Endometriosis is a chronic condition that affects millions of people worldwide, yet it remains widely misunderstood and often dismissed. Contrary to common misconceptions, endometriosis is not just "bad periods." It occurs when tissue similar (but not identical) to the lining of the uterus grows outside the uterus. This can lead to pain, inflammation, adhesions, and a host of other debilitating symptoms. Endometriosis Is Not Limited to the Reproductive System One of the most surprising aspects of endometriosis is that it can be found far beyond the reproductive organs. While it often affects the ovaries, fallopian tubes, and pelvic lining, endometrial-like tissue has also been discovered in the bladder, intestines, diaphragm, and even the lungs. Because of this, symptoms can extend beyond pelvic pain and significantly impact overall health. Symptoms: More Than Just Painful Periods Endometriosis symptoms vary widely from person to person. The severity of symptoms does not always correlate with the extent of the disease. Some individuals with extensive endometriosis may experience minimal symptoms, while others with mild cases suffer debilitating pain. Common symptoms include: Chronic pelvic pain Painful periods (dysmenorrhea) Pain during or after sex (dyspareunia) Infertility Pain with urination or bowel movements Fatigue, nausea, and digestive issues (often referred to as “endo belly”) The Long Road to Diagnosis Despite its prevalence, diagnosing endometriosis is notoriously difficult to diagnose. On average, it takes 7-10 years to receive a proper diagnosis. Several factors contribute to this delay: Symptom dismissal:  Many individuals are told that their pain is “normal” or that they are simply experiencing anxiety. Lack of simple diagnostic tools:  Endometriosis does not show up on routine ultrasounds or MRIs. The only definitive way to diagnose it is through laparoscopic surgery with biopsy. Symptom overlap with other conditions:  Endometriosis can mimic other disorders such as irritable bowel syndrome (IBS), bladder dysfunction, and pelvic floor disorders, making misdiagnosis common. General lack of awareness:  Many healthcare providers and patients are still unfamiliar with the complexities of endometriosis. Early diagnosis is crucial for better symptom management and treatment options, yet many individuals struggle to get the care they need. The Role of Pelvic Floor Physical Therapy in Endometriosis Care Endometriosis doesn’t just affect the reproductive system, it impacts muscles, nerves, and the entire pelvic system. This is where Pelvic Floor Physical Therapy (PFPT) can play a critical role in managing symptoms and improving quality of life. Physical Therapy can help by: Relieving pelvic floor dysfunction:  Chronic pain often leads to tight, overactive pelvic muscles. Physical therapy helps release and retrain these muscles for improved function. Reducing pain and muscle tension:  Soft tissue work, manual therapy, and relaxation techniques can ease pelvic pain and discomfort. Improving bladder and bowel function:  Many people with endometriosis experience painful urination, constipation, bloating, and other digestive issues that PFPT can help address. Supporting post-surgical recovery:  For those who undergo laparoscopic excision surgery, physical therapy can aid in restoring mobility and reducing scar tissue restrictions. Advocating for Better Awareness and Care Endometriosis is a complex condition that requires a multidisciplinary approach, including medical treatment, physical therapy, and lifestyle modifications. Raising awareness and advocating for better healthcare education can help individuals receive timely diagnosis and effective treatments. If you suspect you have endometriosis or are struggling with persistent pelvic pain, seeking care from an informed specialist, including a Pelvic Floor Physical Therapist, can make a significant difference. Endometriosis is more than just painful periods—it’s a serious medical condition that deserves recognition, research, and compassionate care.

