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Your spine consists of 33 vertebrae, all stacked one on top of the other and all effecting the other. The neck and low back areas of the spine are designed to be more mobile, which is why pain and injury is more common in those areas. The thoracic vertebrae are the stabilizing connectors between the two. It also anchors your rib cage, which has to be sturdy enough to protect all your vitals organs.

The tightness that you feel occurs because your thoracic spine can actually be “too good” at stabilizing and becomes hypomobile (decreased movement). Joints like to move, so when they are maintained in the same position for a long time, they get stiff and achy. Therefore, when you sit in a slumped position (see picture below) you are asking your thoracic spine to hold you up when you should be relying on your abdominal and back muscles to help. To counteract the added stress and load placed on the vertebrae, you have to get those vertebrae moving!

Here are my favorite exercises to increase thoracic movement and decrease mid back pain!

1. Thread The Needle

• Start on your hands and knees with neutral spine
• On an inhale, take your right hand and reach up towards the ceiling without moving your hips and keeping your left arm straight
• On your exhale, reach your arm across your chest as if you were going to rest your right shoulder on the ground. Again, try to keep your hips still.
• Repeat 10 times on each side, following your breath

2. Cat/Cow

• Start on your hands and knees with neutral spine
• On an inhale, open your chest by sending your heart toward the ceiling and your letting your gaze follow
• On an exhale, pull your belly button in towards your spine rounding out your back and head
• Repeat 10 times, following your breath

3. Modified Downward Dog

• Start with your hands on the back of a chair or counter top in front of you and your legs slightly wider than hip width apart and at a level that is behind your trunk as you stand
• Slightly bend your knees as you sink your hips back and let your arms extend in front of you; let your head and chest fall towards the ground
• Straighten your knees as much as you can, being careful to stop if you begin to round your back
• Repeat 10 times, holding the stretch for 10 seconds

4. Open Book

• Start out laying on your side with your knees bent (fetal position)
• Slowly twist open through your upper body so your top shoulder is on the table
• Repeat 10 times, holding for 10 seconds on each side

5. Puppy Pose

• Start on your hands and knees with a neutral spine
• Gently walk your hands  out in front of you to allow your chest and forehead to sink to the floor
• Try to keep your hips over your knees
• Repeat 10 times, holding for 5 seconds

Hopefully you find these exercises helpful, however, if pain persists please schedule an appointment with your Primary Care Physician. If you enjoyed these exercises and want to learn more or have a skilled physical therapist evaluate and design a specific treatment program for you feel free to contact Atlantic Physical Therapy  via phone 215-271-4100 or email info@aptphilly.com.

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The most common symptom of endometriosis is pelvic pain, especially with your period and far exceeding “normal” menstrual cramping.  Irregular periods are also common, leading to spotting, multiple periods, cramping and pain throughout your cycle. Low back and hip pain, constipation, bloating, and pain with sex can also be caused by endometriosis.

While there is no specific cure for endometriosis there are multiple treatment options available to manage the symptoms. Typically women are placed on birth control to decrease estrogen levels and regulate menstrual cycles. Laparoscopic procedures can be performed with the goal of removing the endometrial tissue, however, there is risk of added scar tissue and adhesion. Although these are the primary treatments, exercise is a great adjunct with absolutely no risk of side effects!

As a woman, I can appreciate that exercising seems like the last thing you would want to be doing when it feels like your pelvis is trying to murder you from the inside out, but, when done correctly it can provide short and long term relief. Women who suffer from endometriosis should start incorporating exercise into their daily routine because of the following benefits:

1. Increases endorphins
   • Endorphins are hormones released into the brain to decrease pain. Basically, they act as as a “natural pain-killer”
   • Elevates your mood
   • Decreases stress
2. Decreases estrogen levels
   • Estrogen is the hormone that controls the thickening of endometrial tissue. If there is less estrogen in the body, there is less signaling for tissue growth.
3. Increases blood flow
   • cells outside of the uterus are not shed through menstrual bleeding. Increased circulation allows this blood to move out of these areas and prevents stagnation. 
4. Decrease risk of scar tissue and adhesions
   • moving and stretching the muscles and fascia promotes proper healing and keeps tissues pliable.

Exercise can include walking, stretching, yoga, lifting or anything else that gets you moving. If you are hesitant to start exercises, ask your doctor for a referral for physical therapy. A trained pelvic floor physical therapist will take a detailed history, establish goals and prescribe exercises specific to your individual needs, interests and capabilities. For our favorite pelvic stretches see our prior blog post 6 Simple Stretches for Pelvic Floor Pain and Tightness or call our office to schedule an appointment and start to eliminate pain caused by endometriosis.

