Anthony here! So, I just recently got certified and credentialed for MDT and I wanted to take some time to talk to you guys a little about what it is and what it means for me as a physical therapist. First let’s talk about the credentialing process.
 
The process to get certified in the McKenzie Method consists of a few different components and classes. The classes are divided into five different sections, A, B, C, D, and a recently added section, E. Once those classes are completed the next step is signing up for the credential examination. The exam has three different parts, a written test, a lab form, and then a skills practical, after passing all that the last step is to claim your certification!
 
So mechanical diagnosis and therapy, or the McKenzie Method, involves understanding a method of treatment and applying that in its form to patients. The reason I like the McKenzie method is because it’s a hands-off approach, I know that sounds counterintuitive to what we do as physical therapists but if we can train a patient on how to understand their pain and find a movement that works for them, they can practice that movement in repetitions at home on their own and get better even when they’re not in the clinic.
 
Sometimes what happens is patients begin to rely on us doing manual therapy or stretching them out directly as their main source of getting better, this creates a dependency and while we will always be here for our patients, we want them to get better so they can live pain free independently and not need our constant help.
 
With the McKenzie Method we can train to minimize dependency, we always do manual therapy and stretching and massaging in our clinics but once we find that movement that works for them, they can work on relieving their pain at home and can continue even after they are finished at our clinic.
 
I’ve seen it work miracles; there are many different and effective forms of treatment don’t get me wrong, but with the McKenzie Method I’ve seen tons of results with neck and low back treatment. It’s why I wanted to get credentialed.
 
Come see me in the clinic or call if you have any other questions on the McKenzie Method and how we use it in our clinics!

- Anthony Durant, PT, DPT, Cert. MDT

Hello everyone, I’m Joey, a physical therapists here at Spine & Rehab Specialists and I wanted to talk to you guys about the home exercise programs we give out to each of our patients. In my opinion, these home exercise programs are one of the most important aspects of the rehabilitation program.
 
Now it should go without saying that when you come to physical therapy, it’s going to be a little physical. I wanted to address this because often times I get the look on my patient’s face when I tell them a part of their program is going to be based on them doing some exercise on their own time but trust me, it’s not as bad as you may initially think! Often times exercise can be scary to a patient with an injury especially if they’ve never really exercised before in their life. Well never fear, I’m here to tell you that exercise doesn’t necessarily mean lifting heavy weights or using a bunch of different equipment, exercising can be as easy as lying down on your stomach! If you don’t believe me come see me,  I promise it’s an exercise that I often prescribe for low back pain.
 
So basically, you don’t always have to be putting an excessive amount of effort into your home program okay? Your exercises may consist of something as simple as keeping an eye on your posture but exercising at any level is always important. The word exercise should not be intimidating when it comes to physical therapy, yes it is going to be physical, yes you are going to do some exercise, but there’s a lot of science behind this okay? A combination of some exercise, some education, some hands-on manual therapy, that’s what’s going to help you get better.
 
That’s what we do right? We want you to live a better life, whatever that means for you. Let us know how we can help you and let’s get active!
 
-Jose Gutierrez, PT, DPT

This blog is the written form of two of our weekly video series, Wellness Wednesdays and Thirsty for Knowledge Thursdays. Our Wellness Wednesdays go over great exercises that can help relieve pain from a specific injury, and our Thirsty for Knowledge Thursdays go over exactly what that injury is and how it happens. Click the "Our YouTube Channel" button on the right side of this page to head over to our YouTube Channel or check out the videos above!



This weeks video topics were on Thoracic Sprains and Strains, Earl and Chris showed some great seated exercises that can help treat the pain and Harry and Anthony talked about Thoracic injuries in more detail and explained how they occur. First, let’s start off with talking about exactly what Thoracic sprains/ strains/ pains are and see how people usually get these kinds of pains.
 
The Thoracic spine is the longest part of the spine and lies between the Cervical spine and the Lumbar spine. The Cervical spine is the neck area and the Lumbar spine is more of the lower back area, so the Thoracic spine would be right in the middle in that mid back area. The Thoracic spine is not necessarily an area of a lot of problems, we normally see more neck and low back problems but it can still be an issue for someone who does not practice good posture on a regular basis. When sitting or standing with proper posture our spines will generally have an inward curve in the Lumbar/ lower back, a more outward curve in the Thoracic spine/ mid back area, and ending with an inward curve at the Cervical spine/ top. When someone is sitting or standing with bad posture, their spines form one big “C” shape which is not its natural position and therefore can cause some pain and discomfort in the Thoracic spine region.
 
When we are in this position it might feel good or comfortable to us in that moment, but sitting in this position often enough or for long periods of time will start to give someone serious problems. We have been seeing these problems more and more in the clinic due to the Covid-19 pandemic causing many people to have to work from home. People are sitting on their couches or beds rather than their normal desks or work spaces resulting in more bending over and less sitting up straight, causing these issues in the Thoracic spine. We usually hear our patients with these issues report having a kind of stabbing pain in the mid back that will be present for one moment and gone the next. What they are probably not realizing is that when they are sitting with correct posture the pains disappear, but those pains always return when they revert back to sitting incorrectly. Even though having good posture is not normally a big area of concern, doing this long enough can lead to pain between the shoulder blades and even low back and neck pain in the future.
 
