Can a Frozen Shoulder be Healed Quickly and Without Stretching?

We put these before and after photos on our facebook page last week and it practically went viral. We thought you all may want to know more about this woman's journey so we thought we'd fill you in. We're going to call her Sally for the rest of this article - not her real name, of course.

Sally came for her first appointment earlier this year. She reported that she was in a car accident years ago that left her with neck pain. Shortly after she was treated by a physical therapist who alleviated the neck pain completely. When she was caring for her baby the year after, she started noticing the return of her neck pain as well as left arm pain, decreased range of motion, and decreased function of her arm. A little while later she tried physical therapy and did not notice any change in her symptoms or function.

At her first visit she had pain and burning between her left shoulder blade and spine, left sided neck pain, and her head felt heavy.

Here's what we noticed in her first session:

  • Standing posture: flattened thoracic (upper back) and cervical (neck) spinal curvitures, right shoulder blade low and unstable, right shoulder low
  • Muscle strength: right shoulder strength was 5/5 and pain free, her left shoulder was generally weaker at a 3/5 and unstable. The head of her arm bone could be heard clunking in the socket as we applied pressure.
  • Alignment: left rotated cervical spine and malalignment of her left first rib
  • PRI: Poor hip positioning and muscular control of the hip on both sides, approximately 6 inches from her toes when bending forward
  • Range of motion: decreased active and passive shoulder range
    • active left abduction 90,  flexion 120 (both out of 180)
    • passive left abduction60, flexion 120, internal rotation 55, external rotation 90 (rotations are out of 90). She also had limited right flexion at 125

Her treatment consisted of a lot of education and only one exercise. This exercise put her on her back and facilitated her hamstrings, abs, and promoted diaphragmatic breathing and getting breath into her right upper chest. After this activity she had proper hip positioning on both sides, restored cervical and first rib alignment, full left shoulder internal rotation and improved flexion by 30 degrees (150 total)


In her second appointment (9 days later):

  • She had not had any shoulder blade burning pain at all since the first session. She continued to have some left neck pain and pain into her left shoulder when she moved it, but the intensity was much better than before. She had not done her exercise in the previous 2 days.
  • PRI: good hip positioning on both sides, poor muscular control of the hips on both sides, integrated strength 3/5 on the left and 1/5 on the right
  • Alignment: unremarkable
  • Range of motion:
    • active left shoulder flexion and abduction 160 (out of 180) with significantly less pain at the end of her range
    • passive shoulder internal rotation 90 on both sides, flexion 145 (out of 180) on both sides

Her treatment in this session was to progress her previous exercise into one in standing while supported by a wall. We also added a reaching component with her left arm and made her breathe into a balloon. This moved her into a much more integrated position as she now has to control all of the joints of her body while standing and performing an exercise. The right arm reach and addition of the balloon helped to strengthen her abdominals both concentrically and eccentrically, especially on the left side. This improved her shoulder flexion to 160 on the left, and 165 on the right (out of 180)

We also added a strengthening activity for her left inner thigh while lying on her right side. This improved her integrated strength score to a 2/5 on the left side.


In her third session (11 days later):

  • She had no shoulder blade or neck pain at all. She felt that she had full left shoulder range of motion, but had a bit of tightness at the end of her range
  • Muscle strength: left shoulder 5/5 and pain-free without any clunking of the head of her arm bone in socket
  • Alignment: unremarkable
  • PRI: proper hip position and good control of hip joint on both sides, limited hamstring motion, 5 inches from touching toes when bending forward, integrated strength 3/5 on both sides
  • Range of motion:
    • active left shoulder flexion and abduction 180 (full range)
    • passive shoulder flexion 180, internal rotation 90, and external rotation 90 on both sides (full range)

In this session we added a hamstring stretch which allowed her to reach further toward the floor while bending over. We tookaway the support of the wall in her standing activity from the session before and made her reach with her left arm to strengthen the left abdominals in both positions of ribcage rotation. Lastly, we added a rotator cuff and scapular strengthening activity in sitting being careful to maintain a good ribcage position and breathing pattern throughout the exercise. This will help to stabilize her shoulder blade position and head of her arm bone in the socket. 

At this point, Sally was completely pain-free, hadfull left shoulder range of motion, and much improved postural alignment. We could discharge her at this point as her therapy goals had been met, but we have seen her a few more times to fully stabilize her posture and left shoulder/shoulder blade so that her symptoms do not return.


Interested in learning more? Want to maximize your results even if you've had unsuccessful physical therapy in the past? Call Integrate 360 at 314-733-5000 or email us at or


The Best Sleeping Positions for Your Body

Sleep is something most Americans have some trouble with, particular if they're in pain. A vicious cycle develops where our pain wakes us at night, then we're more painful during the day because we're not properly rested. It's important to restore restful sleep as quickly as possible in order for our bodies to heal and repair our injury. It's important to be sure your body is properly positioned while you sleep to avoid replicating painful patterns or positions that we are in during the day. This will help us avoid night pain, get a more restful night sleep, and speed us forward in our rehabilitation efforts.

