My shoulder aches after swimming. Do I apply ice or heat?

That depends on how the shoulder injury behaves. If your pain level is a constant 7 or greater (scale: 0 = no pain, 10 = severe pain) and worse with activity, I would apply ice. If the pain is 5, and gets worse or better unpredictably, I would play it safe and apply ice. If in doubt, apply ice. If it is 3 at worst and eases with activity, without worsening the next day, I would apply heat. – Matt Wren M.S., P.T.


I’m a recreational swimmer. My doc said I have rotator cuff tendonitis. What is it? Can I swim through it? Is there anything I can do?

I do not recommend that anyone “train through” pain. Realize that pain and muscle fatigue are two different things. It’s OK to get tired while exercising; that’s normal. It’s definitely not OK to feel sharp, burning, tingling or stabbing pain while training. Pain is Nature’s way of telling you something is wrong and needs to be checked out. Pain is a signal similar to the check engine light on your car’s dashboard. Ignoring the ‘check engine light’ and continuing to drive can lead to engine damage. Ignoring pain or covering it up with medication and “training through it” will lead to compensatory movement, altered mechanics and possibly, multiple injuries.
I would need to ask you some questions to determine an answer.
1. How long have you had it?
2. What is your mileage, and how many times do you train per week? ...be honest.
3. What strokes hurt, and which don’t hurt?
4. Do you use paddles or a kick board?
5. What part of the stroke is the problem: the catch, the power phase, or the finish (recovery) phase?
We need to find the why behind the injury. – Matt Wren M.S., P.T.


I got a new bike, and now my first and third fingers, on one hand, are numb?

Gradual progressive numbness, related to cycling, is never good. The first thing to check is the saddle height and lumbar differential. Take a 3’ long straightedge and place it on the bike seat and handle bar. The saddle-stem height differential should not be greater than 1-2.” If the seat height is appropriate for you, it could be that your handlebar is too low. It could also be that the reach is too long for your body. Both of these will increase stress on the neck, and lead to nerve symptoms in the arms and hands. If after making the above adjustments, you still have pain, we can do a dynamic bike fit. Click here to see how PT Works can help. – Matt Wren M.S., P.T.


I added aero bars on my bike. Is the bike fit the same for both aero bars and traditional drop
handlebars?

No. It depends on whether you’re riding a multi-sport bike or a triathlon bike. The multisport bike seat tube will be a laid back 72 to 73° angle. This bike will handle well in a variety of conditions. Using an aero-bar on this bike will change the handling and may be uncomfortable on your lower back and neck. You’ll have to move your seat up and forward to be comfortable and efficient. The extra body weight on the front wheel will make bike handling a bit twitchy at speed. A true triathlon bike’s seat tube will be an aggressive 76-80° angle. This is relatively steep compared to a multisport bike and is only meant to be comfortable at high speeds in the aero position. This bike is an F-14 fighter jet – not your cruise to the bagel shop kind of bike. Click here to see how PT Works can help with a bike fit. – Matt Wren M.S., P.T.


I just changed running shoes and now my Achilles tendons are killing me. Is there any correlation?

I’d have to ask you several questions before I can answer accurately:
1. Why did you change running shoes in the first place?
2. How long did you wear the old pair? You should rotate your shoes every 300 to 500 miles.
3. Did you change the model or the shoe brand? If you were happy and running well with the old model and brand, why did you change?
4. Did you have any hints of injury before wearing a new shoe or was a progressive injury the reason you changed your shoes in the first place?
Some training shoes have a slightly elevated heel for comfort. Most performance shoes however, have a low heel, allowing a faster heel toe transition. Dropping your heel down may irritate the Achilles tendon. Finding a running shoe that works for you is a trial and error process. Our Shoe Fit Program (www.ptworksllc.com/shoe.html) will help save you time and money. Once you find the correct shoe brand and model that works for you, stick with it.
Other than shoe choice, most injuries can be traced to three things.
1. Genetics: a person who is biomechanically challenged. (i.e.: severe flat feet, bowed legs)
2. Training error: too much too soon; not enough rest; dehydration; short warm up or cool down.
3. Environmental changes: too many hills; running when it’s too hot or too cold.
– Matt Wren M.S., P.T.


