Good Posture for Good Health

Good Posture Helps Reduce Back Pain

Correct posture is a simple but very important way to keep the many intricate structures in the back and spine healthy. It is much more than cosmetic – good posture and back support are critical to reducing the incidence and levels of back pain and neck pain. Back support is especially important for patients who spend many hours sitting in an office chair or standing throughout the day. We can also help ourselves by doing some exercises throughout the working day. Here are some simple exercises to keep mobile and ease tension in tight muscles:

1. Shoulder Rolls: Sit up straight and take a deep breath in as you raise one shoulder up towards your ear. As you exhale roll the shoulder back and down. Do this three times then repeat on the other side. Then do them both at the same time. Repeat three times. These will help release tension in your upper back and shoulders.

2. Neck Stretch: Sit up straight and use one arm to anchor yourself to the chair, while bringing the other arm up and over to the opposite side of your head as you gently let your head fall to that side. Hold for 10-15 seconds and repeat on the other side. This will help to lengthen your neck muscles, decreasing compression of the cervical vertebrae of your spine.

3. Chest Opener: Sit up in your chair and clasp your hands behind you. Take a deep breath in and roll your shoulders down and back. Hold for 10-15 seconds while taking a few deep breaths. For a deeper stretch, stand up with your legs a few feet apart and clasp your hands behind your back, take a deep breath in and bend forward as you exhale, allowing your arms to come up over your body. Hold for 10-15 seconds.

4: Wrist Stretch: Extend your arms in front of you. Use your left hand to pull the right wrist back. Hold for 5 seconds. Turn the right hand down now and use the left to stretch. Hold for 5 seconds. Repeat 3 times on each hand.

5: Glute Stretch: Sit with both feet planted on the floor. Bring the right ankle up to rest on the left knee. Lean forward and hold for 10-15 seconds. Repeat on the other side.

Ankle Sprains

Ankle injuries are some of the most common for athletes competing in running, soccer, or basketball, but can plague even casual hikers and joggers. To prevent ankle injuries that can send you limping to your nearest Scottsdale physical therapy center, there are a few things you should know.

First, it is important to understand how the ankle works. The ankle, or talocrural region, is the region where the foot and leg meet. It is composed of three joints (the talocrural joint, the subtalar joint, and the inferior tibiofibular joint) and three bones (the tibia, fibula, and the talus). The joint surface of all bones in the ankle are covered with articular cartilage and bound by the strong deltoid ligament and three lateral ligaments. The ankle distributes the weight of your body to the bones in the feet.

The most common injury to the ankle is a sprain or twist. This occurs when the ankle is rolled, twisted, or turned in an awkward way, causing the ligaments to stretch or tear.

To help minimize the chance of injury, try these 3 tips:

  1.  Balance training: By improving your balance, you are honing your body’s proprioception. This is your body’s ability to control itself in all types of positions. Balance exercises can be as simple as alternating standing on one leg for as long as possible. To increase difficulty, try standing on one leg and leaning as far to each side as possible or balancing with your eyes closed. These exercises can be aided by the use of a bosu ball or wobble board.
  2. Ankle strengthening: Weak muscles around the ankle area make you much more likely to suffer a sprain. Resistance range-of-motion exercises with a thera-band are a great way to strengthen the muscles in the ankle. Place the band around the top of the foot and curl the toes at the end of the movement to work the internal muscles of the foot. Complete three sets of 20 in each direction. Another way to strengthen the muscles in the ankle is through calf raises. These should be completed both sitting and standing to strengthen the Achilles tendon and calf muscles.
  3. Stretching: Stretching the muscles in the legs is important before and after strenuous physical activity. Try some of these stretches:
    • Gastrocnemius stretch – stand on a step with heels off the back of the step. Keep the knees straight and slowly lower the heels down below the level of the step until you can feel a stretch.
    • Soleus stretch – stand with one leg in front of the other close to a wall. Place your hands on the wall and lean forward. Bend both knees as if trying to touch the front knee to the wall while keeping the back heel down.
    • Shin stretch – cross left foot behind right, stand on the toes of your left foot, and bend the right leg to push your ankle towards the ground as if dragging your toes on the ground. Hold for 15-30 seconds and switch legs.
    • Peroneal stretch – sitting in a chair, cross one leg over the other knee so that the ankle sits on top of the knee. Using your hands, stretch the foot towards you. Hold and switch sides.


