Torticollis and Physical Therapy

by Laura Neal on June 28, 2016 · 0 comments

Torticollis & Physical TherapyCongenital muscular torticollis is a term used to describe the shortening of a muscle in the neck known as the sternocleidomastoid. This muscle is responsible for bending your neck to the side and rotating your neck to the opposite side. This condition occurs commonly in infants due to a number of factors including positioning in utero, reflux, and positioning after birth. When this muscle becomes tight and shortened, a baby will tilt their head to the affected side and rotate their head to the other side. This positioning can affect the strength of their neck and eventually even prevent certain motor milestones from being attained. Additionally, torticollis can contribute to and often co-exists with a condition known as plagiocephaly, a flattening of the head.

It is important to correct torticollis as early as it is detected. If the condition was due to positioning in utero, this can be as early as 2-3 weeks of birth. Not correcting this condition early can lead to more complications including severe flattening of the skull and facial asymmetries. These conditions require further interventions including helmets which are costly and time consuming.

The majority of treatment for torticollis, particularly in very young infants, involves positioning. It is important that babies consistently change positions and are not left in a position for a long period of time. While it is important for babies to sleep on their back, as this has been found to decrease the risk of sudden infant death syndrome, tummy time when awake is one of the best positions to prevent torticollis and strengthen a child’s neck.

Along with positioning, your therapist will likely give you gentle stretching and strengthening exercises for your child. Depending on severity, treatment for torticollis is usually very quick if caught early. The majority of the treatment will be done at home through a home exercise program performed by the parent, with subtle changes made depending on your child’s age and severity. Additionally, your therapist will look for any red flags indicating that your child is falling behind in their motor milestones.

If you notice your child has a head tilt, only rotates his/her head to one side, or has flattening of the back or sides of his/her head, contact your physician and get referred for PT right away.

Balance Can Improve With Physical Therapy

by Julia Young on May 2, 2017 · 0 comments

Balance is defined as one’s ability to maintain their line or center of gravity over their base of support (i.e. your feet when you are standing). In other words, it is having the control to stay upright and steady. When talking about balance, you might hear some other terminology used, including postural control and stability or equilibrium.

Balance is a combination of three sensory systems that form a feedback loop with the central nervous system to integrate them together and provide the proper activation and stabilizing techniques. The three systems are as listed: vestibular system, visual system, and proprioceptive or somatosensory system. The proprioceptive/somatosensory system is complex and consists of neurons and pathways and is most relied upon.

Proprioception is the bodies (muscles stretch, joints position, tendon stretch, skin) perception of movement, vibration, position and pressure. When these factors change, the pathways send a message back to the brain that sends signals for correction and adaptation.

The visual system takes in the visual field around you including depth, size, moving objects, etc. This information is incorporated and the body reacts.

The vestibular system which in the ear includes the utricle, saccule, and three semicircular canals provide sensory information regarding motion, equilibrium and spatial orientation. These impulses are sent to the brain about movement and which canal is stimulated and in turn the body reacts and adapts
Balance problems occur when 1 or more of the systems in the body are not working properly.

Physical Therapy can help! Your PT will complete a thorough evaluation that includes your overall health history, medications, activity level, what you have difficulty with, examples of balance loss or being fearful of balance loss, and much more in order to paint a bigger picture of what the issues may be.
Physical therapists can offer numerous and a combination of options for treating balance problems, based on individual needs. PTs have extensive training to evaluate multiple systems of the body, including the strength of muscles, sensation and coordination, joint movements, inner ear, eye tracking, and position awareness. With this information, your physical therapist with teach and prescribe exercises and movement techniques to improve on the deficits.

Do You Suffer From Chronic Low Back Pain?

by Angela Bartsch on March 27, 2017 · 0 comments

You are not alone. 80% of Americans will experience low back pain at some point in their life. Prolonged postures and/or repetitive movements are often the cause of chronic low back pain. Studies have shown that poor hip strength, limited hip mobility, and decreased motion in the mid back are all risk factors for experiencing low back pain. These limitations are often associated with prolonged sitting as a result of desk jobs. The great news is that these risk factors are areas that a physical therapist can address with you. A physical therapist can help assess your current movement patterns, joint and soft tissue mobility, and strength to determine a proper intervention for addressing your pain. For example, if a patient presents with decreased motion in the mid back, decreased hip motion, and strength, a potential treatment would consist of joint mobilizations to the mid back and hip, soft tissue mobilization to the mid back and hip musculature, mobility exercises to address the mid back and hips, and therapeutic exercises to maintain the positive changes made in mobility and improve strength. Physical therapists are trained to address movement dysfunctions that may potentially be causing pain. Additionally, it is recommended for patients who are required to sit most of their day, to set a timer as a reminder stand and move every 30 minutes in order to prevent hypomobility of muscles and joints.

