Are you a dancer with pain in the front of your hips (anterior hip pain)? Have you been told that you have ‘snapping hip syndrome?’ You are not alone! Anterior hip pain and snapping hip syndrome are very common in dancers. What is snapping hip syndrome? There are two kinds of snapping hip syndrome. The first is when the iliotibial band (IT band) snaps over the outer hip bone, known as the greater trochanter as shown below. 2. The more common type seen in dancers is when the iliopsoas tendon snaps over bony prominences in the front of the hip joint as shown below. It is usually caused by overuse, tightness, and dysfunctional muscle firing of the hip flexors - muscles you use every time you lift your leg to the front or side (think fondues, developpes, and grand battements). Due to dysfunctional muscle firing patterns, the head of the femur (thigh bone) is pulled forward in the hip socket. The snapping then occurs when the tight hip flexor muscle/tendon of the iliopsoas snaps over the head of the femur. How is it treated? Snapping hip syndrome and other anterior hip pain can be treated conservatively with physical therapy. Treatment will likely include: Neuromuscular reeducation to restore proper coordination of the hip muscles Lumbopelvic stabilization exercises Hip joint mobilization to restore proper mechanics as needed Muscle energy and release techniques Targeted stretching Most importantly, dancers need dance-specific exercises in order to improve muscle firing patterns while dancing. Typically a physical therapist (PT) will begin by training your deep core muscles to improve lumbopelvic stabilization. You may then work on training the iliopsoas (the deep hip flexor muscle) to fire before the rectus femoris and tensor fascia latae (TFL) (the superficial hip flexors), when lifting the leg. Your PT may have you perform low developpes to the front and side, focusing on your muscle firing pattern and technique (such as not hiking the hip, turning out from the deep hip external rotators, etc). You will also likely do hip extension strengthening exercises, specifically focusing on your gluteus maximus in order to help normalize hip joint mechanics. Often dancers will also need soft tissue mobilization to the TFL and rectus femoris, and possibly the iliopsoas. They then need to be taught how to properly release and stretch these muscles on their own. Stretching is not always the answer! Dancers love to stretch when something hurts. But depending on how you are stretching, you could be causing more harm than good, especially with anterior hip pain. To stretch the front of the hips, dancers typically like to hang out in deep lunges. But what most dancers don’t know is that in this deep lunge position, you are stretching your hip joint capsule more than your hip flexors, which could be contributing to your anterior hip pain. If you have a snapping hip, stretching in a deep lunge is particularly a bad idea, as it sends the head of your femur even further forward than it already is. Instead, make an appointment to be evaluated by a dance medicine physical therapist so that you can be properly treated and return to dancing pain free! If you’d like to make an appointment to be evaluated by one of our skilled Dance Medicine Physical Therapists, please call (212) 353-8693 or email schedule@zionpt.com.

You signed up for the Corporate Challenge…. Now what!? Top 10 Things to Do 10. Invest in a new pair of running shoes - running shoes typically last about 6 months 9. Write down a goal for the race - for example, finish time, don’t walk, have fun, high five spectators 8. Foam roll - most gyms have foam rollers, if not it’s $10 on Amazon..happy muscles = better running 7. Sleep more - our bodies recover from hard work while we sleep 6. Hydrate - drink water alone or with electrolytes often throughout day especially if you are drinking coffee and/or alcohol 5. Go for a run in the evening - the race is a 7pm or later start, acclimate to evening conditions 4. Practice fueling before a run so you know what to eat pre race - usually bland items, simple carbs 3. Look at a course map so you know where to expect ascents, descents, and flat terrain 2. Find a buddy to train with 1. Enjoy the process - exercise is fun! And even more satisfying when you achieve a goal! Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

