

Joane is the founder of Challenge Physical Therapy, Inc. in Thousand Oaks, California, the creator of “The Missing Link to Neck and Back Pain Relief” program (available as downloadable video), and lecturer / educator at hospitals, foundations and physical therapy clinics.

Joane came to the valuable discovery of how pelvic dysfunctions are a major factor in causing spinal pain through her own personal experience with back pain. She discovered how pelvic issues can be the underlying cause of neck, mid back and low back pain as well as many other potentially debilitating physical conditions. Her training in orthopedics and manual therapy, combined with her knowledge of treating the pelvis and spine, makes her an expert at eliminating pain and dysfunction throughout her patient’s bodies. She applies her expertise in orthopedics and manual techniques to treat all of the joints and pain throughout the body. Joane’s unique approach empowers patients to reduce their pain and rid their limitations, allowing them to resume the activities they love.

In 1981 Joane earned her Bachelor’s Degree in physical therapy from Mount St. Mary’s College in Los Angeles, California, and trained with pelvic specialist, Dr. Alec Thompson through 1988. She completed her Master’s Degree in Orthopedic Manual Therapy at the Ola Grimsby Institute, also in Los Angeles, in 1995.

After working as a physical therapist for over 20 years in the areas of orthopedic out-patient clinics, rehab, skilled nursing, home health, and acute care hospitals, Joane opened Challenge Physical Therapy in Thousand Oaks, California in 2000. Bringing the highest quality, most effective, cutting-edge treatments and empowering her patients with the ability to create a pain-free life are the hallmarks of her practice.


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, December 20, 2018

New Year’s Resolution

It’s almost the end of 2018 and time when many people create a New Year’s resolution. According to Wikipedia, a New Year’s resolution is when “a person resolves to change an undesired trait or behavior, to accomplish a personal goal or otherwise improve their life.” For many people in the U.S., their New Year’s resolution will include getting fit or losing weight to improve their health.

Succeeding in your fitness goals can be improved if you find an activity that you enjoy. In my family, we have a tennis player, a power lifter, pickleball player, tai chi participant, and cyclist. Although we all have our different activities, we have friends that we’ve met through our activities that help motivate us to continue to stay involved. Scheduling activities with friends and family creates additional motivation to show up. Participating in a tennis league, meeting friends at the gym, or planning a group ride also adds a level of competition that can help improve your skills and fitness.

Fitness can also be gained with other activities like walking or dancing. This video of Toni Basil dancing at age 74 is just incredible.

 Toni Basil Dancing at 74 years old.


According to the Washington Post, 58% of U.S. adults never do any muscle strengthening exercises. As a result, taking baby steps are important to making progress towards a healthier you. This article 22 New Year’s Resolution Ideas That Will Make 2019 Your Best Year Yet suggests breaking down your resolution into smaller goals such as focusing on your core.

You can do exercises such as:


  • Plank on Elbows - Lie on your stomach with your forearms resting on the ground by your side. Tighten your quads to keep your legs straight. Tighten your abdominal muscles and raise your body by pushing up on the floor so that only your forearms and toes are touching the ground. Keeping your body straight, hold your position. Lower yourself back to the floor. Relax and then repeat. Don’t forget to breathe while holding your position.



  • Side Plank with Knees Flexed - Lie on your side with your lower forearm supporting your upper body. Your knees should together and bent at 45 degrees. Place your upper arm along the side of your body. Tighten your quads and abdominal muscles, raise your hips off the floor. Hold. Lower your hips back to the floor, relax and then repeat. Don’t forget to breathe while holding your raised position.



  • Bridge - Lie on your back with both knees bent, feet flat on the floor and arms at your side. Engage your abdominal muscle then raise your hips up trying to make a straight line from shoulders to knees. Hold then lower down slowly keeping abdominals tight.



  • Hand and Knee Balance (Bird Dog) - Position yourself on your hands and knees, with arms shoulder width apart and knees slightly apart. Tighten your abdominals, raise one arm and opposite leg slowly until they are horizontal. Keep hips even and back flat. Hold. Return to starting position and relax. Repeat with opposite arm and leg.



  • Dead Bug - Lie on your back with your arms extended in front of you as if you are reaching for the ceiling. Bend your hips to 90 degrees then bend your knees to 90 degrees. Flatten your back onto the floor, rotating your pelvis up. Tighten your abdominal muscles. Extend one leg, straightening the knee and hip to drop the leg just above the ground. Simultaneously drop the opposite arm above your head just above the ground. Make sure to keep your back flat on the floor. Return to the starting position. Repeat with the opposite side.


You can find these exercises in the Fitness - Core category in the PT-Helper mobile app to add to your Favorites which allows you to customize each exercise’s repetitions, sets, and hold time. You can also set up 3 daily reminders to notify you when to do your exercises.


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.

                      

Thursday, December 13, 2018

Frozen Shoulder Exercises

Shoulder exercises are among the most commonly searched exercises in Google when compared to exercises of other body parts.

