Ergonomics for Your Home Office

With so many adults and students working from home right now, DIY home-office setups are becoming the new standard for workspaces.
One thing is for sure: we have seen a surge in number of people with posture related issues from long days of zoom calls while hunched over a kitchen table.

What Can Physical Therapy Do to Help?
Poor posture can lead to a whole host of issues including (but certainly not limited to) neck pain, back pain, carpal tunnel disorder, hip impingement, and headaches. Physical therapists are trained to treat many different disorders that can result from poor posture, and can provide skilled advice on how to modify your office and desk to keep your body aligned. Treatment options often include joint mobilizations, personalized stretching programs, traction, postural training, and nerve mobilizations to help relieve tension.

Seeking Ergonomic Advice?
At Active Marin Physical Therapy, our therapists are trained to provide skilled and personalized ergonomic assessments. We are available for both in-person and telehealth consultations. Online telehealth consultations are a perfect match for ergonomic evaluations because it allows the physical therapist to see you in your natural environment at your desk. Contact us to set up a consultation.

5- Step Ergonomic Checklist
How do you know if your home-brew desk setup is setting you up for success? Here are the basic elements to check:

1. Is your computer screen at eye level?
It is essential that your computer is at eye-level in order to avoid neck and shoulder pain. If you have a desktop computer, consider using a computer stand or adjustable computer mount to raise your screen to eye level. If you are using a laptop or an ipad, prop your device up on an elevated laptop stand– it can make a huge difference.  If you also need to do a lot of typing on your device, you may consider getting a wireless keyboard and mouse to set under your laptop stand so that both your neck and arms can be in a comfortable position while using your laptop or iPad.

2. Does your chair support your low back?
Many office workers find that a chair with lumbar support helps ease their back pain. If your chair does not have lumbar support, try placing a rolled up towel or a lumbar support roll behind your lower back for extra support. A cushioned seat pad can also help relieve pain and distribute forces when you are sitting in a firm chair all day.

3. Are your legs parallel to the floor?
The ideal situation is to have a chair that is height-adjustable so that your thighs can be parallel to the floor with your feet flat on the ground. If you cannot adjust the height of your chair, and your feet do not reach the ground, consider using a footrest to set your feet on.

4. Are your hands at the same height as your elbows? 
Whether you are using a sitting or a standing desk, the ideal desk height is one where your hands are at or slightly below your elbow level when you are using your keyboard. If your desk is too low, place sturdy books or boards under the desk legs to raise the height of the table. If your desk is too high, you can use a keyboard tray that allows you to use your keyboard below the top of your desk. If you are able to invest more money in your desk set-up, a sit-to-stand desk can be a good ergonomic option that prevents back pain.

5. Are you frequently looking down at paper on your desk?
If you are frequently referencing written notes while using your computer, you should consider using a document holder which allows you to prop up your notes next to your computer. There are many low-cost options for document holders, and they can save your neck a lot of pain from being bent over all day long.

Have more questions or want personalized assistance? Contact us to set up an in-person or telehealth ergonomic consultation.

Achilles Muscle Strain

Everyone’s talking about Kevin Durant’s devastating Achilles tendon Injury. But what is the Achilles tendon? Was this preventable? How long will it take to recover?

What is the Achilles: The Achilles tendon is a band of connective tissue that connects the calf muscles (Gastrocnemius and Soleus) to the heel bone (Calcaneus). Its primary function is force transmission between the muscle and bone to perform plantar flexion of the foot, or pointing of the foot towards the floor.

Image credit: https://boneandspine.com/wp-content/uploads/2015/01/achilles-tendinosis-site.jpg

Mechanism of Injury: The force of quickly pushing off of the foot requires the calf and Achilles to transmit force from the muscles to the heel, allowing propulsion. With Kevin’s prior calf strain having had 32 days to heal, is it likely that the calf muscle was no longer the weakest point in the kinetic chain. With immobility or disuse over even short periods of time, the Achilles tendon can remodel and become weaker relative to the strength it had before resting. His return to sport was likely too quick to allow the Achilles to return to its prior pre-injury strength, leading to overloading and subsequent rupture.