Riverdance China Tour 2012/2013

I am recently back from a Riverdance tour that took us to 24 different cities in China. The tour included performances at the world renowned Beijing Exhibition Centre Theatre and many other state of the art venues. We did 10,000 kms of touring with the climax of the tour taking place at the Shanghai Grand Stage just after the Chinese New Year. Thankfully there were no major worries from a Physical Therapy viewpoint apart from a few typically tired and overused muscles.

All About Arthritis


You will develop arthritis at some point in your lifetime. It can be very mild, causing a little stiffness as you age, or it can be extremely painful and debilitating. Fortunately, there are things you can do to prevent and manage this condition.

Arthritis is not actually a disease. Arthritis is a term used to describe joint inflammation (“arthro” = joint;  “itis” = inflammation). When inflammation is present, the joint is usually painful. However, not all joint pain is arthritis. Problems like trigger points, sprains, or tendinitis can cause pain, but the joint itself remains healthy.

Arthritis refers to problems with the joints. There are over a hundred different forms of arthritis and growing. The forms relate to wear and tear of the cartilage such as osteoarthritis (OA) which is by far the most common. It affects approximately 400,000 people in Ireland. The second most common form of arthritis is rheumatoid arthritis (RA) which is associated with inflammation in the joints. In Rheumatoid arthritis the body’s own tissues in the joints are attacked. About 1% of the adult population in Ireland is affected by Rheumatoid arthritis.


Doctors will often refer to this type of arthritis as degenerative joint disease, or if it affects the back, degenerative disc disease. It sounds scary, but it’s the most common and least serious type of arthritis. Osteoarthritis is simply wear and tear of the cartilage on the ends of the bones. One research study found that 37% of all adults have osteoarthritis in their hands or feet. Everyone over sixty-five years of age has it to some degree. However, because the cartilage is not sensitive to pain, you most often do not know you have it.

Stiffness is a key feature of osteoarthritis. Typically, your joints feel stiff in the morning and will loosen up after you move around for awhile. Sometimes the joints will make crackling or crunching sounds with movement. In the early stages, you will only feel pain after excessive activity. The pain is usually an aching sensation within the joint. You will seldom see swelling because inflammation in the joint tends to be minimal.

Rheumatoid arthritis

Rheumatoid arthritis is not nearly as common as osteoarthritis. It occurs in only about 1% of adults.

This type of arthritis is called systemic arthritis because it can affect many of your body systems. For example, it can affect your heart, lungs, nerves and skin. Whereas osteoarthritis usually develops as you get older, rheumatoid arthritis can occur at any age.

Usually the symptoms appear over a period of weeks or months and are accompanied by fatigue, fever, and diffuse pain. Subsequently, specific joints become inflamed and are painful, tender, swollen and red. Many joints become involved and both sides of your body are affected equally. There are periods when it goes into remission. It’s progressive however and overtime the involved joints often become somewhat deformed.

New Services and Skills

As a member of The Irish Association of Physical Therapists and like all primary healthcare professionals, we are obliged to make sure we keep our skills up to date. This is formally called continuing professional development (CPD) and has been revised recently to be in line with similar healthcare providers. Over the last year I have completed a number of courses that I hope will add to my ‘toolbox’ and improve my skills and outcomes as a Physical Therapist. I have used all of these skills over the last few months depending on the client and their presentation. Here is a few of them and a brief explanation of what it is and how it can help you.


