Running is easily one of the most popular forms of exercise in the United States, and as 5ks, 10ks, and half and full marathons become more popular, the number of runners is ever growing. Unfortunately, as a runner you are often so passionate about running that it becomes the only form of exercise you do. In the beginning this isn’t an issue. Your running times decrease, your mileage increases, and you think all is well. But then you start to feel little aches and pains in your hips or back or hamstrings. What happened? You thought you made the appropriate, gradual increases.

Why is the pain there? Chances are the missing link is strength training! There is a lot of benefit in combining strength training with your cardiovascular training so that you can minimize injuries and maximize your gains at the same time.

So what strengthening exercises should I be doing? Some key muscle groups to include are your hip flexors and abductors. The hip flexors are the muscles that bend your hip upward and advance your leg while running, while the abductors are the muscles that hold you up while standing on one leg, as in running. Both of these muscle groups are often weak in runners and overlooked in strengthening programs. Strong hip flexors can increase your speed and endurance, while your hip abductors are important in maintaining your balance, thereby preventing injury to your knees and ankles. Strength training should be performed two to four times a week and can involve resistance bands, free weights, and circuit weight machines. Some exercises that require minimal equipment and can be performed almost anywhere include:

• Side-stepping with a resistance band- Using a small, looped resistance band around both ankles, step side-ways while maintaining an athletic bend in your hips and knees. Step down a hall and then return, facing the same direction throughout. Make sure to keep your toes pointing straight ahead.

• Steamboats with resistance bands- Using a looped resistance band around one ankle and anchored to something strong, advance your leg forward against the resistance. Turn 90 degrees and repeat in side-ways direction. Turn 90 degrees and perform backwards. Finally, turn the final 90 degrees to perform to the other side. Maintain straight, yet unlocked legs throughout. Be sure to do this on both legs.

• Lunges- Step one leg forward and bend both knees in a staggered stance. Bend until the rear knee approaches the ground, while keeping the forward knee located above the foot. Then, straighten both legs, as you retreat back to your original position. Repeat back and forth with each leg.

• Single-legged squats – While holding onto something stable, slowly bend and straighten one leg, keeping the opposite knee bent. Perform in front of a mirror so you can see yourself. Make sure your knee stays in line between your hip and toes.

• Planks- Hold yourself up on your forearms and toes, keeping your body straight from end to end.

• Mountain Climbers-  Get on your hands and knees with your hands under your shoulders and your knees under your hips. Alternately bring each knee forward towards your chest, between your arms.

• Side-lying hip abductors – Lie on your side, and back against a wall. Slide your top leg in a pillow case, up and down the wall, keeping your body straight on it’s side. Perform on both sides.

Form is the key with all exercises! You may want to have your physical therapist or other fitness professional watch you to make sure your form is correct. You may want to start with 10 repetitions of each exercise until your muscles are used to them. Then, you can add repetitions and/or sets gradually, working towards 3 sets of 15 repetitions each, two to four times a week.

Running is an excellent exercise to participate in and has numerous mental and physical health gains. It is a sport you can take with you anywhere you go, and which does not require you to rely on anyone else. It can be part of a lifelong health plan, as long as you stay healthy and injury free!

Jen Seaton PT, DPT is a physical therapist with Tidewater Physical Therapy. Jen earned her Bachelor’s of Science in Human Nutrition, Foods and Exercise from Virginia Tech and continued to Virginia Commonwealth University, Medical College of Virginia for her Doctor of Physical Therapy. She has a special interest in the active population and athletes. When not in the clinic, Jen is active in a variety of sports herself such as softball, scuba, and running.

Tidewater Physical Therapy is a sponsor of Richmondmom

Leakage. There, we said it.

Also known as incontinence, the condition that afflicts more than 13 million people in the U.S. annually is hardly a taboo topic.

For those over the age of 65, incontinence occurs in 51 percent of the population, according to the Centers for Disease Control and Prevention. Women have a higher rate of incontinence than men. Incontinence encompasses leakages related to either or both the bowel and bladder.

Incontinence risk factors

For the aging, incontinence is associated with a number of factors, including chronic conditions such as diabetes and stroke, cognitive impairment and mobility impairment. Bladder incontinence can also be influenced by aging-related changes in the lower urinary tract, urinary tract infection and other health-related conditions to include mobility impairment.

