How To Properly Use An Elliptical

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

Gloves: An Underrated Winter Accessory

Take a look outside and you’ll see the same thing over and over again - people walking with their hands in their pockets. Sure, you may only be outside for a few minutes or it may not seem like they’re totally necessary, but using gloves can do more than keep your hands toasty. They can help decrease your pain!

When we place our hands in our pockets it doesn’t allow our arms to swing when we walk. This is a very important part of the gait cycle for a few reasons; it helps us to utilize momentum and it allows our entire skeleton proper biomechanical activation and movement when walking. If we stop swinging our arms because our hands are in our pockets, holding something, or we have a purse under our shoulder, it eliminates this. This means our body has to work hard to move forward through space, the forces of walking cannot be easily transmitted throughout the body, and motion is essentially stopped in our lower spines and not able to move up through the spine and thorax as intended. This can cause malposition of our bones and joints, fatigue, and pain. 

So when you’re walking, try to maintain your arm swing as much as possible. Wear gloves, use a cross-body purse or messenger bag, and stop carrying unnecessary items in your hands. Making this simple change can have a huge impact on your pain levels. 

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

Don’t Let Pain Cause You To Miss Out On Life

Don’t lose vacation days, or even pay, because of pain! Let Integrate 360 Physical Therapy help you on your journey to being pain-free again!

Even if you have tried physical therapy in the past, we can likely help. We are different from traditional PT as we are the only Postural Restoration Institute (PRI) certified clinic in the greater St. Louis area. All of our therapist are also PRI certified. Additionally, our patients see the same physical therapist each visit. We do not have therapy extenders. You will work one-on-one with your physical therapist at each visit.

PRI is a type of physical therapy that treats the source(s) of your dysfunction and pain, not just the symptoms. Regardless of the site of your pain, we assess and address (if necessary) your entire musculoskeletal and joint position and function. Just because your knee hurts, it doesn’t necessarily mean your knee is the problem. When an area(s) of your body isn’t able to move properly, it will find a way to compensate. Eventually, these compensation patterns break down because they are not biomechanically correct. As time goes on, your body finds other ways and areas of the body to compensate for this original dysfunction. Eventually, your will develop pain at one or multiple areas of compensation. Essentially, your neck may hurt because your right ankle doesn’t move well. If previous interventions and practitioners only addressed your neck and shoulders, it would make sense that you would not experience total relief.

Let us assess your entire body. We will then customize a therapeutic exercise program to treat the cause of the problem, just not mask the symptoms. Our treatment plan is different from traditional therapy as well. We typically give 3 or less exercises for your home plan, we ask you to do them only once a day, and we see our patients weekly or less. Our exercises are not simply strengthening or stretching exercises. They are movement patterns that teach your body how to move correctly via neuromuscular reeducation. We are able to see you less frequently than traditional therapy because we are essentially teaching your body a new skill, and skills take time to be learned. Once you have mastered that skill, we will then teach you a new one or continue to make it more challenging.

Let us help you reach your goal of wellness! Call us at 314-733-5000 or email us at Lesley@Integrate360PT.com or Nancy@Integrate360PT.com to set up your evaluation or simply allow us to answer any questions you may have. 

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

Can Physical Therapy Help With Snoring?

As outlined in the article Snoring, from The Mayo Clinic, one type of snoring is obstructive sleep apnea (OSA). This occurs when your airway significantly narrows or closes completely while you sleep. This can cause you to take in less oxygen or even stop breathing momentarily. It can also cause you to snore as the soft tissues of your airway rattle as you try to pull in air. 

Airways narrow for many reasons, but are regularly seen in individuals with temperomandibular joint (TMJ) disorder or neck dysfunctions. In both cases, the head tends to move forward causing the cervical spine to lose, or even reverse, it's curvature which will reduce the airway. 

Physical therapy can help to restore airway space by addressing the neck and jaw joint. At Integrate 360 physical therapy, we use techniques that correct the many reasons you developed your dysfunction - poor diaphragmatic breathing, poor scapular position and strength, rigid ribcage, scoiosis, etc. Assessing your entire body, it's ability to move and integrate multi-area motion is what makes us different from traditional therapy. The traditional model promotes assessing the problematic area as well as screen the areas above and below to see if they are related. This model allows the evaluating therapist to miss many components of their patient's dysfunction. 