In 2006, about 7.5 million people in the US went to the doctor for shoulder problems with more than 4.1 million of these visits for rotator cuff problems. According to the American Academy of Orthopedic Surgeons, shoulder injuries are often caused by repetitive motion activities such as swimming, tennis or weightlifting. Shoulder injuries can also be caused by regular daily activities. An unusual example is when a good friend injured his rotator cuff while on a Mighty Mouse amusement park ride: he had his arms up in the air when the car took a sharp turn causing a high lateral G-force whipping his arms to the side while his body moved in a different direction. Ouch!

The shoulder is the most movable joint in our body but can also be unstable because the ball of the upper arm is larger than the shoulder socket that holds it. To remain in a stable or normal position, the shoulder must be anchored by muscles, tendons, and ligaments. Common problems according to the US National Library of Medicine include

  • Sprains and strains
  • Dislocations
  • Separations
  • Tendinitis
  • Bursitis
  • Torn rotator cuffs
  • Frozen shoulder
  • Fractures
  • Arthritis
Rest, Ice, Compression and Elevation (RICE) is often the first treatment for shoulder problems. However, prolonged rest or lack of motion in your shoulder can lead to a Frozen Shoulder. The Cleveland Clinic recommends that the “chance of a frozen shoulder can be prevented or at least lessened if physical therapy is started shortly after any shoulder injury in which shoulder movement is painful or difficult”.

The American Academy of Orthopedic Surgeons shares some example stretches that can be done at home to help with a frozen shoulder. Variations of these can be found in PT-Helper’s exercise library.
  • Wand External Rotation - While lying on your back, hold a wand with your involved side palm up and un-involved side palm down, elbows bent. Using your un-involved hand, move the wand away from your body while keeping your elbow of your involved side at your side until you feel a stretch. Hold then pull the staff back across your body back to your starting position. Hold then repeat.

 

  • Active Assisted Supine Flexion - While lying down on your back, grasp your hand or forearm with your opposite hand. Raise arms up and overhead as far as comfortable to feel a stretch in the affected shoulder. Hold, then return to starting position.


  • Posterior Capsule Stretch - Cross one arm over your body and grasp at elbow with opposite arm. Gently pull hand towards opposite shoulder. Hold, then gently release. Your therapist may advise you to perform laying on your side, or leaning against a wall. Do not perform this exercise if you feel a sharp pinch in the front of your shoulder. Stretch should be felt in the back of your shoulder.


You can find these exercises in the Shoulder category in the PT-Helper mobile app to add to your Favorites which allows you to customize each exercise’s repetitions, sets, and hold time.

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.

                      

Thursday, December 6, 2018

THE INFAMOUS LOW BACK

By guest blogger Guillermo Contreras

One of the most common areas we see individuals report injuring, and we’d argue any physical therapist or CrossFit coach/trainer, is the low back!

In fact, most research shows that throughout a lifetime, the prevalence of non-specific low back pain is estimated at 60%-70%. That means if you take a look around your own CrossFit box, 60-70% of your fit fam will experience low back pain during their lifetime. A study in 2012 showed that in the United States alone, there were approximately 2 million incidents of low back pain in one year!

Why do we share that? Because we want to make sure that you know that, well…”stuff” happens and sometimes you get hurt. But! We want to make sure you know that there are people out there make it their goal to help you get better, reduce your pain, move better, perform better and ultimately help make you a stronger more resilient athlete.

That’s where CrossPhysio comes in! If you CrossFit long enough, chances are high you may feel the occasional ache and pain. Unfortunately, you may also experience an injury. The following exercises are three of our favorite exercises to help you get back following a back injury and reduce the risk of injury from occurring.

**Let us start by quickly mentioning that these exercises are not a fix-all strategies. Pain and injuries are complex and we do not claim that these alone will help with all that you may be dealing with currently. If you are injured, please seek the advice and guidance of a rehab professional if you are concerned with the extent of an injury or your pain**

Bird Dog


The bird dog is one of our favorites for a variety of reasons. It can be performed easily with no equipment. It teaches proper positioning and stabilization of the spine with both arm and leg movement. And it is so much more than just a “back exercise”.

The Bird Dog incorporates spinal stability, scapular stability, rotary stability, glute activation and abdominal/core activation. It’s a full body exercise designed to get you moving well and improve your body awareness. Not to mention, there are A TON of variations that can be performed to make these harder depending on where you are in your progress following an injury.

Who knows…maybe we’ll post about those some day too!

Dead Bug/Bent Knee Hollow Holds


CrossFit heavily impresses upon the concept of “core-to-extremity movement”. If you’ve never heard that before, simply put, it’s means starting any movement by fully engaging the muscles in your “core” – ie. the glutes, hips, lats, abdominal musculature – before transferring forces outward to the arms and legs – Or, as Kelly Starret of MobilityWOD puts it: “getting organized prior to performing any movement.”