Risk factors for bowel incontinence include chronic diarrhea, inadequate fiber and water intake and chronic constipation. Health factors include diabetes, stroke, neurologic and psychiatric conditions, cognitive impairment and mobility impairment.

In addition to the financial burden, people suffering from incontinence may carry an emotional burden of shame and embarrassment that adds to the physical discomfort and disruption of their lives.

Treating incontinence

Incontinence is not inevitable with age, however, and is a treatable and often curable condition. Tidewater Physical Therapy specializes in women’s health services, including the treatment of incontinence and pelvic pain. Tidewater Physical Therapy’s services are aimed at increasing a woman’s quality of life through self-management and using specific strategies to reduce symptoms and improve function.

People with incontinence suffer most commonly from stress incontinence or urge incontinence.

Stress incontinence stems from the increased abdominal pressure and weak muscles, resulting in the accidental release of urine— this happens, for example, when people laugh, cough, sneeze or jog.

Urge incontinence occurs when people must get to the bathroom right away from an immediate urge that there is no stopping.

But because people feel discomfort in talking about incontinence issues, many people fail to seek treatment. However, talking to a family doctor or gynecologist for a referral to see a physical therapist who specializes in women’s health, can truly help incontinence symptoms and ease feelings of shame, isolation and depression.

The role of physical therapy

Physical therapy helps incontinence patients gain control of their symptoms and will reduce the need for pads, special undergarments and medications.

In a private treatment room of the clinic, patients will have their pelvic floor muscles evaluated.

The pelvic floor is like a sling of muscles and it runs from the pubic bone in the front and goes all the way to the tailbone in the back. It’s one of the components that make up the core of the body.

Treatment includes heat to relax the muscles, electrical stimulation, ultrasound and manual therapy. The first day of therapy, 20 to 25 minutes is spent simply educating patients on what exactly the condition entails.

A therapist will help patients “find” the right muscles and use them correctly. The pelvic floor is one of the components that make up the core of the body, so it’s important to work on core exercises. Pelvic floor exercises, such as Kegel exercises, will work to strengthen the muscles that control your bladder, and put the patient in control of their urges again.

Finding a Physical Therapist

As part of your healthcare team, a physical therapist will make an assessment of your condition and create a plan to start you on the road to wellness. Our team will communicate with your physician of record and obtain a referral, if necessary, for your continued treatment. We will also work with your insurance carrier to make sure services are covered by your plan. To make your own appointment, find a clinic near you.

This article is sponsored by Tidewater Physical Therapy

We hear it time and again: “Pain during pregnancy is normal… The baby must be sitting on the nerve…”  We are told so by our friends, our sisters, our mothers and even uninvited strangers.  But the truth is that pain during pregnancy is not normal. It is not expected because the baby is small and cushioned well, so he or she cannot be sitting on a nerve.  However, pain during pregnancy is common. Statistics show 50-80% of women experience back pain while pregnant.  This can range from significant to completely disabling pain– 80% will be unable to go through their daily routine because of their intense pain.

So the term “Pain is normal” is not a good enough answer for me.  I’m a Physical Therapist, trained to help you with your “mechanical pain”.  Mechanical pain means the pain that is coming from muscles, joints, lose ligaments, discs, and pre-existing asymmetries.  A trained Physical Therapist can evaluate each of these structures for you, determine what is causing your specific pain, and help create a plan to help relieve that pain.  Our evaluation results in a treatment plan that can implement in the office, and teach you an exercise program that you can take home to manage your pain.

Instability in the muscles and ligaments is the most common cause of the pain, resulting in other muscles working too hard to stabilize the tissues, resulting in spasms and shooting pain, that may even travel down the leg.  Learning how to safely do a pelvic floor muscle contraction is the start of that stability.

Let’s try it:  lie down, or sitting a chair, with your legs and back at rest. Then, squeeze up and in, imagine that you are trying to hold in urine.  Try your best not to squeeze your gluteals, your knees, or your feet together, really isolate those pelvic floor muscles. Hold for a count of five, and repeat the exercise ten times.  You can be make it harder by holding longer, or steadily increasing the intensity of the squeeze.

Another strong stabilizer is your abdominals! Again, sitting or lying, sink your belly button in to your spine, hold for a count of five, repeat ten times.  Another nice way to help reset unstable joints is rhythmic motions, sit close to the edge of your chair and rock your hips backward and forward. You will be making your pelvis tilt forward and back, repeat ten times.  All theses exercises can be done several times a day for the best results.