During the 2012 Olympic games, numerous athletes wore a bright colored tape on their shoulders, knees, and backs called kinesiotape. David Beckham, Lance Armstrong and Serena Williams are also fans of the tape. The Kinesio Taping method involves taping over and around muscles in order to assist and give support to muscles or to prevent over-contraction of muscles, depending on patient presentation. Kinesio Taping can easily be integrated into a patients’ existing treatment plan. It also can be used on clients with postural problems and tightness in typical areas (neck shoulders and back).

Dry Needling

Dry Needling involves multiple advances of a fine filament needle into the muscle in the region of a “Trigger Point” (muscle knot). The aim of Dry Needling is to achieve a local twitch response to release muscle tension and pain. Dry needling is an effective treatment for chronic pain of neuropathic origin with very few side effects. This technique is unequalled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.

The needle used is very thin and most subjects do not even feel it penetrate the skin. A healthy muscle feels very little discomfort with insertion of this needle. However if the muscle is sensitive and shortened or has active trigger points within it, the subject will feel a sensation like a muscle cramp -‘the twitch response’. The patient also may feel a reproduction of “their” pain which is a helpful diagnostic indicator for the practitioner attempting to diagnose the cause of the patient’s symptoms. Patients soon learn to recognise and even welcome this sensation as it results in deactivating the trigger point, reducing pain and restoring normal length function to the involved muscle. Dry needling is similar but not the same as acupuncture.

Spinal Mobilisation Course

Spinal mobilisation is the gentle manual manipulation of the joints in the spine to release the body’s own healing powers which then are able to restore the joints or tissue being treated to normal functioning. This is done in the right place at the right time in the right way. If done correctly it can improve the faulty functioning of body structures such as joints, muscles and tendons.

Shoulder Injury

Torn Labrum

The shoulder joint is a ball and socket joint, similar to the hip; however, the socketof the shoulder joint is extremely shallow, and thus inherently unstable. This means that the bones of the shoulder are not held in place adequately, and therefore extra support is needed to help the muscles stabilize the joint. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements. The biceps tendon attaches to the labrum.

How can a labral tear occur?

The labrum can get torn from repetitive, high force movements such as, throwing hard or a tennis serve. Having an extreme stretch of the biceps tendon with exercises like dips or full range bench press can also lead to labral damage. Falling on an out stretched arm or having a hard impact at the shoulder can also lead to a labral tear. The labrum becomes brittle with age and can become more vulnerable to fraying or tears.

What are the symptoms of a torn labrum?

Symptoms of a labral tear depend on where the tear is located, but may include:
An aching sensation in the shoulder joint, Catching of the shoulder with movement, Pain with weight bearing on the arms, Pain and/or loss of range in shoulder internal rotation and reaching across the body.

What are the common types of labral tears?

SLAP Tears
A SLAP (superior labrum anterior to posterior) tear is a type of labral tear most commonly seen in overhead throwing athletes such as baseball players and tennis players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder, and when severe can be related to complete detachment of the biceps.

Bankart Lesions
A Bankart lesion is a labral tear that occurs when a shoulder dislocates. When the shoulder comes out of joint, the labrum is torn, and makes the shoulder more susceptible to future dislocations.

Posterior Labral Tears
Posterior labral tears are less common, but sometimes seen in athletes in a condition called internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder.

How do I know if there is a labral tear?

A doctor or physical therapist can do movement tests to see if the labrum is irritable but the tests are not considered to be consistent. An MRI is often needed to confirm a labral tear. If a shoulder problem is not getting better a consultation with a physician who specializes in shoulders is advised.

What is the treatment for a torn labrum?

