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.

Why Does Everyone's Right Shoulder Droop?

What do you notice in the above picture? At first glance it just looks like three boys hanging out during a soccer game. They're all wearing different clothes and are different heights. Two of the boys are leaning on one another while the third stands independently. Despite their differences, they are all standing with the same postural pattern. 

Take a look at them, no matter how they are leaning, they are all standing on their right legs, crunching or shortening the right sides of their trunks, and lowering their right shoulders. Doesn't this seem weird considering two of the boys are leaning in opposite directions so they can lean on one another? How does that happen?

This common pattern is due to our naturally-occurring anatomical asymmetry. It begins with the asymmetrical attachment of our diaphragm. This primary muscle of respiration attaches to the back part of our lower ribcage and onto the front of our lower (lumbar) spines. The attachment sites are bigger and more robust on the right side. As this side has more attachments, it is "stronger" and tends to pull our lower spines into right rotation. Eventually this will pull our pelvis into right rotation as well. When our pelvis' and lower spines are oriented toward the right, our right hip joint is in a better, more functional position to weight bear. Therefore, we all tend to put more weight on our right leg than our left. 

Additionally, this muscle is asymmetrically domed. Because of our heart, the left side of our diaphragm tends to flatten which flares our ribcage and weakens our abdominals on that side. The liver, on the right side, helps to preserve the muscle's domed shape here. This makes the right side of our abdominals stronger than the left. Due to this and the flared ribs on our left side, our trunks tend to lean to the right. This gives us the classic lowered right shoulder. Complicating matters, when our trunks lean slightly toward the right, more weight is displaced onto the right leg. This further ingrains our postural asymmetry. 

In PRI language, this is called a Left AIC (anterior interior chain) position and it is the most common postural pattern. As our bodies spend more time in this position and our compensatory strategies we use due to this pattern break down, we tend to go further into compensatory patterns and this Left AIC pattern can degrade into others. To read more about this, check out our blog post What's Your Postural Pattern. This poor postural pattern, and therefore problematic loading on our muscles and joints, can lead to pain and dysfunction. A PRI trained therapist evaluates the entire body and it's systems to look for musculoskeletal position and function. We can then intervene on not only the area of pain, but also all of the surrounding areas that are feeding into the problem. Because of this more holistic approach, we are able to bring relief to many patients that have "failed" with physical therapy before, no matter where the site of pain is.

Next time you're at the mall, restaurant, or airport, watch people as they stand. Typically, no matter where they are looking, what direction they're learning toward, or what side they may be holding a heavy bag or purse, they'll likely be standing on their right leg with their right shoulder low. 

Physical Therapy Can Play A Vital Role In Concussion Management

The American Physical Therapy Association has written a tremendously informative article on concussions entitled "Physical Therapists Guide to Concussions." This is important for everyone to read! Not only do concussions happen in contact sports and with serious falls, but are also common with motor vehicle accidents. It is important to know the symptoms of a concussion so you can get medical help as soon as possible. 

As the article points out, physical therapists are vital in concussion management. We see our patients over a longer duration of time and for longer individual sessions than a physician can. This allows us to fully assess your deficits and help tease out what may be related to a concussion and what may not. It also allows us to more clearly see how you are progressing over time. We can help treat your dizziness, muscles weakness and lack of endurance, and refer you to other providers who might help speed your recovery. 

At Integrate 360 Physical Therapy, we look at the body's mechanics as a whole and how the neurological system is assesses incoming information. Through our specific Postural Restoration exercises, we are able to help restore musculoskeletal position and functional strength to help the body work as a whole again. We also have trusted dentists, neuroptometrists and podiatrists we work with if we think your system needs more specific evaluation and treatment.

Last year, I worked with a gentleman who sustained a significant concussion and continued to have symptoms (particularly headaches, dizziness, and visual disturbances) so severe he was unable to work, even several months after the injury. He was told by his doctors to be patient and that his symptoms would ease over time. When he came for his physical therapy evaluation, his musculoskeletal position was greatly disturbed. With our specific Postural Restoration exercises, his joint position was corrected allowing him to have better awareness of where he was in space. We then strengthened him in this position to maintain proper global alignment. This significantly eased his complaints of dizziness. He continued to complain of visual disturbances so he was referred to a neurooptomotrist we frequently work with. After treatment with the neuroptometrist, his visual disturbances were eased and his headaches were infrequent. 

If you suffer a concussion or believe you still haven't healed from one, contact us and let us help you heal from it fast! Call us at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com

The Headache Mystery

Headaches affect millions of people. They can be absolutely debilitating affecting your social and professional lives. This can lead to degradation of relationships and cause depression. Headache sufferers will try things from over the counter pain meds to chiropractic to Botox injections to deal with the pain. CNN has published this article talking about some of the types of headaches, their symptoms, and potential causes in the article "Migraines to cluster headaches: The most painful headaches you could ever have".

