What is Achilles Tendinitis and How Can Physical Therapy Help It?

By Nick Mazzone PT, DPT, CSCS

What is Achilles tendinitis?

 The Achilles tendon is the thick band that connects the rear calf muscles to the heel. Achilles tendinitis is considered an overuse injury and may be caused by a sudden increase in physical activity and is commonly seen in the running population. Some risk factors for the development of this condition may be improperly fitting footwear, a stiff ankle and foot, weakness of the muscles that act on this region, and over-pronation of the foot during walking or running. If left untreated, this condition can lead to degenerative changes in the makeup of the tendon itself, which will further exacerbate the symptoms. At this point, the condition would be considered a tendinosis.

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What should be done in the early stages of this condition?

 In the early stages of the condition it may be wise to combine active rest with techniques that help decrease swelling.  This would mean refraining from running, long distance walking, or any other higher intensity activity that may have led to this issue in the first place. The active part of this equation would include gentle strengthening and range of motion exercises for the region to help improve blood flow for healing and address some of the issues that may have contributed to the condition in the first place. It is important to elevate the leg above chest level so that gravity can assist in decreasing swelling. If desired, ice can be used in combination with these methods as well.

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What can PT do for me in later stages of this condition?

 Once the acute stages of the condition have passed, it is important to restore normal function of the muscles in this region. Your physical therapist will prescribe a specific program based on your flexibility and strength assessments. Foot posture and stability will also be addressed after screening is completed. Stretching of the Achilles tendon is important; however, it is more important that we gradually reintroduce normal activities to the foot and ankle. Progressive loading of the Achilles tendon combined with eccentric exercise is the gold standard method for healing this condition.

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What does progressive loading and eccentric exercise mean?

 Progressive loading of the Achilles tendon simply means that we will be using specific exercises to gradually increase the amount of pressure that the Achilles tendon is under. For example, early exercises may include an activity performed with a resistance band while the foot is off the ground and later stage exercises may include activities on one leg.

 

Eccentric exercise simply means that we are strengthening the muscle’s ability to contract while it moves from a shortened position to a lengthened position. Most functional activities require eccentric strength. An example of an eccentric-focused exercise would be standing on your toes and then slowly lowering the heel to the ground. The eccentric portion of the exercise is the part where you focus on slowly lowering the heel to the ground (muscle is lengthening).

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Check out this video that shows an example of a program that utilizes eccentric activity with progressive loading of the Achilles tendon:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

 Main photo (green background) retrieved from http://www.achillestendonitis.co.uk/

Photo of anatomy of Achilles region retrieved from https://www.researchgate.net/figure/The-anatomy-of-the-Achilles-tendon-and-the-suralis-muscle_fig1_262230849

Photo of “RICE” retrieved from https://www.quora.com/How-do-I-heal-my-Achilles-tendon

Photo of foot posture retrieved from http://okanaganpeakperformance.com/knee-solution-seminar-recap

Photo of heel raise retrieved from  https://fitness.stackexchange.com/questions/14976/is-this-a-good-at-home-exercise-routine-for-a-beginner

How Can Physical Therapy Help My Sciatica?

By Nick Mazzone, PT, DPT, CSCS

What is Sciatica?

Sciatica is one of the most common symptoms associated with lower back pain. It refers to the sensation of burning pain that tends to radiate from the buttock down the leg. The distance the pain travels is typically correlated to the extent of the irritation effecting the nerves. The name “sciatica” comes from the sciatic nerve, which is one of the largest nerves in the body. The spinal nerves that become irritated are typically those that eventually come together to form the sciatic nerve (from spinal level L4 to S3). Sciatica is not a permanent condition and does not typically require surgical intervention.

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What causes sciatica?

 These symptoms are typically caused by excess pressure on a nerve after it exits the lumbar spine (lower spine). This pressure can come from a herniated disc, arthritis in the lumbar region, and other conditions in which the space that the spinal nerve travels becomes compressed or shrinks.

 

How can physical therapy help improve this condition?