As with any shoulder injuries, initially, the movements which irritate the injury must be stopped and the inflammation controlled. At Premier Physical Therapy we will discuss the daily activities which may be irritating the condition. Icing is critical to control the inflammation in the early phase. Another priority in the early phase is to normalize the shoulder motion with safe stretches, including some to improve internal rotation. Then, a comprehensive shoulder-strengthening program should be undertaken, emphasizing the back part of the shoulder and the ability to keep the shoulder blade in good posture. It is important to progress at a cautious rate so as to not irritate the torn labrum. As the symptoms recede and the strength returns,the mechanics of irritable motions must be addressed. For example, technique refinement with swimming, throwing, weight training, or a work task might be done with coaching or video analysis. In severe cases of labral tears the conservative treatment won’t sufficiently resolve the problem and surgical intervention may need to be explored. Even if surgery needs to be done ultimately the conservative program will make the post operative-recovery faster. At Premier Physical Therapy we make you an active participant in your rehab and not a passive recipient of our care. We will teach you how to fix yourself with the above-mentioned approach and return to your every day activities.

The power of massage

Research report

Massage has been used in every culture throughout history. Not only because it feels so good, but because of its profound effects on health and well-being. The healing powers of this ancient healing art are slowly being revealed to modern researchers as they uncover its effects on a wide range of conditions ranging from eczema and bulimia to HIV and diabetes.

Until about ten years ago, the benefits and effects of massage were not well understood. Massage therapists knew that it could increase blood and lymph circulation, decrease heart rate and blood pressure, improve mobility and reduce people’s pain. However, the impact of massage on the wide range of conditions that a massage therapist treats had never been scientifically examined.

Massage under the microscope

That situation changed when the first institute devoted exclusively to the study of touch was created in 1992 – the Touch Research Institute.

The driving force behind the Touch Research Institute is its director Tiffany Field. Motivated by the death of her own child, she obtained a research grant in 1975 to study child development.

Ten years later, as an assistant professor of pediatrics and psychology at the University of Miami, she was looking for ways to help premature infants develop faster. She noted that they respond with increased weight gains, improved developmental scores, and earlier discharge from the hospital.

The power of massage

Studies from the Touch Research Institute have looked at people of all ages with a variety of health conditions and complaints. The range of benefits is remarkable. Here are some highlights from a few of the many published studies.

Labor pain: Massage during the first 15 minutes of each hour of labor decreased the mother’s anxiety and pain. There was less need for medication and the length of labor was shortened.

Migraine headaches: Massage therapy decreased the occurrence of headaches along with sleep disturbances and distress symptoms.

Asthma: Children with mild to severe asthma who received regular massage were better able to exhale (a problem with asthma because the air passages constrict). In addition, the children suffered less stress and anxiety.

Premenstrual symptoms: After massage therapy there was improved mood and a decrease in anxiety. Pain and symptoms of water retention were also reduced.

Juvenile diabetes: After a month of regular massage, average blood sugar levels dropped into a normal range. The massaged children were also more likely to stick with their treatment regime.

Sexual abuse: Following massage, abuse survivors showed a reduced aversion to touch. They were less depressed, less anxious and had lower levels of stress hormones.

Bulimia: Bulimic teenagers received massage twice weekly for five weeks. The girls had an improved body image and felt less anxious and depressed. Results were similar for those with anorexia.

Pregnancy: Women who had massage through pregnancy showed decreased levels of stress hormones and experienced less anxiety. There were fewer complications before and after birth including fewer premature births.

Pregnancy Massage

Pregnancy can be a joyous time for a mother-to-be. However, the changes in a woman’s body and natural fears and anxiety can also be very stressful, both physically and emotionally.

Side lying position for a comfortable treatment

Many women avoid massage during pregnancy because they don’t think it’s possible to lie properly on the table. Lying prone (face down) will likely be comfortable until the fourth or fifth month. After that the therapist will work on your back as you lie in a semi-prone or side lying position.

Physical therapy massage has a profound ability to decrease stress as well as prevent or minimize many of the common symptoms and discomforts of pregnancy. Regular massage therapy sessions can mean the difference between a comfortable, relaxed pregnancy and one defined by miserable aches and pains.