Below are some examples of mobility exercises you sit at a desk for the majority of your day in descending order: seated thoracic spine extension, kneeling hip flexor stretch, hand/heel rock, doorway pec stretch.

“Stretching” Versus “Warming up”

by Julia Young on February 20, 2017 · 0 comments

Stretching or prolonged stretching can be thought of as bringing a specific joint to its end range and holding this position to improve flexibility and/or mobility. This may sound familiar to you; from when we are small children we are taught that this is the appropriate prelude to a recreational activity or sport. While this is not a harmful activity, there are been many studies and much evidence that this type of stretching does not necessarily prevent injuries or improve performance. Stretching, as it is defined as above, does have its place in everyday life and many times will be prescribed in Physical Therapy to regain flexibility that has been lost due to tightness of muscles (from aging, surgery, posture, alignment) to ultimately improve one’s mobility or efficiency of movement patterns. If you want to recover flexibility, mobility, or range of motion this type of stretching is appropriate and important.

Let us talk about “warming up”. Considering that most recreational sports or activities require movement that occurs within a joints range of motion, requires muscle contraction and endurance; it is most beneficial to complete dynamic stretching before engaging in the activity. Dynamic stretching can be thought of as a joint mobility drill; a warm up consisting of movement and the active use of muscles that increases blood flow and prepares the body for higher level activity.

The picture to the right provides examples of dynamic stretching.

Dynamic Stretching

In conclusion, both types of stretching are significant and should be implemented when needed. If you feel that you have lost mobility, flexibility, have increased injuries or would like to get back to more recreational activities Physical Therapy may be able to help!

Quick Anatomy Lesson:
There are four muscles that assist the larger deltoid group to lift and lower the arm and are collectively known as the rotator cuff. The rotator cuff lies under the roof of the shoulder, the acromion, which is part of the shoulder blade. There is a space between the rotator cuff and the acromion which is filled by the subacromial bursa, a fluid filled sac that allows for smooth gliding of the rotator cuff under the acromion during shoulder movements.

The rotator cuff functions to depress and centralize the humeral head in the joint. When the arm is raised overhead, the rotator cuff depresses the humeral head allowing it to glide freely underneath the acromion. If there is any abnormality with the rotator cuff, the depressing and centralizing of the humeral head will be compromised. Consequently, during overhead movements the humeral head can glide upward and closer to the acromion causing possible impingement. The rotator cuff and the acromion will rub against one another, causing pain and possible inflammation, which is commonly known as impingement. Some pathologies of the rotator cuff include: tendinopathy due to chronic use, partial or full thickness tear, and calcific tendonitis. Some indirect causes are: glenohumeral instability, labral tears, abnormal movement patterns of the shoulder due mobility issues at the thoracic spine, scapula, and/or shoulder.

Physical therapy treatment:

Each shoulder impingement can present differently. A licensed physical therapist will perform a thorough personalized evaluation to determine a specific intervention based on your presentation.

The goal of physical therapy is to reduce pain, improve overall movement of the upper arm, and patient education in regards to preventing further injury. This is accomplished through:
• Therapeutic exercise intervention intending to improve movement patterns
• Strengthening appropriate musculature of the rotator muscle group
• Improving overall patient posture to ensure optimal overhead movement patterns
• Manual therapy techniques to assist in pain reduction and restoring proper movement.

Improving the improper movement patterns, strengthening the rotator cuff muscle group, improving overall posture to ensure overhead movement patterns are optimal, and manual therapy techniques to assist in reducing pain and restoring proper movement.