Abdomino-phrenic Dyssynergia (APD) is a condition where the diaphragm and abdominal muscles don’t coordinate together as they should, leading to uncomfortable and often times unrelenting bloating. If you’d like to understand the mechanism of APD more indepth, visit our webpage ( linked here ). In many cases, APD responds well to physical therapy. Your therapist will teach you personalized exercises and techniques to help reset the abdominal and diaphragmatic functioning (and will also take a look at your back, pelvic floor, and even neck or hips!), but treatment often requires a multifaceted approach that includes more than just physical therapy exercises and manual treatment. Here, we will discuss some of the lifestyle changes you can make to start to reduce your bloating that you may not have considered before. What you eat vs. How you eat:  Many people with APD have tried elimination diets (like the low-FODMAP diet) with limited success. Identifying and avoiding triggering foods is highly  important, and if you haven’t worked with a dietician/gastroenterologist to identify those, that is an important next step. However, while many people consider what they eat, fewer consider how they eat. The process of eating is the start of digestion, and it is important to set yourself up for success:  Chew your food thoroughly.  Most people do not chew each bite enough, sending food to the stomach that is not mechanically broken down. This makes it difficult for the stomach to do its job, and can contribute to bloating. Chewing your food more will also cause you to eat more slowly, allowing for improved digestion and decreased gas. Mind your posture.  Do you bring your fork all the way up to your mouth, or do you bring your mouth down to meet your fork? When we chew and swallow sitting upright, our esophagus is oriented vertically, and food can easily move to the stomach with the assistance of gravity. When we are hunched forward, the path to the stomach is less direct and can lead to ingesting air and slower swallowing. Stress Management: Did you know your stress levels can have a profound impact on your digestion? The nervous system has two main modes: "fight or flight" (sympathetic) and "rest and digest" (parasympathetic). If you’re constantly in a stress state (even at low levels) your body diverts resources away from digestion and muscular tension can develop or worsen. Our nervous system doesn’t know the difference between being chased by a lion or having a big work deadline, and if it thinks we are being chased by a lion it does not worry about digesting lunch. Reducing stress is important for many reasons (as I’m sure you’ve heard!), and digestion is a major one. Here are some ways to reduce stress and support your gut health: Practice deep breathing or mindfulness exercises - there are endless breathing exercises out there, but the “best” one is the one that you can do regularly. Something as simple as breathing in for a count of 4 and out for a count of 8 is a great place to start. Doing this more frequently for short spurts is more effective than doing it less frequently for longer.  Incorporate relaxing activities  like yoga, a nice walk, meditation, or spending time with friends. Whatever makes you happy and feel more at peace- try to do more of it!  Create a calming bedtime routine  to wind down after a long day. This can help improve sleep quality, which can further decrease stress levels (see below!)  Prioritize Sleep: Sleep isn’t just for energy — it’s essential for digestion, too! When you’re sleep-deprived, stress hormones (like cortisol) can spike, keeping you in “fight or flight” mode and slowing your gut motility. High cortisol can also increase sugar cravings (and sugar intake increases cortisol- a self sustaining cycle) Aim for 7-9 hours of quality sleep each night to keep things running smoothly. Exercise:  As physical therapists, we could shout the benefits of exercise from the rooftops all day! Most people are familiar with how exercise can keep your heart, bones, and lungs healthy, but fewer are familiar with the benefits for our gut. In short, there are very few (if any) body systems that don’t benefit from regular exercise. Here are some ways that exercise can improve your gut functioning and decrease bloating: Stimulates digestion - Exercise increases blood flow throughout the body, including to the gastrointestinal tract. A short walk after meal times can really help move things along! Decreases stress- Exercise increases “happy” chemicals like endorphins, and decreases stress hormones like cortisol.  Improve Sleep- Research has shown that regular exercise improves our sleep quality. It’s all connected!  Postural Support- keeping your muscles strong and balanced can prevent one muscle group from overworking. If our back and abdominal muscles are not strong, our diaphragm might try to pick up the slack by tightening up to keep you upright. Regular strengthening exercises can help prevent this.  Your Next Steps: Making lifestyle changes can be difficult for many reasons. If this list seems overwhelming, try picking just one category to start to make changes in. Commit to those changes, and see how your body responds. You might notice that if you are able to commit to one small positive change, others will gradually follow. Trying to take on too much at once can lead to feeling overwhelmed, so focus on one step at a time.  As you start to make these changes, your physical therapist can help discuss your progress and support your journey. Additionally, they will add in highly specific exercises and manual treatments to address the mechanical dysfunction of Abdomino- Phrenic Dyssnergia.

