Pilates with Kierstin! Thoracic Mobility

Kierstin Elliott

Exercise: Thoracic Mobility

Set Up: Set up your foam roller vertically (so it runs up and down your spine). Sit on a mat with the end of the foam roller placed right between the bottom tips of your shoulder blades. Lean back into the roller with arms stretched back so hands are gently placed on either side of roller. Place feet flat on the mat, parallel.

Execution: Inhale to prep, exhale to lift hips off the mat, finding extension through the psoas. Inhale to lower hips down. After about 3-5 hip lifts, reposition the roller a couple inches further up the back, mid shoulder blades. Repeat hip lifts. Pause here with hips on the mat and take a few lateral bends right and left, allowing the roller to become an extension of your spine. After about 4-6 reps on each side, reposition the roller one more time towards the top of your thoracic spine (upper shoulder blades), being careful not to place it on the neck. Repeat the hip lifts.

Focus: Focus on stabilizing your pelvis during lateral flexion and connecting to breath during the hip lifts.

Importance: Mobilizing the thoracic spine! This alone comes with so many benefits: deeper, expansive breath, more accessible spinal rotation, mobile shoulders, greater spinal extension and flexion, better connection to core, etc.

Modifications: Place a small pillow or towel roll under head if neck support is needed. Take a few moments after the lateral flexion for some snow angels to stretch the pecs and open the chest.

How to Start a New Exercise Program When You’re Feeling Intimidated

How to Start a New Exercise Program When You’re Feeling Intimidated

woman stretching on ground
Photo by Jonathan Borba on Pexels.com

Kierstin Elliott

Maybe you were an avid gym-goer, cross fitter, or yogi and then you got injured. Or maybe fitness has never been a part of your life, but now your doctor or PT has told you that a fitness regimen is necessary in order to help you feel like yourself again. Whatever the case may be, you just don’t know where to start, or you feel intimidated to return to what you were doing in the past because that is how you got injured in the first place. My advice is to start slowly. Educate yourself on how and why you got injured and what the next steps are on your road to recovery. Set goals on what you need to accomplish and build a plan to achieve them. Last but not least, train smartly. If you follow this check list, then you should definitely feel more confident moving forward!

It is imperative when you are transitioning from injury rehab to the fitness world, or starting a new exercise program for the first time, that you build a foundation. It is so crucial you stay true to your journey and not compare yourself to others. Trust that progress takes time. Resist the urge to jump right into something new if you’re unsure about form, alignment, and technique.

The first step would be to invest in private sessions. Educate yourself on what you’re getting into and find an expert in what you want to master. Having a coach who devotes the entire hour to your body and your needs will help you garner a deeper understanding of how your breath, body, and mind connect. Learning the proper form with a watchful eye on alignment, will ensure you have a strong foundation to move forward or join group classes.

Once you’ve gained confidence with your new (or old) exercise program, set some fitness goals. You’ve laid a strong foundation and now it’s time to build a skyscraper! Do you want to improve strength, flexibility, endurance? Once you have clear goals set, create a timeline. Establishing a realistic timeline will hold you accountable to sticking with your exercise program and crushing your goals!

The point I’ll end with is to train smartly. No matter what discipline you train in, if you are not focused on form, alignment, and breath control, you are only setting yourself up for future injuries. If you are in a group class, don’t be afraid to ask questions if something is unclear, doesn’t feel quite right, or if you know you need a modification. If you are doing an at home workout on your own, try to do it in front of a mirror to check out your form. If there’s no mirror accessible, simply take it slow and use the knowledge you’ve acquired from a trainer, coach, or PT. Take notes. Practice. Your exercises won’t be perfect the first time you attempt them. Be patient and mindful. It’s all about the journey 🙂

What is Myofascial Release and Why do We Always Talk About it So Much?!

Fiona McMahon PT, DPT

Corey works on lower back 1

If you follow anything in the physical therapy world, you probably have heard about myofascial release, or MFR if your hip to our abbreviations. It has been a darling of the manual therapist’s tool kit for some time. But did you know their many different camps of physical therapy and these different camps prefer different tools? I love coming from a field that can produce multiple solutions to any given problem. I feel it maximizes every unique individuals’ chances of finding meaningful relief through treatment, but it’s definitely fair to say that MFR does have some detractors in the physical therapy field. In this blog, I will be discussing why MFR is a wonderful tool for treatment of pain conditions and functional issues. MFR doesn’t always get the love it deserves and it is my hope, that by the end of this blog you will understand how MFR is thought to work and why it can be so helpful.