 This condition is relieved by decompressing the region in which these spinal nerves travel. This can be achieved through a specific mobility and strengthening program that includes postural education and awareness training. These specific exercises will depend on the location at which the nerve is being irritated. Generally speaking, in order to decrease pressure in the lumbar region of the spine, you must be mobile in not only the lumbar spine but the thoracic region (mid back) and hips. This will help take pressure off the low back by allowing a more even distribution of movement. Think about it this way: If you are lacking proper mobility in your thoracic spine, your lumbar spine will have to make up for this lack of mobility. This can lead to increased stress and strain in this area. The same idea works for the hips.

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Postural training is important in helping to decrease pain and inflammation in the low back. The pelvis and lower spine are anatomically connected (the lower spine actually sits in the pelvis), and therefore movement between the two will be interrelated. The position of the pelvis will dictate the posture in our lumbar spine during all activities (including at rest!). Depending on where the nerve irritation is occurring, this positioning of the pelvis will either increase or decrease pressure on the nerve. If the irritation is occurring at the point where the nerve exits the spinal canal (at the nerve root), extension of the lumbar spine should help alleviate the pressure by “opening” the region where the spinal nerves exit, while flexion of the lumbar spine may increase pressure due to “closing” of the region. Refer to the picture above for a visual of this phenomenon. “Lordosis” is known as lumbar spine extension, while “flat” spine refers to a flexed spine. The picture below demonstrates these movements.

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Check out this video that demonstrates a simple mobility exercise for the sciatic nerve to help alleviate your symptoms of sciatica:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

 

 

Resources:

 Main photo of sciatica pain in leg retrieved from https://www.magnilife.com/blog/5-effective-ways-for-dealing-with-sciatica-pain/

Photo of irritated nerve retrieved from http://arizonapaintreatmentcenters.com/from-dr-craig-peterson-mva-sciatica

Photo of lumbar flexion and extension retrieved from https://b-reddy.org/making-pull-ups-and-burpees-more-shoulder-and-lower-back-friendly/

Photo of pelvis position and lumbar spine retrieved from https://body-motion.co.uk/injuries/postural-pain/improve-your-sitting-posture/

What is Tennis Elbow and How Can Physical Therapy Help?

By Nick Mazzone, PT, DPT, CSCS

What does tennis elbow mean?

“Tennis elbow” is the nickname given to a condition known to the medical community as lateral epicondylitis (also seen ending in -osis or -algia). This name describes the region from which the pain originates on the outside of the elbow. The lateral epicondyle is the part of the upper arm bone that serves as the origin for all of the muscles that extend the wrist.

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What causes tennis elbow?

Tennis elbow is considered an overuse injury. It typically occurs after repetitive stress to the involved region over time, however one traumatic incident such as a fall or work accident may also cause inflammation in this region. Tennis elbow got its name because it is a common overuse injury seen in those who play the sport. Tennis players tend to hold a tight grip on their racquets while producing powerful forces with their wrist extensor muscles. In certain cases, this may be a recipe for inflammation. Another common population that tends to get tennis elbow is the office worker. Being in a position of wrist extension while typing for prolonged periods may cause repetitive stress to the outside of the elbow.

Here is an example of what your posture should look like while in front of your computer:

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How Will Physical Therapy help me?

Your physical therapist will design a specific treatment plan tailored to your needs based on your background and activity level. The program will consist of soft tissue mobilization to assist in the healing process, stretching/mobility training, functional strengthening of eccentrics (the muscle’s ability to control movement from wrist extension to wrist flexion) and grip strengthening, training of ergonomics and posture, and education on how to prevent the condition from reoccurring.

Your specific program will depend on how you acquired the condition in the first place. An office worker will be trained to alter their desk setup in order to decrease the stress on the wrist extensors. A tennis player may be prompted to consider changing the thickness of their racquet handle or the tightness of the strings. Both of these variables may help contribute to the repetitive stress that occurs during the sport since more force production is necessary to produce the desired effect when these conditions are not optimal.

  This picture shows one way to stretch the wrist extensor muscles.

This picture shows one way to stretch the wrist extensor muscles.