What is blood flow restriction training?  Blood flow restriction (BFR) training is a method that uses inflatable cuffs placed around the limbs. These cuffs are inflated to specific pressures to partially restrict arterial inflow and fully restrict venous outflow in working muscles during exercise. BFR is not a new concept as it was popularized by Dr. Yoshiaki Sato in Japan in the 1980s.  How does BFR work? BFR aims to mimic the effects of high-intensity exercise by using a cuff to create a hypoxic (low oxygen) environment. This environment leads to various types of stress, including metabolic, mechanical, and neurological stress, which contribute to muscle hypertrophy and strength gains. Simply put, BFR allows you to create high-intensity work with low loads during exercise.  Is BFR Safe? Safety concerns surrounding BFR often focus on muscle damage, blood clotting, increased blood pressure, and pain. While these are valid concerns, research suggests that with proper precautions, BFR is generally safe, especially under the supervision of a physical therapist with training in BFR. Physical therapists are aware of contraindications for the use of BFR. Contraindications include history of clotting disorders, hypertension, DVT, or stroke.  BFR Applications BFR training has various applications, including: Rehabilitation:  BFR can be used in rehabilitation settings to prevent atrophy, mitigate pain, and promote muscle protein synthesis, especially when dynamic movement is limited. BFR is great after surgeries when loading or high weights are contraindicated.  Early Loading:  For sub-acute injuries or painful joints, BFR can be incorporated into aerobic exercises like walking or cycling to enhance recovery and prevent atrophy. Strength and Hypertrophy:  BFR can be combined with low-load resistance training to increase strength and hypertrophy, making it suitable for individuals who need to unload joints or have poor motor patterns. Pain Management:  BFR has shown promise in reducing pain, particularly for conditions like chronic pain and tendinopathy. BFR training offers a promising approach to achieving muscle hypertrophy, strength gains, and pain reduction. While it's essential to consider safety precautions and individual needs, BFR can be a valuable tool for rehabilitation, athletic performance, and overall fitness. If you're interested in exploring BFR during your rehabilitation journey, contact us to schedule an appointment at Zion PT. Our clinics are equipped with SUJI BFR units, one of the most advanced BFR systems on the market used for athletes in the NFL, NBA, and MLB. Learn more about SUJI here . All of the physical therapists at Zion PT are certified to administer BFR through SUJI’s certification program.  Contact Zion Physical Therapy today for all of your physical therapy needs! Phone: 212-353-8693  • Fax: 347-507-5510  • Office Email: frontdesk@zionpt.com

Sever's disease, also known as calcaneal apophysitis, is a condition that affects the growth plate in the heel bone. This condition is prevalent in active children involved in sports that involve running and jumping. Symptoms include heel pain during or after physical activity, pain and tenderness on the back of the heel, and difficulty walking or participating in sports or activities. With Sever’s Disease, we must address calf strength and ankle mobility, and strengthen the hip and thigh muscles to take excess stress off the calf and ankle. During periods of very acute pain from Sever’s Disease, decreasing overall activity temporarily may be helpful as well to allow for more recovery. Assessment of restricted areas is key in Sever’s Disease to determine why excess stress is being placed on the calf and achilles. Shown here is a test we use to determine ankle mobility and compare the affected side to the unaffected side. Physical therapy is a key component and the first line of treatment in the comprehensive management of Osgood-Schlatter's and Sever's disease. If your child or someone you know is experiencing symptoms of these conditions, seeking the guidance of a skilled physical therapist can make a significant difference in the journey towards recovery. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

Menopause is a natural phase in a woman's life that marks the end of her reproductive years. Despite it being a nearly universal experience, there is little support or information regarding the changes you can expect in your physical and sexual health. One common issue experienced by women in menopause and perimenopause is pain with sex, medically known as dyspareunia. These symptoms are often not talked about, glazed over, ignored, and stigmatized, leading many women to avoid seeking help. Despite common belief, there are several options for addressing this discomfort and its impact on intimacy. Understanding Pain with Sex (Dyspareunia): Dyspareunia is characterized by persistent or recurrent pain experienced before, during, or after sexual intercourse. The pain may manifest as a burning, stinging, or sharp sensation in the vaginal area, making sex uncomfortable or even unbearable. Some women describe the sensation of “hitting a wall”, making vaginal penetration impossible. In