What the heck is the myofascial system?

As the name would imply, the myofascial system is the combination of the muscular system (myo) and the fascial system (fascial). Most of us have a pretty good concept of the muscular system but the concept of fascia is slightly more elusive. Fascia is the covering and connection of just about everything in the body. It wraps around organs, nerves, and muscles and allows these parts to retain their shape and function well. The composition of fascia is fascinating, even if you aren’t a total nerd, like me. We may encounter fascia when removing that filmy substance from a chicken breast while preparing it. When you see that film it looks pretty simple, but on a microscopic level that “stuff” is actually teaming with diverse and different cells all doing different things. Within fascia we have adipocytes, (fat cell makers), fibroblasts, which make collagen and elastin…. AND ARE CONTRACTILE! Yes I put this in all caps because it is amazing and it can be easy to overlook when you are thinking about fascia. Fascia also has mast cells (which make histamine) and histocytes (are part of the immune system). It’s honestly a cell party inside that stuff. Keeping with the metaphor of cell party, the house those cells are chilling in is made up of collagen (which provides support), elastin (which provides strength and flexibility), and ground substance (which is the cushioning).

All this stuff together helps fascia to accomplish some pretty cool tasks. Like I said before, fascia covers everything in the body and helps it keep its form. It also allows organs and muscles to slide and glide over each other, which is obviously very important when we are thinking of muscles. But what’s most interesting, in my opinion, is that fascia acts as a sense organ. It is innervated with type III and IV sense receptors and responds to light touch. It can contract and when fascia is stimulated it has an effect on the autonomic nervous system (think flight or fight). You probably could guess that issues within the myofascial system could wreak havoc on the rest of the body.

What goes wrong with the myofascial system and why does it get messed up?

The concept of fascia and its dysfunction contributing to pain is not necessarily a new one. People were thinking about myofascial pain although they had different words for it as early as the late 1600’s with the first description of trigger points in 1816. Trigger points have been called many different things from “nodular tumors” in the 1800’s to “muskelshweile” meaning muscle calluses, which is my personal favorite.

So where do these “muscle calluses” and trigger points come from? The reasons are myriad. Fascia can become restricted with discrete injuries (what I term, “the Oh Poo moment”, where you know you have injured yourself) or they may build quietly over time due to poor posture and other types of repetitive strain or chronic muscle holding.

Fascial restrictions and trigger points can cause a whole host of symptoms. It should seem obvious that restrictions in the fascia of a certain area of the body will restrict the movement in in that area. But fascial restrictions can present in less obvious ways.

Fascial restrictions can affect organs and dysfunction in the organs can affect fascia. This is because of the somatovisceral reflex and viscerosomatic reflex respectively. We see a lot of organ and myofascial interplay at Beyond Basics Physical Therapy. We commonly see increased trigger points in parts of the body that are innervated by similar nerve root fibers off of the spinal cord. Specifically, we may see someone who has endometriosis adhesions on their rectum experience pain and trigger points in their pelvic floor. Additionally trigger points in the pelvic floor can refer to other parts of the body and present as pain in the bladder or rectum, and other places.

Restrictions and trigger points in the fascia are linked to a whole host of symptoms. Treating the body at the level of the fascia is often very helpful at easing or resolving these symptoms. Below is a non exhaustive list of symptoms and conditions related to myofascial trigger points and dysfunction:

  • Fibromyalgia pain syndrome
  • Myofascial pain syndrome
  • Migraines
  • Tension headaches
  • Whiplash
  • Pelvic pain
  • Complex regional pain syndrome
  • Back pain
  • Urinary and fecal incontinence
  • Sports and orthopedic injuries

How do we treat it?