THE IMPORTANCE OF REST Contributed by Guest Blogger, Coach Mikael Hanson www.enhancesports.com I wanted to begin with a discussion on the importance of rest – an area that I see over-looked all too much and which is increasingly important especially as we get older. In my twenties recovery came easy and rest days, well those were few and far between and in my opinion for the weak minded. I used to become overcome with guilt for skipping a training day. Even when I was sick, I lived by the mantra that somewhere, someone is training and when you meet them in competition, they will beat you. They say, with age comes wisdom. I no longer feel guilty for missing an occasional workout, and realize that some of my best performances have come after a period of forced rest. It may have taken two decades of lessons, but I now look forward to my recovery days and it is not uncommon for me to string together back-to-back rest days. The forty-something me is also much more in tune with my body. I take my resting heart rate and check my body weight every morning, looking for those early warning signs of not being properly recovered (perhaps bordering on obsessive-compulsive behavior). SLEEP As someone who has battled with the debilitating affects of insomnia I know all to well what a lack of sleep can do to not only one’s performance but also to their state of mind. Former professional triathlete and now endurance coach, Wes Hobson, believes one should not train unless they got a minimum of 6 hours of continuous sleep the night before - if that were the case, I would have had to skip the last half decade of training! Living in New York City, one complaint I constantly hear from many of my athletes is their inability to get enough sleep. Work commitments, quality family time, training, recovery, all take their toll on us amateur athletes. A close look at the training regimen for any professional endurance athlete will invariably include at least 8 hours of sleep each night PLUS a nap. Now if we could all do that, I think most of us would be able to elevate our performances! I have battled sleep troubles for years and knew I really needed to focus on my own sleep routine if I wished to stay competitive on the racing scene as well as just plain healthy as a person with a family. This is one of the reasons I have my athletes keep track of their own sleep patterns and resting heart rates as part of their training log - to help them identify when they have not gotten enough rest and need to take it easy! As for how much sleep one needs - that is a very individual thing. Here are some tips to help you sleep or at least find a relaxed state: Caffeine - Yes, the lifeblood of endurance athletes - but try to go decaf after 3pm! Sugar - Ever see how your kid acts after a post-dinner cupcake? Well - we are the same and some extra sugar in the blood stream will keep you up! Alcohol - No, a glass of wine or beer before bed DOES NOT help you sleep! Dinner - Avoid eating late and spicy meals and you will find falling asleep a tad easier! Environment - Make sure where you sleep is dark and try to avoid reading or watching TV in bed as you want the bed to represent a place to sleep in your mind. Relaxation - Can't seem to leave work at the office? Try writing down the exact things weighing on your mind on a pad of paper before bed and get into a routine of relaxation before you sleep - a few minutes of stretching and deep breathing from the diaphragm will help! Natural sleep aids - Valerian root and melatonin are both natural sleep aids that do help some (myself not included and be warned that Valerian root has a very distinctive smell!). Also magnesium is said to help open up the capillaries and can help you relax at night. Avoid taking your vitamins at night (better taken in the AM). One of my favorites - a nice hot bath before bed works wonders! SIGNS OF OVER TRAINING Over-training is a word endurance athletes hear a great deal and is something no longer isolated to the ranks of Pro athletes. Even us amateurs can fall victim to over-training, especially when trying to balance training and racing with a family and full time job. Over-training should not be confused with another term thrown out by the endurance world, over-reaching. Signs associated with over-training syndrome include: Extended decreased performance Elevated resting heart rate Significant change in body weight (either up or down can be a sign) Difficulty sleeping (perhaps a source of recent insomnia?) Prolonged muscle soreness Frequent illness or onset of colds Low energy level and motivation (especially toward training) Mood swings Decreased appetite Several poor workouts in a row Besides training, several other non-exercise related factors can contribute to the onset of over-training; poor eating and hydration habits (before, during and after exercise), recent illness or injury (and resuming training without being fully recovered), poor sleep habits, travel and jet lag, are among the most common non-exercise contributors to over-training. Add to this list psychological stresses like death of a loved one, new addition to the family, stress at work or financial problems and you can see just how quickly over-training syndrome can sneak up on an athlete. Over-reaching can be a normal aspect of one’s training regimen. To over-reach is when one ‘overloads’ their training volume over a brief period in hopes of seeing significant results in a shorter period of time. Pushing one’s body to this higher limit of activity (but not going into the over-trained zone), allows for the body to enter a super-compensation mode, where upon recovery your overall fitness level is much higher than before. The key factor for over-reaching to work is pairing it with proper recovery (without, you risk over-training). While over-reaching may take several days to a week or more to fully feel like your old self again depending on the training load, over-training can take months to fully recover from. What is the remedy for over-training? Try simple, old-fashioned rest. Put the cycling or running shoes in the closet, skip some races and just chill. Let your body recover, so you can come back fresh and strong! Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