If you've already seen a therapist at Integrate 360 Physical Therapy, you probably already know what pattern you tend to fall in (read our summary of patterns here if you cannot remember). This will help you determine your best sleeping position. If you are a left AIC or are not sure what position you're in, try the following guidelines:

Lying on your left side: Chose a pillow that supports your neck and feels comfortable but that places your head a little bit higher than your spine. Lie with a pillow under your left lower ribs, and a pillow between your knees. Try to rotate your top hip forward so that your right knee is slightly ahead of your left.

Lying on your right side: Chose a pillow that supports your neck and keeps your head level with your spine. Place a pillow between your ankles and pull your top hip back so that your left knee is slightly behind your right.

See pictures of the sidelying positions at the bottom of this handout.

Lying on your back: Sleep with a very thin pillow behind your head so that your neck is aligned with the spine of your middle back. A pillow with too much support will push you head forward or up toward the ceiling too far. Sleep with a pillow or two, or even a small ottoman, under your knees. This will keep your pelvis rotated backward and take the stress off of your lower back and front of your hips.

This positioning helps to combat a left AIC pattern and can be very helpful for some PEC patients as well. Remember that in a left AIC pattern, the pelvis is stuck in right rotation, left ribs are flared, and neck is left sidebent. The above position helps to take you out of this pattern and all over-stressed structures to relax.

If you are a PEC or the above positions are not comfortable for you, try keeping your neck level with your spine no matter what side you are sleeping on. You may also try to move the pillow between your ankles no matter what side you are on. If that doesn't help your back or hip pain, try simply moving the pillow between your knees and do not worry about either knee being ahead of the other.

Try very hard to avoid: sleeping on you stomach! This puts our lower back in a lot of extension and makes us turn our heads to a very sharp angle. This is just plain hard on our bodies and will hold us in our extension-based and pain-provoking patterns. Moving one leg out to the side adds insult to injury. This rotates our already stressed pelvis and lower back and stretches out the front of the hip that is moved out toward the side.

Want to know your pattern? Know more positioning trips throughout the day? Start a rehabilitation process to help heal your body for good? Contact Integrate 360 Physical Therapy at 314-733-5000 or email or today!

Tips to Decrease Your Pain While Gardening

Spring is here! The sky is getting blue, flowers are blooming, and the weather is warming. For many of us, gardening is something we take pleasure in doing. We love the way our yards look when our gardens are in full bloom and the grass is thick and green. However, it's a lot of work! Sometimes painful work! Bending forward, lifting heavy mulch bags, raking - it can all add up to some serious pain. Here are some tips to help you garden with less discomfort.

1) Pace yourself- Just like with a sport, our bodies cannot go from couch potato to 10K status overnight. The same is true with gardening. There are just certain positions or motions we don't do for prolonged periods outside of gardening season. Don't think that you can work in the yard for 8 hours your first day out without repercussions. If you do need to spend a lot of time in one day working on projects, take breaks at least every 30 minutes. This doesn't necessarily mean you have to stop and sit down, but walk around the yard or simply work on a different task for a bit of time. When we start on a repetitive task that keeps us in a certain position or doing a task like raking, our muscles fatigue after some time. When that happens and we "push through," our body compensates by using alternate muscles to get the job done. When that happens, pain develops. It's better to give your muscles some time to recover and complete the job properly over a longer duration of time.

2) Reciprocate - We all tend to use side of our body more than the other. Most of us are right handed will weed, rake, and plant using primarily our right arm. Be sure to use your left side! You may not be able to use it as long, but it's important. This give the muscles on the right side of our bodies a chance to recover, and it allows our brains to be aware of the left side of our bodies. Our brains are very efficient, when our bodies perform an exercise utilizing the right side, our brains will turn on those muscles and disallow them from turning off. Conversely, they will "ignore" the left side. Reminding your brain that you have two sides will help to keep your musculoskeletal system balanced.

3) Breathe - many times when we are performing a task, particularly one that's physically challenging, we hold our breath. Aside from doing horrible things to our blood pressure, this puts our musculoskeletal system in a bad position. It causes our lower backs to arch, diaphragms to drop and flatten, ribcage to tighten up, and shoulders, backs, and necks to become overextended to make up for our restricted thorax motion. Remember to breathe through the activity! If you can, remember to fully exhale, depress your ribcage, and hold that exhale for just a moment. This will allow the diaphragm to restore to its normal, domed position and improve the mechanics of your entire body. You don't have to breathe this way the entire 8 hours that you're gardening, but if you're experiencing some pain or performing a particularly challenging task, this tip will help you to stave off further dysfunction and pain.