Clinically, most overuse tendon injuries are due to repetitive motion, which creates ‘‘microtrauma’’ that accumulates over time.¹ Additional factors include muscular imbalance, muscular weakness, anatomical factors (leg length discrepancy etc.) and training errors.

Muscle strain injury/healing and how Physical Therapy can optimize healing:

By placing the injured muscle at rest for the first 4–6 days after the injury, the excessive scar formation and re-ruptures at the injury site can be best prevented.

At this point it is recommended that gradual mobilization, both active and passive, be started followed by a progressively intensified exercise program to optimize the healing. Healing is optimized by restoring strength of the injured muscle, preventing muscle atrophy, and loss of flexibility, all of which can follow prolonged immobilization. The rehabilitation program should consist of progressive agility and trunk stabilization exercises as well as exercise to lengthen (eccentric exercises) the injured skeletal muscle.

Proper progression of exercises, active and passive range of motion, Kinesiotaping, Active Release Technique, movement retraining, agility, plyometric training in addition to modalities such as ice, heat, ultrasound and electrical stimulation are all supported by the literature to optimize recovery after an Achilles tendon rupture.

What this means moving forward:

“…healed tendon has been shown in many studies to take upwards of a year to more closely approach the functional strength of uninjured tissue.” (T.W. Lin et al. / Journal of Biomechanics 37 (2004) 865–877

According to a 2011 study, “When players were compared with matched controls, an Achilles tendon rupture resulted in fewer games played ( P < .001), decreased play time ( P = .025), and worse performance statistics ( P < .001) at 1 year but not 2 years postoperatively ( P > .05). When individual sports were compared, NBA players were most significantly affected, experiencing significant decreases in games played, play time, and performance.³

Unfortunately for Kevin Durant, he will likely experience significant reductions in his performance next year. According to the literature he will likely require 2 years before his player efficiency returns to his preinjury levels. Hopefully this article brings to light the importance of a rehab in the world of sports medicine and the information can be useful for anyone suffering from musculoskeletal injuries.

References:

1. Hess, et al. Prevention and Treatment of Overuse Tendon Injuries. Sports Medicine. 1989;8(6): 371-384.
   2. T.W. Lin et al. Biomechanics of tendon injury and repair. Journal of Biomechanics. 2004;37(6): 865–877
2. Trofa, DP. Professional athletes’ return to play and performance after operative repair of an Achilles tendon rupture. Am J Sports Med. 2017;45(12): 2864-2871

Return to Running with Run Analysis

What is run analysis?

Run analysis is a method of watching your running mechanics on a treadmill using specific markers placed on the body. Using slow motion video capture settings, we can closely analyze your running technique, looking for deviations from statistical “ideal” running form and comparing values to athletes at the highest level. Whether you’re recovering from an injury or just wanting to optimize mechanics to improve efficiency and speed, we have the knowledge and expertise to help achieve your goals.

Many people ask what “style” of running is best? When comparing heel strikers, forefoot runners, and midfoot runners, the research shows that it depends on the person and type of injury history they have to determine which technique is best. If a person is prone to Achilles tendinitis, then forefoot striking could exacerbate that due to increased loading at the ankle. If a person is prone to hip and knee joint related issues, heel striking could be problematic.

A few metrics we use to assess gait include cadence (the number of steps per minute), knee window (the amount of space between your legs as you take a step), foot strike pattern (mid/fore/rear foot), knee flexion angle during heel strike, and knee flexion angle during swing, just to name a few.

Physical Therapy can help alleviate discomfort and correct injuries caused by running through individualized strength training, manual mobilization to release shortened muscles and tendons, flexibility exercises, education regarding proper footwear and orthotics, and biofeedback.

The best way to create lasting change and return to pain free running is through optimization of running mechanics. We believe the best way to optimize mechanics is through run analysis.

Less loading forces = less work = better performance

Sport Imagery: A Powerful Tool for Olympians

Olympic athletes have trained their bodies to near perfection by the time they arrive in PyeongChang for the 2018 Olympics.  However it is the mental preparation for the pressure that comes with competing at the 2018 Olympics that is critical, and may ultimately determine a gold versus silver medal.  Visual imagery has long been a part of the training regimen of elite athletes and has become increasingly more utilized across the world.