So the secret to avoiding those pains and strains in the Thoracic spine? Listen to all those times your mother told you to sit up straight and practice good posture! If you are already starting to get those pains though don’t worry, we have some tips and easy exercises you can do to help relieve those pains and get your back, back (pun definitely intended) to it’s natural pain free state. One quick tip we always give patients who have trouble figuring out how they should position themselves to have good posture can be done in three easy steps:
1.First slouch, then over correct your posture by squeezing your shoulder blades together and pushing your chest out
2.Do this movement 10 times
3.On the last one, overcorrect by about 15-20 % less and find where you feel balanced the most, this should be the correct posture for you
Another way to relieve pain and correct the posture some is to put your hands behind your head and stretch out the opposite way. Stretch backwards and make a “C” shape in the opposite direction of when slouching forward, that should help reset your back and posture a little.

​Other than those two tips, there are also some easy exercises that can be done while seated that can help relieve Thoracic pains and strains, here are 6 to start off with.
 
The first exercise is called External Rotation Series and the only equipment you will need for this are some weights. In the video, Earl and Chris used two one pound weights but for someone doing these at home a simple can of corn or soup is a great substitution, or these can be done without any weight if needed. Once you have your weights, you start by raising your arms at a 90 degree angle in front of you, and then lifting your arms straight up towards the ceiling. Bring your arms back down to a 90 degree angle, keep them at that 90 degree angle but now open your arms so that they are in a straight line with your shoulders and then push your arms straight up to the ceiling again. Once you have that movement down, do about 3 sets with 10 to 15 repetitions.
 
The second exercise is called a Swimmers Press. This exercise will also require a one pound weight in each hand (or soup can or nothing if you don’t feel like it). With a weight in each hand you will start off by doing a basic bicep curl, once your hands are positioned close to your body in the bicep curl you twist your wrists so that your palms are facing outward. Now that your palms are facing outward, you push your arms straight up to the ceiling, bring your arms back down to the bicep curl position, twist your wrists back to facing your body and lower your arms back down to your waist. When doing this make sure to not drop your arms after you lifted them up above you, slowly bring them down in the correct movements. Once you got that movement down this can be done for about 3 sets of 10 to 15 repetitions as well.
 
The third exercise is called Seated Middle Trapezius. For this one you have your arms at waist level with your weights in your hands, your palms facing up, and your thumbs pointed out. Next you squeeze your shoulder blades together as you move your arms outward. While you are doing this never let your elbows leave your ribs, your elbows should be touching your ribs even as you squeeze your shoulder blades and move your arms outwards. Once you got this movement down you can do about 3 sets of 10 to 15 repetitions.
 
The next and fourth exercise is called the Kayak. For this exercise you can use a number of different items, Chris is using a towel and Earl is using a stretch out strap, but you can easily use maybe a t shirt or a dog leash or anything of that nature. To start you position you hands about a shoulder length apart from each other on your rope (or rope substitute) and hold it with both of your thumbs out and facing the same direction, one hand should be facing palm up and the other palm down. Once you are holding it correctly you stretch your arms straight out in front of you, and move it up and down diagonally across your body, you should reach up to your head and then back down to your knees all while keeping your arms perfectly straight. When moving you move up in the direction that your thumbs are pointing then when you have done a few sets on that side, switch your hands around the other way so that your thumbs are both pointing in the other direction and repeat the movements for that side. Make sure you are twisting the upper body well and squeezing that core. Once you have the movement down this can be done for 3 sets of 10 to 15 reps.
 
The fifth exercise is called a Seated Dead Bug. For this exercise you won’t need any equipment at all, just you! Start by putting your arms out in front of you and your feet planted firmly on the ground about shoulder width apart. Next you lift one knee up and touch it with your hand that is opposite to the knee you lifted. Continue this motion switching between each side. As you are lifting your knee make sure you are twisting good and strengthening your core, it should look somewhat like a march as you are tapping with the opposite hand. As you are tapping your knee, the hand that is not in use should be lifted in the air and stretched behind you following your twisting body. Once you are good with the movement you can do this for about 3 sets of 10 to 15 reps.
 
The sixth and final exercise is more of an extension, so once you feel pretty good with doing all those exercises, you want to make sure you can move in all directions that your upper back is supposed to move (bending backwards, bending forwards, rotation etc). One way to do an extension is to start by having your arms crossed against your body with your hands on your shoulders and sitting at the end of your seat. Next lean forward a little and then start arching your back and pointing your elbows up to the ceiling while they are still crossed. If this causes some shoulder pain another way it can be done is by uncrossing your arms and putting your hands on your shoulders. Once you’ve done that you can arch your back and lift your elbows up to the ceiling while keeping your arms in front of you, don’t let your arms open up while you are arching your back. Once you have that down you can do that for about 15 repetitions.
 
Those are some different exercises you can do if you do have any Thoracic sprains or strains, we gave a general recommendation of doing around 3 sets of 10 to 15 repetitions for each exercise but that part is definitely up to you and how you are feeling with the exercises. If you are still having problems or if you have any questions for us, give us a call at either of our locations and take advantage of our free consultations so we can help you guys with whatever you need.

This blog was transcribed from our 13th episode of our Spine & Rehab Specialists podcast series featuring Harry Koster, PT, Cert. MDT and Marlene Gomez, PT, DPT. Scan this QR code or click the button on the right side of this page if you are interested in listening to this, or any of our other episodes!