Bankart Repair of The Shoulder

by Ericka Mizuta on January 24, 2017 · 0 comments

A Bankart lesion is common with anterior shoulder dislocation and can contribute a great deal of shoulder instability. When the shoulder dislocates or “pops” out of the joint it can tear the attached joint capsule and the labrum (a thick band of cartilage attached to the glenoid bone. It lines the shoulder socket and helps keep the ball of the humerus/upper arm bone in place). Patients with a Bankart lesion will have symptoms that include clicking, catching, pain, feeling of instability, and feeling of weakness.

A Bankart Repair is done arthroscopically and the goal of the procedure is to re-attach and tighten the torn labrum and ligaments. The surgeon will use sutures and bone anchors to secure it in place.

tightening torn labrum and ligaments of the shoulder

After surgery, Physical Therapy is indicated to ensure that the patient returns to their previous level of function. Physical Therapy usually does not start until 4 weeks after surgery as the first phase of healing required by the surgeon includes immobilization and use of a sling that fixes patient in the proper alignment of efficient healing. The next phases focus on improving the range of motion, stability training, and strength training to return to high levels of activity.

Did you know that following pregnancy all women in France get a prescription for physical therapy? More than half of women experience urinary incontinence either during or after pregnancy. Unfortunately, in the USA most women are simply told to “do your kegels” and sent on their way, but the fact is most women end up doing them wrong, and you may be doing yourself a disservice. A kegel is a contraction of the pelvic floor; the muscular sling that sits within the pelvis. The pelvic floor consists of multiple tiny muscles and they perform two main functions: to keep your vaginal and rectal openings closed when they need to be (ex. Coughing, sneezing, running, etc.) and for postural support at your pelvis, low back, and internal organs. Performing kegel exercises without really knowing what you’re doing can lead to tightness and pain within these muscles and may only create more issues.

Here are some basic tips for starting your pelvic floor rehabilitation:

Begin on your back. The difficulty of contracting a weak muscle will always be influenced by gravity. While performing your contractions in sitting or standing may be more convenient, you’re making your pelvic floor work against gravity. By starting out lying down (or even with your hips elevated on a wedge) you are reducing the impact of gravity and therefore more likely to isolate the right muscles, which brings us to the next point…

Make sure you are isolating the right muscles. The pelvic floor muscles are internal, which means you shouldn’t be squeezing your glutes (your butt) or your abdominal muscles. When contracting your pelvic floor, think of pulling up, as in as if to stop the stream of urine. Testing this in the bathroom can be a good way to see if you are using the correct muscles, however this should not be performed as an exercise, as it can increase risk for UTI or bladder dysfunction.

Start small! I’ve read some magazine articles that suggest holding a kegel for 10 seconds. That is way too long for these tiny muscles after going through the trauma of vaginal delivery or even just supporting the weight of a baby for 9 months! Start by holding your contraction for as little as 2-3 seconds and rest for twice as long. Begin with small sets- perform 5 contractions 2-3 times with longer rest breaks in between. Again, these muscles are small and they fatigue quickly, they need adequate rest time.

Perform both slow holds and quick contractions. As mentioned above, the pelvic floor serves two functions, which means it needs to be exercised in two different ways. In addition to your slow holds, perform quick contractions (1 second on, 1 second off, fully relaxing during the off time). This will strengthen the fast-twitch fibers that we need to recruit on the spot during sneezing or coughing!

See a physical therapist! If you are having persistent urinary leakage or are just unsure whether or not you are doing your exercises properly, physical therapy can help. Just ask your doctor for a prescription for pelvic floor rehabilitation and call Mizuta & Associates Physical Therapy.

What does it stand for?
BPPV stands for Benign Paroxysmal Positional Vertigo.

What is BPPV?
Now this is usually the part that makes peoples head spin (ha, pun intended). Anyways, our ears have organs or structures called otolith organs that monitor the movements of your head relative to gravity. For a variety of reasons these crystals can become dislodged and move into another part of your inner ear called the semicircular canals. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to- causing the spinning or dizziness feeling.

What are other symptoms of BPPV?
Symptoms can include vertigo, dizziness, loss of balance, falls, and nausea. The feeling of vertigo can last from a few seconds to a few minutes. Usually, a nystagmus is present during these bouts of vertigo. A nystagmus is a rapid and involuntary eye movement.

