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.

Thursday, August 8, 2019

What is Golfer's Elbow and Treatment Options

By guest blogger Scott Bradley DPT, PT, CSCS 

If you have pain on the inside of your elbow with certain movements then you might have golfer’s elbow or what we call in the business, Medial Epicondylitis. Golfer’s elbow can happen to almost anyone and can cause pain and weakness with normal activities like doing a biceps curl, opening a jar, carrying objects, or putting things on a shelf. Golfer’s elbow also presents in a wide variety of sports including swimming, baseball, golf, softball, and even tennis.

Golfer’s elbow is typically located at the proximal attachment of the common flexor tendon at the inside of the elbow, which is where most of the forearm muscles that flex the wrist are located. The two muscles most commonly affected with this injury are the pronator teres and flexor carpi radialis.

Golfer’s elbow is caused by repetitive microtrauma to the common flexor tendon at the medial epicondyle of the elbow, hence why it is called medial epicondylitis in the medical community.  This condition can be an acute or chronic issue. Acutely, an average person will play 9 holes or do some housework with power tools which will cause some nagging pain on the inside of the elbow. This pain usually resolves within an hour after activity. The load applied on the muscles exceeds the body's ability to handle, resulting in microtrauma to the area. This microtrauma results in acute inflammation and pain. This is the most common case and if not properly addressed it can become a chronic issue which will require more intensive therapy.

My Doctor Recommended an Injection, Is it a Good Idea?

Instant relief of pain will always sound good, but will it accelerate the healing process? The answer is probably not. The cortisone injection will assist in relieving the annoying pain but little else; it will not fix the underlying issue associated with Golfer’s elbow. Once the pain is gone many people will continue doing the activity that caused the pain. Without the proper exercises and stretches however, you will have pain again once the injection wears off. The best advice I give my patients is that if the pain is unbearable a cortisone injection may assist in relieving the initial pain but physical therapy will help fix the underlying problem. This is also supported by the research.

This research article found that those who had a corticosteroid injection had reduced pain at 6 weeks following the injection but had no difference in symptoms compared to the control group at 3 and 12 months. (1)

How Do I Fix It? 

Exercise- Duh! Below are some simple beginner exercises you can do to help accelerate the healing process and reduce pain.

Wrist Flexion Isometrics 

  • Bend the wrist of your injured hand slightly
  • Place the opposite hand on the palm of your hand
  • Press into hand for 6 seconds and repeat 20 times

Forearm Pronation Isometrics 

  • Place arm on table with thumb up
  • Place opposite hand on the top aspect of the inside of the forearm
  • Then press forearm into hand for 6 seconds and repeat 20 times

Elbow Flexion Isometrics 

  • Place your affected elbow bent to about 90 degrees with your palm facing upward on a table. Place your opposite hand on your affected wrist. 
  • Press wrist into hand for 6 seconds and repeat 20 times

Wrist Flexion Stretch Arm Straight

  • Hold the arm to be stretched straight out in front of you with your palm facing toward the ceiling.  
  • Grasp your hand with the other hand, and slowly bend the wrist downward so that the fingers point toward the floor. 
  • Hold this stretch for 30 seconds, repeat 3 times 

Wrist Flexion Stretch Arm Bent

  • Bend the affected elbow so that it is at a 90 degree angle
  • Place the other hand on the affected arm’s fingers
  • Gently pull back on your fingers until a stretch is felt
  • Hold this stretch for 30 seconds, repeat 3 times 

There is no one size fits all recovery program for Golfer’s elbow. The earlier you address the symptoms the faster your recovery and the less restriction in your daily activity. A combination of conservative treatments to start with consisting of: isometrics, eccentrics and gentle stretches are great starting points. If you are still having trouble tackling the nagging pain on the inside of your elbow seek out a qualified physical therapist to help you in your recovery process. Most Golfer’s elbows resolve within a year with no surgery. So stay consistent with your exercises and hopefully you will be back to playing 18 holes in no time.

About Scott Bradley DPT, PT, CSCS

Scott graduated from Florida Gulf Coast University with his degree in exercise science and his Strength and Conditioning Certification. He attended Wheeling Jesuit University PT program. Scott has experience working with D1 athletes, NFL pros and NFL combine training. Scott currently works in Fort Myers, Fl in an outpatient physical therapy setting specializing in golf recovery.


Taylor SA, Hannafin JA (2012) Evaluation and management of elbow tendinopathy. Sports Health 4: 384-393.What is Golfer's Elbow and How to Treat

Thursday, July 25, 2019

Contract Relax/Antagonistic Contraction Stretches for Running

I recently had the good fortune of attending a stretching seminar for runners at Pro Bike + Run, one of Pittsburgh’s local cycling and running stores. The seminar was presented by Ben Jennings, DPT, OCS at NovaCare Rehabilitation.