Here are some tips that will come in handy to help with your pain as well. Think about your posture. Imagine the string pulling your head up as you stand and walk. Keep your abdominal and pelvic floor muscles engaged when you change positions, like when you are going up and down stairs, or when lifting heavy objects or children.  Wear sensible shoes, not heels and flip flops, throw the Uggs back in the closet, and instead, chose a strong heel, and good arch support.

We have touched on some important exercises and tips to help you with your back pain, but there so much more to learn.  Be sure to tell your ObGyn about your pain, no matter how small, even if you are in your first trimester! Ask if a Physical Therapist would be safe and appropriate for you. Remember, back pain is not “normal” and something you need to live with, but it is common. So don’t settle for dealing with unnecessary pain.

Mona Saeed DPT, Certified MDT, CHT earned her Bachelor of Science degree fromBarnard College, Columbia University, New York, NY, and her Doctorate in Physical Therapy from Stony Brook University, Stony Brook, NY.

In addition to general orthopedics, Mona is experienced and certified in McKenzie’s method to treat cervical and lumbar spine dysfunction. She also has the unique experience of treating patients with pain related to pregnancy as early as 6 weeks to full term, in both high risk and “normal” pregnancies.

Many of the physical therapists at Tidewater Physical Therapy Inc. hold Direct Access Certification through the Virginia Board of Physical Therapy allowing them to evaluate and treat patients without a prescription. As part of your healthcare team, a physical therapist will make an assessment of your condition and create a plan to start you on the road to wellness. Our team will communicate with your physician of record and obtain a referral, if necessary, for your continued treatment. We will also work with your insurance carrier to make sure services are covered by your plan. To make your own appointment, find a clinic near you.

This article is sponsored by Tidewater Physical Therapy.

Wake up. Checks phone. Runs shower water. Checks phone. Brushes teeth. Checks phone. Makes toast. Checks phone. Walks to car. Checks phone.

Sound like you? It’s actually a lot of us. According to a Pew Research Internet Project, as of January 2014, 90 percent of American adults owned a cell phone, and 58 percent of those adults used a smart phone.

Hands down (pun intended), your hands are one of the most used parts of your body, and it’s easy to take them for granted and even easier to forget how often we are using them in every day life.

The amount of time we use our cell phones has gotten a lot of attention in recent years – and with good reason. But we need to pay more attention not just to our cell phone use, but also to all the activities we use our hands for. Why? Because of the many small joints and muscles in hands, they are more susceptible to injury.

We’ve comprised a list of some of the activities that could cause you problems if you don’t start paying attention now. Luckily, you can prevent problems with minor lifestyle changes and an assessment with a certified hand therapist.

Gardening

The sun is shining, the birds are chirping, flowers are blooming and you are out in your garden from sun up to sun down. Weeding, planting and digging are repetitive motions that can cause what physical therapists call “repetitive strain injuries.”

Here’s what to do:

1. Warm up before you dig—get your body loose.
2. Wear task appropriate gloves.
3. Take a break each hour to switch into a different activity.
4. Use good posture.
5. Use gardening tools with padded handles to protect small joints.
6. Use long handled gardening tools to shift the pressure from your hands to your shoulders.

Cell Phone Use

Many modern hand injuries stem from technology related issues, namely overuse.

In 2005, the American Society of Hand Therapists warned consumers that hand, wrist and arm injuries were at an increased susceptibility from the repetitive motion on small buttons and awkward wrists movements.

And just think how much more dependent society is on their cellphones than in 2005 (can you even remember what your cell phone looked like 10 years ago), especially when frequent text-ers now send more than 1,200 text messages a month!

In 2013 alone, 968 million smart phones were sold, adding to the possibility of tendinitis due to “texting thumb.”

Even though people generally text with both of their thumbs, most people tend to put greater pressure on their dominant hand. These repetitive joint movements could eventually develop tendonitis, a condition that can be treated with physical therapy or prevented with these tips.

1. Keep your arms in front of you to minimize the amount you are looking down.
2. Write extensive emails from your computer, not your phone.
3. Use a headset or the speakerphone feature whenever possible. Talk to text is a great tool. Use it.
4. Minimize texting when you can, or support your arms, hands and phone on a briefcase or lap while you text.