Physical therapy massage is especially useful because pregnant women are often unable to take many medications that are normally used to manage common problems. Massage can help manage these aches and pains and is completely safe for both the mother and fetus.

According to a recent study published in the Journal of Psychosomatic Obstetrics and Gynecology, the benefits extend beyond just making mom feel good. Researchers found that for women who received regular massage, there were fewer complications both during pregnancy and afterwards, including fewer premature births.

How can physical therapy help?

Massage can have a beneficial impact on a whole range of problems associated with pregnancy, not just muscle aches.

Morning sickness is the nausea and vomiting that many women experience early in the pregnancy. Although it is called morning sickness, it can occur any time during the day or night. As with many other problems, hormones are largely to blame. However, stress also appears to play a very significant role. By using regular massage to relax, the incidence of nausea and vomiting can actually be reduced.

Hormones can also cause constipation as they cause the muscles of the digestive tract to relax. Gentle massage to the abdomen can help relieve constipation by activating a reflex that stimulates movement in the intestines. Massage therapists can also use rocking and passive range of motion techniques to get things moving. Deeper abdominal massage that is often used to relieve constipation in non-pregnant clients is never used, so there is no risk to the fetus.

Headaches are another common problem in pregnancy. A non-drug approach is by far the best way to treat them. Massage has been proven to be extremely useful in dealing with headaches and should be considered the preferred treatment choice. Research shows that headaches become shorter and less frequent with regular massage.

In the second trimester more pronounced physical changes take place. As the abdomen and breasts grow larger, a woman’s posture starts to change. Typically most women develop an increased curve in their lower back or sway back to compensate for the extra weight at the front of their bodies. It’s no surprise that about half of all pregnant women develop back pain.

Massage can help through this period by minimizing muscle imbalances, relaxing tense muscles and improving their blood flow. A physical therapist can help minimize episodes of muscle cramps, spasms, and myofascial pain, especially in the lower back, neck, hips, and legs. Other benefits of pregnancy massage include:

  • Tranquil relaxation and reduce stress.
  • Increase in blood and lymph circulation, which can reduce swelling.
  • Reduces stress on weight-bearing joints.
  • Improves outcome of labor and eases labor pain.
  • Enhances the pliability of skin and underlying tissues.
  • Provides support for the new mother with physical and emotional strains of mothering.

Taming your tension

Muscle tension is like a car that’s idling too fast. The car is revved up and working hard but nothing useful is happening. There’s more wear and tear on the motor. Not only that, but the motor is burning more fuel and creating more pollution.

With muscle tension your muscles are working hard, but are not doing anything that’s useful. The tension doesn’t help you move and it certainly doesn’t make your muscles stronger. It doesn’t really accomplish anything at all.

It does, however, cause a lot of wear and tear on your body. It strains the tendons that hold your muscles to your bones. It pulls the joints tighter together which not only causes horrible grinding and crunching sounds, but also causes the cartilage in your joints to wear out. The tension limits your movement, interferes with your co-ordination and may make you more accident-prone.

The tense muscles burn up the fuel in your muscles, making you feel tired. They also create the equivalent of car exhaust – toxic waste products (called metabolites) that fatigue your muscles and make them feel sore and achy.

You know from experience – tension is not good.

It’s important that you get your tension under control. Not only will you feel more comfortable, but you’ll also prevent a lot of problems from occurring, from kinks in your neck to early arthritis. To manage your tension, it helps to know what causes it.

The culprits

Stress is one of the major sources of muscle tension. When under stress, you become like a turtle trying to pull its head into its shell. Your shoulders round forward and lift up as your head pulls back. If your stress level is high, you may actually notice your shoulders around your ears. More often than not, the stress isn’t quite so significant and the shoulder muscles simply tighten up.