addition to physical pain, this condition can lead to emotional distress, relationship strain, and a decline in sexual desire, impacting a woman's self-esteem and overall quality of life. Dyspareunia is a condition that can occur at any age for many reasons, but often develops in association with menopause. We will dive into why this may occur and what to do about it next. Causes of Dyspareunia During Perimenopause/Menopause: Vaginal Dryness: During perimenopause and menopause, there is a significant fluctuation and eventual decline in estrogen levels, which can lead to thinning and dryness of vaginal tissues. This change in estrogen levels is expected and normal, but the subsequent lack of lubrication can make the vaginal walls more sensitive and causes irritating friction to dryer tissues. Vaginal Atrophy: The decrease in estrogen levels can also result in vaginal atrophy, where the vaginal walls become thinner, less elastic, and more delicate. As a result, friction during intercourse can cause pain and discomfort. Psychological Factors: Menopause often brings emotional and psychological changes that can include stress, anxiety, and unexpected changes in mood. These factors can impact a woman's ability to relax and enjoy intimacy, leading to heightened sensitivity to pain during sex. Previous Medical Conditions: Certain pre-existing medical conditions, such as endometriosis, pelvic inflammatory disease, or urinary tract infections, often contribute to pain during intercourse. If these symptoms or conditions were present prior to menopause, the pain experience associated with them may change as the hormonal environment changes. Pelvic Floor Dysfunction: When the body experiences pain, a common and unconscious defense mechanism is for muscles to contract or “guard”. The overactivity of already sensitive muscles can increase friction, sensitivity, and pain while attempting penetrative or even non penetrative sex. Treatment If you notice discomfort or pain during intercourse, you should always reach out to your doctor for possible treatment options. Many women benefit from medical management of their menopause symptoms, including but not limited to hormone replacement therapy (HRT) or topical vaginal medications. Your provider can work with you to identify what would be most helpful for addressing your needs. While medication is one option for managing symptoms associated with menopause, there are many other things you can do to optimize your pelvic functioning: Lubrication:. Lubrication can decrease friction and discomfort, reduce associated muscle guarding, and increase pleasure during intercourse. Look for a lubrication without scents or flavors to reduce likelihood of irritation (we like Slippery Stuff or Good Clean Love for water based lubricants, or Uber Lube for silicone based). Vaginal Moisturizers: Some women find that vaginal dryness is bothersome beyond intimacy. In these cases doctors may suggest hormonal treatment, but there are also topical, non hormonal agents that can be used to provide longer term relief from dryness. (we like Revaree or Replens). Stretching and Strengthening: Tissue health in any part of the body can be improved with stretching and movement, pelvic floor included! Many patients get relief from gentle yoga based stretching focusing on relaxing their pelvis and opening up the hips. Depending on symptoms, patients sometimes need strengthening as well to decrease tissue thinning and combat atrophy. Pelvic Floor Physical Therapy (PFPT): When independent exercise isn’t enough, a pelvic floor physical therapist can work with you to identify what movements will work best for you to decrease tension, improve coordination, and optimize overall muscular functioning. Pelvic floor PTs can also help reduce muscle tension manually with myofascial treatments aimed to relieve overactive muscles and reduce sensitivity. Remember, pain during sex is common, but not normal. There are many options for treatment and management- reach out to your GYN or physical therapist to get your personalized treatment plan today! Additional resources: Find a Menopause Informed Doctor Books: “The Menopause Manifesto” by Dr. Jen Gunter Instagram: @menopause_doctor , @themenopausesociety Youtube: “Discussing Sexual Health Concerns With Your Health Care Professional” by MenopauseSociety Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

Osgood-Schlatter's disease is a common orthopedic condition that primarily affects adolescents during their growth spurts. This often arises due to overuse and stress on the growth plates in the bones, leading to pain and discomfort. In this blog, we'll delve into the specifics of Osgood-Schlatter's Disease and explore how physical therapy can play a crucial role in managing and alleviating the symptoms. Osgood-Schlatter's disease is characterized by inflammation of the patellar tendon and the tibial tuberosity, the bony prominence just below the kneecap. It commonly occurs in those involved in sports that require repetitive knee movements, such as running and jumping. Symptoms typically include pain and tenderness just below the kneecap at the tibial tuberosity which worsens during more physical activity. So how does Physical Therapy help? These symptoms are arising due to excess stress on the knee through the quad and patellar tendon, seen above. The first step is to begin to take stress off of the knee during leg movements, which we do by strengthening the hip muscles. An example of differing exercise selection can be seen below. At Zion Physical Therapy, we will design customized strength programs to target the quadriceps, hamstrings, calves, and glutes, promoting better knee stability and reducing stress on the patellar tendon. Along with strengthening, we must also improve mobility in the hip and ankle to take excess pressure off the knee during activity. Once pain is more under control, we re-introduce sport/activity specific exercises to get our patients back on the field. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

Let’s talk about Juvenile Arthritis Awareness. That’s right, juvenile! When most people hear about arthritis, they probably don’t first think of kids but did you know that approximately 300,000 children in the US have some type of arthritis? Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory autoimmune disorder that occurs before age 16. The mean age of onset is 1-3 years old and it affects twice as many girls as boys. With JIA, the body’s immune system attacks its own tissues making them irritated and inflamed, causing them to thicken and grow abnormally. It eventually causes damage to the bone and cartilage (padding) of the joint and surrounding tissues. COMMON SYMPTOMS: Many have periods without symptoms (remission) and periods of worsening symptoms (flareups). Joint pain, stiffness, swelling. Pain is more severe in the morning or after naps. Pain is common in knees, hands, and feet. Decreased range of motion. Limp, due to pain in the lower body. Joint deformities, abnormal growth. Muscle aches Extreme fatigue. DIAGNOSIS: Patient and family history, symptoms, number of joints involved, lab tests, sometimes imaging. CAUSE: Largely unknown. It may be due to environmental triggers, viral or bacterial infections, or genetic predisposition. Most experts believe it’s due to an overly active immune system. TREATMENT: The goal is to stop or slow the progression of inflammation, relieve symptoms, improve function, and prevent more joint damage. PT: Focuses on gentle range of motion, physical activity, stretching, joint protection, muscle relaxation, hot/cold packs, and may use a splint or orthotic to maintain normal bone and joint growth. During a flare-up, rest and reduce symptoms. Treatment includes icing and performing a type of muscle strengthening called isometric contractions. During periods of remission, stay active and involved in sports and activities with peers. This will help maintain range of motion, build and maintain strength, and can help decrease symptoms. Top Physical Activities: Swimming, cycling, yoga, and tai chi. Swimming is great because it is low impact and does not require repetitive stress to load-bearing joints. Kids Yoga Poses: Medication for pain control, joint preparation for mobility, and treatment assist normal growth of a child. Want to learn more? Check out this website: https://www.arthritis.org/juvenile-arthritis Does your child have juvenile arthritis? Call Zion PT at (212) 353-8693 or email schedule@zionpt.com and we’ll start with an assessment, then treatment to help regain function, mobility, and decrease pain.

WHAT IS CONSTIPATION? Constipation is defined as infrequent (fewer than three) bowel movements per week. About 80% of people experience constipation during their lifetime and brief periods of constipation is normal. Common symptoms can include: Decrease in amount of stool Need to strain to have a bowel movement (BM) Sense of incomplete emptying Need for enemas, suppositories and/or laxatives in order to maintain regularity Any persistent change in bowel habits, such as an increase or decrease in frequency or size of stool, blood in stool, or an increased difficulty in evacuating, warrants a medical consultation. WHAT ARE NORMAL BOWEL HABITS? For most people, it is normal for bowel movements to occur from 3 times per day to 3 times per week. Some people can go for a week without experiencing discomfort or harmful effects. Normal stools should be about the size, shape and consistency of a ripe banana. WHAT CAUSES CONSTIPATION? Constipation may be the result of several, possibly simultaneous factors including: Limited fluid and fiber intake Imbalances in the diet (too much sugar and animal fat) Sedentary lifestyle Repeatedly ignoring the urge to have a BM Slow movement of the stool - too much water absorption in the colon Lifestyle changes, such as pregnancy and travel Laxative abuse CAN MEDICATIONS CAUSE CONSTIPATION? Yes, constipation can be caused by medications you are taking for other conditions. Common medications include pain medicines, antidepressants, psychiatric medications, high blood pressure medication, diuretics, iron supplements, calcium supplements, tranquilizers, antacids containing aluminum. Changes in bowel habits should always be reported to your physician. If you have a history of constipation or have recently become constipated, discuss this with your