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The word Arthritis can be broken down into two parts. The first part “artho” means joint and “itis” means inflammation so putting it all together Arthritis can be a number of different conditions that affect and cause inflammation in the joints. The majority of the time people assume Arthritis is just an “old age” thing and one day we will all have to accept it, but that is definitely not the case. There is a specific kind of Arthritis that does progress over time with age but that is specific to Osteoarthritis and there are many different types of Arthritis that are not associated with older age. One of the most common types of Arthritis is Rheumatoid Arthritis, it is more systemic and a little bit more severe but it is not one that automatically comes with old age.
 
Osteoarthritis tends to develop over time progressively and causes what some people call “wear and tear” to the cartilage surrounding the joint. Most of the joints in our body have a thin lining of connective tissue called cartilage. Cartilage surrounds the ends of the joints and its function is t help reduce friction when the joints are moving, it helps everything move smoothly. Compare it to ice for an example, a smooth layer of ice is ideal for gliding smoothly across but if you were to take some tool and crack the ice it becomes rough which is what’s happening to the cartilage. There’s some damage and wear and tear in the in the cartilage it’s not as smooth as it used to be, so the joints won’t move as smoothly anymore which causes those symptoms like stiffness and joint pain. Normally cartilage is very smooth but over time it can get sand-papered out.
 
Genetics play a part in causing Arthritis, some people might genetically be more prone to getting it than others but there are multiple different things that can contribute to it beyond just genetics. Things like injuries, bad habits, and more can contribute to that wear and tear that’s happening. Arthritis is typically seen in joints called weight bearing joints so we see a lot of people who have it in the knees and the hips because they carry a lot of load but it can affect other joints as well. We take into consideration what the patient does throughout the day, we need to know what their occupation is or if they play any sports or anything of that repetitive nature where they would be using the same joint over and over. For example, a baseball pitcher uses the shoulder over and over they might get arthritis in the shoulder or someone who has a very labor-intensive job that requires a lot of bending or picking up that’s when we see it in the knees, the hips, the back/spine, and places like that.
 
When most people find out they have Arthritis they automatically think they are going to have to choose between living with it and the pain or getting some kind of replacement surgery or something of that surgical nature, but that is usually not the case. There is a lot of evidence that Physical Therapy does reduce a lot of the pain and symptoms and also improves function. A lot of what we target is improving mobility in the joint, reducing the pain and reducing the symptoms. When people have arthritis they typically tend to not want to move as much and that is what contributes the most to the stiffness in the joints, the less you move you the weaker and tighter your muscles get. Although the part of the body that has Arthritis is the main point of the pain and discomfort, it is not the only part of the body we look at.
 
For example, if someone has arthritis in the knees we will not only address the muscles immediately around the knee, we will also take a gool look at the hip to see if there is any weakness or lack of mobility that the knee has to take the extra load for. It’s a matter of us taking a look at the whole body not just that one joint, we need to identify what deficits and problems there are and then really address them. As Physical Therapists we can’t go in there and replace the cartilage or try and fix everything but the benefits people experience from trying Physical Therapy as a treatment are phenomenal.
 
Surgeries are a big deal they are not just expensive, the recovery process is a big long process to deal with as well and it can be very painful. Some people come into our clinic looking like they are heading towards a total hip or total knee replacement and they end up not needing it or at least postponing it by a couple of years because of the care and education we provide through Physical Therapy. Plus, if you have a surgery you are going to need Physical Therapy afterwards either way so it definitely can be beneficial to start at therapy first. PT beforehand is going to be beneficial as far as strengthening the muscles and gaining some joint range of motion back so that the recovery is a little easier on your body, and also in the aspect of educating the patient on exactly what is going to happen to their body and how they should go about taking care of it after.
 
When treating Osteoarthritis specifically the most common treatment options are pain medications for the pain and anti-inflammatory medication to help if there is some inflammation or swelling which is often present with Osteoarthritis. Other than that there’s more invasive treatments like surgeries or certain injections to help the cartilage but even then these are all temporary solutions. And there is obviously also, Physical Therapy. So far for people with Osteoarthritis, Physical Therapy has proven to be very beneficial. It’s really a matter of the earlier you do it the better and more effective it will be as a treatment. After a certain point with Osteoarthritis there can be major issues inside the joint that can be harder to treat but if someone with that kind of damage had come in maybe a few years earlier that damage could have been majorly slowed and even prevented.
 
Physical Therapy for someone with Osteoarthritis would consist of a few different things. Education is one of the most important things we do here for our patients, we can educate patients on techniques they can use to preserve the joints and on how to do things and move in a better way that doesn’t put as much strain on the joints. Modifying certain activities helps a lot, we have seen patients that are trying to kneel but have a hard time getting up for an example, and when we watch them get up we notice they do it in a way that is putting more force through their knees than necessary. We look at things like this so we can modify the way patients move and show them a better way to get up from a kneeling position for example to help them protect their joints in the long run. They aren’t necessarily moving incorrectly but there is definitely a better way.
 
Treatment options for Rheumatoid Arthritis is a little different. Rheumatoid is different from Osteo Arthritis because it’s systemic, which means it’s a chronic and inflammatory condition. It’s inflammatory in that it’s the immune system that is attacking the joints in the body, it can even involve multiple joints and it tends to progress and become a little more debilitating over time. People with Rheumatoid Arthritis tend to experience not only pain and inflammation in the joints, but joint stiffness, redness and warmth in the joints, and the joint stiffness in the morning tends to last longer. Osteoarthritis can cause inflammation too on some occasions but with Rheumatoid Arthritis it is a much bigger deal.
 