The US Olympic team traveled with nine sports psychologists this year to help athletes with overcoming fears and visualizing success.  Being able to envision success is critical to achieving such goals for athletes.  US team sports psychologist and professor at Univeristy of Utal, Dr. Detling states, “You are training those muscles, and if you are training those muscles to fail, that is not really where you want to be. So one of the things I’ll do is if they fail in an image, we stop, rewind and we replay again and again and again.”†

Visual imagery is a mental training technique which involves the athlete creating a picture of their sporting event in their minds.  Visual imagery can be used for the following:

-Increase confidence before competition
-Help with healing and recovery
-Improve relaxation between events
-Reduce discomfort and muscle inhibition that comes from intense physical demands
-Overcome prior mistakes and fears of failure associated with past errors

Here is a highly effective visualization exercise to help mentally gear up for the performance of a lifetime—whether you’re a dancer, high school baseball player, swimmer, avid runner, or recreational tennis player.  Spending just a few minutes before any big event just may give you that extra winning edge!

1. Find a quiet place and sit comfortably with your eyes closed.  Start by imagining yourself just before your event.  Picture yourself approaching the starting line, climbing up onto the diving block, getting into position, lining up with your teammates, etc.
2. Take a deep breath and begin to notice the sounds you hear around you
3. What do you see?  What’s happening around you?
4.  What do you smell?
5. Notice the sensations inside your body and on your skin.
6. Take another deep breath and let the event begin!  Picture yourself as if watching a movie.  Watch yourself spring into action—it’s your best performance ever!  Pay attention to the sensation of your flexing muscles and the movement of your body.  Note all of the sensations, sights, sounds, and smells as you push your body to its limit.
7. Take another deep breath as you gear up for that final push.  You may even feel your heart rate and breathing speed up a bit as you imagine the exhilaration of this moment.
8. Finally, imagine your big win.  Listen to the crowd cheer and feel the congratulatory pats on your back.  Allow the emotions to bring a smile to your face and congratulate yourself on your best performance ever!
9. Take one last deep breath and open your eyes.

This exercise is really easy and well-worth the few minutes it takes to do.  Creating successful mental imagery requires practice and patience.  To learn more about how to practice this technique and the power of mental preparation before an athletic event, here are a few links to articles we think you might enjoy:

Huffington Post Article on 5 “Mind-Hacks” for Performance

Psychology Today article about Sport Imagery

A Peer-Reviewed Article from the Sport Journal on Performance Strategies

New York Times Article on Sports Imagery

 

†Source: Clarey, Christopher. “Olympians Use Imagery as Mental Training”  New York Times. Feb 2014. Link to Article.

How to Manage Hip Arthritis

Osteoarthritis

Osteoarthritis (OA) is the most common cause of hip pain in adults over 50. Simply put, OA is a degeneration of the hip joint. The cartilage that lines the joint degenerates over time until the femur (ball) and the acetabulum (socket) no longer have the lubrication and protection required for normal, smooth joint motion.  This can become quite painful and ultimately lead to decreased activity levels and increased difficulty with daily tasks such as walking and standing up, especially first thing in the morning.

Treatment for hip OA can include stretching and strengthening of the muscles surrounding the hip. Ultrasound and hot packs can be used in the short-term management of pain and activity limitations in order to return to exercise and begin therapy quicker. Manual therapy including joint mobilization, soft tissue release and massage all have significant evidence supporting their use to improve function and reduce activity limitations in people with OA.

2017 updated risk factors for osteoarthritis of the hip include, but are not limited to:

• Decreased hip internal rotation and flexion range of motion
• Morning stiffness
• Male sex
• Higher BMI
• Hip pain
• Age over 50

Hip Internal Rotation : range of motion becomes limited

 

Hip Flexion also becomes restricted and painful

 

We’re here to help. In many cases, a prescription of manual therapy to improve hip range of motion, as well as an individualized exercise program can help to prolong or prevent joint replacement surgery.