physician. HOW DOES CONSTIPATION AFFECT THE BLADDER? Constipation is another possible cause of bladder control problems. When the rectum is full of stool, it may disturb the bladder. Chronic constipation and/or straining can lead to excessive stress on pelvic organs and nerves. This condition also contributes to bladder dysfunction. HOW IS CONSTIPATION TREATED? Most people in Western society need more fiber in their diet. Fiber supplements or other bulking agents sold at drug stores are available. Fiber supplements take several weeks, possibly months, to reach full effectiveness, but they are not habit forming or harmful as some laxatives can be with overuse or abuse. It is important to avoid regular use of laxatives and enemas as they decrease the ability of the bowel to function. You should discuss your fiber needs with your physician, pharmacist or nutritionist. Typical dietary recommendations for fiber are between 25-35 grams per day. Most Americans consume only 10-15 grams per day. When adding fiber to your diet it is important to remember to drink plenty of fluids at least 6-8 cups per day. Your body has a natural emptying reflex. Approximately ½ hour after eating a meal or drinking a hot beverage, a reflex occurs to increase motility or movement of the stool down to the rectum. This reflex usually occurs in the mornings when trying to get yourself or your family ready to get out the door. Try getting up earlier to eat breakfast and allow time to take advantage of this reflex. It is also helpful to properly position yourself on the toilet to allow for maximal relaxation of your pelvic floor muscles. Be sure your feet are supported or use a stool to obtain maximal hip and knee flexion, similar to a squat position. Leaning forward and supporting your elbows on your knees is also beneficial. Pay attention to the relaxation of your pelvic floor muscles while emptying your bowels. Be sure to take time to empty your bowels. Remember the word “rest” in restroom. Exercising on a regular basis is also helpful to stimulate a sluggish bowel. This recipe is commonly suggested to promote regular bowel function by increasing dietary fiber. You may experience a bloated feeling and have gas when adding fiber to your diet but this should pass within a few weeks. This may be eased by adding fiber slowly to your diet. RECIPE FOR BOWEL REGULARITY * (ASK YOUR GI MD BEFORE STARTING THIS) Mix together: ● 1 cup applesauce ● 1 cup unprocessed wheat bran or oat bran ● 3/4 cup prune juice Begin with 1-2 Tbs. each evening mixed with or followed by one 6-8 oz cup of water or juice. This should help to soften and regulate your bowel movements within 2 weeks. If no change occurs, slowly increase serving to 3-4 Tbs. This may be stored in your refrigerator or your freezer. One to two tablespoon servings may be frozen in sectioned ice cube trays or in foam plastic egg cartons and thawed as needed. * 1 tablespoon is approximately 2 grams of fiber with wheat bran & 1 gram with oat bran. Contact Zion Physical Therapy to schedule an in-person or online tele-health appointment: Phone: 212-353-8693 Office Email: frontdesk@zionpt.com Online Form: Request Appointment

Balance. How many runners are out there that own “balanced” as a trait? You eat a plate of different colored foods, go to yoga (occasionally but it counts!), spend time at the gym doing strength work as running gurus suggest, sleep often. This is balance. Now how many of you can lift one leg off the ground and continue to read this without falling over? Pick yourself up off the ground if it didn’t work out, sit, and let me tell you about balance. As we run, our two feet are never on the ground at the same time. We expect each leg, on it’s own, to hold us up and propel us forward as we cycle through gait. Simply standing on one leg, your support limb is working really hard to keep your other hip up - which is known as stability. When we add forward motion that standing leg's muscle must provide enough capacity to propel our bodies through space in addition to not allowing our other side to drop down. That means the stance leg has to be really strong in multiple directions – which is why we have a lot of muscles that cross the hip joint and work together to make running beautiful! If you find yourself unable to stand on one leg in quiet standing, think about the muscle imbalances that exist and work against you while running! The body will make compensations and allow us to run even if our hips are weak and stability is decreased – as in, you don’t see people trying to run and falling all over the place in Central Park. However, when muscles try to work harder than they are capable, or too much at an action they really aren’t designed for, we suffer from varying degrees of overuse, strain, tendinopathy, joint dysfunction, and pain. This is a PSA for all runners to start addressing balance- in the weight room, at work, in the living room – it all counts. Stand on one leg as you brush your teeth or cook dinner, try some single leg squats or deadlifts (shown below) - being aware of your opposite hip and controlling it if it drops down. If you have some odd pains with running or are concerned about your stability, #getPTfirst!

