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.

     A few weeks ago, I wrote a short blog about Musculoskeletal ultrasound and introduced it as a new way imaging can be obtain aside from X-ray or MRI. I talked about how versatile it can be when it comes to delivering results in timely manner as well as easing the burden of long wait times at multiple doctor sites.  Over the course of the last 3 weeks, I have been able to perform several ultrasound scans and produce images for patients on site. I have also been able to gain much needed familiarity so that I may bring you guys more information and blog posts describing my experience. 
     Recently I have had the opportunity to scan a shoulder and offer the patient an anatomical reason as to why they were unable to elevate the arm after a short period of uncomfortable rehabilitation. For the patient, our musculoskeletal ultrasound was the only piece of inside information accessible which really cleared the air because now this patient was fully updated about the condition of the shoulder from an anatomical perspective which made them feel at ease.   Fortunately, the results were more on the positive side and our patient was able to make a recovery with skilled physical therapy.  
     The example I presented is an unfortunate, but common experience that everyday people have in which there arises sudden and unexplained pain accompanied by swift functional decline. This can be a frightening experience especially when our mind starts wondering off on terrible thoughts about surgery and disability.   This is the very reason musculoskeletal ultrasound has been an important adjunct to our delivery of care. Remember folks, our goal is to provide you the best clinical experience possible. Having visuals to go along with our clinical assessment has now become a crucial step to delivering exceptional care.

-Anthony Durant PT, DPT   ​

"The best way to help prevent back, neck, and shoulder pain is by sitting upright. One of the ways the population can work on strengthening the postural muscles is by simply DOING IT! As per Robin McKenzie himself, slouching is considered the "kiss of death" and leads to a variety of musculoskeletal problems. Strengthening posture muscles takes time and it isn't easy. Most people are so used to slouching and have never been taught how to sit properly. Here are three tips to correct your posture:




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1. Stick your butt out
2. Bring your shoulder blades toward the spine without lifting your shoulders up
3. Push your head back as if a super-duper ugly person was leaning in to kiss you"

All joking aside, posture is very serious as it can cause a lifetime of pain. take these tips and do your best to apply them to your daily activities. You might be surprised the impact good posture could have on your life!

-Jose Gutierrez, PT, DPT

     The Centers for Disease Control (CDC) estimates that 1.6 million to 3.8 million people experience concussions during sports and recreational activities annually in the United States.  In order to stay safe and avoid permanent damage, it is important to know the warning signs and treatments for concussions. 

      Our PT Anthony filled us in on some important facts about concussions. 

     "Symptoms may be presented as dizziness, trouble with balance, loss in concentration, changes in mood or behavior, loss of memory, blackouts, headaches, neck pain and sensitivity to light and environmental noise."

     "New research of CTE, chronic traumatic encephalopathy, shows long-term consequences of changes in neurodynamics of brain tissue can cause changes in our internal wiring. This results in accelerated mood changes, depression, memory loss and even death."

     "There is no such thing as mild concussion. Insult to brain causes symptoms (you do not have to black out to receive a concussion) that should all be taken seriously. This includes terminating athletics until further notice and consultation with the appropriate health professionals."

     If you have suffered from a traumatic brain injury, WE CAN HELP! With out baseline testing, balance exercises, vestibular training & the care of one our talented therapists, we can help you get "better today for a healthy tomorrow!"

     -Jose Gutierrez, PT, DPT

     Just like any other Tuesday morning I wake up, a little later than usual, knowing I don’t have to go into work until 2pm. Pulling the covers away I swing my legs over, proceed to stand, and then it happens. I’m stuck. My name is Joe Hernandez, I am a Physical Therapist, and I have neck pain. 
The irony. Someone who has worked on dozens of necks at this point and can’t even move his own. Pain sears where my neck attaches to the rest of my body. Lights are brighter than usual; I can barely open my eyes as the pressure building behind them makes me feel as if they are about to pop out. What do I do? I quickly begin the exercise I generally prescribe in these instances. Ow. Okay. Ow.

     Wait, that really hurts. Ow. This is what they’ve been feeling? 

     Eventually I manage to get my head turning again but not all the way. I attempt to get through the day as my head feels so heavy, I can barely hold it up, and then it happened. My arm starts to go numb. I was getting worse. I was becoming afraid. 
That knife in the back of the shoulder blade I’ve heard patients describe so many times has now found its way in mine. I continue with my exercises. They weren’t making it worse, but they weren’t making it better. I needed help. 

     Luckily, I was surrounded by a handful of other therapists. Finding time out of his schedule, my colleague offered me help. “How’s your pain?” he asks. I ponder on the pain scale. What even is the difference between a 6 or a 7? How do I even choose? “Like a 6,” I mutter, wondering if that was the right answer. “And your headache?” Wait…how did he know I had a headache? And so, the treatment begun. 
     
     He did the things I usually do with my neck patients. A massage here, a stretch there. I could feel my trust build as I could finally completely rest my head into his hands. The pressure began to gradually increase, taking me to my threshold of pain, but never going past it. A few minutes later, with my head fully extended off the treatment table, he lifts my head up. “Take it for a spin,” he remarks. My pain was gone. 
     