Check out this video for 3 simple exercises to help with your tennis elbow:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

 

Resources 

Main photo retrieved from https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987

Photo of bones of arm retrieved from http://cruxcrush.com/2014/06/26/climber-problems-elbow-injury/

Picture of wrist and finger extension retrieved from http://www.militarydisabilitymadeeasy.com/images/handmuscles/

Picture of ideal desk posture retrieved from xhttps://www.microsoft.com/accessories/en-us/support/ergonomic-comfort

Photo of wrist extensor stretch retrieved from https://www.therapeuticassociates.com/athletic-performance/golf/stretching-for-golfers/

What is Assisted Stretching and How can it help me?

Nick Macaluso

Stretching is kind of like flossing... everyone knows they should be doing it, but who really does it? It’s one of those things that we’re all going to start making into a habit tomorrow, but somehow tomorrow never comes. To our credit though, when we get that cramp in our thigh, or piece of spinach in between our teeth, we know exactly what we need to do. But how do we identify the exact muscles that tend to cramp or spasm, and prevent it from happening? How can we isolate and stretch the muscles we hold the most tension in to prevent and alleviate pain? How can we most effectively just enhance our mobility for a higher quality of life? The answer, Assisted Stretching.

What is Assisted Stretching?

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Assisted Stretching is a hands-on method of stretching in which a person is gently supported through a series of stretches by a trained practitioner. Assisted Stretching is more effective than stretching by yourself because the practitioner stabilizes your joints in positions that allow you both to isolate and stretch one muscle at a time while expanding your fullest range of motion. The benefit to being able to isolate and stretch individual muscles is to give both you and the practitioner a better understanding of where exactly your body may be out of alignment. Perhaps your low-back pain is just a result of tight hamstrings, or your sciatica is just a result of tight glutes. Both of which can be relieved from general stretching, but without the assistance of a trained practitioner, it is nearly impossible to isolate the exact muscle and relieve its tension.

Why is Assisted Stretching so productive?

Aside from being able to realign your body by isolating the muscles being stretched, Assisted Stretching is an opportunity for you to relax and repair your body and mind while still using your time constructively. Many of us after long days or weeks want nothing more than a massage to take the tension out of our backs, necks, shoulders, or hips, but aside from the relaxation, what is the massage doing to prevent that tension from returning? Most of the time, tension builds in areas of our bodies that are either overactive or misaligned due to habitual poor posture. While massages are great, if you’d rather spend your time relaxing AND simultaneously preventing the tension from returning, Assisted Stretching is for you.

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Stretching is one of those things that people spend their lifetime studying and writing about because of its incredible complexity and near infinite amount of benefits. But instead of wasting your time with all that, experience the hype for yourself by scheduling a 20 minute Assisted Stretching session with Nick Macaluso at Evolve Physical Therapy. Sessions run in 20 minute increments and can last anywhere from 20 minutes to 2 hours depending on how long you would like to be stretched. While this service is open to the public, all active patients of Evolve must first speak to their therapist to ensure an Assisted Stretch is right for them.

For more information or any questions, give us a call at 718-258-3300 or contact us today!

How Can Physical Therapy Help My Plantar Fasciitis?

By Nick Mazzone, PT, DPT, CSCS

What is the plantar fascia?

The plantar fascia is a thick band of connective tissue that runs from the lower surface of the heel to the beginning of the toes. This fibrous band of tissue is placed under tension during walking and other activities in which you place weight onto the feet. This tension creates support and stabilization of the arch of foot, which will help stabilize the entire lower extremity during these types of activities.

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What causes this structure to become inflamed?

While the exact mechanisms behind the causes of plantar fasciitis are not completely understood, the condition has been correlated with some mechanical issues at the foot and ankle. One of the more common impairments associated with this condition is inadequate dorsiflexion of the foot. Dorsiflexion is the movement performed when the top surface of the foot comes closer to the front of the leg.

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Another impairment that is commonly associated with plantar fasciitis is weakness of the posterior tibialis muscle. This muscle helps to increase arch height during activities in which weight is placed on the feet.