Should I stretch before or after exercise? I hear conflicting opinions.

It’s not so much a matter of when you stretch but how and what body parts you stretch. Granted there are some people who are naturally flexible, who gain sufficient mobility through exercise; these people don’t need to stretch much. On the other end of the spectrum are those who are naturally tight and stiff and must work very hard at gaining and maintaining flexibility; these individuals should stretch before and after exercise. Your exercise prep routine should match your genetic predisposition – whether that is being flexible or being tight. Your routine should also match the activity for which you are preparing. For example, if the activity requires running, cutting, stopping and jumping, emphasize stretching the legs in the sport-specific dynamic patterns you will need on the field. Realize that muscles do not move in single planes of motion but rather in complex movement patterns. Hold each stretch position for 30 seconds before relaxing, and then repeat three to five times. Never produce pain while stretching. The
brain will perceive pain as an emergency signal and force the body to tighten the involved muscles. It is impossible to increase mobility while the brain is telling your body to do otherwise. A stretching and dynamic warmup activity should be unique for each person. No two people are alike in terms of genetic predisposition for flexibility and mobility needs. If you’re unsure about which exercises are right for you and your specific sport, click here. PT Works can help. – Matt Wren M.S., P.T.


Spring soccer training recently started, and my son complains of heel pain. Could this be plantar fasciitis?

I need more information:
1. How old is your son?
2. When and in what part of the heel does the pain occur?
There can be several different locations and/or causes of pediatric heel pain. Children and adolescents involved in soccer, track, or basketball are especially vulnerable to overuse syndromes.
Plantar fascia pain is an inflammation of the band of tissue (the plantar fascia) that runs along the bottom of the foot from the heel to the toes. The pain is intense when getting out of bed in the morning or standing after sitting for long periods, and then it subsides after walking around a bit.
Calcaneal apophysitis, also known as Sever's disease, is an inflammation of the heel's growth plate (see diagram) due to repetitive stress. It occurs in those who are very active, obese or who have tight calves and Achilles tendons. It commonly occurs in the 8-14 age range.
Tendo-Achilles bursitis. This condition is an inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. Achilles Tendonitis is usually located 1-2 cm above where the tendon attaches to the heel. This inflammation of the tendon usually occurs in children over the age of 14. Stress fractures or hairline breaks resulting from repeated stress on the bone often occur in adolescents engaged in athletics, especially when the intensity of training suddenly changes. Acute fractures in children under the age of 10 can result from simply jumping 2 or 3 feet from a couch or stairway.
I would recommend your son discontinue playing soccer until he has been seen by his doctor. Physical therapy will help your son by determining and treating any mechanical or alignment dysfunctions that may have caused the strain/stress on his tissues. Apply ice to the painful area for 10-15 minutes as needed for pain. – Terri Berkshire M.S., P.T. and Matt Wren M.S., P.T.




How do I choose the best clipless pedal system for my bike?

That depends on whether you ride a mountain or a road bike. Each situation requires a different set of pedal features. Most cleat systems have a 9° to 20° float or rotation and move with your natural leg motion during the pedal stroke. The critical question is, “how do I adjust the cleats to match my unique biomechanics?” I see so many cyclists with the wrong cleat set-up. Some people naturally toe in or toe out when they walk or sit. The cleat set-up should closely match their natural position. Personally, I toe-in on one foot and toe-out on the other, so my cleat position is set accordingly. Be patient and don’t be afraid to “tweak your ride.” Click here to see how a PT Works Bike Fit can help. – Matt Wren M.S., P.T.


Why do some athletes, especially runners, lie on the ground and elevate their legs up on a tree, wall or fence after a race?