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What is chronic pain?

Pain is a crucial evolutionary tool that helps us to learn what things are dangerous. From our first fall as a toddler, an association between pain and events that may threaten our well-being begins to develop; with every subsequent fall, that connection becomes stronger and stronger. This sharpens our instincts and increases our chances of survival. It also allows us to know if we have physical damage in our body that we need to attend to. Everyone experiences sporadic pains like headaches or sore knees from tripping on the sidewalk. Pain, officially becomes identified as chronic, when it has lasted in a specific body part for more than 3 months. Now, let’s look into some of the factors involved in the development chronic pain to gain a better understanding of it.

How does chronic pain develop?

To better grasp why we feel chronic pain, it’s important to understand the mechanics. Our brains send signals to different parts of the body all the time. This includes messages that we are in pain. Chronic pain is a reality when the brain has sent pain signals to a specific body part for longer than 3 months. Doctors do their best to find and alleviate the root cause. If, however, they cannot find a root cause, they consider possible mental or emotional causes.

Is there always a psychological component to chronic pain?

Those who suffer from chronic pain, but don’t have an underlying cause might create a connection to activities that are not dangerous. Consequently, their increased fear and anxiety can produce the psychosomatic (“in the head”) experience of pain.

Unfortunately, there is no concrete causation between chronic pain and trauma. However, science has made a correlation among the two. Furthermore, the experience of trauma, irrespective of it being physical, psychological or both, can strengthen the link between an activity and pain. In layman’s terms this means that if you were injured in a traumatic way, your chances of developing chronic pain increases.

Can the psychological aspect of chronic pain be resolved?

Usually, once enough time has passed, and the damaged tissues have healed, the main culprit becomes the pain itself which is increased by a hypersensitive nervous system. As soon as this incidence is identified, and other structural damage is ruled out, a physical therapist can work with you to resolve tour pain.

This is why health professionals are wary of solving chronic pain is usually through surgery or other avenues that change the structure of the tissues themselves. Rather, with personalized physical therapy options that help to strengthen new connections in our brain that do not lead to the experience of pain. With that said, every case is different and it is always possible that pain is caused by a specific structural issue which is why it is important to consult a healthcare professional, obtain second opinions etc.

How can chronic pain be treated?

As previously mentioned, there are many different treatment avenues. Seeing a physical therapist at Atlantic Physical Therapy is the perfect option to help you to get better. After an initial evaluation, your therapist will guide you through the right progression of exercises to appropriately challenge your body and encourage your brain to strengthen new pathways that don’t produce pain. Additionally, physical therapists can also help you to differentiate between pain from harmful stimuli and non-harmful stimuli; that knowledge ensures you stay on the right path to getting back to your pain free life.

Chronic pain summary

Here is a short YouTube video that summarized everything I just explained in an awesome animation, enjoy!

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When people think of physical therapy, they tend to think of rehabilitation from injuries from the neck down like rotator cuff injuries, knee injuries or back pain, but did you know that physical therapist also have the expertise to treat jaw pain and other kinds of facial pain? Jaw pain will often be diagnosed as Temporomandibular joint dysfunction or TMD but it can take some time before reaching this diagnosis. People with this disorder often bounce from doctors to dentists to oral surgeons often feeling like the only possible way out is surgery with uncertain outcomes. While surgery may help for certain cases, it is always indicated, just like with any other body part, to try conservative treatments like physical therapy first.

What can cause TMD

Psychological factors like stress and anxiety
Poor posture
Traumatic dental procedure
Dental procedures that change your teeth occlusion like implants or root canals
Car accident
Blow to the jaw etc…

I have worked with many patients with TMD or other types of facial pains and have seen very positive outcomes working alongside dentists and oral surgeon to provide patient specific multi-disciplinary care.

Here is a useful chart that can help you determine if you should discuss treatment of TMD with your health specialist.
-­‐
TMD PAIN SCREENER

1.In the last 30 days, how long did any pain last in your jaw or temple area on either side?
a) No pain
b) Pain comes and goes
c) Pain is always present

2. In the last 30 days, have you had pain or stiffness in your jaw on awakening?
a) No
b) Yes

3. In the last 30 days, did the following activities change any pain (that is, make it better or worse) in your jaw or temple area on either side?

a) Chewing hard or tough food
a) No
b) Yes

4. Opening your mouth or moving your jaw forward or to the side
a) No
b) Yes

5. Jaw habits as such as holding teeth together, clenching, grinding, or chewing gum
a) No
b) Yes

6. Other jaw activities such as talking, kissing or yawning
a) No
b) Yes

a=0
b= 1
c= 2

If you scored 3 or more it would be a good idea for you to discuss treatment options for TMD with your dentist or doctor and consider consulting a physical therapist prior to any more invasive options.

