Thursday, October 17, 2019

An Inspiring Individual: Marylin Tsakok

Every once in a while, we like to feature someone who inspires us with their dedication to health, fitness and movement. This week our feature is Marylin Tsakok.

All through her childhood, 20’s and 30’s, Marylin had struggled with her weight and self-esteem due to her sedentary lifestyle. In her late thirties, through strict diet and treatments, she lost 25 lbs in 6 months. She reached one of her goals but she also wanted to find something that was affordable, fun and sustainable to maintain her weight.  So she joined a Tae Bo class for the first time.   She was hooked after the first class and loved how it made her feel after every class. She slept better and felt more confident.  In fact, she loved it so much that she dreamed of becoming a certified Tae Bo instructor.

To reach her dream, she first became certified as a personal trainer as well as a group fitness trainer in order to increase her chances of becoming a Tae Bo Instructor.  At the age of 46, ten years after her first Tae Bo class, she went to Los Angeles (from Toronto) to get tested. She passed the test and got certified to fulfill her dream!

Her zest to learn continued. She travelled far to attend fitness workshops for instructors.  At age 54, she became a certified jump rope instructor.

She took early retirement from work at age 55 to focus on her desire to being a top-notch fitness instructor as her second career.

She is now 59 years old and a grandmother!  She teaches group classes 4 to 5 times a week at corporate offices, a local college and a country club.  Her classes include kickboxing, muscle conditioning, bootcamp and spinning. She also volunteers at a local non-profit helping more than 20 women to stay fit.  When not teaching, she practices CrossFit and Animal Flow!

Marylin said, “I am getting stronger and I feel I move better every day.  Not sure when I am going to slow down. But as long as I can move reasonably well, I will keep on moving.  One is never too old or too late to exercise.”

Thursday, October 10, 2019

Physical Therapy Exercises for Shoulder Stingers

As we are in the middle of football season, it is more common to hear about athletes experiencing shoulder stingers or burners. According to, a shoulder stinger or burner is an injury to a group of nerves known as the brachial plexus that extend from the spinal vertebrae C5 and continue through T1. Symptoms of a shoulder stinger include severe pain that radiates down the arm and may have degrees of numbness and weakness of the arm and neck pain. Injury to the brachial plexus often occurs as a result from a collision in contact sports which can compress or overstretch the brachial plexus. Besides football players, other athletes such as gymnast, skiers and cyclist can get stingers when they experience hard falls.

To prevent stingers, recommends building up your neck musculature. To build neck musculature, you can use an exercise ball to do neck extension, flexion and side bending exercises against a wall. Or you can buy exercise equipment like Iron Neck which are meant to specifically improve neck strength and mobility.

 To treat a shoulder stinger, the Summit Medical Group recommends several exercises, some of which are shown below:
  • Isometric Neck Flexion (In Neutral): With good posture, place your hand or fingers on the front of your forehead. Press your head into your hand or fingers as if you are trying to bend your chin down to your chest. Slow on, hold, then slow off. Do not cause any pain.
  • Isometric Neck Extension (In Neutral): With good posture, place your hand behind your head. Press your head back into your hand. Slow on, hold, then slow off. Your therapist may advise you to perform this laying down pressing into a pillow. Do not cause any pain.
  • Isometric Neck Side Bend (In Neutral): With good posture, looking straight ahead, place your hand or fingers on the side of your head. Press your head into your hand or fingers as if you are trying to bring your ear towards your shoulder. Slow on, hold, then slow off. Do not cause any pain.
  • Shoulder Shrugs: Stand tall, raise both shoulders up to your ears simultaneously. Lower them back down. Repeat.
  • Shoulder Abduction: Stand with your arms down at your sides. On your affected hand, point your thumb away from your body. Keeping your elbow straight, raise your affected arm out to the side so that your thumb points up. Pause, then slowly lower to starting position. Repeat.

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

Thursday, October 3, 2019

Are golfers really athletes?

By guest blogger Chris Kopp PT, OCS, CMPT, Titleist Performance Certified

There was a time when golf was viewed more like a game than a true sport.  Professional golfers back in the day did not necessarily portray themselves as the fittest individuals compared to other sports stars. In fact, smoking cigarettes was commonplace even when on TV.  Not any more.   Just look at the some of the physiques on tour now, particularly current #1 golfer in the world Brooks Koepka. His arms are like tree trunks.  If any of you happened to watch and listen to the 2019 US Open golf coverage, over and over again you heard about the strength it required to hit that shot or this golfer has been known for his power (winner Gary Woodland). However, they also referred to their incredible touch and mental toughness. Most people think Tiger Woods was the inspiration for this change of working out and playing golf, but that is not exactly true. How about a little trip down memory lane and how golf became an “athletic activity”.