4) Stop arching- No matter if we are standing, squatting, or kneeling. Our posture tends to degrade and we allow our super-strong low back extensors to compensate for our weak core and allow our backs to arch. No matter what position you are in, think of rounding your back or tucking your tailbone underneath. Coupled with a full exhale and depressed ribcage, your abdominals are now in a much better position to function and give your core the support it needs.

5) Reach - Whether we are placing flowers to be planted in the garden where we want them, spreading mulch, or pushing a lawnmower proper reaching is important. If done incorrectly, the shoulder blade is not positioned in the right spot on the thorax. This doesn't allow for a stable shoulder blade for our arm to work off of and will cause us to use our upper traps and necks to do the work - ouch! As you stretch your arm out or push against that lawnmower, think about reaching your arms forward and allow your upper back to round slightly. This allows the slightly rounded shoulder blade to sit on the thorax appropriately. When this happens, the shoulder blade is much more stable and the arm is situated in the joint so that the rotator cuff and other stabilizers can do their job.

If you want further clarification of these tips or are ready to start a custom-tailored program to completely alleviate your pain, contact Integrate 360 at,, or call us at 314-733-5000

How to Incorporate PRI Principles Into Your Gym Routine

You've done it. You've started a rehabilitation program utilizing Postural Restoration Institute's (PRI) concepts and tools and you're ready to get back to your gym routine. How can you best incorporate the strategies you've learned in PT into your work out? Follow these tips and you'll be on your way.

1) Don't forget your core- Remember that without proper diaphragmatic position/activation coupled with a neutral lumbar spine (low back), the abdominals are in an elongated and weakened position and cannot work to their fullest potential. Before performing ANY activity, perform a deep exhale and depress or "pull down" your ribcage. At the same time, perform a posterior pelvic tilt by pulling your belt buckle up toward your nose. You should then feel your abdominals engage. Be sure to maintain this position throughout whatever exercise you're performing. This is particularly important when using free weights or pulleys as you don't have any machinery around to help you keep you in good position.

2) Reach! - In order to maintain proper core engagement as well as fully strengthen your back or chest, your ribcage must be in the proper position on which your shoulder blades can sit and go through their full range of motion. For any activity in which you are pressing away from you - push ups, incline press, planks, etc., start with a full exhale and perform your posterior pelvic tilt and ribcage depress. Be sure to keep this posture throughout the entirety of the exercise. Now, when you are pressing the heavy object away from you, or pushing yourself away from a stable object (like the floor in a push up), think about reaching with your arms as your elbows become fully extended. This allows the upper back to round, allowing for full contact of the curved scapula on the rounded ribcage. This allows for full periscapular stabilization, particularly of the serratus anterior and lower trap.  Once your shoulder blades are properly stabilized, whatever muscle you are trying to strengthen around that area can now be fully, and properly strengthened.

3) Don't arch your back  - Extending or arching your back turns off your abdominals and gluts and activates your lower back. This will cause pain or tightness in your back, poor exercise performance, and minimal results. Again, before performing any activity breathe out fully, depress your ribcage, and perform a posterior pelvic tilt. Think of rounding your lower back into the floor, workout bench, back support, etc. As you are performing your activity, keep your pelvic tilt and be sure your lower back stays against the support. Once your lower back begins to pull away, you're no longer utilizing those abs or glut. Your hip flexors and lower back extensors are now taking over. Ouch!

4) Squat correctly -  It's a common misconception that a squat must be performed with an arched lower back and your knees behind your toes or you'll hurt yourself. In order to do this, you must lose your posterior pelvic tilt, extend your back, and lift your chest. This will cause your lower back extensors to control all of the weight you are squatting with. Your abs and gluts are in an elongated position and cannot work appropriately. Start by performing your pelvic tilt and depressing your ribcage with a full exhale. Then, try squatting straight down allowing your weight to settle in your heels. On your way back up, you'll be able to drive with your hips as you engage your gluts.

watch this video for poor/typical squatting technique

watch this video for correct squatting technique

5) Hinge correctly - Utilize the same mechanics as described for the squat. This video does a great job demonstrating proper form.

Always remember to speak to your therapist with specific concerns or questions about your routine. Not only can we give you additional information, we can watch you do the activity in question to be sure you're using the best form possible.

Feel like you need help bridging the gap between PT and hitting the gym? Integrate 360's therapists have developed relationships with personal athletic trainers in the area and can refer you to someone who is familiar with PRI as well as the type of training you're interested in. They can help you transition back to the gym or your sport while feeling confident that you're performing activities that will help keep you healthy for life!

For you trainers, this article was inspired from this one from . He does an amazing job of explaining how to utilize PRI principles with your clients and has some great videos to share.

What's Your Postural Pattern?

Integrate 360 Physical Therapy is a Postural Restoration Certified clinic. That means that our treatments are centered around the Postural Restoration Institute's (PRI) school of thought and our therapists are either PRI certified and/or have received ongoing education from the institute (their website can be found here). 