Approximately 50% Of Women Globally Develop Pelvic Organ Prolapse (POP) Caused By Childbirth! Imagine your pelvic floor muscles are like a hammock. This hammock generally supports 3 organs in females: the bladder, uterus and rectum. The hammock is designed to stretch but still be supportive. If the “hammock” is damaged or weakened, it may lose support and strength and may not be able to support all the organs. These organs may start to drop into or through the vaginal walls, which otherwise known as pelvic organ prolapse. Pelvic Organ Prolapse occurs when a pelvic organ such as the bladder, uterus, bowel, or rectum descends from the normal anatomical position. A prolapse can descend within the pelvis or protrude from the body as well. So, what can put you at risk to develop a prolapse? Several risk factors exist, including systemic hyper-mobility and obesity. Several types of prolapse exist, including: Cystocele (prolapse of bladder) Urethrocele (prolapse of urethra) Uterine prolapse (prolapse of uterus) Rectocele (prolapse of small rectum) Enterocele (prolapse of small bowel) Most common symptoms include: Feelings of pressure, bulging, pain, or fullness in vagina, rectum, or both -- sometimes you may even see a physical bulge coming out of the vagina or rectum Incomplete bladder or bowel emptying Urinary incontinence & frequency Low back/pelvic pain that worsens with standing or exercising and is relieved with laying down Chronic constipation If you do have a pelvic organ prolapse, there are many conservative options to manage your symptoms, including pelvic floor physical therapy. Pelvic floor muscle training is the #1 recommended intervention for pelvic organ prolapse. Recent high quality studies have shown that pelvic floor muscle training can significantly improve feelings of heaviness, reduce vaginal position and bulging, and also reduce urinary and fecal incontinence. A pelvic floor physical therapist can educate you on pelvic floor muscle training and teach you strategies to help reduce your symptoms and improve your quality of life! Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

These simple instructions were designed to help answer common questions about your postoperative recovery as well as guide you back to your previous level of activity.  Check with your physician prior to beginning this program. WHAT DO I NEED TO AVOID? It is very important that you avoid anything that will stress or strain your incision.  Every day activities like lifting groceries and toileting can cause problems. They can put undue stress on your bladder repair and potentially weaken it.  Try not to strain (hold your breath and bear down) while having a bowel movement and avoid constipation. If you need to cough or sneeze, you should place a pillow or your hands over your lower abdomen and support it as best you can to counteract the intra-abdominal pressure. WHAT CAN I LIFT? It is recommended that you do not lift anything over 10 pounds in the first 6 weeks after surgery. After 6 weeks, you may gradually increase the weight of objects you lift. Never lift anything you feel you cannot easily handle. Technique is important. Do your pelvic brace by contracting your pelvic floor and lower abdominal muscles together as you begin to lift heavier objects.  It is extremely important to use proper body mechanics when lifting.  Be sure your back is straight and your knees are bent.  When you lift even a light object, keep it close to your center of gravity (near your belly button) and lift with your legs not your back. WHEN CAN I EXERCISE? Once you get home you should climb stairs only as necessary to get to your bedroom or bathroom. A gentle walking program will gradually build up your endurance and can be initiated for short distances (around the house) in the first week. Remain at low level, gentle walking until your recheck appointment when your doctor can see if you are healed and ready for more vigorous activity. Consult with your physician about when it is OK to begin a pelvic floor exercise program.   Pelvic floor muscle exercises, also known as Kegel exercises, help strengthen and support your bladder repair. If you have difficulty learning how to contract these muscles you may need extra help to relearn how to use the muscles and to start strengthening them. At this time, you should consult your therapist to instruct you in proper abdominal muscle training, lifting and postural exercises. This will ensure that the correct muscles are functioning. WHEN CAN I BE SEXUALLY ACTIVE? It is not recommended that anything be placed in the vagina for 4 to 6 weeks post surgery. This includes tampons and douching.  