Patients who suffer from Rheumatoid also tend to get flare ups where there’s even more inflammation and symptoms and joint stiffness and pain and even in extreme cases, joint and bone destruction. And because it’s systematic the patient during the flare up will feel just generally unwell, they might be tired or have a low grade fever even. There can be some erosion of the bone itself and that’s where you start seeing the damage and the deformities in the joints. For example Rheumatoid in the hands over time may look like bent and stiff fingers and just completely different. It’s definitely a more sever condition than Osteoarthritis and not necessarily related to wear and tear, almost any age can be affected its not just specific to the older population.
 
The important thing to remember when treating Rheumatoid is that its systemic and chronic so early on you really do need to see a specialist to prevent the eventual damage and try to slow the progression of the joint damage. A doctor might offer treatments such as cortical steroids and anti-inflammatories but also specific medications that are used to suppress the immune system because that is what is attacking their joints. These different medications and disease modifying drugs often come with a lot of side effects and at times can stop working when the patient’s body becomes accustomed to it causing the patient to switch often between a number of different medications. Cortical steroids can often weaken the bones as a side effect as well when the patient is already at risk of that just by having Rheumatoid.
 
When working with a Rheumatoid patient we also take into consideration the fact that their medication is suppressing their immune system so they might be more prone to infection that some of our other patients. We also have to consider if the patient is a fall risk and address their balance so they don’t end up suffering a bone injury on top of all the other pains that come with Rheumatoid.
 
There are many different kinds of arthritis but these are two of the most common and the teo we probably see the most of in our clinic.

This blog was transcribed from our 8th episode of our Spine & Rehab Specialists podcast series featuring Harry Koster, PT, Cert. MDT and John Moreno, PT, DPT. Scan this QR code or click the button on the right side of this page if you are interested in listening to this, or any of our other episodes!


Our legs are important as they help us to walk, run, drive, navigate stairs, move objects, kick, as well as perform a variety of other functions. When we injure our legs, it can have a heavy impact on our lives. The rehab process to get better from an injury does not always go very smoothly as putting pressure through and injured area can be painful and cause further damage and/ or inflammation. Unfortunately, that’s the only way one’s legs can get back to full function, but with one of our amazing pieces of equipment we have here, the AlterG, it doesn’t have to be as difficult or as painful as you think.
 
Essentially, the AlterG is a treadmill, however, what sets it apart from a standard treadmill is the sort of space bubble it has wrapped around it. The “space bubble” allows the machine to control the amount of air that’s within the environment. What this does for you is offload the pressure that you are applying through your legs. With some adjustments to the settings the AlterG can remove up to 80% of your body weight, which will basically feel like you are walking on clouds!
 
So now that the patient is lighter, what’s next?
 
We have the patient go through an exercise regimen at the reduced pressures, once their body becomes accustomed to this, we can start adding the pressure on slowly over time in a controlled manner. That way the patient can slowly but surely get back to full weight bearing without having to go through so much pain. It’s useful not only for walking, but for squatting, running, jumping, standing on one leg, balance, as well as other types of exercises.
 
There are many different conditions or injuries in the lower extremities that could benefit from rehab with the AlterG, anyone who has trouble or pain with walking, standing, climbing stairs, running, or any pain related to the lower extremities could benefit from spending some time in the AlterG. The possibilities go beyond just basic lower extremity pains, things like neurological disorders, general injuries, post-surgical injuries, sprains, and many more can also see significant results from using the AlterG; essentially any injury from the hip down is a candidate for rehab on the AlterG. We may use it for some lower back pain rehab but not for every case.
 
The AlterG is a great device that can help us help our patients in the lower extremity rehabilitation process. It provides an environment that will help patients get back to their prior level of function in a much less painful way. Therefore, if you are experiencing any disfunction or pain in your legs/ lower extremities and need help, give us a call here at Spine & Rehab Specialists so that way we can evaluate you and get you started on your road to recovery!

I’d like to talk about Autism Spectrum Disorder (ASD), describe what it is, and talk about the benefits of Physical Therapy.  The technical definition of ASD looks something like this:
“Autism Spectrum Disorder (ASD) is classified, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as a disorder which is characterized by persistent deficits in social communication and interaction, as well as several types of restricted or repetitive behaviors.  Under this spectrum, the disorder ranges in severity which is determined through a variety of behaviors observed in the individual. These behaviors include: deficits in social-emotional reciprocity, deficits in non-verbal communicative behaviors and deficits in maintaining and understanding relationships, as well as stereotyped or repetitive motor movements, insistence on sameness, highly restricted fixated interest that are abnormal in intensity or focus, and hyper or hypo reactivity to sensory input.  Due to all these symptoms, the development of social interaction and communication skills are greatly impacted.”
This is a whole lot to take in, so let me break this down. ASD is a very real and very serious disorder, which is seen as a range, or spectrum, of specific “symptoms”. Since this is a spectrum, there can be a whole lot of areas, or severities that someone diagnosed can fit. It also means that there are not any single- symptom types that fit one person or another, it means that there are many things to look out for. Things such as difficulty communicating, both listening and talking, as well as difficulty keeping or starting relationships or friendships. There are also some physical behaviors that can show, like repeating specific movements over and over (like rocking back and forth repetitively or self-aggression such as biting their own arm or hitting themselves) or moving objects in one very specific way day-to-day, it also means that if this pattern is broken, distress will follow.
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Exercise as a Treatment for ASD