When evaluating someone either for the first time or for a follow up session, we like to know their postural pattern. Diagnosing the correct pattern not only allows us to convey a large amount of information quickly to either another provider or in our documentation, but it helps us decide how we need to move forward in your rehabilitation. The patterns are often abbreviated and describe the patient's musculoskeletal position as well as over and underactive muscles. Here's a breakdown of the basic or most common patterns.

AIC- This stands for anterior interior chain and usually affects the left side. This is the most basic pattern developed when our body starts to get into poor postures or move in less than ideal ways. Our diaphragm is the muscle that connects our thorax to our lower back and is the primary muscle of inspiration. This means we use it 20,000-24,000 times a day and if it is not working correctly, it can have dramatic effects on our posture. Because it has a larger attachment on the right side, it is more stable there. When the diaphragm is not in good position or isn't utilized properly, the left side of it will flatten out. This will cause our left ribs to flare out and will turn off our left abdominals. Our trunks will then bend toward the right a bit. Additionally, when our left abdominals turn off, the left side of our pelvis will rotate forward. These malalignments make us stand more on our right leg than our left. People in this pattern will feel more weight on their right foot than left, and the weight will be on the outside of our right foot, but on the arch of our left foot. This pattern can give rise to many different types of pain, but typically lower back, knee, and/or hip pain on either side is common. The Statue of David is a good example of this pattern.

 Left AIC

Left AIC

PEC - This stands for posterior exterior chain. This typically happens when someone has been in an AIC pattern for some time and they have compensated to try to avoid pain or promote function. This is essentially an AIC, but on both sides. Both sides of the pelvis have rotated forward which causes the lower back to dramatically arch. This will then cause the thorax to lean back, ribs to flare out on both sides (turning off the abdominals on both sides). We will then typically move our shoulders and shoulder blades forward in order to reach things in front of us, and develop a forwardly positioned head. This pattern still gives rise to lower back, hip, and knee pain, but can also cause shoulder and neck pain as well as headaches.



BC- This stands for brachial chain and typically refers to the position of the thorax and shoulders. This can affect one or both sides and is simply called a left/right or bilateral brachial chain. This is slightly different than the patterns above where a one sided pattern is referred to as an AIC, and the same pattern on both sides is called a PEC. A one sided BC, usually a right BC, typically develops from a left AIC. Or simply, a one sided lower body problem usually gives rise to a one sided upper body counter-compensation. In this pattern, the ribs are flared on the left side and the trunk is bent over to the right. Because of the orientation of the ribs, the right shoulder blade sits lower and farther from the spine than the left side. This makes the shoulder blade inherently unstable and as it is the base of the shoulder joint, the right shoulder will not move very well. Patients with this pattern typically have some sort of right shoulder pain or pathology such as rotator cuff injuries, torn labrums, impingements, and/or frozen shoulders.

When this occurs on both sides, the ribs are flared on both sides of the ribcage, the upper back is bent backward, both shoulder blades are low and far from the spine, and neither shoulder functions well.

 Right BC

Right BC

These postures can also affect the neck. There are many more postural abbreviations within PRI, but as these are the most basic and common, that's all we will cover in this post.

You can now see how a few letters can convey a large amount of information and give therapists a great idea of what muscles will be over/underutilized, what joints are over/undermobilized, etc and how this affects our interventions.

Want to know what pattern you're in and how to fix it? Contact the therapists at Integrate 360, the only PRI certified clinic in the St. Louis area, for your evaluation. Email us at , , or call us at 314-733-5000.

Why Physical Therapy is Worth the Cost

12220623-Dollar-signs-Isolated-on-white-background-3d-rendered--Stock-Photo.jpg has a great article explaining why physical therapy is worth the investment. I have added the text from the article below, but you can see the article for yourself here:

"It’s inevitable: the year comes to a close and the exodus of patients leaving from physical therapy starts. Just this year alone we had close to 15 to 20 patients opt out of finishing their therapy. Why?

A few may be close to discharge and find the start of a new year as an opportunity to take things on themselves. I fully support that choice! However, many of my patients cite the reason they are stopping therapy is due to the fact that “Insurance won’t cover them anymore”. While this isn’t entirely true, the truth is that a new year often means meeting a new deductible – and if you hadn’t noticed yet, deductibles are not getting lower. The average patient in my clinic has to meet a $1000-$2000 deductible prior to any insurance coverage and then often are covered at 80% beyond that. I can understand why patients are struggling to stay with PT. That’s a huge chunk of change not everyone has available to dish out. However, I write this article bearing in mind that most people end up meeting their deductible at some point during the year. Ultimately, as conscious consumers you will choose to spend your health care dollars in the place of best value and highest return on investment. I will argue that PT is one of, if not the best place to put money toward your deductible.