As the article infers, headaches are still very much a mystery. Symptoms within a classification of headache are not consistent and  may overlap from one classification to the next. This makes treating them very tricky. It also makes diagnosis difficult.

In our clinical experience, we have been able to bring relief, if not eliminate our patients headaches, with PRI (Postural Restoration) physical therapy. It is not uncommon for us to evaluate a patient that has gone through the medical ringer - MRIs, CT scans, medications, Botox or muscular injections, and even physical therapy without improvement of their symptoms. 

How is this possible? As we've mentioned in previous blog posts, PRI evaluates patients in a very unique way. We not only look at the mechanics and musculoskeletal position of the painful area, but also of the entire body. Once deficits have been identified, we strive to increase strength and range of motion, as well as to reeducate the body how to move in a biomechanically correct and functional way. This is the best way to fully heal and address the source of the pain. We do this by activating muscles in polyarticular chains, or muscles that work in unison when we walk and move. Our bodies do not utilize one muscle or joint at a time, so isolated rehabilitation will not yield fully and/or lasting results. 

We also evaluate sensory input into the brain (how our feet sense the ground, our visual system, and jaw joint position) to see if faulty information is being sent, causing compensated movement strategies. Such compensations can "lock" us into a pattern of dysfunction and pain. If there is a problem in one of these areas, we can help by utilizing exercises and manual techniques. If more is needed, we work closely with a trusted group of dentists, neuroptometrists, and podiatrists to address the problem areas. 

Due to the fact that headaches can come from a multitude of causes (poor posture, stress, increased fight or flight nervous system tone, visual strain, TMD/TMJ, neurological conditions, etc.) and may be due to several at the same time, PRI's holistic and integrated approach evaluates and treats all of these issues on some level. Medical imaging of the brain and neck (routinely used when trying to diagnose the medical cause of a headache) cannot see poor movement patterns, increased fight or flight nervous system tone, and/or jaw joint dysfunction. Therefore, the physician often makes an educated guess on what type of headache you have and how to treat it. This helps explain why headaches are so difficult to treat since headache symptomolgy and classifications are ever-changing and hard to pin point. 

Integrate 360 Physical Therapy's integrated, holistic approach allows us to cast a wide net in terms of areas treated and treatment interventions. This typically allows us to catch the deficit that had been missed by previous healthcare team members. Let us help you take back your life.

If you'd like more information or want to see how we can be of help in eliminating your headaches, call 314-733-5000 or email Lesley@Integrate36PT.com or Nancy@Integrate360PT.com 

How Physical Therapy Can Help Your Anxiety and Stress

We have mentioned many times in our blog posts that PRI is a holistic and global form of physical therapy. Not only do we look at the body and its mechanics as a whole to assess and address our patient's pain and dysfunction, but we also address the neurological system that is impacting movement patterns as well.

The Autonomic Nervous System (ANS) can be broken into two parts: the Parasympathetic Nervous System (the "rest and digest" system), and the Sympathetic Nervous System (the "fight or flight" system). Symptoms of an overactive sympathetic nervous system include increased heart rate, shallow breathing dominated by our accessory respiratory muscles versus our diaphragm, muscular contraction or tightness, weight bearing on the balls of our feet, and/or biting on our front teeth. 

Our patients typically present with an extended lower back and forward tipped pelvis. This places weight on the balls of our feet, shallow breathing with our accessory respiratory muscles (because our diaphragm is now in a non-functional position), and poor jaw position causing biting on our front teeth versus our molars. This begins a vicious cycle: increased sympathetic nervous system tone causes more of these muscular impairments and positions which causes more sympathetic nervous system tone. The goal of PRI is to reduce sympathetic nervous system over-activation in order to restore musculoskeletal balance and reeducate the body how to move. 

Although we are typically manipulating the ANS in order to address musculoskeletal issues, our techniques directly effect anxiety as well. It is impossible to feel anxious without an increase in our sympathetic nervous system. Therefore, the very same exercises that PRI uses to fix our patient's low back pain, can have a profound effect on their complaints of anxiety and be used as a tool to manage it. 

The use of a balloon and abdominal muscles that is at the heart of PRI principles is meant to reposition and regain function of the diaphragm. Not only does this help restore posture and musculoskeletal function, but it also directly decreases sympathetic nervous system tone while increasing the parasympathetic system. We have heard many stories from our patients about how they use their home exercises to help them manage stress more than they do for their lower back pain. We have also seen the change in our patient's nervous system tone while performing exercises. The patient that used to breathe quickly and shallowly and had a slightly flushed look has a more relaxed respiratory pattern and complexion. We also frequently hear things like "I can finally take a deep breath!"

Interested in learning more or want to see this in action? Call Integrate 360 Physical Therapy at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com today to set up your evaluation.