When you resume penetration or intercourse, it may be uncomfortable and you may need to use plenty of lubricant.  Go slowly to allow the tissues to stretch gradually.  If pain persists, massaging the scar may help. Discuss any problems with your physician. POSTURAL CONSIDERATIONS It is common to maintain a more bent or flexed posture after any kind of abdominal surgery. It is important to do some gentle exercises and to stand up straight to avoid poor posture becoming a habit.   General posture exercise Stand against a wall with your knees slightly bent. Place your arms in a “hold up” position or in the shape of a goal post. Perform a pelvic brace by contracting your pelvic floor and lower abdominal muscles together. In this position slide your hands up toward the ceiling being careful not to let your  arms come away from the wall. Repeat this exercise 3-5 times at least 2-3 times a day. WHEN CAN I EXERCISE MORE VIGOROUSLY? If you participate in running or jumping sports, avoid returning to those sports until at least 12 weeks after surgery. This may be difficult to do because you feel ready to return to your previous level of exercise, however your bladder may not be as ready as you are. Return gradually doing 30%-50% of what you did prior to surgery. For example, if you ran 3 miles per day before surgery, start out with no more than 1 mile. If you feel any discomfort, pain or pressure in the lower abdomen, ​stop exercising immediately​! If you have any questions about your postoperative recovery, please call your physician or therapist. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

*WHAT: Autism spectrum disorder (ASD) is a developmental disability that involves developmental delays, as well as social, communication, and behavior impairments. It’s a spectrum because the signs, which can begin as early as childhood, can range from mild to severe. *CAUSE: All aren’t known but the following may increase the likelihood of someone developing ASD: environmental, genetic, and biological factors. *SYMPTOMS: Research shows that individuals with ASD may have impaired motor skills including limited coordination and postural control. They can have more difficulty with planning and executing certain motor skills and learning through imitation. Two core signs include challenge in social communication and interaction as well as restrictive and repetitive patterns of behavior. *TREATMENT: The good news is that research shows that PT can help those with ASD to improve development and skills. There is no “standard” treatment that exists for kids with ASD as treatment is based on each individual child’s impairments and functional limitations. Researchers found that combining PT with fun activities has great benefits. Fun activities like dancing to music and yoga, along with specific PT exercises prescribed by a skilled pediatric PT can help with physical, social, and cognitive abilities. Get Moving With Some Yoga Poses: Turn On Some Favorite Tunes And Have A Dance Party: Interested in learning more about autism spectrum disorder? The Zion PT team of physical therapists are here to help and can set you up with an evaluation. Call (212) 353-8693, or email schedule@zionpt.com and check out this website for more info: https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-autism-spectrum-disorder

The pelvic floor consists of several layers of muscles that cover the bottom of the pelvic cavity. These muscles have several distinct roles: 1. To support the pelvic organs, the bladder, uterus and colon within the pelvis. 2. To assist in stopping and starting the flow of urine or the passage of gas or stool. 3. To aid in sexual appreciation. How to Locate the Pelvic Floor Muscles: The Urine Stop Test At the midstream of your urine flow, squeeze the pelvic floor muscles. You should feel the sensation of the openings close and the muscles pulling up and into the pelvic cavity. If you have strong muscles you will slow or stop the stream of urine. Try to stop or slow the flow of urine without tensing the muscles of your legs, buttocks. Do this only to locate the muscles, NOT AS A DAILY EXERCISE!!!! Feeling the Muscle You can insert 1 or 2 fingers into the vagina to feel the contraction and lifting of the muscles. You should feel the opening of the vagina tighten around your finger. Place a fingertip on the anal opening. Contract and lift the muscles as though you were holding back gas or a bowel movement. You will feel your anal opening tighten. Watching the Muscle Contract Begin by lying on a flat surface. Position yourself with your knees apart and bent with your head elevated and supported on several pillows. Use a mirror to look at the anal and vaginal openings and the perineal body (the area between the two openings). Contract or tighten the muscles around the openings and watch for a lifting of the perineal body and closure of the openings. If you see a bulge or feel tissues coming out of your openings, this is an incorrect contraction and you should notify your health care provider for more instructions. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