1. Physical Therapy (PT) is cheap. Almost to a flaw. Now before you balk at this idea bear in mind the rest of the medical world out there. A trip to a PT roughly costs $100 a session (average). A trip to an orthopedic doctor, pain specialist, or other such professional will cost you roughly $150 for the consultation + more if further tests or imaging is ordered. What if medication is prescribed or injections are performed? Have you seen the price of medications today? And with those professionals what most often happens? A referral to PT. This not only pushes the start date to rehab further back, but also take precious time up (maybe away from work or kid)s. Speaking of time…

2. PTs take their time. Really. Value to most patients is what they get from an encounter with a medical professional. Lets break down a trip to a medical professional first (for ease I will use an orthopedic specialist but please reference your favorite): 30 minute drive. 15-120 minute wait prior to seeing doctor (no joke I’ve had patients wait 2 hours for a doctor). 5-15 minute consultation. 30 minute imaging. 10 minute check out. 30 minute drive home. Go home with meds: 30 minute fill up. Referral for PT. Follow up in 30 -60 days. Or not at all. Upwards of 4 hours invested on the long end.

Cost: $150 for consultation, $150 for imaging, $20 for medication. $320 towards your deductible.

Now lets look at PT. (SIDE NOTE: in almost every state PT is open access meaning you do not need a referral from a physician prior to treatment). 30 minute drive. 5-15 minute wait to see PT (if that). 60 minute consultation: this includes hands on treatment, supervised exercise routines, pain control techniques, in depth education on condition. Go home with strategies for pain control, corrective exercises, home program. Follow up in 2-7 days.
Cost: $100. A little over 2 hours invested.

It’s simple math. With PT you get more for less.

What are some other benefits you ask?!

3. PTs are trained in differential diagnosis. We’ve gone through 7 years of high level training including dissection of a cadaver and differential diagnosis classes as well as pharmacy courses, radiologic imaging courses and have significant hands on training during our schooling. We are movement specialists. Want to know if you have a torn rotator cuff? We have tests for that. Shoulder impingement? We have tests for that. Herniated disc? We have tests for that. Inner ear versus peripheral vertigo? We have tests for that. If your condition isn’t appropriate to physical therapy – we have the resources and knowledge to point you in the right direction at a much lower cost than your general practitioner or a specialist.

4. Our skill set is large. Physical therapists treat anything from vertigo to low back pain to incontinence to visual tracking dysfunction to lung clearing techniques. We use dry needling, spinal manipulation, belted mobilizations, soft tissue tools, active release technique, kinesiotaping as well as electric and ultrasound modalities (and much more) to get you better. More often than not the answer is yes, we treat that.

5. PT is becoming the Go-To profession of the medical world. Want an MRI? Go to a physical therapist first. Surgery? Go to a physical therapist first. In the military PTs are often the primary provider. Why? Because more often than not most musculoskeletal problems are solved with physical therapy. More and more studies are coming out about the cost effectiveness of physical therapy. And outcomes with physical therapy continue to be shown years down the road. You not only get treated in the short term, you learn how to make yourself better in the future.

6. We are part of a preventative model. What is the famous quote… “An ounce of prevention is worth a pound of cure”? PTs are unlike any other profession in our ability to treat problems now but also to educate and steer you clear of trouble spots in the future. We are a wellness community which is dedicated to lifelong wellness, not just short term fixes. You get to know us and we get to know you. You can’t really put a price on that.
Something you may not know: you don’t have to be in pain to see a PT. Outcomes are better when you catch the problem early. Don't know if you have a problem? Get a movement screen just like you get your yearly checkup. Want to get in shape? PTs can put you on a safe and effective program- for almost the same cost as a personal trainer you get hands on care, body work if needed, appropriate exercises, a wide skill set and a commitment to prevention.

As the new year gets in full swing and you stride forward full of resolution steadfastness bear in mind the value you want to get from your health care dollars. I may be biased, but in my mind there is no better value than a physical therapist."

Contributed by Dr. Eric Christensen


This article is spot-on in quickly explaining why it's not always worth running around to physicians and having significant testing done, especially if it's not clear why you're having the symptoms you're experiencing. Physical therapy can not only typically fix the problem without any need to see a specialist, but if it does appear that you need to see another practitioner or physician, we can help steer your toward the proper person. We can also provide them information that we have gathered in our sessions with you to help them come to a diagnosis more quickly.

The doctors aren't sure what's causing your symptoms? Integrate 360 Physical Therapy  is the right place for you! Many times there isn't a test or image that will show what is specifically causing your pain. There aren't enough white blood cells, joint inflammation, or pathologies present that can be picked up by these tests, but YOU ARE HAVING PAIN. Most of the time, our bodies are not moving efficiently and are causing muscle overuse, spasm, tendonitis, etc. This is what causes our pain, but it cannot always be picked up via blood test or image.