For an appointment with a physical therapist with experience working with this particular diagnosis as well as other kinds of facial pain please call Atlantic Physical Therapy in Philadelphia, PA at 215-271-4100.

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In the most basic sense, physical therapists are trained and educated in human movement. They excel in helping those who cannot move properly whether it’s the result of injury, disease, or disability. The goal of working with a physical therapist is to return to normal function and restore quality of life.

Here’s how one of our patients explains it: “Dr. Friedman helped restore mobility in my neck and totally eliminate pain caused by a muscle spasm in my back.  She tailored my treatment specifically for my injury and restored me to full function in no time. ”

Physical therapists evaluate patients of all ages and backgrounds to devise a plan to reduce pain and improve or restore mobility. The evaluations consist of range of motion, strength, flexibility, posture, gait, balance, and functional measurements. They take their exam findings and devise a customized program that includes exercises, functional activities, and modalities to assist in recovery. The rehab experts also help people wishing to avoid the loss of mobility or prevent future episodes of pain through fitness and wellness approaches.

Physical therapy is an obvious choice when you’ve sprained an ankle or developed tennis elbow,but what about when you need to boost your mood? Though highly skilled in methods that improve mobility and reduce pain following an injury, physical therapists can also play a key role  in improving a patient’s mental health by using exercise, a core component of any physical therapy regimen. Exercise is known to benefit patients with mild to moderate mood disorders such as depression. While physical therapists cannot diagnose or treat depression directly, exercise as a part of a physical therapy program can help improve mood. PTs are trained to recognize the signs and symptoms of depression and identify the ways in which mental health disorders
interfere with a person’s ability to enjoy life.  They also know when it’s appropriate to refer a patient to a mental health care professional.

Each new year brings a chance to make positive changes that impact yourself and those around you. In 2017, private practice physical therapists are committing themselves to raising awareness of the services offered, talking about how patients benefit, and reminding the public of contributions to our nation’s health and wellness goals.

Our professional organization is called the The American Physical Therapy Association or APTA. The APTA represents more than 85,000 physical therapists, physical therapist assistants and students of physical therapy nationwide. For more information about physical therapy and its sub specialties please visit www.apta.org.

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Did you ever see the movie Legally Blonde? One of my favorite lines to quote is Elle’s defense of “exercise gives you endorphins, endorphins make you happy and happy people don’t shoot their husbands.”

Endorphins are produced in our body to create a feeling of euphoria and to stop pain signals from reaching the brain after an injury. Endorphins can also be produced from exercise. Once again proving the relationship between pain, physical activity and mental health. The challenge to the physical therapist treating patients with a mental health diagnosis is to help them understand this intricate connection between pain and movement. Sometimes patients have increased pain with specific movements and they end up avoiding activity altogether, and not just physical activities. Pain can limit a person’s ability to hangout with their friends, play with their children, go to dinner with their spouse or participate in a family event. Imagine how isolating and hopeless one might feel not being able to enjoy their life.

Physical therapists and patients have the capability to retrain the brain to not associate movement with pain through the correct exercises and stretches. Being more active means producing more endorphins and more endorphins lead to improved self-esteem, self image which allows a greater sense of well being. Exercise can also improve sleep quality, endurance, mood, mental alertness and cognitive function as well as reduce stress and anxiety. All of which are essential for mental health and pain management.  

Physical therapists are experts in the musculoskeletal system, and although most of us are type A personalities and have that drive to excel at everything, there are limitations to our abilities. It is important that we recognize this and, when appropriate, counsel patients on seeking professional help from our psychologist friends to enable a holistic approach to treatment.

Additional resources:

Understanding Pain in less than 5 minutes, and what to do about it

National Fibromyalgia Association

The Philadelphia Department of Behavioral Health and Intellectual disAbility Services  

For more information or to set up an appointment, you can contact us.

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Pretty funny,  but I definitely can relate to the sentiment. I’ve run the Broad Street Run 5 times now and consider it a mini miracle to come out of it pain free. It also got me thinking about how to explain what normal pain is, what injury related pain is and how to know whether to enlist the help of a medical professional.

We’ve heard time and time again “No pain, no gain.” It can be very confusing to try to decipher the difference between “good pain” associated with making gains in strength and endurance and “bad pain” associated with injury. Knowing the difference between these two conditions is crucial. Understanding the difference can can assist in making you a stronger athlete and save you from avoidable injuries.