Elevating your legs after a vigorous exercise session or endurance race is an effective way to assist your body in evacuating metabolic waste products created by the effort. These metabolic waste products can collect in your veins and in the lymphatic system of your legs, and if not properly evacuated, they can lead to the delayed onset of muscle soreness.
An active recovery or a warm-down jog, walk or ride, is adequate in most cases to speed the recovery process. However, there are situations where athletes have to exert themselves in back-to-back races with little to no rest interval between the events. Elevating your legs against a wall or fence is a type of passive recovery that can be effective in evacuating metabolic waste products while keeping your caloric expenditure to a minimum.
I also encourage runners to use a self-massage called the THE STICK. You can find it at local running stores or on line at www.thestick.com. Self massage for 5-10 minutes will do your legs a world of good. Personally, I use elevation and THE STICK frequently after training runs and my legs feel much better the next day. – Matt Wren M.S., P.T.


My daughter complains of shoulder pain after pitching in her softball games. Is icing enough to control the symptoms?

Ice is good to control painful symptoms. However, if your daughter has consistent pain each time she pitches, there may be more to it than muscle soreness. In other words, there may be faulty pitching mechanics which are causing repetitive strain to the shoulder. At PT Works, a thorough assessment of her strength and mobility will be conducted. Video analysis will be done to view her mechanics while she pitches. By slowing down the video, the PT can easily watch body alignment during the different pitching phases. This information can shed light on mechanical errors that could be straining the shoulder. Your daughter’s coach and/or physician can be issued a copy of this video to help with proper pitch-training, and her PT would focus on strengthening and mobilizing the correct areas to reduce pain and enhance performance. – Danene Brown P.T., D.P.T.


Tips to return to distance running and cycling training after a sedentary winter.
(As seen in SBQ • Winter 2008 issue)

Build aerobic base:
1. Begin with steady effort runs and cycling rides 60-70% max HR.
2. Use a HR monitor to keep yourself honest. HR monitors run about $100 and are well
worth the investment. If you are a beginner use the formula 220 minus age to
get your HR max and then calculate your aerobic base training range by
HR max x 60% and 70%.
3. Avoid all-out efforts until you build a solid base fitness level. Depending upon how much inactivity you have had over the winter, it could take as long as 6-8 weeks to re-establish a solid fitness base.
Avoid injury:
1. Increase run / bike mileage no more than 10% per week.
2. Train with others who have the same fitness levels and goals as you. It can help keep you progressing at a steady pace. Training with those who are faster or farther along in their training will only encourage you to overdo it, get injured or feel ‘behind’ in your training
3. Avoid “spring knee.” Cyclists should start by using low gearing on the bike for 6-8 weeks; it’s not hammer time. Got a stiff lower back? Raise the stem 1 inch; you can lower it again later in the season.
4. Watch road conditions. Look for pot holes, cracks, loose sand on the side of the road and around turns. Look out for the unaware drivers who have not seen cyclists and runners on the road over the past several weeks. Dress to be seen while running and cycling.
5. Hydrate. Although it’s not hot outside, you will lose fluid with respiration even on cold days. Drink up.
6. Upgrade. Update your running shoes (rotate shoes every 300 to 500 miles), and get your bike tuned up.
7. Dress for success.
a. Wear tights when the air temp dips below 60° to protect the knee ligaments, tendons and cartilage from wind chill on the bike. In the spring, a warm sunny day can change to cloudy cool, windy and back again very quickly. It doesn't have to be bone-chilling cold for an athlete to get into trouble. Hypothermia can occur on what might otherwise be considered just a cool spring day.
b. Carry gloves, hat and shoe covers; you can’t wear it if you don’t have it. Why do you think cycling jerseys have pockets in the back?


CONGRATULATIONS!!

To our Train Smart client, Dr Robert Singer, age 78, for accomplishing his goal of climbing Mount Kilimanjaro–19,341 feet–which he reached January 14, 2008. We look forward to helping you train for your next climb!




Last year several of my volleyball players were sidelined with ankle injuries. What can I do
differently this year to prevent ankle injuries?