Here is where it gets “controversial” in the health community. Fascia is strong. Really, really strong. Some would say as strong as steel. There are many in the community that claim myofascial release is impossible because there’s no clinician who is strong enough and applying enough force to break through and make a difference in the knots… I mean, I have a pretty solid deadlift but you won’t be finding me bending metal beams anytime soon. This argument misses the point and fails to recognize how complex fascia is. Think back to our cell party. We are not simply trying to break through fascia; we are providing a sensory stimulus and allowing the fascia to adapt or change in response. When true myofascial release is formed correctly, very little force is being used and it is usually an extremely gentle technique that can be tolerated by many patients who may not have been able to tolerate more aggressive techniques. When performing myofascial release, the clinician engages the barrier, meaning they apply enough force to feel the first inklings of resistance, and they hold their pressure there and slowly take up slack as the barrier melts underneath them. There is nothing forceful about it. In fact, when I first learned this technique from a mentor trained in Barnes myofascial release technique, she would always say, “If you think you are working too hard, you probably are”. There’s nothing steel beam bendy about MFR at all. Myofascial release allows the tissue to respond to the input the clinician is providing, rather than aggressively stretching, mashing, or pulling it. Although the exact mechanism of how MFR works is elusive, many theories recognize the individual players and cell types within the fascia, (remember our cell party), whether that be down regulation of the autonomic nervous system, (reduced fight or flight), activation of the central nervous system, and release of chemicals from the cells within the fascia.

The fact is with physical therapy, there are so many different tools that one can use. Usually clinicians tend to gravitate towards what they are good at and what tends to help the maximum number of their patients. At BBPT we value MFR as a helpful tool in our repertoire.

Ajimsha M.S., Al- Mudahka N. Effectiveness of myofascial release: Systemic review of randomized control trials. J Bodyw Mov Ther. 2015 Jan;19(1):102-12.

Horton R, “Mobilization of the myofascial layer: pelvis and lower extremity”. Raleigh, NC, USA. 9/22/2017- 9/ 24-2017. lecture.

Shah J, Thaker N, Heimur J, et al. Myofascial trigger points then and now: A historical and scientific prospective. PM R. 2015; 7(7): 746-61

Marathon Training: Why I Chose Jess

Fiona McMahon PT, DPT

Beyond Basics Physical Therapy has some exciting news. We are running the New York City Marathon for the third year in a row with Team Tisch MS. What makes it doubly exciting is that for the first time ever not one but two physical therapists will be running! Both Molly Caughlan and I will be running to raise $5,000 each, for a total of $10,000 dollars to directly support the work of Tisch MS Research Center of New York to help END multiple sclerosis.

Over the course of the next 7 or so months, you will see blogs documenting our progress towards our goal as well as blogs highlighting the work Molly will be doing with her amazing physical therapist, Tina Cardenia, and Myself, and my awesome physical therapist, Jessica Babich. Molly will soon introduce herself and say why she is working with our girl, Tina. But for now, let me explain why I am so excited to return to work with Coach Jess, ( yes, I am calling her coach Jess now, it’s a thing).

In 2017, together, Jessica and I managed to shave off 17 whole minutes from my last NYC Marathon. My dream of all dreams would be to seek out a BQ (Boston Qualifying time), which would require another time shave of about 13 minutes… and 2 seconds to be precise. Which… is a lot (like, a lot a lot). But shoot for the stars, as they say.

So why did I chose Jess to help me with this lofty goal? Because she is a jack of all trades. In 2017 she was able to tie in visceral (organ based) approaches, with orthopedic and pelvic approaches. She is thorough from checking my sneakers to my head and neck control while running. Working with her two years ago, made me feel like I had a new body.

Working with Jess was a commitment, but one that I saw pay dividends in the end. I won’t lie there were definitely times I wished I could sleep in an extra hour rather than come into PT early, but the thing is, that extra physical therapy kept me injury free and helped me maximize my training. You can have the highest VO2max in the world (a measure of cardiovascular fitness) but if something is keeping you from running efficiently, you won’t be running at your top times. You just won’t. Jess has no tolerance for inefficiency and can spot it with a laser focus and then work her magic to correct it.

Jess has been nerding out lately about new ways to facilitate or wake up the core for efficiency. She’s almost always playing with new techniques when she has the time to do it. Literally, she is always in the clinic gym playing with techniques. This is a major reason I love working with Jess: for her, it’s not just work it’s a passion.

Stay tuned for more from Jessica, Tina, Molly, and Me as we work our way towards Marathon Sunday.

Click here to Donate to myself or Molly. We’re competing to see who can raise the most… so if you’re team me or team Molly, make your donation count

Click here to donate to:

 

Fiona

fiona2018

Molly

Molly

 

A Holiday Gift for You! BBPT is Offering Free Consults for People Living in the Greater NYC Area!

Group Serious 2

Any persistent pain or chronic back or pelvic pain can be tough. It is tough to have and often times it can be extremely isolating. Many of our patients have to go through a number of clinicians before they even get a diagnosis of pelvic floor dysfunction. If you are reading this blog, you probably have some questions about pelvic floor dysfunction and if physical therapy is right for you.