Physical Fitness In Golf

Gary Player was really the first professional golfer to take physical fitness seriously. In fact, he was often ridiculed for his work-out routine. However, if you see Gary Player now compared to some of his peers from his era of professional golf, you can see that maybe Gary was right in his approach. Greg Norman was another that also took exercise seriously. Certainly when Tiger came along and all the success he had and his muscular build, it really did push the needle toward golf and athleticism and ultimately became a huge influence for the common day professional golfer.

But when is too much of a good thing a bad thing? That is really the key to any activity and training. Tiger has obviously had severe physical break downs, knee surgery, several back surgeries that eventually led to a fusion. However, it is Tiger’s dedication to his fitness that has also allowed him to come back and play at a high level even with his back fused, winning the Masters this year and the Tour Championship last year. Pretty amazing really.

Golf can be an activity that puts tremendous stress on the body, particularly the spine due to the rotational nature of the game and the frequent bending and stooping-teeing the golf ball as well as picking up the ball out of the hole. Anyone who plays golf regularly or even infrequently has most likely experienced back pain. Sometimes, it is just bending down to get something out of the golf bag or putting on their shoes. Other areas that can be injured are of course the knees, hips, and shoulders.

When participating in any sport that requires repetitive motions and stresses, injuries are inevitable, however, they can be prevented with a little effort. Most of us do not have the time that professional golfers do or the resources available to have personal physios, chiropractors, massage therapists, and trainers. That being said, here are a few tips:


Yes, try and get to the course before your tee time and perform a structured warm-up program. I like the Orange Whip or a weighted club to loosen up, around 20-30 gentle swings gradually increasing your range of motion of your body as you go.

Deep squats with club overhead (as far as your knees will allow). Big leg swings, arm circles and gradually working up from pitching wedge to driver.

The best advice is to consult with a golf specific fitness or health professional and be properly evaluated in order to learn what would be a good routine specific to your physical capabilities and limitations. The stronger and more flexible you are, the reality is you are less likely to hurt yourself playing and you may even become a better, more consistent golfer as well.

About Chris Kopp PT, OCS, CMPT, Clinic Director, Titleist Performance Certified

Chris Kopp graduated Magna cum Laude from the University of North Florida and is a board certified Orthopedic Clinical Specialist and certified Orthopedic Manual Physical Therapist with 20 years of experience in outpatient orthopedics and is the senior therapist on staff. Chris can evaluate and treat all musculoskeletal conditions including the spine and extremities.

He has an excellent reputation for rehabilitation of shoulder conditions including post-surgical as well as the lower extremity and has specialized training in the foot and ankle and working with runners of all abilities. As an avid golfer and life-long athlete himself, Chris also oversees Premier’s golf rehab and sport specific training programs. Additionally, Chris is on faculty as an instructor for Florida Institute of Orthopedic Manual Physical Therapy and functions as Premier Physical Therapy’s Center Coordinator of Clinical Education and provides physical therapy education to area students as well as licensed professionals.

Chris is passionate about representing physical therapy in a way that the profession was created and continues to evolve, which is to return individuals to their goals in the highest functional capacity possible while incorporating compassion and a caring spirit. He lives in Atlantic Beach with his wife and two children and enjoys an active Florida lifestyle.

Chris is owner of Premier Physical Therapy Jacksonville and Ponte Vedra specializing in golf fitness and rehabilitation.  He can be contacted at or visit for more information.

Tuesday, September 24, 2019

Local Senior Athlete: Willie Manteris

There’s been a lot of news recently of exceptional seniors achieving amazing physical feats from “World’s Toughest Horse Race Won by 70-Year-Old Idaho Man Named Bob” and “This 71-Year-Old Grandmother Just Smashed a Half-Marathon World Record”. These people are amazing athletes but I also want to highlight that many local individuals are breaking the stereotypes of senior living even if they aren’t breaking world records.

I would like to introduce you to Dr. Willie Manteris, DMD, our local “old man” in my weekly cycling group. Willie is 69 years old and graduated from University of Pittsburgh dental school in 1975. During his years as a practicing dentist, he’s volunteered in Mexico, Guatemala, Honduras, El Salvador, Ecuador, Vietnam, Bhutan and Cambodia treating patients in need though various charitable groups.

In addition to his local dental practice, volunteer trips, and raising 2 children; Willie started running marathons at 47, triathlon events at 50, and focused on cycling at 65 years of age. His longest ride to date is a 12 hour ride in Spain in 2017 when he got lost. His other longest ride was a 112 mile ride as part of an Ironman event in 2002.