There can be several reasons for your players’ ankle injuries. What to do about them is straightforward. Ankle injuries can be related to weakness, coordination and agility problems of the ankle, knee, hip and trunk. Preventive exercise should address all of these areas.
Dynamic Single Leg Swing: Stand on the right leg with the knee slightly bent, rapidly swing the left leg forward and backward 20 times and then side to side, in front of right leg, 20 times. Swing the leg as fast as you can without losing balance. Repeat 5 times while standing on each leg.
Single Leg Toe Touch: Stand on the right leg while holding a volleyball overhead. Now slowly reach forward as far as you can, then downward to touch the toes, reach forward again and back over your head. Repeat 10 times, on each leg, without losing balance.
Bump Practice Against a Wall: many players will practice bumping against a wall. Try doing so while standing on one leg. Count the controlled contacts without losing balance and compare the right leg to the left.
These drills will help you and your players discover agility and coordination deficits between the right and left legs as well as fix the underlying problems. – Matt Wren M.S., P.T.


Is plyometric training safe for children?

Plyometrics is a method of conditioning originally reserved for adult athletes. The American College of Sports Medicine considers plyometric training a safe, beneficial and fun activity for children and adolescents provided that the program is properly designed and supervised.
Plyometric exercises start with a rapid stretch of a muscle (eccentric phase) and are followed by a rapid shortening of the same muscle (concentric phase). Plyometrics are a natural part of most movements such as double and single leg jumping, hopping and skipping. Common games and activities seen on any school playground such as hopscotch, jumping rope and jumping jacks are considered plyometrics.
As with any exercise, there is the potential for injury if the level of difficulty and volume of the training program progresses too rapidly. Children should be supervised and instructed in proper exercise technique and rate of progression. Participants must wear supportive athletic footwear and exercises should be performed on surfaces with some resilience; grass, mulch bed, rubber floor mat….not a concrete floor. A good resource: Progressive Plyometrics for Kids by Falkel, Faigenbaum and Chu available at Amazon.com. – Matt Wren M.S., P.T.


I’m a high school coach; many of my football players have problems with recurrent lower back pain. We have a good strength and conditioning program, and these are strong, powerful kids but something is missing. What can we do differently?

First, we would need to assess the athlete for a lumbar stress fracture which is common in football linemen, gymnasts and cheerleaders. If an athlete complains of increased low back pain with a standing back bend, he will need to see a physician and get a lumbar spine X-ray, a CT or a bone scan to rule out a stress fracture.
If the tests are negative for stress fracture, then we next would need to assess how the athlete moves.
For an athlete to move efficiently on the field or court, he / she must develop:
a) mobility (flexibility across multiple joints as with squatting or lunging);
b) stability (balance control, body awareness);
c) sports skills; and finally
d) strength and power.
Without mobility and stability an athlete will not be able to develop efficient movement patterns for sport skills such as running, cutting, jumping and lunging. This will lead to compensation by the foot, ankle, knee, hip and lower back. These compensations are inefficient movement patterns and may lead to injury. To layer strength and power training on top of these compensations would be a mistake. The result will be an over-powered, under-mobile, clumsy athlete and injuries will likely result. This is a common situation I see in the teenage athlete where weight room statistics and body image are a concern, and mobility and stability are not a priority.
Without mobility, dynamic stability is not possible. Without mobility and stability, efficient sport skills are not easily developed. Athletes must develop mobility, stability and efficient sports skills BEFORE adding strength and power training. – Matt Wren M.S., P.T.


CONGRATULATIONS!!

To our Train Smart client, Dr Robert Singer, age 78, for accomplishing his goal of climbing Mount Kilimanjaro–19,341 feet–which he reached January 14, 2008. We look forward to helping you train for your next climb!




My physician told me I have a frozen shoulder and that it will go away on its own… but my friend did physical therapy and got better.

Your physician and friend are BOTH correct. Frozen shoulder, aka adhesive capsulitis, is a metabolic condition afflicting the shoulder joint lining. Its etiology is often unknown, but those having a previous shoulder injury are more prone. It occurs most often during the fourth and fifth decades of life. The lining of the joint becomes inflamed and restricted, causing pain and immobility of the shoulder. Interestingly, frozen shoulder usually resolves in about one year without treatment. However, most can benefit from PT to reduce pain and improve mobility for daily activities in less time. PT would include modalities to reduce pain, hands-on techniques to increase joint mobility, and therapeutic exercise to restore functional abilities. – Danene Brown P.T., D.P.T.