1. Dry needling can help reduce local and referred pain and soreness If you're comfortable with needles that don't involve much, if any, pain, you might consider this therapeutic technique if your physical therapist recommends it. A specially trained physical therapist uses a thin needle to release muscle tightness, ease tendonitis and inflammation, and/or promote healing or muscle activation. 2. How does dry needling work with chronic muscle tightness? It stimulates a trigger point in a skeletal muscle. You might call it a knot, and it can cause more widespread pain than just the muscle in which it's found. Another name for a trigger point is myofascial pain syndrome. A tight band of skeletal muscle inside a larger muscle group, a trigger point can be tender when you touch it and may cause pain in other areas of your body. As part of a larger treatment plan, your therapist is using dry needling to try to release the trigger point, relieving pain and/or improving your movement. A twitch can occur when the needle goes into the trigger point, and may be a sign that the therapy is working and reducing muscle tension. 3. What is a typical Session that uses Dry Needling like? At Zion Physical Therapy, you can expect to get treated with Dry Needles for up to 5-10 minutes. Once completed you can expect to do light stretching and then follow up with some exercise to utilize the muscles fibers that just were “freed from the knots” to work normally again. This should help your muscles have better memory of working normally again, leading to less pain when you leave the office that stays lowered. 4. Therapeutic dry needling promotes healing. The technique also can help with muscular issues that don't involve trigger points such as rotator cuff damage. The needle creates a tiny lesion in the tissue, promoting blood flow and healing to the area. 5. Dry needling is different from acupuncture. Dry Needling is NOT acupuncture. The two philosophies are quite different. Therapeutic Dry Needling is based on Western medicine. Acupuncture is based in Chinese medicine and focuses on balancing the flow of energy in the body or Chi. 6. No liquid is involved. The needle itself produces release in the trigger point. There's no solution injected into the muscle. The needle is also not dipped in any solution. 7. Physical Therapists are trained and allowed to administer Dry Needling to patients. As part of their entry-level education, physical therapists are well versed in anatomy and therapeutic treatment of the body. Physical Therapists have taken Gross Anatomy where they learned the depth and three dimensional anatomy required to administer Dry Needling effectively and safely. Physical therapists who perform dry needling are required to supplement that knowledge by obtaining specific postgraduate education and training. 8. Dry Needling does not cost extra! It will be included as part of your session with us at Zion Physical Therapy. Learn more about Trigger Point Dry Needling If you have any questions about whether Trigger Point Dry Needling is right for you, please reach out to Zion Physical Therapy at (212) 353-8693 or email schedule@zionpt.com.

What Is Spina Bifida? Spina bifida occurs before birth when the neural tube (what later becomes the spinal cord) does not fully close during the first month of pregnancy. As a result, there is a malformation of the bones protecting the spinal cord and damage anywhere along the spinal cord and surrounding nerves. Surgery is typically required shortly after birth. About 1,500 babies in the US are diagnosed with the condition per year. It can cause physical, cognitive, and sensory impairments. How Can Physical Therapy Help? PT is important in helping children move, reach developmental milestones, and prevent or decrease long-term complications. Treatment will be tailored to meet the patient’s specific needs and goals. Activities may include walking training (with or without assistive devices), treadmill training, stretching, and exercises for strength, balance, and coordination. Recommendations for equipment to maximize function may include orthotics, crutches, walkers, standers, or wheelchairs. Furthermore, PTs at Zion PT work closely with your child’s pediatrician and can help determine if the patient could benefit from other health care services. Interested in learning more? For more information, you can go to https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-spina-bifida To schedule an evaluation with a pediatric Physical Therapist, call (212) 353-8693 or email schedule@zionpt.com.