Tried physical therapy with no or minimal results? Integrate 360 is the place for you! Traditional physical therapy treats at, or closely around, the point of pain. For example, if you're having knee pain, a traditional therapist will evaluate your knee and then quickly screen your hip and ankle to see if they are complicating matters at all. Many times, this isn't thorough enough of an evaluation and the patient will experience less than optimal, or temporary results.

At Integrate 360, no matter what your symptoms are (vertigo, incontinence, back pain, shoulder injury, headaches, jaw pain, etc.), we look at your entire body/system. The body is all connected and must be working correctly in all areas in order to be symptom free. For example, if someone had an ankle injury and limited mobility because they never received physical therapy, it can absolutely effect their shoulder pain! If they have a compensated walking pattern or standing posture, their spine will not be properly aligned. When their spine is off, their ribcage is in the wrong position. This make it very difficult for the shoulder blade to sit in the correct position on the ribcage and will be inherently unstable. The shoulder blade is half of the shoulder joint (the other half being the arm bone), so if it's not stable, it becomes very hard to move one's shoulder using the correct musculature. When poor mechanics occur, pain develops.

Come see our therapists at Integrate 360 and let us save you time, money, and offer you better results than moving through the medical system or seeing a traditional physical therapist. Call us at  314-733-5000 or email or for more information.

Balloons - Quite Possibly The Most Underrated Therapy Tool

Balloons. They're good for so many things - decorating a party, making funny sounds when you deflate them, but did you know they can be the "miracle" rehab tool that's been missing from your routine?

To understand why this is one needs to understand the position and function of the diaphragm. The diaphragm is the primary muscle of inspiration and attaches to the back of your lower ribs and the front of your lumbar spine (bones of your lower back). When it's properly positioned, the diaphragm should have a domed shape. As this muscle functions, it flattens drawing air into the lungs and rebounds into a domed position causing air to be passively exhaled.


When our diaphragm is not properly positioned, it cannot work effectively. This can happen for many reasons - chronic sinus conditions, poor posture, and even disorders such as anxiety. When the diaphragm isn't working as well as it should, it tends to flatten out and lose it's natural domed position. Then we will be unable to inhale fully as the muscle's total range of motion has lessened. When this is the case, our bodies will compensate so we can continue to take in air and live. We can do this in a few ways: 1) we will use muscles of our upper trunk and neck such as our sternocleidomastoids and upper traps to attempt to lift the ribcage during inhalation instead of letting our lower ribs move out to the side gently and inflate our upper chests and backs, 2) we will use our lower back extensors to extend, or lean back, our rib cage so that we are able to inflate our abdomens with air or "belly breathe", or 3) a combination of these compensations.

These changes may go unnoticed for a very long time, but when done chronically, they can change our musculoskeletal position and cause muscle imbalance within our bodies and create pain. When someone has breathed this way for a long time, we typically see an arched lower back and pelvis that is tipped forward due to the spinal attachments of the diaphragm pulling the lumbar spine into extension. This can cause irritation of the low back extensor muscles and discs. It also causes our thigh bones to rotate outward which inhibits our gluts from firing and overusage of other hip muscles like the piriformis which can cause pain down the leg.

We also tend to see extended or backward-bent ribcages and flared lower ribs. This will ultimately cause a forward head and poor scapular position as we try to see and manipulate the world in front of us. These deficits can cause neck and shoulder (blade) pain as well as headaches.

So, how does the balloon help? We must utilize our abdominals to help force the air out of our thorax into the resistance of the balloon. This will help take our extended lower spine and ribcage and bias it into flexion, which will ultimately put it in a much more neutral position. Additionally, activation of the abdominals on the front of our bodies causes the muscles on the backs of our bodies, our low back extensors, to inhibit and relax. This can greatly reduce lower back pain and put our pelvis in a better position.

It is not only important to be able to blow air into the balloon, but it's also important that we can keep air in the balloon (keeping the neck of the balloon open) while we breathe in through our noses. This works on eccentric control of the abdominals. This allows our muscles to stay engaged even while they are elongating, such as when the ribcage is expanding as we take air in through exhalation during normal activities. This is very important as our core needs to be active at all times to keep us in good postural alignment and moving properly.  As the abdominals make up 1/4 of the core, it's essential that we don't "turn off" our abdominals with every inhalation throughout the day. Another muscle of the core is the diaphragm itself so its position and function is just as important as our abdominals. (The rest of the core is made of muscles of the lower back and pelvic floor.) This also establishes proper intraabdominal pressure which inherently stabilizes our core.  

What's the take home message? If you cannot blow up a balloon or keep it inflated while you breathe air into your nose (and keep the neck of the balloon open), your diaphragm is not functioning as it should and your body is not performing at it's best. Even if you are in a physical therapy program and are noticing good results, if you are building strength on faulty foundation or on top of compensated breathing patterns, the moment you stop performing your exercise program on a regular basis, you are likely to begin experiencing your symptoms again.