​Studies have shown that individuals with ASD can benefit from regular exercise, to put it in a technical sense, these benefits include:
“Observed increased focus as well as an observed increase in ability to stay on task and increased academic focus with notable observed decreases in self-injury and aggression. Similar studies have shown the intensity and duration of exercise as a determining the level of notable improvements (higher intensity exercise or longer duration exercise programs would result in highest observed benefits). Decreases in sleep disturbances were observed in individuals with ASD after participating in exercise programs.”
Ok, so this is also a big bite to eat, so if we break this down, it basically says that exercise can help focus, both at home and in school settings. It also says that the movements we discussed before, like self-harm, will be less frequent, possibly stopping entirely. The higher improvements in these behaviors were seen with higher intensity exercise programs, which does not mean that lower intensity programs can’t show benefits, they just showed different results.
Where does Physical Therapy fit in? Well, to start, the first word of this is “Physical” which implies movement of the body through controlled and calculated exercises. Similar studies have shown that exercise can be a preventative measure for controlling certain behavior patterns seen in those with uncontrolled lack of focus and aggressive behaviors.
All in all, it’s just a great idea to get out and exercise, if there are any concerns for those with ASD during exercise, bring them in for Physical Therapy. Skilled and highly trained Physical Therapists can provide safe and controlled exercises that will help provide all of these benefits and more.

- Chris McMillen MAIS

This blog was transcribed from our 6th episode of our Spine & Rehab Specialists podcast series featuring Harry Koster, PT, Cert. MDT and Lukas Gilmore, PT, DPT. Scan this QR code or click the button on the right side of this page if you are interested in listening to this, or any of our other episodes!


Let’s talk about motivation! I am sure we all have some sort of idea of what motivation is, but we are going to go more in detail for this blog today.
 
Motivation is the process that initiates, guides, and maintains goal-oriented behaviors. It is what causes you to act, whether it is getting a glass of water to reduce thirst or reading a book to gain knowledge. Motivation involves several key points; the biological, emotional, social, and cognitive forces that activate behavior, among may others. In layman’s terms, “motivation” is frequently used to describe why a person does something – the driving force behind human actions. Motivation does not just refer to the factors that activate behaviors; it also involves the factors that direct and maintain these goal directed actions (though such motives are rarely directly observable). We must often infer the reasons why people do the things that they do based on observable behaviors, which isn’t always 100% accurate, but it’s the best we have to work with. We can break this down into three parts with an Activation phase, Persistence, and Intensity.
 
Motivation can be split up into two different kinds: Extrinsic Motivation and Intrinsic Motivation.
 
Let’s start with Extrinsic Motivation. Extrinsic Motivations are those that arise from outside of the individual and often involve rewards such as trophies, money, work bonuses, social recognition such as likes on an Instagram post, or praise in general. Even those things can be extremely powerful forces to “drive” someone, they’re often short lived in the grand scheme of things when considering areas such as Physical Therapy, health, and wellness. With that said, they can be effective at redundant/ boring tasks to get things done quickly. Jobs that give a piece rate pay grade is a good example. Another example is a parent forcing their child to remain I their bedroom to study longer. If the homework the child is doing is boring, with a reward by doing it, the child may be likely to get it done quickly.
 
To summarize, Extrinsic Motivation is outside motivators that are normally incentivized with rewards. Now, let’s get into Intrinsic Motivation!
 
Intrinsic motivations are those that arise from within the individual. An example would be doing a complicated crossword puzzle purely for the personal gratification of solving a problem. Intrinsic motivations usually have longer-lasting effects and boosted creativity and fulfillment. To show the opposite of our earlier homework example; a parent educating their child on why they should want to do the homework, for achieving greater potential and enjoying the learning process, will likely increase the probability that their child will be creative on his/ her approach to the subject. I.e. internalization of views yields greater autonomy.
 
So how do we benefit from motivation? Why is motivation so important in our everyday lives?
 
Motivation is important because it shapes everything that we do to change our lives for the better, or for the worst. Motivation helps improve the efficiency of people as they work towards goals. It helps people act and encourages people to engage in health-oriented behaviors and avoid unhealthy or maladaptive behaviors such as risk taking and addiction. Motivation helps people feel more in control of their lives and improve their overall well-being and happiness, which I would say is all pretty important.
 
Let’s also take a look at the science behind motivation. Your brain runs on dopamine. We normally associate dopamine with pleasure, but it also has been found to fire before a reward (external or internal) is given. Researchers at Vanderbilt have demonstrated that dopamine has a strong impact on willingness to work. They used brain mapping to define “go-getters” and “slackers.” The “go-getters” had higher dopamine in the areas for motivation and reward, whereas the “slackers” had more dopamine in the area for emotion and risk.
 
Remember when we talked about creativity being most commonly seen in intrinsically motivated people earlier? A spin-off experiment of the Candle Problem, which was originally created by professor Dunker in 1945, was conducted in 1962. For those unfamiliar, the Candle Problem is one where a few items were made available; a box of tacs, a candle stick, and some matches, all of which were on a table in the corner of a room. The idea was that the participants needed to find a way to get the candle lit above the table without dripping was on the table. Some unsuccessful attempts were made one being melting the wax a little and trying to stick it to the wall, and another being trying to tac the candle to the wall; neither worked.
 