Just sitting or staying still for periods of time will also cause your muscles to tighten up. By remaining static, you are in a sense training your muscles to lock your back or neck in a certain posture. When you begin to move, your muscles remain tense in an effort to maintain your position. It takes some time for the muscles to realize that they can let go and relax. The longer you sit without moving, the more you train your muscles to lock into position and the longer it takes to release them.

In looking at the way that tension is created, you can see that the areas that are most vulnerable to tension are your neck, shoulders and back. Although tension can develop in any muscle in your body, these are the areas that are most commonly affected.

Physical Therapy to the rescue

Massage plays an important role in helping you deal with your tension. As a physical therapist it is possible to adjust how fast your “muscle motors” are idling, just like a mechanic with a sluggish motor.

Physical therapy uses many modalities in affecting change within tightened and tender muscles. The benefits of physical therapy and massage include:

– Increases circulation, allowing the body to pump more oxygen and nutrients into tissue cells and vital organs.

– Stimulates the flow of lymph, the body’s ‘trashman’, which helps fight against toxic invaders. For example, in breast cancer patients, massage has been shown to increase the cells that fight cancer.

– Increased circulation of blood and lymph systems improves the condition of the body’s largest organ – the skin.

– Relaxes and softens injured and overused muscles

– Reduces spasms and cramping

– Increases joint flexibility by stimulating synovial fluid, essential for pain free   movement

– Reduces recovery time, helps prepare for strenuous workouts and eliminates subsequent pains of the athlete at any level.

– Releases endorphins – the body’s natural painkiller – and is being used in chronic illness, injury and recovery from surgery to control and relieve pain.

– Reduces post-surgery adhesions and edema and can be used to reduce and realign scar tissue after healing has occurred.

– Improves range-of-motion and decreases discomfort for patients with low back pain.

– Provides exercise and stretching for atrophied muscles and reduces shortening of the muscles for those with restricted range of motion.

Dealing with Discs

Your back consists of stacked bones called vertebrae. There are discs between the vertebrae that act as shock absorbers and that allow the spine to bend. Each disc consists of a soft semi-fluid center (the nucleus) that is surrounded and held together by strong ligaments.

The discs in your spine can be the source of a great deal of back pain. This pain can range from a nagging ache and sciatic discomfort to excruciating pain that incapacitates you. There are simple measures you can take to reduce the risk of disc problems occurring and to reduce your pain once problems do occur.

To understand how disc pain happens, it is important to understand normal posture. When standing upright there is a natural inward curve in the lower back called a lumbar lordosis. With this natural lordosis, your body weight is distributed evenly over the discs.

Lumbar vertebrae and discs

The lordosis is lost whenever you slouch or bend forward. Back problems develop if you find yourself in these positions for long periods of time. This occurs because the vertebrae are placed in a position that pushes the nucleus backwards and stresses the ligaments at the back of the disc.

If the pressure on the ligaments is severe enough they may become weak and allow the soft inside part of the disc to bulge outward (prolapse) and press on the spinal nerves. This can cause sciatic pain in the buttock or down the leg.

Prevention is best

Ideally, you want to stop back pain from developing by taking some simple steps to reduce strain to your back.

Many chairs don’t offer sufficient support for your lower back. Even well designed chairs can be used improperly. For example, most people sit in the middle of the seat and then slouch backward against the back support.

It is important to maintain the natural lordosis in your lower back while sitting. You can use a specially designed lumbar support that can be attached to your chair or simply roll up a medium sized towel and place it between your lower back and the backrest of your seat.

As well, stand up regularly, put your hands on the back of your hips and bend backwards five or six times.

Many activities around the home like gardening, making the bed and vacuuming cause you to stoop forward. Make sure that you stand upright occasionally and bend backwards to relieve the strain on the back ligaments. If you are doing any lifting, make sure to keep your back straight and bend from your hips and knees.

In the event that your back starts hurting be sure to see your physical therapist right away. They’ll be able to help you out or refer you to a qualified medical professional.