Is Your Gym Routine Holding You Back?

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Finding some sort of physical fitness is essential in today’s culture of sedentary jobs and lifestyles. For many, the gym is their primary location for fitness. This can be due to weather restricting outside activities, convenience, comfort (working out is always more comfortable in a temperature controlled setting with easily accessible water), range of activities offered, etc. However, the gym can create an environment where your body actually develops problems, instead of maintaining optimal health. 

Aside from burning calories and improving our cardiovascular fitness and physical strength, fitness activities should help us become more aware of our bodies. As we are active, we should notice groups of muscles that are working hard, areas of tension or discomfort, how taxing each activity is, etc. It should be a time to connect with our bodies and learn about them. This will help us to determine areas of weakness or dysfunction, or track our progress and functional goals. 

However, the gym is set up for things to be easy and convenient. Cardio equipment is typically grouped near TVs with magainzes nearby. While this can make our time on machines go faster as you're not constantly watching the clock, it can have a negative impact on our bodies. First, diverting your concentration to a TV or magazine takes your consciousness completely away from the body. We no longer are able to perceive if our weight is staying more to one side than the other, if there is slight tension in our lower backs, or what muscle groups are actually working. This makes it easy for our bodies to use compensation patterns to complete the activity. These compensation patterns eventually lead to breakdown, pain, and/or dysfunction.

Additionally, machines of any nature can also be problematic. They are designed to help place the user in a safe position and be sure the motion is happening around the correct axis (ie the knee extension machine makes sure that we are straightening at the knee and not the hip). This is helpful for someone new to fitness or is not very body-aware, but it becomes really easy for the machine to passively hold us upright. It is important that no matter if we’re doing a strength machine or cardio machine, be sure that you are “owning your body.” If you’re doing a simple bicep curl machine, don’t simply let your entire upper body rest upon the chest bar, use your own core musculature to hold yourself up in space and control unwanted motion at the core and shoulder, THEN perform your bicep curl. On the elliptical, use your abs to help rotate your ribcage as you articulate the handlebars and position your hip over your foot. Don’t simply “throw” your weight back and forth by sticking out your hip and/or leaning with your shoulders. Either way will cause the pedals to go down and calories to burn, but only one is truly beneficial for your body in a holistic manner. 

Lastly, don’t get stuck in a rut! If you’ve been doing the same machines, strengthening exercises, or routines for more than 2 weeks, you’re on your way to an overuse injury or muscular imbalance. Our bodies are very good at being efficient and it’s easy for them to go into auto-pilot when performing the same activities over and over. Switch it up! Try the machines in a different order, use a cardio machine you’ve never tried before, run the track instead of using a machine, take a class that’s new to you, etc. The more variability you introduce in your routine, the more your body will respond and the more balanced it will stay. If you’re worried about hurting yourself or using proper form, talk to your physical therapist or set up an appointment with a personal trainer. 

You’ve already done the hard work by getting to the gym consistently and putting in the time, now make sure you get the most out of it you can! 


Written by Lesley Callaham, MPT, PRC on July 24, 2018

Where You Walk Matters

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Walking is a great activity for fitness. It’s free, low impact, and you can do it almost anywhere. It’s appropriate for individuals with and without pain. However, choosing where you walk is important. The right environment can challenge your body while helping you stay in neutral and make strides with your therapy program. The wrong environment can wreck it. 

The worst place to walk is on the treadmill. The mechanics of walking on a treadmill are completely different than walking on the ground. Walking on land requires you to pull yourself over the ground by using your hamstrings. You also have to shift your weight from side to side in order to power the swinging leg forward. As the ground is essentially pulled out from under you on a treadmill, your only goal is to not fall over. There is no signficant and variable change in direction, incline, or stability of the ground. The body doesn’t have to work as hard or focus on keeping your core stable. Additionally, many people hold on to handrails to keep their balance. This is not great for your spine. As your legs are moving, your pelvis and lower back are rotating. When your hands are fixed, the tension cannot be destributed along the spine as designed. Lastly, many people watch TV or look at a magazine while walking on a treadmill. This also causes the body to lock down and operate on auto-pilot as the visual system is now anchored on a visual target.

Walking on a track or inside the mall is better. Your body now has to pull you forward in space and you’ll likely be using your arms, but there is still no change in incline, flooring surface, and it’s still relatively easy to lock your visual system.

Walking outdoors is great. Simply walking in the neighborhood gives you enough incline variability and visual stimulation to keep your body awake and attentive. Walking on a trail is even better. Even if it’s a paved trail, the surface is not completely flat. Your muscles and brain have to constantly monitor how your foot is hitting the ground to keep your balance. Different chains of muscles have to turn off/on depending on if you’re going up or downhill. It’s hard to visually anchor as there is so much visual stimuli for your brain to monitor. 

So get outside and get those steps in! Your body will thank you!


Written by Lesley Callaham, MPT, PRC July 9, 2018.



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

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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 or today!


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


Why Your Foam Rolling Results Don’t Last

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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 or 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.

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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



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

Why We Love Pilates

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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?

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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 or . 


Written by Lesley Callaham February 1, 2018