PRI Tips For The Car

What goes hand-in-hand with summer? Summer road trips! This can mean many hours in the car resulting in pretty significant pain. In order to help quell this, try to keep in mind the following helpful hints. A lot of these will be helpful for your daily commute too!

1) Keep your knees at hip height or higher as well as pointed straight ahead. Keeping your knees high helps to promote a rounded lower back. This can be adjusted by lowering your seat height (available in most cars) or by bringing your seat closer to the steering wheel. Keeping your knees pointed straight forward (versus letting your left leg roll out to the side and resting on the door) will help to keep your hips from rotating while in a poor position. This is especially important if you have hip/buttock/SI/sciatic/piriformis pain!

2) Reduce your lumbar support. In a PRI program, we want to allow the lumbar spine to get out of its overly-extended position and into a more neutral state. This means taking away the lumbar support in your car. Not everyone can do this cold-turkey. Some people need to reduce this slowly. Also, if you’re going to be driving for over an hour, know it’s ok to change your lumbar support as time goes on. The lumbar spine was not meant to be static for more than 20 minutes. Small changes to the lumbar support in your car seat effectively lets your lumbar spine change positions and stave off pain and stiffness. Just keep your lumbar support to a minimum and always return to the lowest amount you can tolerate when you are finished with your drive. That way you’re set up in the correct position when you next get in the car. 

3) Change your headrest if needed. A lot of cars now come with an inclined headrest. This helps to reduce the amount of brain and neck trauma in a car accident, but can be irritating when driving. As the upper portion of the head rest comes forward, we will assume a forward head posture to keep our head from bumping against it. Ladies, we also do this when we wear our hair in a bun or ponytail so try to avoid these hairstyles when driving long distances. To fix this, some headrests can change the amount of inclination. For those that can’t, raise the headrest as much as possible. If this is really irritating to you, try calling your dealership to see if alternate headrests exist for your vehicle. DO NOT DRIVE WITHOUT A HEADREST!

4) Change the inclination of your back rest. Your seat back needs to be in whatever position necessarily to allow your back from your bra-line and below to be resting on the back of the seat. Everything above this should be away from it. If your seat is too reclined, you will not get curvature in your upper back and you will bring your head far forward in order to see the road in front of you as your upper back rests on the chair back. If you seat is too inclined, your entire spine will be straight. 

5) Take breaks. Again, our bodies are not meant to be in any one position for more than 20-30 minutes at a time. You can change your lumbar support and buy yourself some time, but try to take frequent breaks where you can get out of the car and walk around. This lets you mobilize every muscle and joint instead of just your lumbar joints. 

6) Look around. Obviously, you need to be safe while you drive and keep your eyes on the road, but staring at the car in front of you for hours at a time essentially puts the body and its muscles into “auto-pilot” (har har har). If you simply glance around with your eyes as you drive, it helps to keep your body and neurological system from locking into a particular pattern.

Happy vacationing!

Written by Lesley Callaham, MPT, PRC May 15, 2017

The Best Summer Footwear For Your Body

 image from shoes.com

image from shoes.com

It’s finally here- sandal season! Although this can be very exciting, it can aggravate your pain whether it’s new or old. One way to avoid this is to wear the best footwear possible, especially if you have lower back pain, hip pain, or pain in your legs or feet. 

To be clear, the BEST choice of footwear is a tennis shoe. If you don’t already know, ask your physical therapist what that means for you. You can also find the Hruska Clinic 2018 shoe list here.  However, as many people will be wearing sandals over the summer, keep these things in mind when selecting your shoes over the summer:

1) Choose a shoe that attaches to your foot. Try to avoid flip flops or other shoes that can easily fall off of your foot. This will cause you to move your foot different through space or use your toes to help keep the shoe on. This will cause more compensation patterns when you walk and create more pain. 

2) Pick a flat. All heels make your weight move forward to your toes. When this happens, your shoulders will automatically lean back in order to resdistribute your weight and keep you from falling forward. This causes your lower back to excessively arch and your head to move forward which can aggravate ankle, lower back, neck, and shoulder pain as well as headaches. If you do have to choose a heel, pick the smallest one possible. 