We are here to help. If you are living in the Greater New York Area and have some questions about orthopedic, sports or pelvic floor dysfunction and if physical therapy is right for you, I encourage you to call our office. For a limited period of time, we are offering free 15-minute phone consults with our licensed physical therapists to patients in the greater New York Area. For those of you living outside this area, a fee may apply to the consult but can be applied towards payment for a PT visit if you chose to visit us. Don’t miss this opportunity to learn more about your pelvic floor and what PT can do for you.

The Physical Therapists at Beyond Basics also treat orthopedic (sport and joint injuries), pediatric pelvic floor dysfunction and orthopedic injury, and much more. Give us a call to discuss how PT can help with any one of these issues!

All the best,

Beyond Basics Physical Therapy

212-354-2622 (42nd Street Location)

212-267-0240 (William Street Location)

Marathon Training: Two Perspectives

sneaker.pngAs we creep closer and closer towards marathon weekend, our very own Tina Cardenia PT, DPT, CFMT and Victoria LaManna (Vicky) PT, DPT, CLT, PRPC were kind enough to share their stories about preparing for the 2018 New York City Marathon. Vicky will be running her first marathon on November 4th, 2018 in order to raise money for Multiple Sclerosis Research. Tina was gracious enough to volunteer her expertise in orthopedic physical therapy to help Vicky have the best run possible for a great cause. If you are interested in donating to support MS research, please donate here and read more about their stories below. If you are interested in hearing more about our orthopedic and sports program here at Beyond Basics Physical Therapy, give us a call at 212-354-2622.

From the Runner’s Perspective

victoria2016

Victoria LaManna (Vicky) PT, DPT, CLT, PRPC

This year I am participating in my first ever marathon in the NYC Marathon for Team TischMS. Truly, this is my first ever 5k, Half Marathon, or Full Marathon. I am traditionally an anaerobic, (short bursts energy) exerciser. I have played soccer, dabbled in Muay Thai kickboxing, yoga, and weight lifting for exercise. The mind-body challenge of running a marathon (and doing it all for a great cause!) appealed to me. But where to start?

Luckily, I am in a profession that specializes in exercise, injury screening, and prevention, as well as injury rehabilitation. One of my co-workers has also run a few marathons and pointed me in the right direction for a training schedule. To further help ensure success in my training process, I also started physical therapy and made sure I got on my co-worker Tina’s super busy schedule.

vicky.pngShe first tested my core strength, checked hip mobility and strength, as well as spine and rib cage mobility. All areas that are important for efficient running. Tina found that I had poor core-first responses to outside forces, meaning that every time my foot hit the ground while running, my core was not firing to connect my lower extremities to my trunk. This could definitely be why I was experiencing right low back pain with running, and it could actually lead to further injury and result in not being able to RUN at all! Tina also found limitations in my breathing, rib cage, and thoracic mobility. Other than back pain, my first main complaint a few weeks into training was that I could not breathe. While you could chalk that up to poor conditioning, it was something that was felt immediately in runs – as if I just did not have the capacity to take a breath in. This is where we started our treatment – rib cage and thoracic spine mobility.

From there, Tina continued treating based on observation of my running pattern. She continued to work on hip, spine mobility and core control based on what she saw was insufficient in my running. My breathing improved greatly, as well as my mobility. I began to run completely pain-free with ease.

About 2 months away from Marathon Day, I injured my right foot trying to complete a 16-mile training run. I was unable to walk without pain and was limping around the office. Tina quickly observed that I had a bone in my foot and ankle that were compressed and out of alignment. Her work to align my foot and ankle, working all the way up again through my hip and trunk helped me to get back to pain-free running.

I am all set to run the NYC Marathon Sunday, November 4th! I am incredibly thankful to Tina for helping me to get through my training pain-free, manage an injury along the way, and quickly get me back on track for race day. And I am thankful for Team TISCH for allowing me the opportunity to join their team and support a great cause that affects many men and women.

Are you training for a marathon? Looking to improve your running form? OR even improve your golf swing? I would highly recommend seeing a physical therapist for an injury prevention screen for any and all sports, recreation or exercise. Setting yourself up for optimal movement and mechanics will enhance your activity, as well as reduce the risk of injury. It worked for me!!