My mother is aging and has had several falls in the last few months… can anything be done?

Number one, falls should be taken seriously. One in three, over the age of 65, fall each year, and of those, 20-30% will lose mobility and independence. Can you believe that 87% of all fractures occur from falls? Half of those with hip fractures cannot return home!
First, it should be determined why your mother is falling. Falls can occur from many factors, ie, developing weakness with sedentary living, inner ear disorders, or being over medicated. Consulting with her family physician and possibly a balance specialist/ENT may diagnose the root cause.
Physical therapy can definitely help to prevent falls by strengthening the muscles associated with balance and stabilization, assistive device prescription (cane, walker), home modifications, and gait training. – Danene Brown P.T., D.P.T.


I’ve been told I have plantar fasciitis… what is it and can PT help?

PF is an overstretch injury of the arch, or plantar fascia, from it’s attachment at the heel bone. This creates local inflammation and pain on the bottom of the heel, typically upon first rising in the morning and with prolonged standing or walking. It is often persnickety and can linger for a year or more. Physical therapy can assist in pain reduction, shoe or orthotic prescription, proper stretching of the calf musculature, and ice application techniques—all which can get you back on your feet quicker! – Danene Brown P.T., D.P.T.


I was in an awful car accident last week. I felt ok for a day or two, then the pain got really bad
on the third day. X-rays are normal. How long can I expect to feel bad?

Initially after an accident you may feel fine because of adrenalin in your system. As this wears off the soft tissue strain will become noticeable causing pain and stiffness. You may feellousy for a couple weeks. It is important during this time to allow your body rest periods through the day and to avoid static postures, as possible, to keep
the tissues from stiffening which will cause more pain. Gradually you will begin to feel better with some set back days. In the clinic we would perform a thorough exam and develop a program to meet your specific needs to aid in your healing process. We can help you manage your pain through education in posture, function, positioning, use of modalities (ice, heat, e-stim, massage) and exercise. – Terri Berkshire M.S., P.T.


I have a bunion and my podiatrist recommended surgery to relieve the pain I have when
walking. Is physical therapy an option?

Yes, physical therapy may be able to relieve your pain; and therefore, improve your quality of walking. Even if you’ve already had the surgery, PT can reduce the recurrence of bunions.
First, I would ask you what type of shoes you wear on a regular basis: for exercise, for work, and for going out on the town. More women than men tend to form bunions as they squeeze the forefoot into the narrow toe box of high-heels. Second, I would determine if you’ve been wearing the correct size, including the width. You can easily do this at home by tracing the outline of your foot while standing, then tracing the outline of your favorite shoe over top. Your shoe should be the larger outline!
Your PT should examine your foot posture while you stand and walk. Pronation is a movement pattern where the arch lowers excessively during stance or walking. This can cause undo stress to the first metatarsophalangeal joint, creating pain and further malalignment of a bunion. An over the counter insert or an inexpensive, heat moldable orthotic may be prescribed by your PT to reduce pronation of the foot. Other biomechanical factors would also be assessed, such as leg length discrepancies or restricted heel cords. – Danene Brown P.T., D.P.T.


One Doctor said I had tendonitis in my elbow, and another doctor said I had tendonosis. What’s the difference?

A tendonitis is an acute inflammation of a relatively recent injury. This type of injury responds well to ice application of 15 minutes, 3-4 times a day; reduced exercise time and intensity; resting. A tendonitis should resolve within 4-6 weeks. A tendonosis is an inflammation that has continued for six months or longer. In a tendonosis, the tendon has undergone a degenerative change and it is actually weaker than it was the day of the initial injury. To heal properly, a tendonosis needs two things:
1. Increased blood flow which will provide oxygen and nutrition to the injured tissue.
2. Controlled, progressive exercise to promote healing.
Applying heat, combined with a slow progressive warm-up and exercise plan, should help the elbow heal. But this will take time. If you don’t address a tendonitis early, it will progress to a tendonosis, which is much more difficult to heal. – Matt Wren M.S. P.T.

