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  • Pelvic Floor Physical Therapy After Birth

    Congratulations on your new baby! You made it through the 1st, 2nd, and 3rd trimesters….and now welcome to the 4th trimester. Yes you read that correctly, the FOURTH trimester. The term “fourth trimester” has been referred to as the baby’s first three months of life. You can find loads of information on swaddling techniques and sleep advice for the baby during this time, but what about advice regarding recovery for moms? Women typically see a healthcare provider frequently throughout pregnancy. Once the baby arrives they receive a 6 week postpartum screening and usually no further follow up. New guidelines from the American College of Obstetrics and Gynecology (ACOG) call for improved postnatal care for potential long term changes after pregnancy. Receiving treatment from a pelvic floor physical therapist can help with challenges that may have developed during or after pregnancy. If you experience any of the following symptoms, pelvic floor physical therapy can help you! Low back or pelvic girdle pain Pregnancy related low back pain occurs in 60-70% of pregnancies (Mogren 2005) and can persist after birth. During pregnancy, the growing baby pulls your center of gravity forward and changes your body mechanics. This can place increased pressure on your lumbar spine and result in low back pain. The hormone relaxin can also contribute to laxity in your ligaments which can cause pelvic/low back pain. Urinary Leakage/Incontinence The involuntary loss of urine is common in the postpartum population however it should improve over time and does not need to be a symptom you are “stuck with forever” after having a baby. There are two types of incontinence Stress Incontinence: Typically occurs during coughing, laughing, sneezing, jumping or running. Urge Incontinence: Sudden urge to urinate and inability to hold urine back while running to the bathroom Bowel Incontinence/Constipation Inability to control gas or prevent the leakage of stool could be a flag that your pelvic floor is not working optimally. Constipation - inability or fear of bearing down to have a bowel movement, heaviness/fullness in the rectum, and the feeling of incomplete emptying. Pelvic Organ Prolapse (POP) Pelvic organ prolapse occurs when there is a lack of support of the pelvic organs Symptoms of POP often include the sensation of “something falling out of the vagina”, pressure, heaviness or fullness in the pelvis that typically gets worse throughout the day Pelvic floor physical therapists are trained in the assessment and treatment of pelvic organ prolapse Painful sex Many women do not feel comfortable returning to sexual activity after their 6 week postpartum check up. If you are having pain with intercourse, there can be many reasons for this including hormonal influences, pelvic muscle tightness, scar sensitivity, etc. Pelvic floor physical therapists will perform a thorough assessment to determine what is causing the pain and treat accordingly Scar sensitivity If you had a c-section, perineal tearing, or an episiotomy, you may have pain and sensitivity surrounding your scar. Your physical therapist can show you scar mobilization, massage, and desensitization techniques to improve pain and decrease scar tissue adhesions. Tailbone pain/Pain with sitting The pressure of your baby passing through the birth canal can bruise, dislocate, or even fracture your coccyx (tailbone). This can cause discomfort, especially with sitting making it difficult to feed your baby or even have a bowel movement. Diastasis Recti/”Mommy Tummy” Diastasis recti is a separation of the most superficial abdominal muscles and stretching of the connective tissue called the linea alba. This occurs to make room for the growing baby during pregnancy. Symptoms: Discomfort and a feeling of weakness in the abdominals Doming or tenting in the middle of the stomach when you lift up or roll over Appearance of a “pouch” in the lower abdomen Physical therapists can recommend safe exercises, manual therapy and bracing/taping techniques to retrain the abdominal muscles and provide exercise and postural retraining. Safely return to exercise Maybe you have no symptoms, but you want to begin to exercise or return to running/sport but are not sure where to begin. Our MomStrong program can help you return to your previous activities in a safe manner and teach you the right exercises to help achieve your goals! What to expect during the initial evaluation and subsequent treatment sessions: During your first visit to our clinic, you will meet your physical therapist and be taken to a private treatment room. In the examination room, you will be able to explain your history, symptoms, goals, and what brings you into therapy. Your therapist may ask you additional questions to further understand what brings you in. They will also explain the components of the examination and explanation of the pelvic floor and its many functions. Oftentimes an external and/or internal examination will be performed. For the external examination, your therapist will assess your strength, range of motion, and joints to determine if your hips, back, or core may be contributing to the problem. For the internal examination, your therapist will leave the room to allow you to undress and give you something to cover yourself. Your therapist may initially perform an observation and ask you to contract your pelvic floor, then bulge. Do not worry if you are unsure how to do this, they will guide you through it. After a visual assessment, they will likely perform a 1 finger pelvic floor muscle exam after obtaining consent from the patient. During the muscle examination, they will ask you to contract, relax, bear down. They will gather information about your strength, coordination, endurance, and ability to relax your muscles. After the examination, your therapist will discuss their findings and come up with an appropriate and agreeable treatment plan with you. They may assign you a “home program” if they feel it is beneficial. Follow up visits may include additional external and internal soft tissue releases, muscle re-education strategies, posture and activities of daily living education, and return to safe exercises depending on your current strength, pain level and goals. Your therapist will discuss this with you when determining the treatment plan. Once postpartum, always postpartum! Even if you had a baby 10 (or more) years ago, you are still postpartum and may find yourself struggling with some of the symptoms listed above. It is never too late to get help! At Zion Physical Therapy, our Doctors of Physical Therapy have special training to help postpartum women with all of the above. If you do not see your particular symptom, please inquire about how we can help! All treatments are conducted in a private treatment room 1-1 for 45 minutes with a pelvic health PT. Call (212) 353-8693, go to our Request Appointment form, or email schedule@zionpt.com to schedule! Jessica Nielson, DPT References: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine . 2005;30(8);983-91. (Evidence level: 2C) Ostgaard HC, Roos-Hansson E, Zetherstrom G. Regression of back and posterior pelvic pain after pregnancy. Spine (Phila Pa 1976) 1996;21:2777–2780. doi: 10.1097/00007632-199612010-00013.