During the presentation, Ben introduced us to Contract Relax/Antagonistic Contraction (CR/AC) stretches. These stretches use a technique that utilizes isometric contraction (without movement) as well as active contraction of the Antagonistic or opposing muscle group of the muscle to be stretched. These stretches start out like traditional stretches and typically have 3 steps:
  1. A strap is used to flex the joint to static stretch the muscle for 20-30 seconds. 
  2. The second step is the isometric contraction part where you activate the muscle being stretched while the strap is used to prevent any movement. This step lasts for 6-10 seconds. 
  3. The third step is to contract the opposing muscle group while simultaneously using the strap to extend the stretch. This step lasts 20-30 seconds. 

Rest and then repeat for a total of 2-3 times.

An interesting component for me regarding these stretches is the use of the opposing muscle group in the third phase of the stretch. Contracting the opposing muscle group will send a neurological signal to the muscle being stretched to relax, allowing a greater stretch to occur.

Some of the stretches that we performed during the seminar are shown below.
  • Prone Quadricep Stretch with Strap (CR/AC): Laying on your stomach, attach a strap around your ankle. Pull on the strap to bend the knee, bringing your heel towards your buttocks as close as possible without pain, you should feel a tightness in the front of your thigh. Hold. While holding the strap tight, contract your quadricep to try to bring your foot back to the ground. Resist this motion with the strap. Hold. Engage your hamstring to move your leg further forward, towards your body. Use the strap to keep your leg in place. Hold. Return your leg to the ground. Repeat. 


  • Seated Calf Stretch with Strap (CR/AC): Sit on the ground with your knee straight and a strap looped around your forefoot. Gently pull on the strap until a stretch is felt in the calf. Hold. While holding the strap tight, contract your calf muscle to try to move your foot forward. Resist this motion with the strap. Hold. Engage your shin muscle to move your foot further towards your body. Use the strap to keep your foot in place. Hold. Relax and return your foot to its starting position. Repeat. 


  • Supine Hamstring Stretch with Strap (CR/AC): While lying on your back, place a strap around the one forefoot. Pull your knee toward your chest by pulling on the strap. Straighten the leg to the point of tightness in the back of your thigh. Hold. While holding the strap tight, contract your hamstrings to try to bring your foot back to the ground. Resist this motion with the strap. Hold. Engage your quadricep to move your leg further forward, towards your body. Use the strap to keep your leg in place. Hold. Return your leg to the ground. Repeat. 


The stretches listed above can be found in the Fitness Legs, Ankle & Foot, and Knee & Hip categories in our PT-Helper exercise library.

Thursday, July 18, 2019

8 Tips to Help You Stay Regular While Traveling

by guest blogger Dr. Susie Gronski, DPT, PRPC, WCS

Traveling abroad can mess with your pooping schedule. Trust me, I know what it feels like when you’re on vacation and can’t pinch a loaf. Over the years, I’ve managed to perfect my traveling poops and thought I’d share with you my one-wipe wonders.

  1. Chew – Digestion starts in the mouth. Chewing releases enzymes in the mouth which starts the digestion process. Conga dance anyone?

  2. Pack plums - To help you rev up the colon, eat fiber. Plums are a great source of fiber with an added bonus… Plums draw extra fluid out of the colon for smooooooth sailing. No plums? No problem. Most fresh fruits come naturally equipped with both soluble and insoluble fiber.

  3. Note: If you’re going to up your fiber game, make sure to drink more water. Fiber tends to clump poop into balls and no one wants to push out a dry, hard, crusty turd.

  4. Move around – Motion is lotion as they say and the same goes for your gut. Movement helps stimulate the colon. What kind of movement, you ask? Anything that motivates you. Keep it simple and fun.

  5. Take some deep belly breaths – Your colon has connections to the diaphragm and the organs underneath it such as the liver and stomach. You can massage your organs and stimulate digestion with deep belly breathing.

  6. Deep breathing stimulates the parasympathetic nervous system, which is the rest and digest response for poop and pee. This relaxed state of the nervous system allows for digestion to work optimally. When you’re hurried, rushing or stressed, other areas of the body utilize more energy, diverting its efforts away from digestion and bowel function. In other words, it’s easier to ‘go’ when you’re relaxed, not tensed up.

    Brushing your teeth could be a good prompt to remind you to take a few deep breaths.