​     Now, almost completely healed as I write this (yes it came back later that day, don’t worry, it’s normal) I can’t help but reflect on what this experience has given me. I now had a personal understanding of what some of my patients are going through. Neck pain isn’t the only thing I treat, and even my neck pain may not be your neck pain, but the best thing from all of this, I knew I was not alone, and neither are you.  

​     Pain is frightening. Having someone move you is uncomfortable. Questioning if you’d ever get back to doing the things you love is depressing. But there is support, and the people here at Spine and Rehab Specialists can provide it. I know this, because I’ve received it. If you’re struggling with neck pain, back pain, shoulder pain, or any type of pain, I’d invite you to reach out to us. If you can’t walk very far, your balance isn’t very good, or you just can’t move the way you used to, I’d invite you to reach out to us. If you simply want your pain to be known, and have someone trustworthy offer you support, please, reach out to us. We may not have experienced what you are going through, but we can absolutely make sure that you don’t have to experience it alone. 

     -​Joseph Hernandez, PT, DPT

     I am almost certain if you are reading this you probably have had at least one MRI or X-Ray scan in your life. Whether that was because your weekend warrior spirit resulted in a knee sprain after that pickup basketball game, or somehow magically you developed some random shoulder pain for no reason that really hurts. Either way how long did it take to receive your imaging results? Or better yet, how many appointments did you have to make and how long did it take to have the imaging performed.  Yes, this can be a rather drawn out process especially if you are in unceasing pain. 

     With that said, I would like to drive your attention to some new tech that can potentially ease the process and quickly deliver the answers you seek as to why on earth you are having pain. That tech is called Musculoskeletal Ultrasound (MSK US) and yes, it is basically the technology they use at the gynecologist but in a much different practice and scope of use.  Try to imagine using the same methods but geared towards looking at the body’s musculoskeletal system directly and in the clinic.  For example, with MSK US, we can scan for any injuries in the shoulder, knee etc. We will be able to determine in combination with our regular physical therapy evaluation the causes of your pain which will enable us to create a more accurate diagnosis and follow up exercise plan. 

     This is just the first of a series of blogs that are to come about MSK US and its role on how we can use this technology to develop a clearer insight when it comes to our diagnosis. Certainly, this capability will help ease your questions of what is really happening in your specific case and injury.  

​     -Anthony Durant PT, DPT   

     COVID-19 may have drastically changed the way we see the world and possibly impact decisions we make about our own health for the future. Many of you may have begun the new year with fitness goals in mind and were poised to fulfil these ambitions this year. Maybe some of you were already engaged in some sort of fitness training and felt unstoppable. Maybe you had that unbreakable gym schedule, that routine of work, school, gym, home in whatever order suited you. It seems unreal now, but in the not so distant past, gyms were loaded with people. It was either very annoying or quite enjoyable, pending if you’re the type of person that can handle the crowds.  

     Now we are faced with one of the most severe global health crises the world has seen in 100 years. As the county trickles with re-opening, I’m sure you cannot help but grapple with the question of “is it safe to go back to the gym”?  Should we risk bring infection back to our families? How will I stay fit and healthy if I cannot go to the gym? And how can I work out with a mask on my face?  I believe people may have become used to the idea that in order to maintain a healthy and fit lifestyle, we had to lift dumbbells in front of a mirror and watch ourselves grow, or that we needed to run on that beefy treadmill in order to lose weight. Although if you spend enough time at the gym that may be apparent, it is another thing to realize that maybe it is ok to skip the gym and with small adaptations you can grow into a new fitness regimen free of risking the health of you or your family. 

     Again, as the world tackles the pandemic and provides us with timetables of potential vaccines being ready at years end, that does not mean your physic must wait a year either. With a little creativity, a couple YouTube videos, or a chat with a physical therapist, you can learn how to exercise minus the fancy equipment. It doesn’t take much really, other than the mentality of - that’s how they used to train in the old days.  Take a minute and evaluate your own residence. Is there a place to thrown down an exercise matt and crank out some pushups, abdominal work, or squats? Is it all unusual to think that we can become stronger with just the use of an exercise matt (or carpet) if we only adapt our thinking and utilize our own resources? 

     Here are some thoughts for you. Number one, I believe you can! I truly believe that you can adapt your normal routine outside of the gym and still achieve your goals. You are fully capable to engage in active and fit lifestyle. Number two, use the environment around you, for example maybe use a chair to work on some dips. Use a matt while you plank, or lunge down your hallway. Maybe speed up the routine and challenge your cardio fitness. Number three, be resourceful and creative with what you have when you want to add some resistance. Weights are expensive now if you can even find any!  Think outside the box and try lifting a gallon of water during your squat routine. Don’t forget inexpensive resistive bands are very helpful and just as challenging to work with.

     In conclusion, I do not think need to give up your exercise routine and healthy lifestyle during these challenging times. Personally, for me exercise was a way to vent the everyday stress of life away and I know that was the case for many of you as well pre-COVID. Now among the many challenges and adaptations we are facing, I challenge you to adapt your exercise lifestyle today. This maybe something you do temporarily, or it may start you on the path of something new in the future.
     
​     -Anthony Durant PT, DPT