3) Choose stability. Grab your shoe at the heel and toe and try to bend it in half. A good shoe will bend at the ball of the foot and nowhere else. The more the sole bends, the less stability it has to offer your body. If your ballet flat can easily fold in half, you are essentially walking around in a sock, not a shoe.

4) Have support. Supporting and stabilizing your arch is essential for maintaining good mechanics and avoiding pain. Sure, having arch support is a good idea, it is not the end all be all. The arch rises and falls as a direct result of where the heel is in space. Therefore, picking a shoe with a good heel counter, or at least has the heel covered or encompassed in fabric will give you more arch support than a shoe with an open back. The more firm the heel counter is, the more support you have. If you have an open feel, try to find a shoe with a heel cup. This is a small indentation for the heel to sit in so that it has more support on the sides and cannot rock around as much. 

5) Pick something comfortable. Even if your shoes passes all of the above tests, it won’t make a difference if the shoe itself is uncomfortable. Everyone will move their foot different to avoid putting pressure on painful areas of the foot like a blister or sore spot. 

Have more questions? Call us at 314-733-5000 or email Lesley@Integrate360pt.com or Nancy@Integrate360PT.com today!

 

Written by Lesley Callaham, MPT, PRC May 7, 2018.

 

Why Your Foam Rolling Results Don’t Last

 Image from strengthontherun.com

Image from strengthontherun.com

Almost everyone who is in pain has tried some sort of soft and/or connective tissue mobilization to feel better. And for a large majority of those people, the result is the same. Typically, they’ll feel better for a short amount of time, but their original pain or tightness always returns. This can be quite frustrating and expensive as people have to consistently return to their chiropractor, physical therapist, and/or massage therapist to feel better even if it only lasts a short amount of time.

Why is this the case? Soft tissues (ie muscles) and connective tissue (ie fasia) do not simply develop knots, trigger points, or limitations in mobility and range of motion for no reason. Typically, a person will move their body differently over time for a myriad of reasons ranging from  injury, surgery, and even psychosocial issues such as a tall middle school-aged girl that develops a slouched posture in order to appear shorter. No matter the reason, when we begin to move slightly differently than how the body was designed, we develop compensation patterns. These patterns will always results in under-mobilized and over-mobilized areas of the body as well as under-active and over-active muscles. Essentially, the body loses its balance. 

Soft and connective tissue interventions help to restore the balance of our tissues, but they do not address the compensatory strategies that lead us to develop these issues in the first place. In fact, if the mechanics driving the dysfunction are not addressed, soft and connective tissue interventions can actually lead to more dyfunction down the road. 

So if you’re interested in fully healing your pain and getting rid of it for good, be sure that your healthcare provider or team of healthcare providers are addressing what’s driving the muscle tightness or fascial immobility. At Integrate 360 Physical Therapy, fixing the problem is always our goal. Of course, we have techniques and machinery that will help us to relax muscles or decrease pain, but the heart of our rehab program is always correcting the mechanics. Additionally, we look at the entire human body to identify and treat any area that is not functioning properly, not just around the area of pain. 

Set up your evaluation today and truly heal your body by calling us at 314-733-5000 or email lesley@integrate360pt.com or nancy@integrate360pt.com today!

Is Cervical Traction Beneficial?

Cervical traction is so popular these days, it’s practically mandatory when going to a physical therapist or chiropractor for neck pain or disc issues. Spinal and orthopedic surgeons even recommend it if their patient is not appropriate for spinal surgery. 

Most people with musculoskeletal dysfunction affecting the neck will present with a “straight neck” or “reversed curve” when looked at on an x-ray. The cervical spine should have a slight lordosis, or curved inward/arched/extended position, when appropriately aligned. Because of the shape of our vertebral bodies (the individual bones making up our spinal column) in the area, this curvature allows for the least amount of disc compression and the largest spaces in the foramina (holes in the columns) through which our nerves leave the spinal column. When we lose this natural lordosis or even reverse it, our discs and nerves are compressed. Therefore, at first glance, it makes perfect sense to decompress the neck using a cervical traction unit. However, our bodies are not that simple. 