If you do suffer from TMJ, we have an arsenal of techniques that can restore your bite entirely and correct your jaw joint mechanics. For those that do need dental intervention, we work together with a dentist to heal this issue. 

Stop buying all of those infomercial products of sleep devices from your dentist. They either do not address the airway space itself, or may not be appropriate for your body given the condition of your neck.

If you suffer from snoring, TMJ, headaches (especially in the morning), and/or neck pain. Let us tell you those other interventions have failed in the past and help you sleep peacefully again!

Call us at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com. 

Written by Lesley Callaham, MPT, PTC on December 21, 2017

Tips to Make Holiday Shopping Less Painful

It's that time of year again! Time to spend hours wandering around the mall, standing in line, and lugging heavy bags around in order to show your loved ones how much you care this holiday season. It's well worth it, but wouldn't it be great to get that shopping done without so much pain? Here are a few things you can do to make yourself more comfortable.

1) Wear the best tennis shoes you have. Think about it, you'll be standing and walking for hours on end. You need to have the most supportive footwear on your feet in order for your entire skeleton to be as supported and help you maintain proper posture. Sure, you may have some boots or Tom's that are really comfortable on your feet, but that won't do. They don't have the cushion, arch support, and/or stability to get the job done. So lace up those New Balance 1080s and get ready to get all 10,000 steps for your day in an hour!

2) Don't carry so much. Walking around with heavy bags, or even just a purse, changes our gait. When there is something in our hands or on our shoulder, we stop swinging our arms when we walk. This cuts down on our momentum and makes us use more energy to keep walking. It also places a lot of tension in our lower backs where the rotating part of our pelvis and lower spine meet the rigid upper spine. It's best to carry things in cross body bags. This keeps our arms free to swing. If you must carry bags, try to keep them light in weight and have them equally distributed between both arms. This way, your trunk won't be pulled over to one side. Try to make as many trips to the car as possible to drop off your gifts. 

3) Stand correctly. Anytime we stand longer than a few minutes, especially when we're tired from  standing in boring lines for some time, we tend to get lazy with our posture. We will move our hips forward, lean back in our trunks a bit, and lock out our knees in order to "hang" on our ligaments instead of using our muscles to keep us up. Combat this by shifting your weight onto your heels. By simply moving your weight onto your heels, you'll notice that naturally stand up straighter and feel less strain on your back.

4) Take breaks. Our bodies are not meant to be in one position for more than 20 minutes or so. The more standing and walking we do, the more tired our bodies become and the more our posture deteriorates. Take a break and let your muscles rest. Go get a cup of coffee or simply sit down and people watch for a few minutes. Try to do this before you start to feel physically tired. We want to fight fatigue as early as possible.

5) Heal your body ASAP. It's inevitable that your body will eventually become tired and may develop some pain. Make an appointment with your Integrate 360 PT or do your exercises to correct any compensation patterns or soft tissue irritation you have developed as soon as possible. It's always easiest to heal pain when addressed quickly. 

Happy shopping and holidays!!!

Written by Lesley Callaham, MPT 

November 28, 2017

4 Things a Physical Therapist Can Do For You That Your Doctor Can't

In the article of the same name from NBCnews.com (read it here), they suggest 4 things that a physical therapist is more able to address than your physician. They are:

1) Assess your risk of injury.

2) Recommend the best workout for your body.

3) Speed your recovery.

4) Correct postural and alignment problems. 

Physical therapists are movement experts. Our entire education is dedicated to the body's anatomy, musculoskeletal and biomechanical mechanics, how injuries and disease processes effect these mechanics, and how to restore mechanics. MDs receive very little, if any, education in these areas. DOs do receive more, but regardless of the amount of education, physicians simply do not have the time to fully address these issues. Due to insurance restrictions, the typical physician office visit is 5-15 minutes. That's hardly enough time to tell the doctor what's bothering you!