My three-year-old son is a toe walker. What do you recommend?

Two words: blinky shoes! Most types of light-up shoes or blinky shoes only light when the heel is on the ground. Excellent motivation and immediate gratification for a 3-year-old to walk with a heel-toe pattern. Not all blinky shoes function that way so make sure the shoe lights up when the heel contacts the ground before you buy. You can also encourage your son to play with playdough or other manipulatives in the squatting position. This is an excellent calf and heel cord stretch. Super-duper slow-motion running forward or backward is another choice that comes to mind. Make it fun at all costs. You will also need to stretch the heel cords manually, and we can show you how to do this as well. – Matt Wren M.S. P.T.


What is spinal decompression therapy? I saw an ad in the paper for spinal decompression
therapy as a new and revolutionary treatment to cure low back pain.

Simply put, decompression therapy is mechanical spinal traction. This type of modality can be effective at treating neck and lower back pain, but I hesitate to say that traction can CURE a specific problem. Be leery of any practitioner who wants to charge you out of pocket for traction, as most health insurance plans cover the cost of mechanical traction. Furthermore, there are a few good products that can be used in the home setting as well.
I assure you, spinal decompression therapy is not new, revolutionary or exclusive. Spinal traction was originally employed for the treatment of spinal deformity (scoliosis) dating back to 4000 B.C. The father of modern medicine, Hippocrates himself, designed and effectively used a traction device in 400 BC. For 20 years, I have treated patients who have neck and lumbar pain with spinal traction, and I am confident in saying that you cannot cure everyone with this treatment modality alone. – Matt Wren M.S. P.T.


I have two friends who have had total knee replacements with very different results. One is back to work and walks two miles per day without pain; the other can barely go grocery shopping due to pain and stiffness. I am concerned about the outcome of my pending surgery—do you have any advice?

The goal of knee replacement is to reduce pain during daily tasks and walking. Several factors can predict the outcome after a knee replacement. First, your overall health and your knee function prior to surgery play the biggest roles. Having adequate range of motion (0-120 degrees or more) and good quadriceps strength are favorable. Being in good health is a benefit for obvious reasons; however, having a concurrent illness may slow your recovery. Also, consider your current level of activity and frequency of exercise. Rehab following this type of surgery requires daily exercise; this is done in a rehabilitation hospital, in your home, or in an outpatient facility depending on your progress at that time. The type of hardware the surgeon chooses for your knee is also crucial. Some hardware resurfaces three separate parts of the knee joint (two for the long bones, one for the knee cap); others have an actual hinge between the two long bones; and some surgeons opt to resurface just one compartment of the knee (medial or lateral portion of the long bones). Your surgeon will choose the best fit for your knee. Post-operative considerations include swelling, pain, and scar tissue formation- these are unique to the individual.

So you see, many factors go into deciding if knee replacement is for you. We suggest meeting your potential physical therapist prior to surgery to discuss your goals, learn the basics of rehab, and get a pre-operative exercise program to familiarize yourself with what’s ahead. Your physical therapist will customize your rehab to meet your needs and goals. – Danene Brown P.T., D.P.T.


I have had foot pain for several years, and someone suggested that I look into custom orthotics. Custom orthotics can cost between $300 and $400. Do you have any other suggestions?

First of all, I know little about the nature of your foot condition or why you’re having pain. I can, however, offer some suggestions. Not everyone needs an expensive custom-made orthotic to solve their foot and ankle problems. I recommend you start with an over-the-counter or prefabricated product to see if that helps. Currently there are several excellent over-the-counter products available which cost between $25 to $40. With that said, those products may need a bit of customization to meet your specific needs. We can help you find the right product and adjust it for you. I have found that a customized over-the-counter arch support will often do the trick and is much more cost-effective as well. – Matt Wren M.S., P.T.


After I do yardwork, I often cannot stand up straight because of back pain. Is bed rest my best option?