  • Post-Prostatectomy Physical Therapy:

    The prostate gland sits just below the bladder and completely encircles the urethra at the point where it leaves the bladder. When the prostate gland is removed in a radical prostatectomy, damage can occur to the urinary sphincter. Damage can also occur when receiving radiation to this area. Depending on the extent of the damage, temporary or permanent incontinence can result. Many men regain normal bladder control within several weeks or months after radical prostatectomy. However, there is no way to predict if leakage will occur or for how long it will continue. Most men experience leakage for weeks to a few months, a small percentage will have continued long-term or permanent leaking and some experience will experience no leakage at all. Our post-prostatectomy physical therapy programs are tailored to the individual needs of each client. Symptoms that may occur after prostatectomy: Urinary incontinence at rest and with activity Nocturia: urinating more than 2 times per night Frequent urination during the day Inability to achieve or maintain an erection Abdominal discomfort Treatments for urinary incontinence after radical prostatectomy: Biofeedback (relaxation training and/or strengthening) External manual therapy Scar mobilization Internal manual therapy if necessary Bladder retraining Kegel exercises (both in isolation and functional training) Lower extremity stretching Core strengthening Extensive patient education Contact our Pelvic Floor care team today for a consult and get started on your individualized plan. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com REQUEST APPOINTMENT

