Sometimes when we are injured we forget to remember that the simple act of getting adequate sleep can be a huge contributor in helping us heal. The National Sleep Foundation’s sleep guidelines recommend 7-9 hours for the average adult with additional sleep and recovery time needed after injury and surgery.
Sleep is an active physiological process, one in which your body is busy carrying out vital activities while you are unconscious. While asleep your body alternates between 2 forms of sleep, REM (rapid eye movement) and non-REM. While REM sleep provides the energy needed to restore the mind, non-REM sleep is essential for restoring the body.
During the restorative phase of non-REM deep sleep, the blood supply available to your muscles increases, delivering extra amounts of oxygen and nutrients to facilitate healing and growth. Additionally, deep sleep allows for scar tissue to form which the body needs to create and repair injuries and allows our pituitary gland to release growth hormone that is essential for increased muscle mass, bone strength and energy.Physical Therapists can teach you how to position your body in the most effective way while sleeping to promote productive healing. For instance, if you have a low back injury it is helpful to keep your spine in a neutral position by putting a pillow under your knees while you sleep on your back or between your knees if you sleep on your side. Proper positioning techniques for shoulder or neck pain can also be instrumental in sleep comfort.
How Can Physical Therapists Help With Sleep?
Physical Therapists provide education about the importance of aerobic exercise to aide with sleep as well as teach relaxation techniques. Diaphragmatic breathing is one such technique which helps relieve physical muscle tension, allows the mental function to slow and relax, improves blood flow to muscle tissues and activates parasympathetic nervous system.
Sleep Hygiene Tips:
- Go to bed and get up at more or less the same time every day
- Sleep when sleepy
- If you haven’t been able to get to sleep after about 20 minutes or more, get up and do something calming or boring until you feel sleepy, then return to bed and try again
- Avoid caffeine, alcohol and nicotine for at least 4-6 hours before going to bed
- Develop a sleep ritual 15 minutes before bed each night to remind your body that it is time for sleep
- Eat a healthy, balanced diet
- Having a hot bath 1-2 hours before bedtime can be useful to , as it will raise your body temperature, causing you to feel sleepy as your body temperature drops again
- Avoid taking naps
- Regular exercise is a good idea to help with good sleep, but try not to do strenuous exercise in the 4 hours before bedtime
- Avoid clock-watching which can reinforce negative thoughts such as “Oh no, look how late it is”
Recommended Sleep Positioning
It is recommended that you either sleep on your back with a pillow under your knees to protect your back or on your sides with a pillow between your legs and arms. A body pillow can be a very nice purchase for proper alignment. Sleeping on your stomach can be very aggravating for your low back and neck as the extreme rotation and hyperextension can cause tissue imbalances.
This month I would like to discuss the benefits of dynamic over more traditional, static stretching when it comes to warming up before training or competition.
Most of us are familiar with “static stretching” which consists of various techniques to gradually lengthen a muscle for up to 2 minutes while the body is at rest. Although this type of stretching has been routinely used as a way to loosen up muscles before exercise, research is now showing that static stretching can actually hinder one’s power output, joint stability, reaction time and coordination. When you think about it, why would one stretch while the body is “at rest” when within minutes you might need to explode from a starting block or hustle up and down a basketball court? Current research suggests that static stretching should be reserved for after work outs or sporting events and may have little benefit before your activity.
The use of “dynamic stretching” which involves stretching specific muscle groups while continually moving throughout a warm up is now considered to be a much more effective, efficient and fun way to warm up before intense exercise.
Benefits of Dynamic Stretching
1. Prepares your body for exercise by actually activating sport-specific muscles and joints you will be using during your workout.
2. Increases your muscles’ core temperature for improved power output
3: Helps you mentally transition from rest to competition by challenging your body awareness, balance and coordination.
4: Improves range of motion and flexibility around your joints which helps reduce chance of injury and improve performance
The Rotator Cuff and Shoulder Girdle
By Megan Morgan, DPT
A recent study that was conducted in Finland determined that Physical Therapy alone for non-traumatic rotator cuff tears (supraspinatus) results in equal functional outcomes at one year compared to surgically repaired tears. All of the groups in the study received the same Physical Therapy (PT) instruction and prescription of a home exercise program as well as 10 PT sessions. The study found that patient’s who did receive surgery did not report any superior results than those who only received PT.
Role of the Rotator Cuff and Scapular Stabilizers
The rotator cuff is a group of four muscles that connect the humerus (upper arm) to the scapular (shoulder blade). These muscles not only create movement of the arm but they play an integral role in providing stability to the shoulder joint. The tendons of these muscles form together to create the cuff; which work together to create a force couple relationship that results in the humerus to remain centered on its base of the scapula (also known as glenoid). When a muscle of the rotator cuff is torn dysfunction of this force couple relationship results and the shoulder has difficulty maintaining its stability.
Another critical component of a healthy functioning shoulder is scapular strength and proper muscle activation. The scapula is the base that connects our humerus to our body via the placement of the humeral head on the glenoid of the scapula. There are multiple muscles that connect our scapula to our spine and these are referred to as our scapula stabilizers. A common analogy for the role of these stabilizers is a seal trying to balance a ball on its’ nose; they have the role of creating a stable base so the ball (humeral head) can stay balanced for the humerus to move on. These muscles are just as important to providing stability to the shoulder joint, as the rotator cuff. Therefore it is important to strengthen these stabilizers and create the proper awareness of one’s scapula position. Physical Therapists are here to help develop your awareness and the appropriate individualized strengthening program.
The study was limited in that it only incorporated individuals whose tears were <75%. Therefore, we cannot apply these findings for all rotator cuff tears, as the severity of tears varies between individual cases. But an important take away message from this study is that for partial rotator cuff tears PT and a home exercise program can independently get you back to your prior activities of choice.