  7. Drink plenty of water – The colon’s main function is to absorb water and residual nutrients not picked up by the small intestine. Dehydration is the number one cause of hard, lumpy, pellet-like stool so make sure you’re drinking enough hydrating fluids.

  8. Traveling often distracts us from our normal routine, including hydration. Airplane travel draws fluid out of the body in larger quantities than you’d expect, so make sure to pack your water bottle and refill it regularly. The little cup of water they give you on the plane just won’t cut it if you want to keep your poops regular.

  9. When nature calls, go – Your gut is a creature of habit. The more you suppress the urge to purge, the more clogged up you’ll be. I know some folks who have an issue pooping in public, but everybody poops. Time to get over your phobia and answer the call of nature as soon as you notice it.

  10. Squat to drop – The Squatty Potty is my friend, but most places don't have this luxury when you’re traveling, which means you gotta get creative! Use whatever you can to prop your feet up: a garbage can, a box, books, a stack of towels, your partner… (just kidding!)

  11. Daily ritual – Just like you have your daily pooping ritual in your everyday life, incorporate a schedule while on vacation. Mimic the same routine you would have back at home, which means you might have to give yourself extra time to poop. If that means waking up 15 minutes earlier, then so be it.

  12. Again, your colon is a creature of habit and will get ornery when the flow is interrupted.

Don’t rush your poops either. If you’re stressing out because you can’t poop, toileting will be more difficult. Even if you don't feel the urge to go, sit on the toilet anyway and breathe. This way you can retrain and encourage your colon to go at a regular time, the time you’re used to going back at home.

Don't freak out if you’re not able to drop the kids off at the pool. Whenever you travel, the colon has an adjustment period and sometimes it takes a day or two to catch up. No need to worry if it doesn’t happen right away. The more you worry about your bowels, the less likely they will cooperate. So let it go and then let it flow.

Don’t let traveling ruin your pooping experience. Better to be proactive than reactive to make each bowel movement poop-errific. Let’s chat!

About Dr. Susie Gronski, DPT, PRPC, WCS

Dr. Susie Gronski is a Doctor of Physical Therapy, a certified Pelvic Rehabilitation Practitioner, and a board certified Women's Clinical Specialist. Her passion is to empower and help people with pelvic pain get their life back.

Thursday, July 11, 2019

New Lower Back Exercises on PT-Helper

If you are a therapist, you can create your own exercises within PT-Helper CONNECT or you can contact us at info@pt-helper.com to let us know which exercises you would like us to add.

We continue to add new exercises to PT-Helper as part of our on-going efforts to improve its capabilities for both therapists and patients. In today’s blog, we focus on 3 new Lower Back exercises that are available in both PT-Helper CONNECT and the PT-Helper mobile app.

  • Vertebral Roll: Lie on your back on top of a foam roller. Bend your knees with your feet aligned with your hips. Raise one arm up into the air while simultaneously lifting the opposite leg off the floor. Tighten your abdominal muscles. Extend your raised leg, straightening the knee so that your leg is parallel to the floor. Simultaneously drop the opposite arm above your head so that the arm is parallel to the floor. Make sure to keep your back flat on the roller. Return to the starting position. Repeat 

  • Lateral Hamstring Stretch with Strap: Lie on your back with a strap wrapped around your involved foot. Bend your involved leg while keeping your other leg straight. Raise your involved leg up into the air. Keeping your pelvis on the floor, pull on the strap with your opposite hand to stretch the outside hamstring. Hold. Return your leg to its starting position. Repeat. 

  • Transversus Activation: Lie on your back with your knees bent and hands resting on your stomach above your hips or by your side. Tighten your abdominal muscles, pulling your navel towards your spine and up. Keeping your abdominal muscles tight, slowly lift one leg up to 90 degrees. Keeping your abdominal muscles tight, slowly lift your other leg up to 90 degrees. Hold. Return your legs back down to the floor one at a time. Do not hold your breath. Repeat starting with the other leg.
You can find these exercises (and many more) 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. 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, June 27, 2019

PT-Helper’s June Blog Posts for Physical Therapists

Sacroiliac Joint Pain Exercises and Stretches
Published on June 20, 2019
Research indicates that about 80% of the population will experience low back pain at some point in their lifetime. This blog presents 4 exercises and stretches to strengthen and stabilize the sacroiliac joint of the lower back.

5 Reasons Hands-on PT May Supplement or Replace Pain Meds
by guest blogger Brian Scherff, PT
Published on June 6, 2019
Brian identifies 5 reasons when physical therapy trumps opioid use. “If preventing long-term opioid use is a treatment goal, the research all supports that those receiving early Physical Therapy had fewer long-term opioid use rates.”