Computer Use

Many professions now require employees work from a computer for eight hours…straight. This can cause inflammation in the hands and wrists, which could lead to the often painful carpal tunnel syndrome. Many corporations are making efforts to prevent repetitive stress injuries including hiring ergonomic experts to assess workstations.

These are ways to modify habits before turning to a physical therapist.

1. Be sure to take rest periods and avoiding repetition. Taking multiple microbreaks (three minutes each) will reduce straining and discomfort without decreasing productivity.
2. Maintain good posture by keeping your spine against the back of the chair, elbows resting along the sides of the body with wrists straight and typing materials at eye level. Keeping the neck flexible and upright maintains circulation and nerve function to arms and hands.
3. Keep hands and wrists in a relaxed position to avoid excessive force on the keyboard.
4. Cut your mouse pad in half to reduce the range of movement.
5. Purchase a wrists rest that fits under most keyboards.

Arthritis

Arthritis is a condition that wears away the cartilage and lining of a joint, or the cushioning between bones, causing pain and stiffness. Arthritis in the hands can make all of those hand motions each day feel like great chores. Before taking on any activity with your hands, especially a long day at the computer or in the garden, prepare you hands in the same way an athlete might prepare their legs for a long run.

1. Practice several stretches including thumb bends, making a fist and stretching your wrists.
2. Take mini-breaks throughout the day to repeat the stretches and give your hands a break.
3. Seek the advice of a physical therapist who can evaluate your condition and prescribe specific exercises to keep you pain free or eliminate some pain.
4. Pay attention to joint problems in your body and talk to your physical therapist about unexplained joint symptoms.

The Hand Therapy Centers of Tidewater Physical Therapy treat patients with a variety of complex upper extremity issues including fractures, injured tendons or nerves, arthritis or connective tissue disorder or reconstructive surgery. Hand therapists can help restore hand function with specialized exercises, advanced therapy techniques and state-of-the-art treatments. Schedule an appointment with a Certified Hand Therapist(CHT) at any one of the following locations:

• Williamsburg Hand Therapy Center
• Gloucester Hand Therapy Center at the Court House
• Richmond Hand Therapy Center in John Rolfe

Many of the physical therapists at Tidewater Physical Therapy Inc. hold Direct Access Certification through the Virginia Board of Physical Therapy allowing them to evaluate and treat patients without a prescription. As part of your healthcare team, a physical therapist will make an assessment of your condition and create a plan to start you on the road to wellness. Our team will communicate with your physician of record and obtain a referral, if necessary, for your continued treatment. We will also work with your insurance carrier to make sure services are covered by your plan. To make your own appointment, find a clinic near you.

This post is sponsored by Tidewater Physical Therapy.

Bruce Brewer PT, MSPT, CMTPT uses Dry Needling to ease a patients discomfort

Dry Needling. It’s among the newest physical therapy trends helping eliminate pain for patients. Because it’s so new, and thanks to the needle in the name, it’s also a treatment that comes with a lot of questions.

No, it’s not acupuncture (dry needling is strictly based on Western medicine), but the needles are the same. Yes, it can hurt just a bit, but that’s when you know it’s working.

Dry Needling is a procedure where a certified physical therapist inserts a sterile, solid filament needle into the skin and muscle of a patient directly into a trigger point to help alleviate pain and other discomfort associated with a variety of conditions.

If you have poor posture, or have been doing vigorous exercise, your body develops knots, or trigger points. What they actually are is a spasm in the muscle. The trigger point, from the constant spasm creates a blockage for blood to flow properly around the rest of the tissue. That blockage causes cellular waste to build up, which then sends pain around the body.

With dry needling, a physical therapist finds the knot creating the blockage and inserts a needle to release or stop the spasm that creates the knot. With that, the blood flows through and moves the cellular waste away, eliminating pain.

“The types of patients we see for Dry Needling are those who have been in pain for some time because of poor posture or ergonomics at work or home, athletic injuries, headaches and back pain. “ said Bruce Brewer of Tidewater Physical Therapy’s Westhampton clinic in Richmond. “Others are current physical therapy patients receiving manual therapy treatments for larger issues and we incorporate dry needling as part of their overall treatment plan.”

At Tidewater Physical Therapy, we practice a sensible and conservative approach to Dry Needling. While we believe in the benefits and have seen the positive outcomes for our patients first hand, we know it is not right for every patient. Specifically, Dry Needling is not recommended for those on high-dose blood thinners or patients at an increased risk for infection because of blood disorders or those undergoing chemotherapy. For further information about dry needling, visit http://www.tpti.com/DryNeedling.