  • Stress Urinary Incontinence with CrossFit Athletes

    “Urinary Incontinence Affects Athletes, Both Men And Women, Of All Sizes And Ages--But No One Wants To Talk About It”. On June 16, 2013 CrossFit Games published a controversial video that started with the phrase, “We’ve seen blood today and now we see urine and that’s what it takes if you want to be the fittest woman on the planet.” You can see the video below. CrossFit is a popular form of exercise that mixes aerobic exercise, gymnastics and weight lifting all in one. While the sport has its benefits, urinary leakage is not one of them and most certainly is not an indicator of fitness. Stress Urinary Incontinence (SUI) is defined as an involuntary loss of urine when coughing, sneezing or exerting oneself physically. Besides CrossFit, athletes who run, spin, jump or participate in any type of physical activity are all at risk for leaking. One study analyzed the level of athletic performance and the volume of training with urine leakage in young female trampolinists. About 72.7% of the participants reported SUI during trampoline practice. A different study conducted on 105 female volleyball players found that 65.7% reported at least one symptom of SUI and/or urgency during sport or in daily life situations. Clearly, there is a relationship between sport and pelvic floor dysfunction, even in young athletes. Urinary incontinence affects athletes, both men and women, of all sizes and ages--but no one wants to talk about it. Except for maybe Whoopi Goldberg who has been quite open about her “LBL,” which she says stands for, light bladder leakage. Whoopi says to embrace it! But why embrace it when you can change it? What Can Be Done? Just like any other muscle group, our pelvic floor muscles can be strengthened and trained to help prevent urinary leakage with sport or daily activity. As a pelvic floor physical therapist, I have worked with athletes of all ages struggling with incontinence. From my experience, I find incontinence during exercise can be caused by a few different reasons. The first, most common reason, is that your pelvic floor muscles are weak and unable to handle the demand that is required during exercise. The second reason can be the opposite issue- when the pelvic floor muscles are tight, overused and fatigue easily. This would mean the pelvic floor muscles would need to be down-trained and released before starting a strengthening program. The last reason can be attributed to a lack of coordination between your pelvic floor and core muscles. Our pelvic floor muscles are the first layer of our core and when the pelvic floor muscles and core muscles don’t work together, the result can be leakage with demanding exercise. By working with a Pelvic Floor Physical therapist, athletes can ensure they are doing what their pelvic floor needs. A Pelvic Floor PT can teach each patient how to strengthen, relax, bear down and coordinate with diaphragm and core muscles for increased overall strength, less intra-abdominal pressure and less overall leakage. Throughout the CrossFit video mentioned at the top, the hosts ask multiple women to confirm if they pee during workouts. The majority say yes. He then says a product needs to be made to fix this. However, he does not realize, leakage is different for each person, which makes it difficult for one product to fix all. Pelvic floor physical therapy, although not a product, can help athletes train so they can become “the fittest woman on the planet.” If you are dealing with symptoms like this, come see one of the pelvic floor specialists at Zion Physical Therapy and get the care you deserve Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com Bo, K. & Borgen, J. S. (2001). Prevalence of stress and urge urinary incontinence in elite athletes and controls. Official Journal of the American College of Sports Medicine 1797-1802 Da Roza, T., Brandao, S., Mascarenhas, T., Jorge, R. N. & Duarte, J.A. (2015). Volume of training and the ranking level are associated with the leakage of urine in young female trampolinists 25(3): 270-275 Schettino, M. et al., (2014). Risk of pelvic floor dysfunction in young athletes. Clinical and Experimental Obstetrics and Gynecology 41(6): 671-676