In the experiment, participants were told to solve the problem as quickly as possible. All the participants were grouped into 2 different groups. One group was offered a money reward for winning and the other group was not, while both groups had the goal to solve it as quickly as possible. They found that the group without the reward did so significantly faster, since the solution required them to “think outside the box”, they used the tacs to tac the tac box to the wall and use it to hold the candle.  A similar experiment was conducted where all components were laid out and the money reward group dominated the other. It was hypothesized that this was because this mow simple solution didn’t require creativity.
 
If your goal is a creative product, then the threat of being late will make that much harder for you to innovate.
 
Now that we know more about motivation, how does it relate to health, wellness, and of course, Physical Therapy?
 
Motivation is extremely applicable to Physical Therapy and other aspects of our health. For one, as we create advanced/ creative ways to optimize our care as Physical Therapists for various treatments and exercises. More importantly, helping patients tap into this creative/ intrinsic motivation to live an active lifestyle that they can take with them long after they finish their plan of care. A patient I have recently reminded me of something the wise JT killings once said, Physical Therapy never stops, it’s something that always continues.
 
One way we try to optimize motivation with our patients in the clinic is by conducting a motivational interview. These interviews are beneficial to physical therapists because it taps into change talk, which shifts patient’s perceptions from being receivers of care, to autonomous individuals in charge of their lives. For those that don’t know much about motivational interviews, change talk is essentially getting patients to talk their way into realizing what matters most to them. The more we as PTs can let our patients ramble on about the positive benefits of health, wellness, and fitness, you are doing it right.
 
Going off of that, gaining customized/ individual needs is extremely important, as knowing what matters most will help intrinsically motivate them to participate. As mentioned in this past Sunday Stroll, examples like grandkids, 5ks, vacations, and more are all goals to address. Goal setting, which is done in our initial evaluations, is addressed throughout care and allows the patients to meet milestones along the way. These help shape perceived positive change in patient’s care.
 
Motivation can be hard because it’s all in your head, or at least most of it is. We need to shift our perception of things in a way that puts you in control of yourself, to maximize autonomy and accountability. If you struggle with motivating yourself resist saying “I must/ have to do this” and “I can’t do this” instead choose to realign your tasks and realize that effort creates excellence over longer periods of time.

This blog was transcribed from our 5th episode of our Spine & Rehab Specialists podcast series featuring Harry Koster, PT, Cert. MDT and Marlene Gomez, PT, DPT. Scan this QR code or click the button on the right side of this page if you are interested in listening to this, or any of our other episodes!
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The vestibular system, in a simple definition, involves a set of small structures inside the inner ear that help detect information about the position and movement of your head in relation to your body and in relation to your surroundings. And by doing this, it provides us with our sense of motion and position, which really comes into play with balance. And it’s not only this sense of movement that helps contribute to maintaining our balance, but the vestibular system also helps use this information to create reflexes to help correct and maintain our postures, our visual stability, which we refer to as gaze stability, and of course our balance.
 
What happens when the vestibular system becomes affected? What kinds of symptoms do people experience?
 
The typical symptoms that people have are dizziness, vertigo, balance difficulties, visual disturbance, and sometimes even hearing impairment. But most of these symptoms occur because the vestibular system is no longer functioning properly to process the information about head and body position effectively, so the information you are receiving will lead you to feel that you are maybe moving when you are actually still or that you moved a lot faster than you actually did. It is important to note that the terms vertigo and dizziness are actually not the exactly the same; the term vertigo really describes a sensation of spinning.
 
These symptoms are not always due to something in the vestibular system, it is important to note that other factors have to be considered when dealing with symptoms of dizziness or vertigo, such as medications, as many will list dizziness as a side effect.  Blood pressure is also another important one to consider, especially if someone mentions that they become dizzy or lightheaded when they stand up. History of stroke or brain injuries, or other neurological conditions or problems such as tumors in certain areas of the brain, can also have symptoms of dizziness. And even problems in the cervical spine in which case people tend to respond well to treatments for the neck.
 
There are various conditions that can affect the vestibular system, two specifically that I would like to focus on in greater depth as they tend to be more common.
 
BPPV – Benign Paroxysmal Positional Vertigo
 
Vertigo is one of the hallmark signs of the first condition I wanted to talk about which is BPPV. This is one of the more simple conditions, and it is something that we have previously discussed in one of our Sunday stroll videos.  In this condition there are these small structures, which are typically described as small rocks or crystals, that become dislodged from the area they are typically contained in, and become stuck within the canals of the vestibular system. While in these canals, these crystals will move every time you move your head or change your body position, which will stimulate the sensation of spinning.
 
This condition has very specific signs and symptoms, one being vertigo that lasts usually less than one minute. It typically takes a few seconds for symptoms to be reproduced with specific movements, and another is a specific eye movement, which is called Nystagmus, that occurs briefly during these episodes of vertigo
 
BBPV is pretty common and something we see in the clinic quite often due to the fact that the crystals previously mentioned may become dislodged with some sort of head trauma, or even with a sudden brisk movement of the head. Which is something that can really catch someone off guard, because of how sudden it can develop.
 