Treatment recommendations include:

• Ultrasound for short-term pain reduction
• Flexibility, strengthening and endurance exercises
• Manual therapy for joint mobility, flexibility and pain
• Education on activity modification, exercise, supporting weight reduction when overweight, and methods of unloading arthritic joints.

Recent evidence suggests that NSAIDs (such as Aspirin and ibuprofen), COX-2 inhibitors, and steroid injections are effective at relieving pain and symptoms in hip OA. However, there is some evidence that suggests NSAIDs may increase the progression of hip OA my decreasing glycosaminoglycan synthesis. In addition, there can be serious gastrointestinal side effects associated with NSAID use. Consult your physician before use.

What can you do at home?

Below is a video with a few stretches recommended to improve hip mobility. This is not an exhaustive list but rather a starting point and something to try. It is always recommended that you see a physical therapist to individualize your treatment approach.

The information provided is not medical advice. If you would like more information please visit us at www.ActiveMarin.com or call to schedule an appointment. 

Achilles Tendon Tears: Are you at Risk?

The Achilles tendon is the largest and strongest tendon in the body, but unfortunately the aging tendon undergoes various changes that put it at risk for injury. Some changes that increase with age include decreased collagen density, decreased glycosaminoglycans and water content, decreased tensil strength and increased stiffness.

A study of 891 ruptured tendons in humans revealed 97% of the changes were degenerative in nature and about 50% of them were Achilles tendons.

How can you keep your Achilles tendons healthy?

Know your risk factors associated with Achilles tendon disorders and schedule an appointment for a physical therapy evaluation to determine the likelihood of your developing an Achilles tendon disorder and to learn research proven treatment strategies to help strengthen and avoid surgical repair.

Risk factors include:
-abnormal dorsiflexion (increased or decreased ability to flex foot)
-abnormal subtalar range of motion (increased or decrease foot joint mobility- pronation or supination)
-decreased plantar flexion strength
-abnormal tendon structure
-medical conditions associated with Achilles tendon disorders: diabetes, obesity, high blood pressure, high cholesterol

Treatment:
Studies have shown and proven that eccentric exercises with a focus on slow and controlled movement is an extremely effective nonsurgical method to treating Achilles tendonitis/tendonosis. Below are some helpful exercises for anyone dealing with symptoms or has been diagnosed with this very common injury.

Eccentric Heel Drop on Step: (Achilles Tendon Strengthening)
Begin this exercise with both feet in a neutral position with only the forefoot on the step
Perform a toe raise with both feet
Remove the unaffected leg from the step and slowly lower the affected back to neutral, keeping knee straight
Perform 3 x 15 repetitions twice a day. This is maintained every day for 12 weeks.
As soon as 2 x 15 repetitions twice a day can be done pain free, the load should be increased.
Progression:  Loaded Eccentric Heel Drop on Step–now add weighted dumbells to increase difficulty and to build strength

Coaches Injury Prevention Workshop

Join Megan Morgan, DPT, orthopedic and pediatric specialist, for a complementary workshop and learn the following:

• How to train proper biomechanics of the lower extremity to reduce ligament injuries
• How to incorporate a sport specific dynamic warm-up
• How to add a simple strengthening and plyometric exercises into each practice to help build strength, flexibility and proprioception
• When is it time to refer your player to seek further intervention for their injury?
Who
This complementary workshop is designed for athletics coaches and trainers working with adolescents in sports such as volleyball, soccer, lacrosse, tennis and basketball.

When
Wednesday August 30th (7:00-7:45pm)

Where
Active Marin Physical Therapy
421 Miller Avenue, Mill Valley

RSVP
Call 415-388-8166 or email info@activemarin.com to reserve your spot.
Ask us about private group lessons for your organization!

Travel Guidelines for a Healthy Back

 

Summer is a time where many people seek relaxation from life’s daily stresses through vacation.  Unfortunately, the journey to a relaxing getaway can be a lot of work, both physically and mentally.  Don’t let your travels cause you pain by following these simple  travel guidelines….