 

From the Therapist’s Perspective:

Tina Cardenia PT, DPT, CFMT

Tina head shot

Victoria LaManna is such an inspiration. She volunteered to run the NYC marathon this year with little to no running experience and I was lucky enough to help prepare her! I have been working with Victoria for the past 6 months and I am amazed by how far she has come and how much she has already accomplished. Each week during our PT sessions there were a couple of things that I would look at to monitor her progress. I would observe her running, assess her core with tests called the Lumbar Protective Mechanism* and the Elbow Flexion Test*, her standing posture, her single leg stance, double leg squat, single leg squat, her glut and hamstring strength and how it connects to her trunk, and trunk rotation range of motion.

I saw that Vicky’s main limitations when I was observing her run were her limited trunk rotation towards the right, poor landing control on both of her legs especially her right one, and running with her feet turned out. One of the main things I looked for when observing Vicky run is the force transfer through her body from her feet to her trunk, and how the force translates through the rest of her body. It looked as though the force transfer wasn’t as efficient as I would have liked and this repetitive stress through her back and legs could potentially lead to injury.

tina and vickyVicky’s limitation with trunk rotation correlated to one of her complaints of having difficulty breathing during her runs. It seemed as though she was only able to get a good breath through only one side of her body. Upon examination, I found that she was limited into rib cage expansion especially on the right side. After some rib mobilization and breathing inhalation retraining and working thoracic spine rotation Victoria was able to rotate more symmetrically and reported an increased ease of breath with running.

Vicky’s lack of control with landing while running meant that she had a lack of eccentric (the motion of an active muscle while it is lengthening) control through her pelvis, causing compression through her back every time she lands. This could explain the low back pain Vicky has been experiencing. To address this, I worked on increasing the mobility and range of motion through her hips, pelvis, and back. I then worked on retraining her body with specific neuromuscular techniques called Proprioceptive Neuromuscular Facilitation (PNF) and specific exercises to help Vicky create a core first strategy with her running. This means, with every step and every movement Vicky is able to initiate with her core muscles first, which prevented her from overusing her bigger muscles which tend to fatigue quickly and can lead to injury and pain.

Vicky was running with her feet turned out causing poor force absorption from her feet up to her body. This style of running can also result in muscle overuse injuries and pain over time. This could have also been contributing to her complaints of shin splints while running. To work on this, I evaluated Vicky’s foot and ankle mobility, her knee tracking with squats, and single leg squats. With knee tracking, I noticed that she went into valgus with both of her knees, but it was worse on her right. Valgus means that her knees were “knocking in” which was an issue of having weak hip strength as well as lack of mobility and flexibility through some of her leg muscles and joints.  I did a lot of manual work to restore good range of motion and mobility and a lot of muscle retraining and drills to train Vicky to use those muscles appropriately and to be able to carry it over into her running.

After all this training and all the hard work that Vicky has been putting into running, Vicky’s running form now looks great! She has much more mobility through her trunk, is able to control her landing much more efficiently and is able to connect her feet for a better push off during running! Even as Vicky increased her mileage, she kept reporting to me how much easier her runs have been feeling, how much easier it was to breathe and how much more ease of motion she had through each run, and I couldn’t be more proud of her hard work!

*The Lumbar Protective Mechanism and the Elbow Flexion Test are special tests that come from the Institute of Physical Art. If you would like to learn more about their approach to PT, click here.

Pelvic Health 101 is back and with BRAND NEW COURSES

Fiona McMahon PT, DPT

Our Pelvic Health 101 courses are back! For those of you not in the know about our courses, they are informational sessions provided by top experts in the field of pelvic pain and pelvic function. These courses allow you to dive more deeply into topics such as bowel, bladder and sexual function and dysfunction, pelvic and genital pain, childbirth, diet, issues with kiddos, and much more.

This year we added a Gent’s Only Session to be a companion to our Ladies only session to help answer some of the specific questions you may have about pelvic floor function as it relates to sexual health, bladder and bowel health, as well as pain.

Our first class is “PH101: Something’s Wrong with my What?”, where our own Stephanie Stamas,will be going through the basics of anatomy of the pelvic floor, what can go wrong and how we can fix it. Our first class is on March 7th at 7pm. Register here: pelvichealth101.eventbrite.com, to reserve your spot. Our classes are extremely popular so make sure you register well ahead of time.

Check out

Location:

110 East 42nd St, Suite 1504

New York, NY

10017

Check out all the upcoming classes here:

Pelvic Health 101 Spring 2018 (2)