  • Endometriosis: The Invisible Disease

    Would You Believe It If I Told You That 1 In 10 Women Walk Around With A Disease Most People Have Never Heard Of ?Endometriosis Affects 176 Million Women Worldwide. It Takes Up To An Average Of 10 Years For Women To Receive A Correct Diagnosis! Endometriosis is a devastating disease that causes menstrual tissue to grow outside of the uterus and anywhere in the body. This tissue can attach itself to other pelvic and abdominal organs, causing scarring, adhesions and cysts, which can create a lot of pain and suffering for the woman. Research shows that about $119 billion dollars are lost each year due to endometriosis. Today, the number of women suffering is significantly higher than a few years ago, which can be largely attributed to under-reporting, misdiagnosis and a lack of nonsurgical/noninvasive diagnostic methods. Endometriosis is one of the largest women’s health crisis because of all the reasons mentioned and because there is no way to confirm the diagnosis without surgery. Despite so many women suffering, endometriosis continues to be hard to diagnose because all tests come back negative and can lead some doctors to misdiagnosis or tell patients the pain is either “normal” or “in their heads.” During the average 10 years it takes a woman to be diagnosed, many women lose days of school and work, lose hope in having children and struggle with intimate relationships. If you have relatives that have been diagnosed with endometriosis, you have a 2-3 times higher risk of also being diagnosed with endometriosis. Common symptoms include: painful periods, severe pelvic cramping, heavy bleeding, bleeding between periods, and periods lasting longer than 7 days. infertility, pain during sex, and painful ovulation. urination and bowel pain. constant fatigue. GI and digestive problems. ovarian cysts. Endometriosis has no cure, but there are conservative treatments that can help manage the pain and depend on the severity of symptoms; these include birth control, surgery and physical therapy. For endometriosis there are two surgical options, ablation or excision surgery, that can help decrease pain significantly. Hysterectomy is not an appropriate surgery for endometriosis! Too many women are told if they take the uterus out, their pain will go away. However, not all of the endometriosis tissue is found in the uterus, which is why this is not an appropriate treatment. Physical therapy is always an option! A skilled physical therapist specialized in treating pelvic floor dysfunction can help through manual work, modalities and therapeutic exercise. I have treated women suffering from Endometriosis and every woman presents differently. Some have surgery and others manage without. I treat women for abdominal and pelvic pain, for issues with defecation, urination, constipation and pain with sex that can all be secondary to endometriosis. A pelvic floor PT can provide significant pain relief and can retrain pelvic floor muscles to decrease pain and improve function. Endometriosis is a silent disease that causes millions to suffer--it is time to break the cycle and get women the help they need. A documentary called Endo What was made to help educate everyone about this debilitating disease. You can watch the trailer and learn more on this website: https://www.endowhat.com/. This film delves into the disease and gives you the most current research from experts including doctors, physical therapists and women who have been suffering for years. The more information that is out there, the less time it may take for someone to be diagnosed and the less time someone has to suffer with this invisible disease. If you are dealing with symptoms like this, come see one of the pelvic floor specialists at Zion Physical Therapy and get the care you deserve. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

  • Joint Replacement Survival Guide

    Refer to this chart by Zion Physical Therapy for helpful tips on your joint replacement surgery.

  • Iliotibial Band Syndrome (ITBS)

    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.

  • The Balanced Runner

    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!

  • Top 5 Warm-Up Exercises for Dancers

    Recommended by an ex-professional dancer & physical therapist! Total honesty- Back in my past life when I was taking dance class twice a day 5-6 times a week and adding to that rehearsals and/or performances I wasn’t in the habit of warming-up properly. Maybe a short barre or a loose mark of the phrases to come in rehearsals or performances and in terms of class...probably hanging out in a center split while chatting with my fellow dancers/friends for 5-10 minutes before start. I had unknowingly led my body down the path of unnecessary pain, fatigue, minor-medium injuries throughout the years. It was only towards the end of my free-lance dancer career in my early thirties that I understood how healthy it was for my body to have the time and attention in the form of specific exercises that targeted my core/hips, so as to properly prepare for the awesomely complex and dynamic routines that dancing entails. After being consistent with this “before routine” my body thanked me during and after a long day of dance. I’d love to share 5 basic core/hip stabilizing exercises with you in the hopes it will help access the sometimes elusive center and turnout more readily and effectively, like it did me. Supine marches- it is important to pull your navel towards your spine and feel the lower abdominals engaging, so as to minimize rotation of the pelvis as your lift/switch legs. Carry over this sensation of activation of the lower abdominal muscles into all barre/center exercises to maintain a strong center. Bridges - your gluteal muscles also help you maintain a stable pelvis. Because dancers are usually in a turned out position, the major gluteal muscles can become a little “lazy”. Help them wake up with this exercise. 2-way Clamshells - this exercise will help you access your hip external and internal rotators. Not only are these muscles the exact one you use when standing in any turned out position they help the hip joint remain stable during any dynamic weight-bearing movement (basically all of dancing). Plank hold - full body engagement of core musculature. Pay attention to how your elbows align with your shoulders and do not sink in your upper body as much as your center. Start slow (10-15 sec holds), focus on proper form and then start adding time. At Zion PT we specialize in dance injury prevention and have helped many dancers recover from injuries and get back to doing what they love best! If you are in need of help or guidance please call (212) 353-8693 to make an appointment with one of our Dance Medicine Physical Therapists!