The second condition, which is a bit more complex, is generally described as Vestibular dysfunction. This is basically when the vestibular system is no longer working well; this can be due to problems withing one or many of the structures involved within this system. Now this can occur in both sides, but typically one side of the vestibular system will be stronger, so the information you are receiving about your movements will still be inaccurate; there will be an imbalance between the feedback you are receiving from both sides, which will cause symptoms of dizziness or moving when you are not.
 
With this condition, people may not always have vertigo episodes, but may tend to feel a baseline sensation of dizziness, a sensation of swaying or that they are always moving, or even that they are being pushed toward one side. With these conditions, people will always have a problem with combined movements of the head and eyes.
 
A vestibular loss like this can be due to certain medications over time actually leading to dysfunction of the vestibular system. Some of these medications may actually be meant to treat dizziness, but because it suppresses the vestibular system it can actually lead to it not working as well. Small tumors within the nerve that works with the vestibular system, known as the acoustic nerve, will also affect vestibular function. There are also certain viruses or ear infections that can cause inflammation of this nerve which will also produce vestibular symptoms. And also surgeries; for example, if someone has surgery to remove a tumor of the acoustic nerve, or even have a cochlear implant for hearing loss, may have vestibular dysfunction afterward.
 
The symptoms of dizziness and vertigo alone is very bothersome because of how unpleasant it is, and at times can be so severe that it can make someone feel nauseous or even lead to vomiting because of how strong the symptoms can be. It can interfere with your ability to perform simple movements such as turning your head, laying down, walking, turning your body, because many of these movements will reproduce those symptoms. And we need these movements to function, for example to drive, to turn our head while walking to look at something, just to perform our everyday tasks. Walking and standing can also be difficulty because your sense of stability and balance will also be affected. This is important to consider when we talk about balance and the risk for falls, for everyone but particularly in the elderly population, in which Dizziness is a risk factor for falls in older individuals
 
According to the CDC, 1 in 4 older adults fall every year. That is a big problem, because falls are also the leading cause of fatal and nonfatal injuries among this population. Broken hips and wrists, head injuries are all a big risk and something we should really worry about as we get older. Not only that, but another issue that tends to occur is immobility, because something that we tend to do when we experience something unpleasant is we try to avoid the specific movements that trigger the symptoms. In these cases, people will avoid turning or moving their head, limit their walking, may avoid laying down in certain positions, which then creates other problems, such as stiffness, muscle tightness, weakness, limited endurance, and sometimes even pain.
 
We as physical therapists, can help patients with these problems depending on the type of  vestibular disorder. So first of all we will do a complete evaluation of all the systems that are involved in balance, including your vestibular system. The Physical Therapist will then develop a Plan of Care that will address the specific impairments to help reduce symptoms, help teach the patient certain movements and exercises to help manage their symptoms, and of course help improve balance. Typically, this can include:
-       Gaze stability exercises, where we work on combining and coordinating eye and head movements
-       Repositioning maneuvers, specifically for BPPV, in which we have to move the head and the body through a series of positions to help move those crystals that we mentioned earlier, out of the canals and back to where they are supposed to be.
-       Adaptation, Substitution, and Habituation exercises – these are just concepts utilized more for vestibular loss, all they basically emphasize on the ability of the body to adapt over time, to adapt to repeated exposure to activities that tend to aggravate symptoms, and strengthening the other systems in the body to make up for the impaired vestibular system.
-       Balance training and fall prevention strategies
-       Gait training, where we may work on walking mechanics
-       Strengthening, flexibility, and proprioception exercises, not only as they play a role with balance and stability, but also because we have to address the secondary effects of becoming more sedentary or avoiding movements because of the symptoms
-       Functional activities for return to previous level of ability
 
It is important to continue to address balance difficulties, even after someone begins to have less symptoms with therapy, this goes back to being able to return to previous activities and ability to function. Similar to when people begin to experience less pain with certain treatment interventions, we want to make sure that the individual can safely and confidently return to the activities they were doing previously to improve their ability to function from day to day, and improve overall quality of life.
 
If you or someone you know has problems with their balance, or has questions, reach out to us and we will gladly talk to you or bring you in, so we can take a look at balance, we can test it and see how you are doing and we will figure out together what we need to do.
 

This blog was transcribed from our 3rd episode of our Spine & Rehab Specialists podcast series featuring Harry Koster, PT, Cert. MDT and Andrea Goche, PT, DPT. Scan this QR code or click the button on the right side of this page if you are interested in listening to this, or any of our other episodes!
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Obesity is not an easy subject to talk about, but well worth having this discussion. When you look at the numbers, they are staggering. According to the Centers for Disease Control, 74 % of people in the United States are overweight. That is three quarters of the population. And according to the CDC, from 1999 to 2018 the rate of obesity had increased from 30.5 % to 42.4 % with 9.2 % considered severely obese. So not only is this a big problem in this country, but it also seems to be getting worse and worse. Obesity is a complex health issue resulting from a combination of causes and individual factors such as behavior and genetics. Behaviors can include physical activity, inactivity, dietary patterns, medication use, and other exposures. Additional contributing factors include the food and physical activity environment, education and skills, and food marketing and promotion.
 