Whether the patient using a machine in a clinic or an over-the-door device in their homes, the idea is have the device pull the patient’s head straight up or slightly forward and up. This does decompress the spine some, but it pulls it out of its natural lordosis. This reinforces bad pastural habits, does not fully decompress the target area, and is temporary in nature. Not only that, but the over-the-door units typically have a strap that covers the chin. This compresses the jaw joint and can complicate, or even create, TMJ dysfunction! 

In order to restore a natural lordosis (and correct poor spinal alignment which decompresses the neck, its discs and nerves) we must take the ribcage and thoracic spine (midback) into account. If the supporting structures of the neck are in the wrong position and/or too rigid, the neck must compensate by changing its position and/or moving too much. Postural Restoration Institute physical therapy is unique in its approach in that we treat the cervical spine by treating the ribcage. How do we do this? By promoting diaphragmatic breathing!

When the diaphragm is utilized as intended, the ribcage is mobilized and normal thoracic kyphosis (rounded position of the spine) is preserved. It also reduces compensatory breathing patterns that overutilize the neck muscles. This promotes natural restoration of the cervical curve, reduces cervical muscle tone, and reduces compression of the neck’s structures. All without the inconvenience, expense, and discomfort that come along with a cervical traction unit. 

Ready to get rid of yours? Call us today at 314-733-5000. We are the only PRI certified clinic in the greater St. Louis region. All of our therapists are certified. 

 

Written by Lesley Callaham, MPT, PRC April 11, 2018

Want a Better Core? Try Crawling.

 Image from Parents.com

Image from Parents.com

The next time you’re around a crawling baby, watch them closely. Babies develop core muscle strength before learning how to manage their arms and legs (ie, they can sit up erect before they learn to crawl or walk). When crawling, they use their abdominal muscles to pull up one side of their pelvis (you can see this by the wrinkles they get on the sides of their trunk. These wrinkles develop over muscle groups that are in use). This causes their leg to advance forward and move their knee ahead of the other. The muscles of their hips and shoulders engage primarily to stabilize the joint, not move their appendages forward through space. Therefore, a baby’s crawling pattern is almost exclusively a core activity. 

As we age, we lose core control for many reasons. If needed we can still crawl, but we use the muscles of our shoulders and the front of our hips to move our appendages forward. This effectively makes our appendages our primary movers which carries our core along for the ride - a pattern opposite that of a baby. 

Crawling is becoming more popular in rehabilitation and fitness settings to strengthen the core. PRI emphasizes this movement in order to activate the transverse abdominis and internal obliques on one side of the body. At the same time we must manage an opposite arm and leg moving forward, while the other two continue to support our body weight. This is essentially what happens during gait - the abdominals and leg muscles must be active as our right leg and left arm move forward through space. In addition, we have to do the exact opposite during our next step!

Although this may seem like a simple task, it’s quite complicated and difficult to perform correctly. When we are not able to manage our bodies the way a baby would, we develop compensation patterns and pain. 

If you try crawling and cannot feel your core activating, your body is at risk for copmensation, pain, and/or injury. Call us today at 314-733-5000 and let us teach you how to appropriately use your core and avoid dysfunction!

 

Written by Lesley Callaham, MPT, PRC on April 3, 2018

Short Of Breath? Your Posture May Be To Blame.

Do you notice that you get out of breath quickly while going up stairs or on a walk? Sure, many disease processes (such as asthma or COPD) may be to blame, but your posture may be a significant factor. In fact, if you do not have a diagnosis of any respiratory diseases, your posture is likely the cause of this problem. 

Our diaphragm is located in the center of our ribcage and attaches on the back of our lower ribs as well as to the front of our lower spine. In order for it to work correctly, it needs to start in a domed position. It then flattens and moves lower in our ribcage in order to pull air into our lungs. When we breathe out, the diaphragm should passively return to its domed position. When the range of motion of the diaphragm is maximized, so is the amount of air we move with each breath.