Current treatments for osteoporosis include pharmaceuticals, nutritional intervention and physical therapy. But what about YOGA?? Yoga as an intervention has excellent accessibility. There is minimal to no cost related and minimal training required. The ‘side effects’ of yoga include improved ROM, improved strength, improved gait, improved posture/balance and decreased anxiety. Ready for some shocking facts?? Currently osteoporosis affects ~200,000,000 individuals worldwide. Per year in the United States, there are over 700,000 spinal fractures and more than 300,00 hip fractures. Of the annually 2 million individuals who experience a hip fracture: 25% will die within a year and an additional 25% will never be discharged home. Roughly $19 billion is spent annually in related health care costs. So what can we do?? Current treatments for osteoporosis include pharmaceuticals, nutritional intervention and physical therapy. Pharmaceutical therapies include: bisphosphonates and serum estrogen receptor manipulators whose common side effects include gastrointestinal distress. Nutrition intervention often includes Vitamin D and calcium supplementation. Physical therapy consists primarily of weight bearing activities and resistance training. Only 28% of women started bone therapy within a year of diagnosis as reported by the Clinical Interventions in Aging. But what about Yoga?? Yoga as an intervention has excellent accessibility. There is minimal to no cost related and minimal training required. The ‘side effects’ of yoga include improved ROM, improved strength, improved gait, improved posture/balance and decreased anxiety. Yoga uses a mixture of 1 – 4 limbs to support body mass against gravity. This translates to upper and lower extremities being utilized as weight bearing support for the body. Since upper extremities do not normally bear load, this use during yoga practice may be classified as high impact for the upper extremities (more research is needed). Generally, there is little to no jumping performed during yoga practice. Jumping results in a higher impact classification. This means that faster paced, advanced asana classes have potential to be classified as a high impact activity. That being said, even low impact, weight bearing exercise has been shown to positively influence bone health. Dr. Loren M. Fishman from Columbia University began researching the correlation between yoga postures and maintaining bone density in individuals with osteopenia or osteoporosis in 2005. A follow-up study was done in 2016 showing that 12 minutes of prescribed yoga regimen actually reversed osteoporotic bone loss. Fishman’s 2016 follow up study included everyone who performed the yoga sequence more than 50% of the prescribed amount of every day. Qualitative evidence indicates improved bone quality. Results showed effective reversal of bone loss of spine and femur, with weaker correlations of positive effects of the hip as indicated by DXA scan. “Poses were chosen specifically to produce torque and bending of the proximal femur, compression of the pelvis and twisting of the lumbar vertebral bodies.” This twisting, bending and compression have been shown to stimulate osteocytes. Osteocytes are the most commonly found cell in mature bone tissue. When performing certain yoga postures, opposing muscle groups must simultaneously engage in order to “hold the pose”. This activity of opposing muscle forces generates activity in osteoblasts and osteocytes which encourages bone density. Yoga is easy to instruct, learn and perform. Please see the following pictures and descriptions for the yoga poses studied by Dr Loren Fishman. Happy practicing! Tree Standing on one leg, place the sole of the opposite foot on either ankle, calf or thigh Avoid placing sole of foot directly over knee joint Palms may press together in front of the chest or reach overhead Triangle Step legs 2 – 3 feet apart Rotate front foot so it is perpendicular to back foot, toes of front foot point forward, both knees are straight Abduct arms to shoulder height Reach front arm forward as opposite hip draws back Front arm reaches down, hand rests on either shin or foot Warrior Two Step feet 2 – 3 feet apart Rotate front foot so it is perpendicular to back foot, toes of front foot point forward, front knee is bent, back is straight Abduct arms to shoulder height, palms face down Shoulders draw down, chest open Lift through the top of the head Side Angle Step feet 2 – 3 feet apart Rotate front foot so it is perpendicular to back foot, toes of front foot point forward, front knee is bent, back is straight Front forearm to thigh, or hand to floor Opposite arm may reach either overhead to sky or in line with head parallel to g Twisted Triangle Step legs 2 – 3 feet apart Toes of both feet point forward Abduct arms to shoulder height Rotate chest so that back arm reaches forward Then reach down towards the floor of front foot Hand may rest on floor or block for support Locust Lay facedown, arms are by sides, palm face down Lift up torso, legs and arms Scoop chin in, while lengthening muscles on the back of neck Gaze is low to avoid excessive extension of neck Bridge Lay on back, soles of the feet on the ground, hip width apart, fingertips are able to touch heels Lift hips into the air while drawing knees together Option to either press palms into