 

Tips for plane travel:

– Sit with your back against the seat, both feet flat on the floor
– If planning to sleep on the plane; have a good supportive neck pillow.
– When lifting luggage into the overhead, brace your abdiominal mucles and keep your chin tucked inwards to avoid hyper-extension of the neck and back;
-Ask for help if your bag is too heavy (or better yet, think ahead and check it at the gate….)
– When waiting at the airport;  stand up and walk around to get some movement.
– To reduce potential blood clots and joint stiffness, perform leg circulation exercises throughout the flight (i.e, Pump ankles by pointing/flexing foot, heel raises seated or standing, calf stretches, bend and straighten knees)
– Choose the aisle seat if possible and get up and walk when allowed

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Tips for Traveling by Car:
– Sit with your back against the seat, both feet flat on the floor and your head against the head rest.
– Use a lumbar support pillow (as seen in picture) if your car seat does not feel supportive enough.
– Have your seat tilted slightly downward towards your feet to encourage more of a neutral spine alignment.
– Stop for breaks frequently every 1-2 hours if possible.
– On breaks; walk around for a couple mins, and stretch legs (calf stretch, quad stretch).

What Is The Difference Between Dizziness and Vertigo?

People often use the word “dizziness” when talking about a variety of symptoms. It is important for you   to be able to differentiate between these symptoms,  because the cause, diagnosis and treatment cn be quite different. Dizziness is a sensation of lightheadedness, faintness, or unsteadiness. Unlike dizziness, vertigo has a rotational, spinning component, and is the perception of movement, either of the self or surrounding objects.

Vertigo is often caused by an inner ear problem.  One common cause is called  benign paroxysmal positional vertigo (BPPV). This occurs when tiny particles of calcium form in canals of the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. With this move of crystals from one area to another, the inner ear tells the brain you’re moving when you are really not.

Physical therapists can perform specific testes to determine if you have BPPV and will guide the treatment. One such test includes examination of the eyes for nystagmus, an involuntary rapid eye movement. If BPPV is found, the patient is guided through a repositioning treatment involving the head and neck called the Eppley maneuver. The PT will guide you through a series of position changes designed to relocate the crystals to their appropriate area in the inner ear. With treatment, symptoms should significantly decrease or completely resolve.

Physical therapy can play a strong role in recovery of symptoms. Treatment would involve an exercise-based program to improve balance and reduce symptoms related to dizziness. Specifically, treatment would include:

● visual stabilization training
● postural education
● balance training
● cervical mobility and stretching

Expected outcomes from treatment include decreased risk of falls, improvement in balance, improved ability to stabilize vision, an increase in cervical mobility, and a return to prior level of function.

Myofascial Decompression

Active Marin Physical Therapy is excited to offer Myofascial Decompression to help patients dramatically improve mobility and reduce muscle tissue tension.  This technique, rooted in Eastern Medicine, uses negative pressure cups coupled with functional movement patterns and Neuromuscular Reeducation.  Myofascial decompression is currently being used by Olympic athletes such as gold medalist Michael Phelps and US men’s gymnast Alex Naddour  for pre and post-workout recovery and detoxification.

What Is Myofascial Decompression?
It is used to decompress adhesions and scar tissue, relax muscles in spasm, decrease trigger point pain, and to reduce inflammation following trauma.  Over time, the treatment can be used to increase muscle endurance, circulation, and lymphatic drainage and to enhance the overall ability to recover from strenuous activity.

What are the benefits?
1. Decompresses adhesions and scar tissue
2. Helps relax muscles in spasm
3. Stimulates oxygenation and detoxification of blood while promoting a feeling of lightness and relief of pressure
4. Helps separate the various layers of fascia and muscle under skin
5. Increases range of motion and promotes healing in scar tissue and chronic injury sites
6. Increases lymphatic drainage & promotes circulation
7. Enhances the overall ability to recover from strenous activity

What can it treat?
Myofascial Decompression has been shown to be effective for tight and stiff muscles as well as those suffering from back pain, sciatica, piriformis syndrome, IT band pain, rotator cuff injuries, and plantar fascitis.