At Integrate 360 Physical Therapy, we spend 60-90 minutes with new patients which allow us to obtain a detailed medical and mechanics history, perform a thurough and global (PRI) assessment, educate you on what the "problems" are and work with you on fixing the underlying issues that are causing your pain, not just addressing the symptoms. Because of our extensive data collection and time spent with our patients, we are able to address the 4 listed items above better than any health professional, physical therapist or otherwise. 

Ready to schedule an appointment? Want more information? Call us at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com 

Written by Lesley Callaham, MPT November 14, 2017

What Your Shoe's Wear Pattern Says About You

A good, worn pair of tennis shoes can tell rehabilitation professionals a lot about our patient's gait pattern (how they walk), mechanics, and posture. Look at the pair of shoes in the picture above. First, be aware that the right shoe is on the left, and the left shoe is on the right side of the picture. It's the same view you would get if you were looking at the bottom of this person's shoes as they lied on their back on a table in front of you. 

Can you spot any differences between the two shoes? The right shoe has more wear in the heel area. It's also evident that as the patient stands on this leg while walking, their weight stays heavily off to the right. You can see how much wear there is on the outside part of the right shoe versus the left. There is also much more wear under the toes on the right shoe. 

First let's talk about normal gait. When our foot hits the ground, we should hit on our heel, slightly on the outside. As that leg supports your weight and moves under your body during midswing, your weight should begin moving toward the center of your foot and your arch should flatten somewhat. As the leg moves behind you in terminal stance, your weight should have moved directly under your big toe so you can use it as a rigid lever with which you can push off from. Essentially, your weight should move from the outside of your heel to the inside of your foot, under your big toe, as your body advances over and in front of your stance foot. 

Based on the wear pattern of the above shoes, it is evident that this person keeps their body weight toward the right, no matter which leg they are walking on. As their body moves over their right foot, their weight stays lateralized on the outside of their foot. They are finally able to transfer some weight to the inside of their shoe, under their big toe, as their leg is behind them to push off.

This person does not know how to properly stand on their left leg. Sure, it supports enough weight so that this person is able to use both legs while walking, but they never get their body properly centered over their left foot as they walk. 

Why is this? Their body is in what PRI professionals call a Left AIC position. It stems from a naturally occuring asymmetry of the diaphragm which has been exaggerated. The right side of our diaphragm is more robus and typically stronger than the left side. When this naturally occuring imbalance gets too out of proportion, our ribs will flare on the left side and it becomes hard to use our left abdominals. This means that our relatively stronger right abdominal wall is able to pull our thorax's over to the right a bit, transferring our weight over our right foot. It will also cause our pelvis' to rotate toward the right side which places the right hip in a more functional position to bear weight as we walk. 

If you see asymmetrical wear like this on your shoes, it's a red flag indicating that sooner or later you will develop some type of pain, dyfunction, or injury. Think of it like when the alignment in your car is off - you'll see asymmetrical wear on your tires. The physical therapists at Integrate 360 Physical Therapy and other PRI therapists across the country are the only rehabilitation professionals that take this anatomical imbalance into consideration in their treatment approach. Minimizing this asymmetry is the key to restoring the natural balance in your body, perfecting mechanics, and avoiding or alleviating pain. 

Call us at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com to set up your evaluation. 

Why We Chose To Be An Out-Of-Network Provider

An article entitled "Physical Therapy Burnout is Destroying Our Profession" on CovalentCareers.com is essentially a list of typical complaints physical therapists amass during their career. These issues are often significant enough to cause many to leave the profession earlier than they intended, or leave it entirely.

One significant cause of "physical therapy burnout" is reduced reimbursement rates from insurance companies. This leads to increased demands on the therapist's productivity to make ends meet. This can be done many different ways. Typically, clinics opt to see more patients per day. This requires visits to be shorter in duration or for one therapist to see more than one patient at a time. Either way, the patient is given less one-on-one time with their therapist. Some clinics urge their therapists to be cognizant of reimbursement rates and, if two treatments will be equally effective for that patient, pick the higher reimbursed option. For example, if manual therapy or ultrasound are deemed, by the therapist, to be equally effective at reducing their patient's painful muscle spasm, they're likely to chose manual therapy as it will be reimbursed at a higher rate by the insurance company. Some clinics may recommend their therapists "pad" their billing with treatments that are not harmful or contraindicated in anyway, but may not be totally necessary.  An example of this would be ending a session regularly with electrical stimulation for patients experiencing pain. It is a billable service that will bring the clinic money, but doesn't require the therapist to spend more time with that patient. The therapist is now free to work with other patients and perform additional billable services.