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This condition can also be considered an overuse injury. For instance, a running athlete may progress their running program too quickly without allowing their body to adapt. This can cause inflammation and pain in the plantar fascia.

What can PT do to help?

Your physical therapist will create a specific treatment plan tailored to your needs and impairments. Most commonly, the treatment will consist of mobility drills and functional stabilization techniques to help support the arch of the foot. These exercises are more effective when performed with weight on the legs in a standing position, as this is more closely related to the way in which these structures actually function in the real world. Your program may start more conservatively depending on your pain and activity tolerance.

The ultimate goal of the treatment is to progressively load these structures so that they become adapted to increased stress. This will ensure that the plantar fascia can handle the demands placed on it during our daily endeavors, whatever they may be. In some cases, a physical therapist will recommend orthotics to help provide support to the arch of the foot.

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Check out this video depicting 3 simple exercises that can be performed to help improve your plantar fasciitis:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

 

Picture of painful foot retrieved from https://www.tcpaindoctor.com/can-prp-help-treat-plantar-fasciitis/

Picture of plantar fascia function during weight bearing retrieved from https://painphysiotherapist.com/2016/05/25/plantar-fascia-rupture/

Picture depicting dorsiflexion of ankle retrieved from http://www.militarydisabilitymadeeasy.com/

Picture of posterior tibialis retrieved from https://www.fixpodiatry.com.au/podiatry-conditions/tibialis-posterior-tendinopathy/

Picture of collapsed arch retrieved from https://www.epainassist.com/sports-injuries/foot-and-heel-injuries/flat-feet-or-pes-planus-or-fallen-arches

Photo of orthotic placement retrieved from https://bestwalkingfeet.com/good-shoes-for-flat-feet/insoles-and-inserts/

Wheeless' Textbook of Orthopaedics. (n.d.). Retrieved from http://www.wheelessonline.com/ortho/Plantar_fascia

 

 

What is the Rotator Cuff and What Does It Do?

 By Nick Mazzone, PT, DPT, CSCS

What is the rotator cuff?

The rotator cuff is the name given to the group of 4 muscles that originate from different positions on the shoulder blade and connect to the humerus (upper arm). These muscles all work together to ensure stability of the shoulder joint during movement (dynamic stability). When isolated, each of these muscles acts on the humerus and moves the shoulder joint in different directions. These muscles are named supraspinatus, infraspinatus, teres minor, and subscapularis.

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Why do we need this dynamic stability?

As we move the arm, these rotator cuff muscles will contract together to help keep the humerus centered nicely inside the cup of the shoulder joint (think ball and socket). If there is an asymmetry in strength among these muscles, the positioning of the shoulder inside the socket may be altered while you move your arm. Over time, this can cause irritation of other tendons, ligaments, and bone in the shoulder region. Some of the common diagnoses associated with rotator cuff muscle weakness are shoulder impingement syndrome and non-traumatic rotator cuff tears.

What happens if the rotator cuff is torn?

The most commonly torn rotator cuff muscle is the supraspinatus. People with supraspinatus tears typically have trouble elevating the arm and may exhibit a compensatory shrugging of the shoulder in order to assist in raising the arm.

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If a partial tear is present, the muscle and tendon have the ability to heal without surgical intervention. In order for proper healing to occur, we must provide an ideal environment for the muscle and tendon to recover. This would include intervention aimed at decompressing the region where the muscle attaches to the humerus, which would be achieved through range of motion exercise and strengthening of all 4 rotator cuff muscles to help produce more efficient movement of the shoulder (to put it briefly).

If a complete tear is present, there are two options that one may follow. The non-surgical route would include strengthening other muscles around the shoulder joint that will help to compensate and act as a substitute for the torn rotator cuff muscle. Fortunately, the shoulder joint was designed to be able to withstand this type of injury and with the right rehab protocol, may return to normal functioning. In cases where this method does not help, surgical intervention is typically indicated. After surgery, patients will be sent to a physical therapist in order to help them return to their prior level of functioning.

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What does physical therapy typically consist of for rotator cuff injuries?