During the summer months, Willie rides his bike 2-4 times a week while going to the gym to work on upper body strength 2-3 times a week. Willie’s weekly mileage on the bike is typically 120-140 miles but I’ve been on single day 100 mile rides with him this summer where he’s easily exceeded his typical weekly mileage.

Willie has been fortunate to not have suffered from a major illness but has come back from multiple broken collarbones and shoulder separations. Willie does suffer from arthritis in both hips and has gone to physical therapy to help manage the pain.

“Just keep moving. Pretty amazing what you can do in later years.”, says Willie. Some good advice.

Thursday, September 19, 2019

Pelvic Floor Exercises

The article “Why Going to Pelvic Floor Therapy Transformed My Life” has raised awareness of how many women suffer from pelvic pain and has prompted me to write about the pelvic floor exercises available within PT-Helper. In the article, the author experiences severe pelvic pain while having doctors tell her that her pain is caused by anxiety. Only after going to a pelvic floor physical therapist was she able to understand the causes of her pain and make progress towards relieving her pain.

An important reminder in the article is not to treat pelvic pain on your own as this may make it worse. Check out the American Physical Therapy Association for help locating a pelvic floor physical therapist.

The PT-Helper mobile app includes pelvic floor exercises that your therapist may prescribe for you to do. Some of our pelvic floor exercises are shown below:

  • Abductor Squeeze : While sitting down with your feet together, place a resistance band around your thighs, slightly behind your knees. Slowly open your legs apart while keeping your feet stationary, engage your pelvic floor muscles. Hold. Slowly return your legs together, completely relaxing your pelvic muscles. Repeat.


  • Adductor Squeeze : While sitting down, place a yoga block or soft medicine ball between your legs, slightly behind your knees. Slowly squeeze your legs together, engage your pelvic floor muscles. Hold. Slowly relax your muscles completely. Repeat.

  • Seated Pelvic Floor : Sit on an chair with nice tall posture with relaxed shoulders and legs. Relax all of your muscles. Lift and squeeze your pelvic floor muscles starting at the muscles around your anus as if trying to stop passing wind. Then tightening your muscles in front as if trying to stop the flow of urine. Hold. Relax and repeat. Make sure to breath while doing the exercise.

  • Seated Pelvic Floor - Slow Squeeze & Hold : Sit on an chair with nice tall posture with relaxed shoulders and legs. Relax all of your muscles. During the Hold Time, lift and slowly squeeze your pelvic floor muscles starting at the muscles around your anus as if trying to stop passing wind. Then tightening your muscles in front as if trying to stop the flow of urine. Hold during the Rec Time. Relax and repeat. Make sure to breath while doing the exercise.


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

Tuesday, September 10, 2019

What is “Prehab’”?? And how to properly prepare for an elective surgery

By guest blogger Anthony Sinacore, PT, DPT, ATC

Barring any significant trauma requiring immediate medical attention, musculoskeletal surgeries are typically elective. Whether its a total joint replacement [of the knee, hip, and shoulders], a rotator cuff repair, or minor spinal surgeries, insurance companies won’t typically classify these as “necessary”, no matter how much pain you’re in.

Whatever the diagnosis is, when the time does eventually come where your pain or related-symptoms are too unbearable to manage, the appropriate step would be to seek out a trusted healthcare provider (i.e. your PCP, an orthopedist, or a physical therapist) to go over the options that may be best for you. Whomever you choose to see for this issue, It is important to have an open and clear conversation with this individual regarding what options you may have, if they align with your current goals, and what time-table for recovery these options provide. If you are unsatisfied with their recommendations, it is highly advisable to seek out a second opinion…remember this is your body we are talking about here.

However, every circumstance is different and there are many times when surgery is the best option. When this is the case, you are going to expect a successful outcome right?

This is where “Prehab” comes in.

Pre-surgical rehabilitation otherwise known as “prehab’’ has become a term referring to the preparatory interventions to help optimize a surgical outcome. In lay terms: setting yourself up for the best recovery possible.

This could mean improving range-of-motion through stretching, maximizing strength, or enhancing cardiovascular endurance to reduce muscle weakness and withstand disuse of the involved region during the initial stages of recovery.

While prehab may come off as common-sense to some, this stage is often neglected in the rehabilitation spectrum. And in most cases, avoiding prehab can be a costly mistake.

Too often have we heard of individuals who fought their pain for weeks, months, and years only to be frustrated to have just as long of a recovery process following surgery.

But why is this the case?