Iliotibial band syndrome (ITBS) is often described as a pain and discomfort along the outside of the thigh and knee. It is a very common overuse syndrome frequently associated with activities that require repetitive knee flexion and extension such as long distance running, biking, circuit training, skiing, dancing, jumping sports...the list goes on! Although the aforementioned activities make us prone to developing ITB Syndrome, a stressed and angry Iliotibial Band will not hesitate to make itself known even if in the absence of said sports. Anatomy The Iliotibial Band is a fascial band that originates from the Tensor Fascia Latae muscle (TFL), attaches high on your pelvic bone (the Ilium), runs down the side of the thigh and attaches to the side of the knee/lower leg (the Tibia). Can you see from this depiction, the reason why your symptoms are distributed in that seemingly strange pattern? Common symptoms Pain (maybe burning) when applying pressure to the side of your knee. Lateral hip or knee pain may worsen when running or walking down stairs. Possibly a slight snapping sensation on the outside of the knee when bending it Symptoms worsen with increased activity. Why is this happening to me? There are many other factors surrounding ITB syndrome, including strength and flexibility of the surrounding thigh and hip muscles, core stability influencing body mechanics, the type of shoes you’re wearing or even training on a slanted terrain could all be playing a role in your current situation. Let’s look at some of these factors briefly; Weak glutes; weakness in your gluteal muscles can lead to changes in your body mechanics during movement, such as the way your feet hit the floor as you run (excessive pronation), the way your knees align when supporting your weight (increased valgus) both of which when occurring repetitively will cause friction to the IT Band which inserts on the outside of your knee. Weak core; weakness in your core can cause poor control of your pelvis and hips, which translates down the chain into faulty mechanics like the ones described above. . What can physical therapy do for me? Physical therapists are trained to observe and assess how your musculoskeletal system is working. We look at the way you run, walk, squat, step up onto a platform etc. looking for the minutiae of your mechanics. We perform strength and balance tests to assess how those things are contributing to the workings of your system. We will identify areas of pain, tenderness, tightness in your body. We gather this information so as to devise a plan that addresses your problematic areas in order to restore and improve mechanics and function, thereby helping you reach your personal goals. A general treatment map for ITB Syndrome includes: Hip/core strengthening: Strengthening weak muscles of the hip, pelvis and core will allow for the stability needed for better lower extremity mechanics. Stretching: ITB flexibility and health can be positively influenced by keeping hip muscles that attach to it lengthened. Foam rolling: Another effective tool to maintain ITB flexibility and health! Body Mechanics: Re-educating your awareness through exercise to maintain alignment and use effective body mechanics will translate to the activities you love such as dancing, running, biking and is an integral part of your rehabilitation process.