The plan of care will consist of manual stretching and soft tissue mobilization of tense muscles, specific strength and stability exercise to improve the function of the shoulder, range of motion exercises to help normalize joint movement, and movement re-education to ensure pain-free use of the arm.

Check out this brief video for 3 exercises that will strengthen the rotator cuff muscles:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources

Photo depicting widespread shoulder pain (top photo) retrieved from https://www.myanthemhealth.com/blog/shoulder-paincould-it-be-my-rotator-cuff

Photo depicting different muscles of the rotator cuff retrieved from https://www.slideshare.net/prkhuman/shoulder-impingement-syndrome-24685952

Photo depicting a rotator cuff tear retrieved from https://www.vivehealth.com/blogs/resources/rotator-cuff-tear

Photo depicting the compensatory shoulder shrug during shoulder elevation retrieved from https://healtheappointments.com/chapter-16-the-musculoskeletal-system-essays/5/

How Can PT Help My Carpal Tunnel Syndrome?

By Nick Mazzone PT, DPT, CSCS

What is carpal tunnel syndrome?

The carpal tunnel is the space formed by the bones of the wrist and hand that allows passage of the median nerve along with tendons of muscles that move the joints of the hand. This space is typically about an inch wide, however it can be made narrower in the presence of irritation and swelling of any of these structures. Narrowing of this passageway can lead to pressure on the median nerve, which may lead to symptoms such as tingling, burning, weakness, and pain in the hand and fingers.

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How do I know it is carpal tunnel syndrome?

Symptoms from carpal tunnel syndrome such as numbness and tingling typically present themselves at the thumb, index finger, middle finger, and half of the ring finger. This is because sensation to these areas is supplied by the median nerve. If the median nerve is being compressed, these areas may become numb or painful. You may also find weakness of the muscles that move the thumb, first two fingers, and wrist. The picture below shows what the hand may look like when a person with long-standing carpal tunnel syndrome attempts to make a fist. It is known as the “Hand of Benediction Sign”.

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What is the traditional treatment for carpal tunnel?

Typically, people suffering with the symptoms of carpal tunnel syndrome receive anti-inflammatory medications or are suggested to have surgery. This surgery involves a “release” of the transverse carpal ligament, meaning that the surgeon cuts this ligament to help decrease pressure on the tunnel and, therefore, the median nerve. The issue is that this does not always solve the problem. If the tendons are still inflamed and swollen, we may still be feeling these symptoms after the post-surgical healing process is complete. For this reason, physical therapy should be a patient’s first option. Many people find that PT alone helps them return to normal, pain-free functioning during daily tasks.

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How do we improve these symptoms in PT?

The symptoms from carpal tunnel syndrome can be resolved by decreasing pressure on the median nerve at the level of the wrist and hand. This can be accomplished by improving flexibility of the muscles and connective tissues at the wrist and hand, especially those on the front of the forearm. Your physical therapist will perform mobilization and stretching techniques, postural training and education, nerve gliding techniques, and soft tissue mobilization. Once the tissues are of proper flexibility, we must ensure that the muscles surrounding the hand and wrist are strong to help stabilize the joints. A home exercise program with specific exercises to help your condition will also be prescribed.

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Check out the video below for a demonstration on how to perform median nerve gliding to help alleviate symptoms of carpal tunnel syndrome:

Resources:

Our knowledge of orthopedics. Your best health. (n.d.). Retrieved April 05, 2018, from https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/

“Hand of Benediction” photo retrieved from http://slideplayer.com/slide/9418409/

Photo depicting carpal tunnel release surgery retrieved from http://www.korshjafarniamd.com/treatment/minimally-invasive/endoscopic-carpal-tunnel-release.php

Photo depicting median nerve compression retrieved from http://nursinglink.monster.com/training/articles/814-carpal-tunnel-syndrome

Photo used at top of page depicting painful wrist retrieved from http://www.pipmchealth.com/conditions/carpal-tunnel-syndrome/

“Tips for preventing and treating carpal tunnel syndrome”photo retrieved from https://www.mispinerelief.com/blog/carpal-tunnel-treatment-and-preventing-for-carpal-tunnel-syndrome/

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

How Can PT Help My Spinal Stenosis?