I think that everybody will probably know that being obese isn’t a good thing, that it isn’t healthy. Obesity is serious because it is associated with poorer mental health outcomes and reduced quality of life. Obesity is also associated with the leading causes of death in the United States and worldwide, including diabetes, heart disease, stroke, and some types of cancer. I think a lot of people are probably aware that obesity contributes to things like heart disease, strokes and diseases like that. But there is another area that people may not realize that obesity can contribute to problems and that is with soft tissue damage and osteoarthritis. Osteoarthritis is a highly prevalent joint disorder estimated to affect more than 37% of adults over the age of 60; it is a leading cause of pain and disability. Osteoarthritis is associated with considerable loss in productivity and healthcare expenditures, accounting for 97% of the total knee replacements and 83% of the total hip replacements in 2004.]
 
Every step you take, all that weight goes through your hip, knee and ankle, and every pound of body weight places four to six pounds of pressure on each knee joint. So if someone is 50 pounds overweight… that means 200-300 pounds of extra pressure on the knee joint. I don’t think I even want to do the math for someone who is 200 pounds of more overweight. That is why the impact of obesity is especially felt in osteoarthritis of the hip and knee joints. Individuals with obesity are 20 times more likely to need a knee replacement than those who are not overweight.
 
So that is a lot of wear and tear on the joints! We used to think that knee osteoarthritis was mostly a  ‘wear-and-tear’ condition, but that is not even true… it gets worse. It is now recognized that knee osteoarthritis exists in the highly metabolic and inflammatory environments of adiposity. Cytokines associated with adipose tissue, including leptin, adiponectin, and resistin, may influence osteoarthritis though direct joint degradation or control of local inflammatory processes. Further, pound-for-pound, not all obesity is equivalent for the development of knee osteoarthritis; development appears to be strongly related to the co-existence of disordered glucose and lipid metabolism.
That’s a lot of official and difficult words, but to summarize it, we now know that certain chemicals, substances associated with fat tissue also contribute to arthritis, on top of the ‘wear and tear’ from the extra weight.

I guess we need to invest in the companies that manufacture the parts for total knees! From 2002 to 2009, the number of total knee arthroplasty (TKA) procedures performed on patients with obesity doubled. The detrimental effects of obesity on surgical outcome results and complication rates are well documented in medical literature. These effects include higher rates of infection and prosthesis failure/loosening of the implant when compared to patients of normal weight. In addition to contributing to arthritis and other musculoskeletal health issues, obesity also is linked to diabetes, heart disease, sleep apnea, liver disease, pancreatitis, certain tumors and cancers, and psychiatric disorders.
This really creates a bigger problem all together. Obesity contributes to knee arthritis, and causes us to have more knee replacement surgeries, but then at the same time, that obesity causes other health conditions that give us worse outcomes on those surgeries. Obesity, in the absence of these conditions, does not appear to significantly increase the risk of orthopedic pre- and postoperative complications. However, in combination with any of these conditions, obesity can adversely affect orthopedic surgical outcomes. Pre- and postoperative complications may include wound healing, infections, blood clots, blood loss, and dislocation of the replacement joint, especially in the hip.

The decision to have a total knee replacement should not be taken lightly but look at all the factors and not just the fact that your knee hurts because you are overweight. Now, how can we, as Physical Therapists, help with this problem? Obviously, we can do the rehab on your knee after the knee replacement, but we can help patients BEFORE getting surgery with patient education, physical exercise, and weight loss (for overweight or obese individuals) should be the first-line knee OA treatment approach. And of course, we know that one of the pillars of weight loss, is exercise (combined with healthy eating – which is a whole different subject that we are not going to be able to talk about today). One of the simplest forms of exercise is walking, right? But how do we tell someone whose knee hurts a lot, to start walking? Great idea, but they literally not going to go very far… but thankfully we have other options for patients that just can’t walk far enough to make a dent in their weight.
 
One of the options would be aquatic therapy… exercises in the water. I read this study, performed in 2010, where the researchers were comparing the effects of aquatic based therapy and land-based therapy in patients with obesity experiencing knee pain from knee OA. The study showed that body fat proportion in the AQE group decreased significantly after intervention and it showed significant improvements in pain, disability, and quality of life. Notably, the change in pain interference with activity in the AQE group was greater than that of the LBE group. So that shows us that there are some good advantages for overweight patients with knee pain to do exercises in an aquatic therapy setting.  So, how would a person that is interested in losing weight, and start aquatics, go about that? We have a therapy pool in the clinic at Physicians Drive that is specifically designed for this. It’s a Hydroworx 500 Pool, with different water depths, we can use different equipment in the water and the best feature I think is the underwater treadmill. Patients can walk at different speeds, forward/ backwards/sideways, it is awesome. And we even have cameras that can help them correct how they walk.

​Now, not everybody has to go in to the water. Some people may not want to get wet, are afraid of water, or just dislike water.  The pool is not for everyone, and we have lots of different ways to help patients without going in to the water. We have the AlterG antigravity treadmill, where we can also unload the joints and provide a more painfree way of moving, exercising and walking. We also have all sorts of other exercises that will help both with weight loss and with painful knees and hips.
 
So we can come to the conclusion that for obese and overweight patients there are lots of reasons to start exercising and start working on that weight, for your heart health, to lower your blood pressure, improve your diabetes, but also help reduce some of these inflammatory substances that exist due to obesity and that may set you up for a poor outcome on knee surgery.  And we have lots of ways to help people get started and help them along the way.