We love it because, just like anything in CrossFit, it is scalable for wherever you are in your rehab or fitness journey. Whether first learning to stabilize your midline, progressively increasing tolerance to loading the midline after an injury, or just looking to challenge yourself and work up a great sweat – and believe us, you definitely can – this one is money in the bank.

Farmer’s Carry


That’s right. Farmer’s carry. Probably one of the simplest exercises you can think of, yet, oh so wonderful, difficult and complex when you need it to be!

If you practice these and its variations frequently, you’ll be blown away by the benefits it will have for your ability to lift heavier loads and carry those groceries into your home in one trip (and let’s be honest…that’s really the reason we all CrossFit).

Grip strength, increased pulling strength, improved work capacity, develop athleticism, overall gainz and – the biggest reasons we think these are pivotal for low back rehab and in building up your resiliency to injury – postural strength/control and enhanced core stabilization/bracing.

About Dr. Guillermo Contreras, PT, DPT, CF-L1, Cert-CMFA


Doctor of Physical Therapy, CrossFit Level 1 Trainer, Certification in Clinical Management of the Fitness Athlete, Certified HawkGrips Practitioner, Functional Movement Techniques Certified

Dr. Contreras has been immersed in the rehab and performance world for over 10 years. Weightlifting for sports, aesthetics and strength since the age of 14, the affinity for strength and performance has always driven his passion for resistance training, movement and mobility. Those passions drive the way he designs his rehab programs and trains and coaches all clients. Whether for sport or life, the principles of safe efficient movement and strength can be applied to all individuals seeking to lead a healthy active lifestyle. He draws not only upon his own experiences, but also years of geeking out on written articles, watching seminars, countless youtube videos and unending Instagram posts filled with knowledge and expertise from professionals in the rehab and fitness community he respects and values for their work.

Graduating from Marquette University with a Bachelors of Science in Exercises Physiology, University of Wisconsin-Madison as a Doctor of Physical Therapy, and a CrossFit Level 1 trainer, he possesses a wealth of knowledge and firm educational foundation to work with all individuals seeking to improve their movement and strength, decrease pain, or lead a healthier lifestyle. He is passionate about strength training, sports performance, mobility and most of all, CrossFit!




We’ve added these exercises into a Home Exercise Program (HEP) using the PT-Helper CONNECT platform and presented on the PT-Helper mobile app. These sample exercises can be quickly downloaded into the PT-Helper mobile app using

HEP code: A7B54B9

You can also find these exercises in the Lower Back category in the PT-Helper mobile app to add to your Favorites which allows you to customize each exercise’s repetitions, sets, and hold time.

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, November 27, 2018

Excy Portable Full-Body Exercise Bike on PT-Helper


Excy was created by Michele Mehl after breaking her leg while rollerblading with her son. Complications during her recovery, included a blood clot, resulted in her inability to exercise like she used to. So she created a portable full-body exercise bike to help herself and others to recover from their injuries.

“After months of physical therapy and relying on caretakers after breaking my leg, I got just a small glimpse into the plight of those living with injury, disability, and disease,” Mehl said. “It was an eye-opening experience that led me to re-think the type of company I wanted to build, which I captured in a blog post from the couch while being non-weight bearing.”

Changes in treatment strategies provide new opportunities for portable exercise equipment to improve outcomes. This Johns Hopkins Medicine article “Recovering from Surgery/Intensive Care” says moving the legs and feet in the recovery room stimulates circulation. One option is to “bicycle” which can be implemented with the Excy exercise bike while the patient remains on the bed. In addition, a study at McMaster University reports that cycling in bed is safe for ICU patients and may help them go home sooner, stronger and happier.

The Excy portable full-body bike can be used with leg and arm isometric, back & forth motion, and forward and backward pedaling exercises to build strength and range of motion. More advanced exercises will also develop core strength.

PT-Helper had the good fortune of meeting Michele at the 2018 American Physical Therapy Association’s Combined Sections Meeting when we were neighbors on the exhibit floor. Our common experience of creating a health-related start-up after an injury as well as our mutual interest in cycling opened the door for us to collaborate.

PT-Helper has added Excy exercises into our library to include the XCS Pro portable total body cycling system, designed to offer easier access to quality bed, chair, and floor pedaling exercises. A few examples of the Excy exercises available on PT-Helper are shown below:


  • Excy Horizontal Floor and Bed Cycling
  • Excy Chair Recumbent Position
  • Excy Hand Cycle on Bed/Floor 


These exercises as well as more strenuous Excy exercises are now available on both PT-Helper CONNECT exercise prescription software and mobile app, in addition to our existing library of shoulder, knee & hip, neck and many other exercises.

Excy is currently holding a $100 off sale on their most popular models which ends on November 30, 2018. PT-Helper users can use coupon code “PT-Helper” at check out to get an additional $50.00 off. Coupon code expires on 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 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 www.urbanpoling.us to obtain the Activator Poles at 30% off*. For more information, videos on the adjustment and technique as well as research visit www.urbanpoling.us 

*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.