By Nick Mazzone, PT, DPT, CSCS

Spinal stenosis is one of the most commonly diagnosed conditions that affects the lumbar spine (lower back). It is common for people with stenosis to feel tightness and pain that radiates from the low back and buttocks down into both legs.

It is estimated that only about 5% of people with spinal disorders actually require surgery (Eidelson, 2018). So, what are the other 95% of people expected to do? This is where physical therapy comes into play. There are many methods your PT will use in order to help address the issue causing your pain and discomfort. This includes but is not limited to therapeutic exercise, soft tissue mobilization, manual stretching of the hips and spine, and postural re-education.

What is spinal stenosis of the lumbar region?

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As you can see from the picture above, stenosis of the spine involves a narrowing of the canal in which the spinal cord sits. This leads to increased pressure on the spinal cord as well as the nerves that branch from it. This is the reason why people feel pain in the buttocks and legs; the region of pain stems from a specific section of the spinal cord that is under pressure. For this reason, two people with the same condition will present with different symptoms.

How can physical therapy help with this problem?

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The treatment plan will be specifically tailored to each patient with stenosis. The main objective is to help decompress the spinal cord and its nerve branches by using techniques that create more space in the spinal canal. Bending backward, also known as extension of the lumbar spine, will decrease the space in the spinal canal due to the way the joints of the spine are oriented. This may increase pain and symptoms in a person with spinal stenosis. For this reason, the treatment plan will be focused on utilizing and improving spinal flexion, more commonly known as bending forward. This will help to widen the canal and decompress the inflamed structures, effectively providing relief of symptoms.

A comprehensive treatment plan will help you find positions of maximal comfort and give you more drug-free and surgery-free options for taking care of your lumbar spine and preventing pain in the future.

Please check out this brief video that provides 3 simple exercises to help decrease symptoms due to lumbar spinal stenosis.

Resources

Eidelson, S. G., & An, H. S. (February 2018). Spinal Stenosis Center | Lumbar, Cervical, Symptoms, Exercise, Surgery. Retrieved March 18, 2018, from https://www.spineuniverse.com/conditions/spinal-stenosis

Picture of person with low back pain retrieved from http://www.omegapainclinic.com/spinal-stenosis-pain-treatment-utah

Pictures of stenosis in lumbar region retrieved from https://www.spineuniverse.com/conditions/spinal-stenosis

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Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.

What Does Foam Rolling Do for Me?

By Nick Mazzone, PT, DPT, CSCS

 Foam Rolling has become one of the more popular health and fitness topics over the past few years or so. These tools can be found in many different shapes, sizes, and colors with varying textures and firmness to fit everybody’s apparent need. If you google this, you will find claims that foam rolling can help you improve range of motion, muscle strength and performance, and decrease pain. It is also often used as part of a warm-up and cool-down within an exercise program.

Who do I believe?

Well, unfortunately there are very few studies on foam rolling and its effects on our muscles and connective tissues. The following bullet points can be used as a summary of the current body of research on this topic:

Positive Effects of Using a Foam Roller

·      Increased blood flow

·      Increased tissue temperature

·      Better short-term improvements in range of motion versus static or dynamic stretching

·      Decreased sensation of pain

What Foam Rolling Will NOT do for You

·      Increase strength or power output

·      Give lasting improvements in range of motion when used as a stand-alone treatment

·      Lead to complete resolution of pain/symptoms when used as a stand-alone treatment

Let’s Discuss these findings…

As you can see, there are some benefits to using a foam roller, however I feel it is important that we clear up some of the common misconceptions on the topic…

Many people who use a foam roller use it in isolation as a method of improving their mobility. I understand why people want this to be true; foam rolling is much easier and less strenuous than stretching. Unfortunately, you will not receive lasting effects from foam rolling alone. While foam rolling will only provide temporary improvements in range of motion, we can take advantage of this temporary improvement by proceeding to perform static or dynamic stretching. With consistency, this can help to improve range of motion on a more permanent basis (although more studies are needed on this topic).