However, there are many things that can upset this pattern. Stress, abdominal surgeries, respiratory diseases, sinus congestion, or even bad education as to how to “diaphragmatically breathe” will cause us to compensate when we try to breathe in. No matter the reason, when our breathing is challenged or our fight or flight nervous system is activated, we will compensate in a few ways: 1) We use our lower back extensors to essentially lean our shoulders back. This allows the front of our ribcage to open up and expand. 2) We use the muscles of our shoulders and front of our necks to pull the ribcage up and back, again opening the front of our ribcage. 3) A combination of the previous two.

When we lean our ribcage back through these compensatory breathing strategies, our abdominals cannot work effectively. Our lower ribs will then externally rotate and flare out. The bottom of our ribcage then becomes wider which stretches our diaphragm. When the diaphragm is stretched, it is unable to return to it’s domed state. Because the range of motion the diaphragm goes through at each breath is lessened, so is the amount of air that we move with each breath. Less air exchange means less oxygen coming into the body and less carbon dioxide leaving the body. This causes us to feel short of breath with even simple physical tasks. 

If you suffer from shortness or breath (with or without a disease process) and/or notice that your lower ribs are flared, come see us. We’ll make a customized program to restore proper thoracic and ribcage posture, abdominal activity and strength, and maximize your diaphragmatic and respiratory function. Call us today at 314-733-5000 or email Lesley@Integrate360PT.com

 

 

Written by Lesley Callaham, MPT, PRC on March 20, 2018

Why We Love Pilates

 Image from http://www.h2lstudio.com

Image from http://www.h2lstudio.com

Whether it’s while working with a patient or during a casual conversation with an acquaintance, physical therapists are constantly asked about their preferences of fitness programs. For me the answer is, by far, Pilates. Whether you’re looking for something to compliment your PRI program or are just looking for a great way to get or stay in shape, it really takes the cake!

Pilates compliments PRI extremely well in several ways. They both:

1) Focus on function and movement precision - Pilates is not a fitness approach that will buff up your “mirror muscles” like your 6 packs and biceps. It focuses on maximizing your true core muscles for stability and control of your movements. It also heavily focuses on activating target areas while quieting others that are not meant to be apart of the exercises. For instance, you do not need lower back tension while performing an arm strengthening motion. The end goal for both programs is for our participants to be able to achieve maximal core stability while performing integrated (throughout the body) movements with control. This is functional movement!

2) Focus on breath - Exercises, whether for fitness or rehabilitation, are not purposeful if you don’t breathe throughout. First of all it’s simply bad for you; It rapidly changes your blood pressure which can lead to fainting or injury. Secondly, it’s NOT functional. We breathe constantly all day long, therefore, in order for these activities to have any carryover whatsoever in our daily lives, we need to incorporate breath into the movement.

3) Focus on quieting the mind and body - Our body has a fight or flight nervous system as well as a rest and digest nervous system. Most people spend too much time in fight or flight, whether it’s because of pain, emotional stress, or type A personalities. When we get stuck in this nervous system, we are constantly “on”; Our muscles, minds, personalities become rigid and static. PRI and Pilates focus on relaxing out of fight or flight and exercising while in the rest and digest nervous system. This is not only good for stress management, it allows our bodies to turn off unnecessary muscles groups and really focusing on the target areas. 

4) Emphasizing a neutral position or posture - Although the body was designed to assume many, many positions for relatively short durations of time, our modern lives tend to place us in just a few postures/positions for our entire day. Because of this, our bodies tend to develop preferences  in our postures that are not healthy or balanced. The very premise of PRI and Pilates is to break out of these preferred postures and adopt a neutral position before strengthening and/or teaching our bodies to function in this optimal position.

The best way to experience Pilates is by utilizing the equipment like the reformer or chair. However, if you don’t have a studio nearby or you cannot afford to attend classes at a studio, there are many great online mat work sessions! 

 

Written by Lesley Callaham February 23, 2017

Why Try PRI?

PRI logo.png

PRI is a type of physical thrapy that is very different from the traditional model we were all taught in school. 