Please contact either Lesley or Nancy at Integrate 360 Physical Therapy if you are unable to blow up a balloon properly and/or have not achieved maximal results with other interventions that did not assess and/or treat your diaphragmatic function as part of your program. Let us make your exercise program work better for you! Email us at , , or call us at 314-733-5000

What is proper squatting? Why is it so important?

Squats have been a huge part of physical fitness for years. We incorporate them into our gym routines and rehabilitation exercises, but are they being performed correctly? This is a topic that's hotly debated in the physical fitness world right now, so I'm sure you've heard many differing opinions.

From a physical therapy view, "functional squatting" (or PRI squatting) is essential for proper biomechanics of everyday activities, not just squatting. Every time you sit down into a chair, you're doing a mini squat. Want to properly pick up that laundry basket from the floor? You'll hopefully use a squat with proper form to do it. That being said, there's a big difference between a functional squat and something you may perform at the gym. Being able to proper functional squat is essential to master before any gym-type or weighted squatting begins.

At one point in time, we can all squat correctly- it's an essential part of our gross motor development from infancy. Next time you're around a toddler that's in your family or out at the park, watch them. They're a perfect example of how we should all be able to squat, regardless of age.

Overtime we tend to the ability to do this correctly for many reasons - orthopedic surgeries that change our joint structure or range of motion, poor posture, poorly aligned musculoskeletal system, poor squat training, etc. At Integrate 360, we use a squat test as a tool to assess a patient's musculoskeletal position and flexibility. We then use it to help guide our therapy. If our patient's cannot do this, they'll have faulty form during a multitude of normal everyday activities that can keep them from fully healing or becoming pain-free.

Lori Thomsen, a physical therapist at The Hruska Clinic in Lincoln, Nebraska, created a great YouTube video further describing the importance of this. You can watch it here.

Can't do this? Call Integrate 360 PT at 314-733-5000 and let's us show you why as well as how. This will help to eliminate your pain or avoid any future pain issues.

Debunking 7 Myths About Physical Therapy has written a great article debunking PT myths. You can read the full article here. Below we have edited the list of myths from the article and made them specific to our clinic. Any additions I have made will be in italics.

1. Myth: I need a referral to see a physical therapist.

Fact: A recent survey by the American Physical Therapy Association (APTA) revealed 70% of people think a referral or prescription is required for evaluation by a physical therapist. However, all 50 states and the District of Columbia (DC) allow patients to be evaluated by a physical therapist without a physician's prior referral. In addition, 49 states and DC allow for some form of treatment or intervention without a physician referral or prescription (Michigan being the exception). On January 1, 2015, patients in Michigan will be able to do so, as well. Some states have restrictions about the treatment a physical therapist can provide without a physician referral. Check out APTA's direct access summary chart (.pdf) to see the restrictions in your state.

Integrate 360 PT welcomes patients with and without doctor referrals. If you come to the clinic without a referral, but have spoken to an appropriate medical provider about this issue in the past year, we will communicate our findings and treatment with that provider as well as any other physician you wish to keep up to date with your treatments. If you have not mentioned this to a provider, or if it's been over a year, we will ask that you call your physician and have a referral faxed to our clinic.

2. Myth: Physical therapy is painful.

Fact: Physical therapists seek to minimize your pain and discomfort—including chronic or long-term pain. They work within your pain threshold to help you heal, and restore movement and function. The survey found that although 71% of people who have never visited a physical therapist think physical therapy is painful, that number significantly decreases among patients who have seen a physical therapist in the past year.

Even if you've been to other physical therapy clinics and experienced "necessary", but uncomfortable treatments, we may be able to provide you with pain-free alternatives at Integrate 360. For example, many traditional therapists will treat a frozen shoulder with aggressive, and often painful stretches both at home and in the clinic. Postural Restoration works differently. We make sure that the foundation or core (ribcage, pelvis, spine) is in proper position before stretching or strengthening. More often than not, when you correct the foundational position or alignment, proper mobility is restored and aggressive stretching is not needed.

3. Myth: Physical therapy is only for injuries and accidents.

Fact: Physical therapists do a lot more than just stretch or strengthen weak muscles after an injury or surgery. They are skilled at evaluating and diagnosing potential problems before they lead to more serious injuries or disabling conditions—from carpal tunnel syndrome and frozen shoulder, to chronic headaches and lower back pain, to name a few.

At Integrate 360 PT, we also treat vertigo/vestibular problems, jaw joint dysfunction as well as women's health issues or pelvic pain. Unsure if we can help? Call us at 314-733-5000 or email us at and let us discuss it with you.

4. Myth: Any health care professional can perform physical therapy.

Fact: Although 42% of consumers know that physical therapy can only be performed by a licensed physical therapist, 37% still believe other health care professionals can also administer physical therapy. Many physical therapists also pursue board certification in specific areas such as neurology, orthopedics, sports, or women’s health, for example.