There is also no evidence that foam rolling increases strength or explosiveness during your workout, however one may argue that by utilizing a foam roller you are increasing blood flow to the area, and therefore, helping to facilitate contraction of specific muscles during exercise.

Foam Rolling may also help decrease pain by working to desensitize the area through repetitive stimulation and can help promote tissue healing by improving local blood flow.

How do you suggest I use the foam roller in my daily life?

·      In conjunction with a stretching program for improving range of motion

·      As part of a warmup routine, especially for activities that have high mobility requirements

·      As an alternative to pain killers for temporary pain relief

·      As a method of soothing sore, painful muscles after a physically demanding workout

 

Check out this video for a brief introduction on how to use a foam roller:

For more information or any questions, give us a call at 718-258-3300 or contact us today!

Resources:

Su, H., Chang, N., Wu, W., Guo, L., & Chu, I. (2017). Acute Effects of Foam Rolling, Static Stretching, and Dynamic Stretching During Warm-ups on Muscular Flexibility and Strength in Young Adults. Journal of Sport Rehabilitation,26(6), 469-477. doi:10.1123/jsr.2016-0102

Cartoon depicting man foam rolling retrieved from https://www.gq.com/story/foam-roller-tips

 

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Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.

 

How Do I Warmup Prior to Lifting Weights?

By Nick Mazzone, PT, DPT, CSCS

The warmup phase is easily one of the most forgotten components of an exercise program these days. Would you intentionally leave it out if I told you that it could lead to increased performance and results during your workout?

Traditionally, people have used static stretching (long holds in a position that lengthens a muscle) before workouts to help decrease their risk of injury, however there is no evidence that this is the case. Static stretching before exercise has actually been shown to decrease maximal force production, jump height, and sprint speed while increasing reaction time and impairing balance (Perrier et. al).

Rather than static, long holds in the lengthened position of a muscle, dynamic movement involves actively moving through a joint’s range of motion without holding at the end point. A study by Perrier et. al found that dynamic movement including skipping, shuffling, and calisthenics of increasing intensity that were chosen based on the movements that would be performed during training led to improved athletic performance versus static stretching and no stretching at all.

Dynamic movements that mimic the exercises you will be performing help to prepare the central nervous system for physical activity. By activating specific muscles prior to exercising, we are facilitating proper muscle activation patterns and therefore, “priming” the nervous system.

Suggestions for a proper warmup routine

·      15-20 minutes of dynamic movement

·      Must make an effort to mimic the activities that will be performed in the exercise  program

·      Must include enough intensity to elevate heart rate

·      Should not approach more than 30% of your maximal effort to prevent muscle fatigue

Example of warmup routine prior to squatting or deadlifting

·      Bridging with a resistance band 3 sets of 15-20 reps

·      Marching with a resistance band 3 sets of 15-20 reps

·      Body weight squatting with a resistance band 3 sets of 15-20 reps

·      Lateral Band Stepping with resistance band 3 sets of 10 steps in each direction

Example of warmup routine prior to overhead pressing or bench pressing

·      Banded shoulder external rotation with retraction 3 sets of 12-15 reps

·      Wall Angels 3 sets of 10-15 reps

·      Overhead Arm Raise at Wall 3 sets of 10-15 reps

·      Banded Wall Climbs 3 sets of 8-12 reps

 

For a preview of upper and lower body warmup routines, check out these videos:

For more information or any questions, give us a call at 718-258-3300 or contact us today!

Resources

Perrier, E. T., Pavol, M. J., & Hoffman, M. A. (2011). The Acute Effects of a Warm-Up Including Static or Dynamic Stretching on Countermovement Jump Height, Reaction Time, and Flexibility. Journal of Strength and Conditioning Research,25(7), 1925-1931. doi:10.1519/jsc.0b013e3181e73959

Warmup picture retrieved from https://www.hosmerchiropractic.com/blog/7-ultimate-dynamic-stretching-exercises/

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Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.