In class we were typically taught that if the knee hurt, it was probably the knee that was the problem. The ankle and hip (joints above and below the painful area) should be screened to make sure they weren’t part of the problem, but the pain was probably coming directly from the knee. Then we should measure its range of motion and muscular strength. The treatment plan from there was easy - stretch what was too tight and strengthen what was too weak. Voila! Your patient is healed. Well, that was all good in theory, but it missed a lot.

Our brains and bodies are extraordinarily complex and for good reason. The brain takes in information from our vestibular, somatosensory, and visual systems to know where we are in space and what things/obstacles are around us. This lets us know how to move our bodies through space to end up at our destination in the safest way possibly. Put simply, our body depends on constant, subconscious neurological input to move our musculoskeletal system properly and without pain.

Traditional orthopedic physical therapy does not take this into account. PRI heavily bases it’s intervention with this in mind. First, we must feel and sense what muscles we are activating during an activity and know (without looking) what position our body is in while performing that exercise. If we cannot accomplish this, no matter how many exercise our patients do, we will never make them truuely functional. We cannot walk around do our daily tasks if we are having to constantly look at the position of our body to know where we are. If we cannot sense and feel a muscle during an exercise, our brain will be unable to utilize it when we are distracted from talking with our family or trying to get some work done. 

Traditional orthopedics also assumes that our musculoskeletal system is always in an ideal position. This is simply not the case. Overactive muscles, surgical history, pain, and many other things will cause us to hold our pelvis, ribcage, or head in positions that are less than ideal. When this occurs, our muscles and joints are not lined up the way in the way they were designed. When things are not aligned properly, we cannot use properly muscles to move the joints and/or the joints will not have normal range of motion. This does not always cause pain, but it will always cause dysfunction that will eventually cause pain. 

PRI evaluations assess the position and function of all areas of the body. We are then able to use this information to help us determine where to start our intervention. Should we start at the neck where our patient’s pain is? Or should we start at the pelvis as it’s faulty position causes compensations all the way up the spine into the neck? We also use this data to help us understand how successful we are with our approach. 

Traditional physical therapy also does not discuss the diaphragm in any length. We are taught that is our main respiratory muscle, is innervated by the phrenic nerve at cervical spinal levels 3-5, and that it may not function with certain spinal injuries or diseases. However, as the diaphragm attaches to the front of the lumbar spine (lower back) and the back surface of the lower ribs, it has huge orthopedic impact. When this muscle is not in the right position, we cannot breathe appropriately. Because the number one goal of any human body is to breathe, we will compensate and find a way to do it. This puts us in awful postures and causes us to use muscular compensation 20-24,000 times a day! If we do not intervene on a dysfunctional diaphragm to allow our patients to breathe better, get out of a cycle of fight-or-flight nervous system dysfunction, and put our musculoskeletal position in the correct pattern, how in the world are we supposed to bring any relief to our patients? 

This model of physical therapy is perfect for anyone that has pain, wants to enhance performance, and become more functional. If you have tried physical therapy or other interventions in the past that have delivered no or limited results, give PRI a try. 

Integrate 360 Physcial Therapy is the only certified PRI clinic in the greater St. Louis area. In our clinic you will be evaluated and work one-on-one with the same PRI certified therapist. For more information or to schedule an evaluation, call us at 314-733-5000 or email us at Lesley@Integrate360PT.com or Nancy@Integrate360PT.com . 

 

Written by Lesley Callaham February 1, 2018

How To Properly Use An Elliptical

elliptical-trainers-1424300.jpg

One of the most popular pieces or cardio equipment is the elliptical. If used properly, it’s a great option when weather forces you to work out indoors and it can compliment a PRI program nicely. However, most people don’t maintain good mechanics on the machine. If you’ve ever had your toes go numb while on one, this pertains to you. 