ground or to clasp them together under bod Supine Hand to Foot 1 Lay on back, one leg is flat on ground, other leg is in the air Either hold on onto foot with hand or use strap Keep raised leg straight without being fully locked out, keeping muscles engaged Shoulders actively draw to ground Supine Hand to Foot 2 Lay on back, one leg is straight on ground, other leg is abducted from body Either hold on onto foot with hand or use strap Keep abducted leg straight without being fully locked out, keeping muscles engaged Shoulders actively draw to ground Straight Legged Twist Seated on the ground, one leg is straight, opposite leg is bent to chest Keeping both hips on ground, twist to side of bent leg Maintain length in spine Bent Knee Twist Seated on the ground, one leg is bent, ankle of opposite leg is on the outside of thigh with knee to chest Keeping both hips on ground, twist to side of top leg Maintain length in spine Corpse Pose Lay flat on back Arms either palm face up by sides, or place palms on chest and/or stomach Resources Brody, Jane E. (2015) 12 Minutes of Yoga for Bone Health. The New York Times (2015) Fishman, Loren M. (2009) Yoga for Osteoporosis: A Pilot Study. Topics in Geriatric Rehabilitation 25. (2009) 244-250. Lu, Y., Rosner, B., Chang, G., Fishman, L. (2016) Topics in Geriatric Rehabilitation 32. (2016) 81-87. DOI: 10.1097/TGR.00000000000000085 Siris, E., Yu, J., Bognar, K., DeKoven, M., Shrestha, A., Romley, J. (2015) Undertreatment of osteoporosis and the role of the gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage. Clinical Interventions in Aging (2015) 1813 -1839. DOI: http://dx.doi.org.ezproxy.uvm.edu/10.2147/CIA.S83488 Wilcox, S., Hager, R., Lockhart, B., Seeley, M. (2012) Ground Reaction Forces Generated by Twenty Eight Hatha Yoga Postures. International Journal of Exercise. (2012) 114-126. Request an Appointment today!

Plantar fasciitis (PF) is a common condition found in runners and can significantly impact running ability and performance. In the past PF was defined as a chronic inflammatory pathology which prompted a treatment approach designed to reduce inflammation with things like rest and anti-inflammatory medication. Currently, however, PF is considered to be more similar to a tendinopathy where inflammation is only a small component of the problem and inappropriate load on the soft tissues is the primary issue. Therefore, just resting may not cut it. The good news is that just like tendinopathies, PF can be improved with the help of physical therapy so you can get back to training and setting new PRs ASAP! In general, the plantar fascia can become a source of pain when it is stressed beyond its loading capacity. Everyone’s loading capacity is different and may change with training (or detraining). A marathon runner will have a different capacity than someone who runs 2-3 miles on the weekend. A good rule of thumb with overuse injuries is “most injuries happen from doing too much too fast after doing too little for too long”. Other factors such as muscle flexibility, range of motion, and foot muscle weakness can contribute as well. Physical Therapy Evaluation Your physical therapist will consider your chief complaints, as well as your current performance, goals, and training regimen, and will take you through a thorough assessment and running gait analysis. Goals of the Evaluation Determine what elements are contributing to potential excessive loading/stress of the plantar fascia. Diminish loading forces, in order to alleviate symptoms, allow healing of the soft tissue, while also avoiding a complete stop in training! Consider foot strike patterns. This is an important element because different foot strike patterns place different demands on your feet and load the plantar fascia differently. When running with a forefoot strike the load on the PF is increased compared to a rearfoot strike. This is not a bad thing as the PF can adapt and get stronger to handle this. However, if not given adequate time to adapt, this may contribute to development of PF. As part of rehabilitation, if appropriate, your physical therapist may change your foot strike pattern and cadence to offload the PF and decrease your symptoms and then gradually return you to running even better than before! Can include a change in distance, intensity, duration or frequency of your runs. Implementation of a strength training program can be helpful and will be tailored to your specific needs and impairments. Manual therapy to promote proper joint mechanics and soft tissue length and tension. Improve muscle flexibility and endurance, especially of the calf and foot intrinsic muscles. This will increase the resilience of your feet and legs and get you setting new PRs in no time! Modalities to control inflammation as needed If you’d like to make an appointment to be evaluated by one of our skilled Orthopedic Physical Therapists, please call (212) 353-8693 or email schedule@zionpt.com. Cristina Sabbadin DPT References:1. Petraglia F, Ramazzina I, Costantino C. Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles Ligaments Tendons J. 2017;7(1):107–118.2. Chen TL, Agresta CE et al. Ultrasound elastographic assessment of plantar fascia in runners using rearfoot strike and forefoot strike. J Biomech. 2019 May 24; 89:65-71. Schedule an Appointment with Zion Physical Therapy today!