Pain

Pain is a neurological signal that there is actual or potential damage to the structures in your body. It’s your brain telling you, “Hey! Something is WRONG! You better look into this.”

Location, Location, Location

Just like in real estate, location is EVERYTHING when it comes to deciding whether pain is normal or not.

Good Pain

Normal or “good pain” is  ALWAYS going to be located in your muscles and NEVER in your joints or ligaments. “Good pain” is technically called “delayed onset muscle soreness” or “DOMS.” DOMS typically occurs 24-48 hours after exercise and lasts 2-3 days. It’s a diffuse soreness that you will feel with activity. You won’t typically feel pain at rest with DOMS.  It’s caused by microscopic trauma to your muscles after an activity that overloads them. It’s a sign that weaker muscle fibers are tearing. Though it sounds bad, it’s actually a good thing! After a muscle fiber tears, new muscle fibers form and make adaptive changes that anticipate the heavier loads you’ve been placing on them. Your body is basically saying “our current muscles aren’t strong enough to handle all that exercise. Let’s make some new fibers that can handle it.” It’s a beautiful thing! Repeating the process of tearing up old muscle fibers and rebuilding with new ones is how we get stronger.  It’s how bodybuilders put on mass. It’s how runners and cyclists get faster. Our bodies are constantly making adaptive changes when you exercise to make you stronger and more efficient. After a long run, you may feel DOMS when walking up and down stairs or getting up from a chair. This is normal and will eventually go away in a few days. The best way to get rid of DOMS is to drink a lot of water and to move. It stimulates the lymphatic system-the drainage system in your body.

Bad Pain

Pain in your joints (the space between bones), tendons (the connective tissue between muscles and bone), and ligaments (the connective tissue between bones) is NOT normal. You should never “push” through this pain. Pain in joints, tendons, and ligaments is a sign of injury. When it comes to distance or endurance events, it’s often a signs of overuse. If you’ve fallen or experienced some sort of traumatic event, it can be a sign of a more serious injury. Swelling and pain at rest is often a sign of “bad pain.” If you are experiencing bad pain, you should stop the activity that’s causing it. If you are running and you have bad pain, then WALK. There is no benefit to your body to toughing out this type of pain. It won’t make you stronger or faster. It may actually lead to more down time if you don’t take the time to address it. If an event has occurred where you’ve fallen or torqued a joint and can’t put weight on it, definitely seek medical assistance right away. Otherwise, it’s ok to just to back off.

I have bad pain. Now what?

REST. ICE. COMPRESSION. ELEVATION. (RICE for short).

Rest

Rest doesn’t necessarily mean that you need to take time off from exercise, but it does mean you need to stop doing any activity that replicates your bad pain. If you experience pain when running, but lifting weights is pain free, then go for the weights. I always like to say, “let pain be your guide.” This means if it doesn’t hurt, then it’s ok to do. If it hurts when you do it, then stay away. Try taking at least a week off of the pain causing activity and make sure you have no pain, swelling, or tenderness before trying to resume that activity again. Make sure you don’t resume an activity at the same intensity as the time of injury. Dip your toes in the water before you dive in, so to speak. Only try a few minutes of an activity and wait a day to assess how it made you feel before you return to a training regimen. Remember that most injuries happen when you over train or ramp up your training too quickly. Your body needs time to adapt, so don’t rush it!

Ice

Ice is a great way to slow the inflammatory process in the body without having to take medication. Although temporary, it also numbs your nerves so you don’t feel pain. Try icing 1-2 times per day for 10-20 minutes.

Compression

Wrapping an injury can help take down swelling. You want to wrap looser as you move distal to proximal. This means you should start slightly tighter at the end closest to your extremities and loosen up as you move closer to the center of your body. But don’t wrap too tightly! Loss of sensation or discoloration is a sign the wrap is too tight. Use a material that is flexible, like an ACE bandage.

Elevation

You can help your lymphatic system out with the use of gravity. If you’ve injured a limb, keep it elevated above the level of your heart to help drain things towards the center of your body. Use pillows to keep an injured leg elevated while you are lounging.

It’s been a week, I’ve used the RICE method and the pain isn’t any better.

Time to see a medical professional. Your family doctor or a physical therapist is a good place to start. Physical therapists with direct access licensure (like us!) can evaluate and treat an injury without a referral from a doctor. If your therapist suspects a more serious injury that requires medical imaging or surgery, they can assist you in with finding the appropriate medical provider. Otherwise, physical therapy can help the vast majority of orthopedic conditions.

Make an appointment here or call 215-271-4100

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