Because this machine is challenging muscularly as well as cardiovascularly, our bodies are quick to use typical compensation patterns to make this activity ‘easier”. This typically involves letting our pelvis rotate forward which extends our lower back. This forces our body weight to go forward onto the balls of our feet (hence the numb toes). We also tend to pull the handles backward toward us or not use them at all. This is problematic as it puts into a generally extended pattern. This is the posture most of us with pain assume throughout the day. It causes us to overuse our outer quads, lower back, and pec muscles which cause muscle imbalances and pain. If you’re undergoing a PRI rehab, this can kill your program. Whether you’re undergoing a PRI program or not, it’s important to use any machine or piece of equipment properly to avoid an injury and make your work out as effective as possible. Get the most out of your work out by following these rules:

1) It’s essential to use the handles on the machine to maintain proper body mechanics. If we hold our arms steady on the equipment, the body’s momentum from our pelvis and legs suddenly stops in our lower backs. This can cause pain and misalignments in the pelvis, SI joint, and/or lower back. When you do use the handles, remember to push them away from you. This helps us to use our shoulder blade muscles on the pushing side as we as our abdominals on the opposite side of our bodies.

2) Keep your pelvis tucked. Thank about pulling you belly button toward your spine and contracting your abdominals. This will help keep our pelvis in a neutral position and disallow it from rotating forward. This takes unnecessary stress off of our lowers backs and allows us to use our glut and thigh muscles as we cycle our legs, and not just our lower back extensor muscles.

3) Keep your weight on your heels. When we walk or stand, our weight was designed to go through our heels. It is biomechanically incorrect to keep your weight on your toes and can cause nerve compression and pain. Putting weight through your heels also helps you engage your hastring muscles which stabilize your pelvis. 

4) Look around. When we stare at the computer or TV screen ahead of us, it tends to lock our body into the extension pattern mentioned earlier. If you feel like you need to watch TV to get through your work out, just remember to look around the gym every few minutes or so. This keeps our neurological system relaxed and fluid and working the way it should. 

 

Written by Lesley Callaham, MPT, PRC January 24, 2017

 

Success Is In The Details

A few weeks ago, I went to Ikea to search for a new couch. Now, as all of you who have been to Ikea know, this is no small feat. That place is designed to make you walk the entire warehouse so you buy as much as possible! I knew this ahead of time so I was prepared to go. As it was a very cold day, I wore warm, rigid soled boots, a heavy coat, and brought my purse full of credit cards.

As I was nearing the end of my five mile trek around the store, I began to notice that my lower back and right SI joint were hurting. At first, it wasn’t clear to me why. I was not wearing heels, nor was I lifting or carrying anything particularly heavy. In fact, I was pushing to cart at times. Then, I realized my problem. I hadn’t really prepared for this trip at all. I had made some small, but impactful errors. 

First, my shoes were all wrong. For the amount of standing and walking I was going to do, I needed proper tennis shoes (preferably PRI approved shoes). Although my boots were appropriately rigid through the midfoot of the shoe, they lacked the support to keep my spine aligned and allow my body to move with proper mechanics. 

Next, I wasn’t swinging my arms. Pushing the cart, carrying a purse, and even putting my hands in my coat pockets at times were causing my arms to locked into a position while my lower body moved. This not only causes a lot of tension as the mobile structures of the pelvis and hips meet the static structures of my ribcage and thoracic spine (hence my lower back and SI pain), it also causes a biomechanical mess. When we walk, our arms are meant to swing for a few reasons. It promotes momentum we can use to help propel ourselves forward and conserve energy. It also requires is to use the opposite arm and leg at the same time. This promotes normal mechanics and a lot range of motion to take place within the body while still staying balanced. 

The point is, daily, nagging pain can be made or broken in the details of what you do, how you do it, and what you’re wearing. If I had simply kept my hands swinging an wore proper footwear, I would have likely been pain-free for the trip - with the exception of my wallet of course!

That may be hard to see for people that have been in pain for some time. When our pain levels get to a certain threshold or we’ve been dealing with this pain for a long enough time, simple changes like these as well as active participation in your rehab exercises need to be practiced regularly in order for the painful tissue to heal. At this stage, you may not notice a large impact in your pain by swinging your arms, but remember that it makes a large impact in the overall time it takes your body to heal. Once your pain becomes intermittent, then you’ll be able to notice things that effect your pain such as footwear, positioning of your body, movement strategies, etc. 

 

Written by Lesley Callaham, MPT, PRC on January 16, 2018