INJURY SPOTLIGHT: Obturator Internus Dysfunction Do you have hip pain? Do you also have hamstring pain? Have you been told that you have Hamstring Tendonitis or Hamstring Syndrome? When asked to describe where your pain is, do you feel like you need to point “up there” to really pinpoint the location of pain? If so, you may have obturator internus dysfunction. Anatomy The obturator internus (OI) is a hip muscle that originates deep within the pelvis, wraps out and inserts on the posterior aspect of the head of the femur (the thigh bone). The OI’s main function is to rotate the leg externally and has a major role in stabilizing the head of the femur into the hip socket. Muscle Dysfunction and Trigger Points Just like any other muscle in the body, the OI can become dysfunctional and trigger points (TrP) can arise for various reasons. In general, a trigger point is involuntarily contracted muscle fibers within a whole muscle. Because the TrP is involuntarily contracted and we cannot voluntarily relax the muscle fibers, blood flow is reduced to that area of the muscle as well as surrounding nerves and other tissues. This loss of blood flow can then result in hypersensitivity directly at the site of the TrP as well as aching pain in the surrounding area. TrPs can be latent or active. A latent TrP is one that does not cause pain unless provoked, like with direct pressure, but it possesses the ability to cause unprovoked pain. An active TrP is one that refers pain to other areas without being provoked. OI trigger points can refer throughout the hip and leg on the side that it is originating from. This is a main reason why many patients are treated unsuccessfully for possible hamstring syndrome and/or gluteus medius dysfunction when really the root of their problem is deeper and located at the OI muscle. IS IT OI? Having had personal experience with OI Dysfunction and treating patients with the issue, I have found that there are a few initial cues that help to tease out whether a patient is suffering from OI dysfunction versus hamstring, piriformis and/or gluteus medius syndromes. The first major sign is that the patient has difficulty pinpointing one location of pain. This is because the OI muscle has many different referral patterns. Patients might say one day that they have pain on the lateral side of their hip or the pain is in the buttock region. Then on another day they might describe a burning-type of pain at the insertion of the hamstring muscle at the “sit bone”; or maybe all three at once. Upon further investigation of these muscles with deep palpation, the patients might report that there is soreness in the area but that is not their “familiar pain.” The next appropriate question focuses on locating where the exact familiar pain is as best as possible. This can be achieved by ruling out other muscles first. When asking a patient to pinpoint the exact location of the majority of their pain I ask it three ways. First, I ask by pointing to a spot directly over the piriformis muscle. Second, I point to the origin of the hamstring muscle at the “sit bone” (red arrow). And thirdly, I ask is it “up there” (green arrow)? If with deep palpation just medially to the “sit bone” and above the bottom of the butt cheek, familiar pain is reproduced you could be suffering from OI Dysfunction. Common OI Dysfunction Symptoms The pudendal nerve runs in close proximity to the OI muscle which can become irritated with OI TrPs and can cause various other symptoms as well. Many patients come into Zion Physical Therapy for hip and leg pain with running and biking and the OI muscle is the culprit. However, the OI muscle is also highly involved with pelvic floor dysfunction due to the potential of the pudendal nerve involvement. The pudendal nerve branches into three smaller nerves which supply sensation and muscle control to the rectal, perineal and clitoral/penile areas. Because of these innervations, OI dysfunction and TrPs of the OI muscle can cause other symptoms such as urinary frequency, urinary burning, itching, tingling, shooting pains into the groin and abdomen and others. OI pain can manifest itself in many different ways. If you have hip, low back or groin pain or abnormal pelvic floor symptoms that have not resolved with medical attention of any kind, then call Zion Physical Therapy to schedule an appointment and determine if OI dysfunction might be the cause of your pain.

Take this Quiz to find out: By Brooke David, DPT Recent reports show that constipation rates are high all over the world--which leads me to ask--why? There are all sorts of factors that play a part in successful defecation such as: hydration, a well balanced diet, activity levels and of course different medication can always have an impact on our normal bathroom routine. But--how do you know if you are pooping correctly? Did you know your form and how you are going can also contribute to constipation? Answer these questions below to help better understand if you are going to the bathroom like a pro or if you need a few lessons. When do you decide it is time to poop? When I get the urge to go When I wake up in the morning after having coffee After work before I shower I need suppositories to flush me out Do you find yourself out of breath during or after pooping? No Yes Sometimes Not sure What is your stool’s normal consistency? Soft banana Sausage type & Lumpy Hard pellets All liquid How long are you sitting on the toilet? 5 mins or less--who has time? 10-15 mins --I like to read the news too 15-30 mins -- gotta play one game of candy crush 30-60 mins+ --just waiting for as long as possible What does your posture & form look like while pooping? Feet on a stool, leaning forward with legs open and space for the belly to expand Straight up nice & tall with feet on floor Slouched with feet on floor or stool--depends on the bathroom I have no idea I have never thought about this! If you answered all #1 then you get an A+! If you answered anything but 1, here are some basic tips to consider to help improve the defecation process: Go when you get the urge--don’t delay if possible! While defecating, open your mouth and exhale--you can grunt or sing as well! Aim for poop to be soft like a squishy banana so it is easier to pass A squatting position relaxes the pelvic muscles so using a stool or squatty potty can help Drink as much water as possible Lead an active lifestyle These are some simple lifestyle changes that can be made to improve your ability to defecate. If you have questions or feel there is more to the problem, then you should come see a pelvic floor specialist at Zion for further help. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com