What is vertigo?
It is the sudden sensation that you’re spinning or that the inside of your head is spinning. Vertigo that is caused by BPPV is usually triggered by specific head movements and can be mild to severe. Head movements that prompt symptoms are usually looking up and tilting head backwards, leaning all the way to bend over, rolling in bed, or when going from laying down to sitting up. These do vary from person to person, but symptoms are almost always brought on my changes in head positions.

Why Physical Therapy?
There are specific maneuvers that make use of gravity and head position to guide the crystals back into the correct chambers. Your physical therapist is trained to diagnose which maneuvers are needed through a variety of tests. In a clear majority of cases it can be correct in as little as 1-3 visits! Maintenance exercises will also be provided to complete at home for lasting effects.

It is important to note that prior to beginning treatment for BPPV your physical therapist will complete a neurological exam to rule out red flags and insure the patient is appropriate and safe for treatment. It is significant to be aware that BPPV should not cause constant dizziness, numbness or pins and needles, trouble speaking or trouble coordinating movements. If you are experiencing any of these symptoms alerting your health care provider immediately is recommended.

Don’t Get Text Neck

by Julia Young on December 22, 2016 · 0 comments

Per the new research and in summary, tilting your head forward increases the amount of stress and weight on your spine. When you tilt just 15 degrees forward, that’s about 27 pounds; at 30 degrees, it’s 40 pounds; at 45 degrees, it’s 49 pounds; and at 60 degrees, it’s 60 pounds of stress!

Many time, we aren’t even aware of how we are standing or sitting because our minds are focused on the tasks at hand, therefore, being aware of posture is the first and most important step for prevention. Computer and texting related neck strain and pain is common as it an everyday and necessary part of our lives. Here are a few easy adjustments you can make:

1. Raise the phone or tablet higher up towards eye level to avoid having to tilt or arch neck.
2. Start by standing or sitting up straight. Obtain neutral spine alignment starting from the pelvis and avoid arching to far forward through your low back. Next, stack your midback and gently pull shoulders back. Lastly, try to align neck to avoid a forward head posture, meaning elongate neck and think about gently pulling chin backwards towards your spine.
3. Take frequent breaks or change positions.
4. Exercise daily as a means of stress management.
5. Complete gentle neck and midback stretches

o Place one hand behind back, lean opposite ear to opposite shoulder. If you feel a stretch stop here. If you want more of a stretch, use other arm to assist.
o Hold 30sec-1 min

o Tuck the chin down toward the neck, then slowly raise it up toward the ceiling.
o Hold 30 sec to 1 min

o Gently tip head backwards while supporting your neck to release some tension on muscles

Active Release Technique

by Angela Bartsch on December 12, 2016 · 0 comments

At Mizuta & Associates we offer Active Release Technique as a course of treatment. Active Release Technique is a hands-on touch and case-management system that allows a practitioner to diagnose and treat soft tissue injuries. Soft tissue refers to primarily the muscle, tendon, fascia, and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART.

Over-used muscles (and other soft tissues) change in three important ways:
• acute conditions (pulls, tears, collisions, etc)
• accumulation of small tears (micro-trauma)
• not getting enough oxygen (hypoxia)

Each of these factors can cause your body to produce tough, dense scar tissue in the affected area. This scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker, tension on tendons causes tendonitis, and nerves can become trapped. This can cause reduced range of motion, loss of strength, and pain. If a nerve is trapped you may also feel tingling, numbness, and weakness.

What to expect:
The four areas of concern (tissue tension, texture, movement, and function) should all change during the course of treatment. Symptoms are often duplicated during treatment and are usually relieved during the first or second treatment. If the symptoms are duplicated and last until the next treatment, then the treatment must be modified. Strength, speed, and endurance are expected to improve within the first few visits.
Whenever possible, active movements are employed for these primary reasons:
1. The patient feels control of the treatment process which lends comfort to the patient.
2. Active motion more closely simulates the requirements of the soft tissues in normal movements.
3. Active motion causes neurological perception of movement and position which causes an impulse to pass through the spinal tract that modifies pain impulses.

Physical Therapy After A Mastectomy

by Julia Young

Structured physical therapy post op mastectomy has shown to improve range of motion and pain, short and long term. Immediately post-operative, it is important to give your body rest and time to heal noting that structures have been cut and moved. Meaning you do not want to have excessive arm and shoulder movements or use […]