Physical therapy utilizes many different interventions to achieve results such as exercises in the clinic and at home, modalities (ultrasound and electrical stimulation), and/or manual techniques (stretching, muscle energy techniques, joint mobilizations). Although physicians or chiropractors may use some of these techniques in their offices, only physical therapists are movement experts and know how to make an exercise program as effective as possible, and personalize it to make it work for you.

 Integrate 360 PT is the only certified Postural Restoration Institute (PRI) clinic in the St. Louis area (check out PRIs main website here). This physical therapy approach is holistic and preventative in nature. It focuses on restoring the body's musculoskeletal balance in the most complete way and teaching our patients to "fix themselves." We want to give you the tools to get yourself better and keep yourself feeling better for the rest of your lives. Our activities also transition from exercises to activities that you can naturally integrate into your daily life. That way, you don't spend the rest of your life doing your exercises! Your exercises seamlessly become incorporated into your life giving you the relief you want without another thing on your checklist.

5. Myth: Physical therapy isn't covered by insurance.

Fact: Most insurance policies cover some form of physical therapy. Beyond insurance coverage, physical therapy has proven to reduce costs by helping people avoid unnecessary imaging scans, surgery, or prescription drugs. Physical therapy can also lower costs by helping patients avoid falls or by addressing conditions before they become chronic.

Please contact us at 314-733-5000 or We can tell you more specifically what to expect in terms of cost and insurance coverage.

6. Myth: Surgery is my only option.

Fact: In many cases, physical therapy has been shown to be as effective as surgery in treating a wide range of conditions—from rotator cuff tears and degenerative disk disease, to meniscal tears and some forms of knee osteoarthritis. Those who have recently seen a physical therapist know this to be true, with 79% believing physical therapy can provide an alternative to surgery.

As stated above, even if you've been to other clinics before and not gotten your desired results, let Integrate 360's unique approach to rehabilitation help you reach your maximal potential without surgery. Remember, you can always have surgery later on if needed, but you can't "undo" an unnecessary or failed surgery. In our opinion, it's always best to exhaust conservative options before taking more extreme measures.

7. Myth: I can do physical therapy myself.

Fact: Your participation is key to a successful treatment plan, but every patient still needs the expert care and guidance of a licensed physical therapist. Your therapist will leverage his or her specialized education, clinical expertise, and the latest available evidence to evaluate your needs and make a diagnosis before creating an individualized plan of care.

Even if you're only interested in a few sessions to get you started on the right track, let the experts at Integrate 360 PT get you on the right path to achieving your goals!

Avoiding Osteoporosis: How to Keep Your Bones Healthy

Osteoporosis is a condition that affects both men and women. According to the National Osteoporosis Foundation, "About 54 million Americans have osteoporosis and low bone mass, placing them at increased risk for osteoporosis. Studies suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis."

Most adults maximize their bone density by age 30. From that point forward, new bone is made but not fast enough to avoid overall bone loss over time. Therefore, it is extremely important to start improving your bone density as early as possible to avoid, or possibly, reverse a diagnosis of osteoporosis.

The Mayo Clinic has published another wonderful article describing bone health including what affects it and tips to keep your bones as healthy as possible. You can read the entire article here.

Did you know that the amount of calcium in your diet, amount of physical activity, tobacco/alcohol use, your hormone levels, and certain medications all have a dramatic effect on your bone density? It's important to speak with your doctor, physical therapist, or other health care professional about these areas of your life. Your healthcare team can come up with the best plan to keep your bones as healthy as possible.

The article recommends getting enough calcium and vitamin D in your diet to give your body the tools it needs to build more bone as efficiently as possible.

  • Women ages 19-50 and men ages 51-70 have a recommended dietary allowance (RDA) of 1,000 mg of calcium a day. This increases to 1,200 mg a day for women after age 50 and men after age 70.
    • Good sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products, such as tofu.
  • As for vitamin D, adults from 19-70 have an RDA of 600 international units (IUs) a day. This increases to 800 IUs after age 71.
    • Good sources of vitamin D include oily fish, such as tuna and sardines, egg yolks, and fortified milk.

Exercise is essential to maintain and build bone mass. Typically, weight bearing activities such as walking are effective for individuals with osteoporosis or osteopenia. If you do not have any problems with your bone density yet, higher impact activities such as running or aerobic classes will be more effective. Your physical therapist at Integrate 360 will be able to give you suggestions individualized for you and your preferences. We will also provide additional physical therapy-based exercises and/or stretches to avoid any postures that can put excessive stress on your joints or bones/spinal segments.

It is also essential to know how to avoid fractures if you do have osteoporosis/osteopenia. Check out our blog post on how to properly fall here.

For more information on osteoporosis, check out the National Osteoporosis Foundation's website here.