Dry Needling is offered at the following clinics in Richmond by certified and licensed physical therapists– Powhatan, Brandermill, Westhampton,Mechanicsville, Colonial Heights, Glen Allen.  In Williamsburg at the Advanced Specialty Center.  On the Peninsula – Denbigh, Oyster Point, Hidenwood, and Magruder.  South Hampton Roads – Red Mill,Kempsville, Franklin, Great Bridge and Suffolk.

This article was sponsored by Tidewater Physical Therapy

BACK PAIN: DURING AND AFTER PREGNACY

It’s estimated that 50-70 percent of women will suffer back or pelvic pain during pregnancy.  Loosening of the ligaments due to hormonal changes, additional weight, and stretching of the abdominal muscles increases stress to the lumbar spine.  If you’re lucky enough to sail through pregnancy without back pain, you’re not necessarily out of the woods.  New moms need core strength to support their spines while they tote around that precious bundle of joy – a bundle that is getting heavier every day.  We habitually carry our children on one side of our body due to upper body strength differences and hand preference.  This asymmetrical force through the spine can also lead to back pain in the months after childbirth.

WHAT IS THE CORE AND WHY IS IT IMPORTANT?

The spine is supported by several groups of muscles called the core.  These muscles working together act like a corset.  Your core muscles include the diaphragm, paraspinals (or back muscles), gluteals, the abdominals and the pelvic floor.  Towards the end of pregnancy, the growing baby is placing outward pressure on your diaphragm, pelvic floor and abdominal muscles limiting their ability to help protect the spine.  This places increased stress on the paraspinals, forcing this muscle group to work harder to compensate for the other muscles which have become too stretched to function properly.   It’s important to tone these muscles after baby arrives to protect your spine from injury.

Remember to consult your physician before beginning any exercise routine after childbirth.  If you’ve had a C-section, your doctor will likely limit your activity until your incision heals. 

THE PELVIS AND DIAPHRAM

In most cases, Kegels and breathing exercises to strengthen the pelvic floor and diaphragm can begin almost immediately after childbirth.  Kegels are performed by tightening the pelvic floor muscles as in stopping the flow of urine.  This exercise has the added bonus of preventing incontinence in women who’ve had a vaginal delivery. 

THE ABDOMINALS

You can also begin deep breathing exercises by sitting or lying in a comfortable position, then taking a very deep breath, imagining you are filling in every nook and cranny in your lungs.  Next, fully exhale, pushing out every bit of air you just pulled in.  Isometric abdominal exercises are also safe to perform early after childbirth.  These are performed while lying on your back and pulling in your abdominal muscles – think about pulling your belly button in towards your spine. 

Now that you’ve strengthened the top and bottom of the “corset,” you’ll need to work on the front, back and sides.  It’s hard to find time for exercise in the first weeks following the birth of a child, so why not exercise while enjoying some time with your baby?

Prone Plank –For the beginner this can be performed on your knees but for the more advanced, try lifting one foot off the floor.

Side Plank – Beginners can perform this exercise on the elbow and knees.  Progress the exercise by moving to the feet and hands.  You can even try lifting the top leg.

Floor Marching– For the beginner, keep your back on the floor and the abdominal muscles tightened while marching your feet up and down.  This should be done slowly and the trunk should remain stable. As you advance, lift your back off the floor for the Marching Bridge.

Squats – this is great for the gluteals!  Make sure you don’t let your knees come over your toes and keep your spine straight.  You can start with a shallow squat and try going deeper into the squat as your strength improves.

I had back and pelvic pain during both of my pregnancies that resolved soon after birth.  As a physical therapist and new mom, I can attest that taking just a modest amount of time to work on your core can really make a difference.  Your spinal stability will gradually improve as your ligaments return to their pre-pregnancy state and your core muscle strength improves.  If you have back or pelvic issues that persist, discuss these with your physician or physical therapist.  You may have an alignment issue that needs to be addressed.

Diana Brooks, PT, DPT is a Physical Therapist with Tidewater Physical Therapy in their Iron Bridge clinic where she also serves as Clinical Director.  Diana is Direct Access certified through the Virginia Board of Physical Therapy and can see patients without a referral from a physician. 

This article is sponsored by Tidewater Physical Therapy