As pathology (take for example, end-stage arthritis of the knee) worsens, compensatory patterns within our daily movements creep in. We start getting up from chairs in a different way, we adjust how we turn around and walk, or we stop performing tasks altogether. I’m sure you know of someone who might say “I don’t do stairs unless I have to”. Let’s face it, pain hurts.

Unfortunately, these bad habits gradually lead to asymmetry. Those small compensatory patterns create a ripple effect across the musculoskeletal system. Muscles away from the injured area begin to work harder and becomes stronger further supporting the compensatory pattern. It isn’t before long that the affected area becomes weaker and stiffer leading to more pain when you do use it. This creates a vicious cycle and over the course of months or years, you decide its finally time to “get the surgery over with”

It’s difficult to remember that the surgery only offers a solution to fixing the source of the problem but not the symptoms associated from the initial issue, such as all the weakness and stiffness that came from “misusing” the area.

It is recommended to see a physical therapist roughly 1 month away from surgery to discuss what interventions may help you best prepare for the elected surgery. Ideally this should be the same therapist you will see after the surgery as they will already be familiar with you, your baseline measurements, and most importantly your rehab goals.

You also shouldn’t be worried about the expenses associated with prehab. A good physical therapist would be able to perform an evaluation and set you up with a comprehensive home exercise program in 1-2 visits. That way you can take the information and perform them independently at home. What better way to get you started on the road to recovery!

About Anthony Sinacore, PT, DPT, ATC

Anthony joined the Action Potential team in July 2018 and brings a wide variety of experience with him.  Prior to enrolling in physical therapy school, Anthony worked as an Athletic Trainer for a local high school in St. Louis, Missouri.  Understanding there can be a much deeper role in the rehabilitation setting, he then pursued his Doctorate degree in Physical Therapy from the University of Pittsburgh.  After graduation, Anthony worked as a ‘travel therapist’ in Texas, providing PT services in the home health and skilled nursing settings for a variety of patients with neurologic and musculoskeletal impairments.  These experiences allowed Anthony to develop a stronger passion for treating individuals, of all age-ranges, with complex musculoskeletal issues.  Anthony completed an Orthopedic Residency at the University of Delaware in 2018, allowing him to advance his Sports and Orthopedic skill sets.  He enjoys using whole-body movement to treat various conditions such as neck and back pain, knee pain, and shoulder complaints. He also believes there is nothing more important in healthcare than a collaborative, inter-disciplinary approach to treating an individual.  When he is not working, Anthony performs home-health visits on the weekend; otherwise you can find him at the local coffee shop reading up on the latest evidence/literature.

Anthony lives in Wilmington with his wife, Allie, and golden retriever, Yogi.  He enjoys traveling, reading (aka listening to audiobooks), playing pick-up basketball, and going on long runs.

Thursday, August 15, 2019

Hand Therapy for Strokes

A stroke occurs when something (like a blood clot or plaque) blocks blood supply to the brain or when a blood vessel in the brain bursts. According to the CDC, over 795,000 people in the United States had a stroke in 2017 killing about 140,000 people every year.

Brain damage from a stroke can cause mobility issues in stroke survivors.  Symptoms are often weakness or paralysis on one side of the body. Exercise is a major component of rehabilitation after a stroke.

FlintRehab has several great blogs on hand exercises after a stroke. PT-Helper has many of these exercises within our Finger and Hand exercise library to help you complete your rehabilitation at home. Some of these exercises are shown below:
  • Wrist Flexion Extension : Place your affected forearm on a table with your hand hanging off the edge of the table, palm down. Flex at your wrist to move your and up. Then move your hand down. Repeat.

  • Assisted Palm Up Palm Down : Place your affected hand palm down on a table. Use your finger on your other hand to help flip your hand into the palm up position. Use your finger on your other hand to help return your hand to the palm down position. Repeat.

  • Rolling Movement : Place your affected hand in front of you or on top of a table with a bottle in your hand. Curl your fingers in to grasp the bottle. Relax your fingers and straighten them. Repeat.

In addition to hand exercises, upper body cycling is also recommended to increase endurance and range of motion on the affected side. PT-Helper has partnered with Excy, a portable hand and pedal exercise equipment, to include their exercises within our library. The Excy hand cycle can even be used on the bed to start your recovery process.
  • Excy Hand Cycle on Bed/Floor - Forward Circles : Sit down on the floor or in a bed. Consider placing a pillow under your knees for better ergonomic positioning. To begin cranking, place one crank arm in the top furthest position away from the body (between 2 and 3 o'clock). Place your hand on the pedal and make sure you have 5-10 degree bend at elbow. As your right hand pushes forward and down, your left hand circles backward and up to complete the rotation of the pedals.

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