To be clear, most physical therapists and therapy clinics are utilizing morally and legally correct billing practices. However, there is immense pressure on physical therapists to find creative ways to bring more money into the clinic without doing anything illegal or against their better judgement. 

Additionally, a typical physical therapist went to school in order to help people lead less painful and more functional lives. The amount of paperwork required by insurance companies to receive any reimbursement money at all is getting out of hand and requiring physical therapists to put in many, many hours off the clock. Our mission was to help people, not to do endless amount of paperwork only to be denied payment.

This is why Integrate 360 Physical Therapy chooses to be an out-of-network provider. We do not depend on insurance companies to be able to pay our bills and we do not have to play their games.

1) We do not employ a full-time billing professional whose entire job is dedicated to submitting and resubmitting claims until they discover what billing code is effective, or go to continuing education courses to remain aware of the highest reimbursed codes. 

2) We are able to work with our patients to determine what the goals of their physical therapy should be. Essentially, the patient is able to be an active participant in their own plan of care. We do not have to set our goals based upon what insurance companies deem is "success."

3) We can be flexible with the length of frequency of our visits. Many health plans cap therapy visits at 20 per year or at a dollar amount. Without these restrictions, our therapists are able to spend more quality, one-on-one time with our patients. We do not employ therapy aids or assistants. 

Unfortunately, this is just not possible when relying on insurance companies reimbursement rates. 

However, we are able to provide paperwork to our patients so that they can submit their claims. It usually requires a trip to their health insurance's website to see how to do this. Then, forms are uploaded and submitted. If the charges are accepted by the insurance company, they typically write a check directly to the patient for reimbursement. This amount will vary and will be dependent on the patient's out-of-network benefits. A simple call to their insurance company will give them this information. 

For any other questions or concerns about this topic, please call us at 314-733-5000 or email Nancy@Integrate360PT.com

Can't Feel The Burn In The Right Place?

It's happened to all of us. You're working out and know you're supposed to be "feeling it" in a certain target area, but you can't. Do you ever wonder why?

The explanation is actually quite simple. That particular muscle is not burning because it's not firing. Why? It's not in the right position to be properly utilized. 

Our body is designed to stand with a certain posture and have our joints in certain positions. The muscles attach on very specific areas of bone so that when they shorten or contract, the bone moves in a very specific pattern. For example, our gluteus maximus (largest glut muscle) originates from the top of our pelvis and part of our sacrum at the back of the pelvis above the tailbone. It then attaches to the gluteal tuberosity on the back of the thigh bone. When this muscle contracts and shortens, your hip extends or your thigh moves backward relative to your pelvis.

The only catch is that our muscles need to have a proper length tension ratio to contract fully. This means that the muscle must not be too stretched, or too shortened in order to be the strongest that it can be and fully contract all its fibers. Therefore, if the muscle is not in the correct position, and does not have the correct length tension ratio, the body will substitute another muscle that is in better position to work. This is why people who have very arched or "deep" lower backs will feel their lower backs working as they do a glut exercise. Because of the position of their lower spine and the consequential tipped-forward position of their pelvis, their glut is stretched out. Their lower back extensors are then in a shorter position and have a much more efficient length tension ratio. Therefore, that person's body will choose to use their lower back extensors rather than their glut during their glut strengthening activities as it is more efficient from a biomechanical standpoint. 

The therapists at Integrate 360 Physical Therapists can help. We do an extensive evaluation looking at your standing posture and performing tests to see if your joints and muscles are properly aligned. We will then work with you on ways to restore your posture and bone/joint alignment so that you can work out and live in a biomechanically correct way. Depending on your goals, this can be done in as little as one session!

Next time your doing a leg raise while lying on your side and you feel it in the outside of your thigh versus your glut, or performing lower abdominal exercises that you feel in the front of your hip joint, give us a call and let us help you. Contact us at Lesley@Integrate360PT.com, Nancy@Integrate360PT.com or 314-733-5000.