Bed rest and ice application (10 minutes at a time, with one layer between ice and skin) are appropriate for 1-2 days following a back strain. After that, it’s imperative to get moving to avoid stiffness. Walking on flat surfaces for 10-15 minutes several times a day is a good way to start. Avoiding positions in which you are bent forward (eg, folding laundry or picking up small children) can prevent flare-ups.
Most back strains are self-limiting and resolve within 1-2 weeks. If you find that your symptoms persist or seem unreasonable, you should consult your doctor. Physical therapy, anti-inflamatories, or muscle relaxers may be prescribed to ease your symptoms.
Your physical therapist would assess your symptoms and prescribe appropriate treatment and exercise to get you back on your feet. Simple, regular back exercises can promote back health for years to come. Also, your physical therapist can educate you on proper lifting and yard work mechanics to avoid this injury from happening in the future! – Danene Brown P.T., D.P.T.


When I roll over in bed, I become extremely dizzy. My doctor explained that I have “loose rocks” in my ear and that physical therapy is the best option. Can you explain this?

About 20% of dizziness is due to Benign Paroxysmal Positional Vertigo, or BPPV. The symptoms include a brief sensation of vertigo (spinning) with position changes and possibly lightheadedness, nausea, and imbalance between those episodes. Calcium carbonate crystals (ie “the rocks”), become dislodged from one part of the inner ear and then collect in the semicircular canals. Normally, the fluid of the semicircular canals swishes with head movement, giving the brain a signal of spatial awareness or equilibrium. The fluid viscosity changes with those dislodged calcium carbonate crystals, thus confusing that signal. This results in brief vertigo lasting a few seconds. The cause could be normal aging of the inner ear, head trauma, mild stroke or a viral infection, and can even be unknown.
The good news is that it is completely benign and treatable! First, your PT would assess for the problem and then treat you with a simple head turning procedure to reposition the calcium carbonate crystals. Your PT may repeat this procedure as often as necessary and issue you home exercise instructions. – Danene Brown P.T., D.P.T.



Running is my favorite form of exercise, but I have had to stop running, and other activities that involve jumping, due to problems with urine leaking out. A friend suggested seeing a physical therapist; how can this help?

What you are describing sounds like a specific type of urinary incontinence; stress incontinence. Stress incontinence may occur when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. This is the most common type of bladder control problem in women. Because incontinence can be a short-term problem caused by a urinary tract infection, a medicine, or constipation you should always consult your doctor before seeing a physical therapist. Stress incontinence can be caused by childbirth, weight gain, or other conditions that stress the pelvic floor muscles or other urinary structures. When the pelvic floor muscles cannot support your bladder properly, the bladder drops down making it difficult to tighten the muscles that close off the urethra. Most bladder control problems can be improved or cured. Specially trained physical therapists can assist in your treatment for stress incontinence. PT can assist through education, biofeedback training, and functional exercises for the pelvic floor so you can get back control and return to your previous level of activity. – Terri Berkshire M.S.,P.T


I had a mastectomy 4 months ago. Now I feel tight and stiff on that side and can’t reach over
my head or behind my back.

After breast surgery, women often keep their arms at their sides in a protective position usually due to pain at the incision site, and /or body image concerns. This position promotes muscle guarding, particularly in the pectoralis major and minor muscles and stiffness in the shoulder. Muscles such as the levator scapulae, teres major and minor and infraspinatus often become tight and this can also restrict active range of motion in the shoulder. In severe cases, you might even develop a “frozen shoulder,” with flexibility greatly diminished in all directions and daily activities severely limited. Soft tissue restrictions in the anterior (front) chest wall, particularly in the pectoralis group is common, and some women lay down more scar tissue than needed in the healing process. Adhesions and tightness in these muscles will interfere with shoulder motion and contribute to poor postural habits. Physical therapy will help to decrease adhesions and restore soft tissue mobility and muscular balance between the anterior and posterior (back) chest musculature. We also help to reinforce good postural and movement habits for activities of
daily living. – Terri Berkshire M.S.,P.T