The overall injury rate related to ski injuries has declined due to the improvement of ski equipment in recent years; such as decreased extremity fractures and other severe injuries. However, the incidence of knee sprains has increased; and according to a recent survey study by the Orthopaedic Journal of Sports Medicine knee injuries account for 1/3 of skiing injuries. The top causes of injury include mechanical forces that occur during a fall, collisions and equipment induced injury.
The two most common injuries are medial collateral ligament (MCL) sprains (15-20% of ski injuries) and anterior cruciate ligament (ACL) tears (~100,000 reported annually from skiing). The MCL is a ligament that stabilizes the inner portion of your knee from valgus forces (lateral to medial). The ACL is an internal ligament in the center of your knee, which stabilizes your knee to maintain proper alignment. With injury to your ACL, your knee becomes unstable.
Regardless of the severity of a ligament sprain, physical therapy is an integral part of your rehabilitation. In certain cases surgery is the treatment of choice due to the severity of the tear and patient’s desired return to physical activity. Physical therapy is important for surgical cases, pre-operatively and post-operatively. Less involved tears can be treated successfully with conservative care (non-operatively) with the help from physical therapy to normalize an individual’s knee range of motion, strength, proprioception and walking pattern. All of these factors are important variables for an individual to return to their prior level of physical activity; such as the ski slopes.
General Reminders to Avoiding Ski Injuries:
- Preparation: Lower extremity strengthening and proprioceptive exercises should be a part of your work-out routine in the couple months leading up to ski season. Follow the link below for strengthening exercises, use exercise code: KJ8UHAT Preventative Exercises
- Appropriate equipment and equipment settings: bindings should be adjusted to your level of skiing experience
- Stay on slopes appropriate to your skill level
- Consider taking lessons: it never hurts to get tips from the professionals on the mountain to work on your form
- Fatigue: last run of the day, only you know your body and if you feel fatigued, do not push yourself to squeeze in one last run, as this is the most common time injuries occur
To see the original article click here (http://ojs.sagepub.com/content/2/1/2325967113519741.full.pdf+html) and to read more on tips for knee friendly skiing click here (http://www.vermontskisafety.com/kneefriendly.php)
Did you know that physical therapy can be an effective treatment for a variety of pelvic floor disorders such as incontinence, urinary frequency and pelvic pain? As experts of the musculoskeletal system, a pelvic floor physical therapist is trained to evaluate pelvic floor muscle function in order to determine an individualized course of treatment to optimize muscle function.
The most common reason for a person to be referred for evaluation by a pelvic floor specialist is urinary incontinence. Both men and women can suffer from incontinence for various reasons such as childbirth or surgery, however some patients suffer from incontinence for no apparent reason. One misconception is that all patients with incontinence should simply do kegals (pelvic floor contractions). This, however, is not always the best advice.
Incontinence can occur due to a weakness of the pelvic floor musculature, however it can also be due to an overactive pelvic floor. A hypertonic pelvic floor can cause the pelvic floor muscles to become less effective when the intra-abdominal pressure increases, such as with laughing, sneezing or coughing. Therefore, symptomatically, stress incontinence due to weakness and overactivity can appear similar, however the treatments can be very different.
The only way to asses whether a patient’s incontinence is due to weakness or over active pelvic floor muscles is to perform an examination to determine the strength and tone of the pelvic floor. Based on that information, a pelvic floor specialist can determine whether strength training, or relaxation training (or a combination of both) will be most effective in treating the patient’s symptoms.
There is also a large behavioral component to physical therapy for pelvic floor dysfunction. Patients can have triggers causing them to feel the need to urinate more frequently. This can be due to an overactive/irritable bladder, or it can be caused by the fact that the bladder is not fully emptying during urination. Proper pelvic floor training can help determine the best treatment for urinary frequency.
Whether the symptoms are due to weakness or overactive pelvic floor muscles, pelvic floor physical therapy can be an effective treatment for pelvic floor dysfunction. To schedule an appointment or to ask specific questions, please call our office at 415-388-8166 or email Whitney Rogers, our women’s health expert, at http://www.activemarin.com.
by Dylan Bartley, MSPT, CMP
Researchers at Columbia College of Physicians and Surgeons in New York produced some promising results in the treatment of scoliosis with just one simple exercise: a side plank. This common yoga pose was performed on the convex side of the curve. So if your scoliosis bows out to the right, you should put your right arm down and lift your right hip up off the floor. They offered variations to accommodate varying levels of fitness and different types of curves. The poses were held for as long as possible, once a day, starting at 10-20 seconds.
To measure the success of their intervention, they took x-rays before and afterwards and measured the degree of curvature in their subjects. After 6 months, they found a significant improvement of an average of 41%. They tried to see if there was a difference between younger subjects and older subjects with more degenerative changes and both groups responded well with no significant difference between the two groups.
Scoliosis is a problem of imbalance and asymmetry that tends to progress as we age and can lead to debilitating arthritis and muscle spasm if it goes unchecked. Over the years doctors have tried to stabilize it with complicated surgeries involving rods or uncomfortable braces. Physical therapists have tried to correct it with stretches and strengthening the core and spinal muscles. It would make sense that to treat this problem of asymmetry one would need to attack it with a set of asymmetrical exercises. Unfortunately, there has been little research to back up these hunches until now.
If you are interested in getting an assessment of your spine to see if you have scoliosis or if you’re ready to treat a scoliosis you’ve always known you’ve had, physical therapy is a great place to start. We can set up a custom protocol that would match your current level of fitness and show you how to progress things as you get stronger. Furthermore, structural factors such as a leg length discrepancy or pelvic/sacroiliac dysfunction can be the driving force behind your scoliosis and may be treatable with physical therapy.
To see the original article, click here