Orthopedic Conditions in Gaming There are many benefits that video gaming can provide: decreasing stress and anxiety, providing hours of entertainment, and even paying out financially for those who compete professionally in ‘E-Sports’--the top ‘pro-gamers’ in the world take home millions in single tournament prize money, and U.S. colleges are now offering their students thousands in scholarships to recruit for e-sport teams. Whether you play video games for fun or for competition, it is important to be aware of the orthopedic conditions that can arise with prolonged game-play. Overuse Injuries in Gamers Just as with other activities and sports, overuse injuries are common amongst the gaming community; these injuries are uniquely different from those of a basketball player or a marathon runner, but the mechanism of injury is the same: the participant is performing an activity or movement too much, too fast, for too long, and the body can't handle the physical demands of the task. Orthopedic injuries of the hands, fingers, and wrists are prevalent amongst players due to increased APMS (actions per minute) on keyboards and forceful ‘button-mashing’ of controllers; this can lead to players developing upper extremity conditions such as: Gamer’s Thumb, Mouse Elbow, and Carpal Tunnel. Spinal conditions in the neck and lower back are familiar to the casual and professional gamer alike due to poor ergonomic positioning, and a lack of core and postural stability. How to Prevent Injuries and Improve Performance with Gaming In order to prevent these injuries, players need to be able to adapt to the stresses placed upon their bodies, and require progressive loading of the involved joints and muscles and purposeful rest breaks. E-Sport athletes can keep their bodies at the top of their game by increasing their endurance capacity, incorporating strength and conditioning into their training routines, and practicing proper nutrition and sleep habits--this can be the difference between longevity in your hobby or sport, and a life-altering or career-ending injury! Tips to Promote Longevity with Gaming and Decrease Injury Risk Monitor your time spent playing video games, limiting it to 2 hours a day for the casual gamer- Place an alarm on your phone, or set ‘parental controls’ on your console or device: Listen to your body for when it is time to rest, especially if you begin to feel pain and discomfort! Take 5 minute rest breaks every 30 minutes: walk around, stretch your legs, and mobilize your hands, shoulders, and wrists. Avoid slouching too far in your seat to decrease pressure onto your spine: use a small pillow to support your lower back, and keep your feet planted on the floor or a step. Find the ideal posture of your shoulders, elbows, and wrists while holding the controller, keyboard, or mouse: a good posture involves neutral wrist alignment, the shoulder blades retracted and slightly lowered, and the shoulders, elbows, and wrists approximately at a 90 degree angle. Be aware of the positioning of your screen or monitor: The top one-third of the screen should be level with your eyes, and it should be at least 20 inches away from your face. Schedule out at least 30 minutes of daily moderate exercise: prioritize cardiovascular activity, and strength and resistance training. How Physical Therapy can help with Overuse Injuries related to Gaming: Get a Diagnosis and a ‘Game Plan’ to Help Recover from an Injury. Ergonomic Assessments for Postural Alignment and Stress Reduction. Manual Therapy to Improve Blood Flow and Reduce Tissue Restrictions (soft tissue and joint mobilization, stretching, and muscle energy techniques) Therapeutic Exercises for Upper Body and Core Strengthening. Self Care and Mobility for Pain Management. If you’d like to make an appointment to be evaluated by one of our skilled Orthopedic Physical Therapists for postural-related injuries, please call (212) 353-8693, email schedule@zionpt.com, or request an appointment online.