  • Labral Tears in Dancers

    Remember when Lady Gaga had to cancel her world tour because of a labral tear? Labral tears are one of the more common diagnoses when it comes to hip pain especially in the dance world. Performers, dancers and athletes are all prone to suffering with hip pain at some point in their careers. But, it doesn’t have to put you on the sidelines if you seek out treatment early on. Keep reading if you want to learn more about labral tears and how to treat them. What is the labrum? The hip is a ball (femoral head) and socket (acetabulum) joint which allows motion in all directions. The labrum is a rim of cartilage that surrounds the socket and serves to provide stability to the joint by deepening the joint socket. It also protects the joint surfaces. Think of it like a silicone covering around the joint. Labral tears can occur through trauma, be present since birth (congenital), they can occur secondary to femoral acetabular impingement (when the ball and socket don’t fit together correctly), can occur due to capsular laxity and and they can occur on a degenerative basis usually from overuse. Athletes of all kinds are at risk for labral tears but especially dancers — they present with the highest risk overall due to the extreme ranges they use in their movements. What causes a labral tear? Extreme ranges of motion especially those that involve twisting and rotation can cause a labral tear immediately or can lead up to a labral tear over time. All those beautiful lines you are making in the studio could be leading to issues with your labrum. Early intervention is key to long term preservation and a return to doing the things you love. You don’t have to stop doing the things you love but you do need to learn how to better control your biomechanics to decrease symptoms and improve your ability to grow as a dancer/athlete. One study demonstrated that if a labral tear is present, forces through the hip joint increase by up to 92%. Because of this, untreated labral tears can lead to further degeneration and symptoms in the hip such as premature arthritis, tendonitis/tendinosis, bursitis and a loss of range of motion. The earlier you seek treatment, the better chance you have at preserving your mobility and preserving the hip joint. So, what do the symptoms feel like? Symptoms are highly variable but usually one of these will describe your symptoms: Pain in the ip or groin with crossing your legs Pain in the hip at end ranges Pinching, catching or a grating feeling in the hip Pain with combined flexion, adduction, and internal rotation (knee across chest) Pain with combined flexion, abduction, and external rotation (knee bent and resting out to side) Pain with resisted straight leg raise (raising leg against resistance) The good news is that many dancers and athletes have labral tears that become non symptomatic with conservative treatment. The first thing to do would be to see a physical therapist or orthopedist specialist (brownie points if they are familiar with dancers) to evaluate you to determine if you could have a possible labral tear. There are several other diagnoses which could mimic a labral tear and you want a professional to evaluate your spine, hip, knee and ankle mechanics to determine where the symptoms are emanating from. If the symptoms are indeed emanating from a possible labral tear, conservative treatment could consist of physical therapy which can include soft tissue mobilization, joint mobilizations, modifying activities for a short time period and a targeted exercise, stretching and mobility regimen to be performed first with your therapist and then on your own as prescribed by your therapist. Common compensatory mechanisms we see in the office specifically with dancers who present with labral tears are poor coordination of the core muscles with hip movement, little to no internal rotation of the hip, a lack of control at end ranges of the hip (hiking the hip up to get that develope higher?) and a poor length tension ratio between the hip flexors, hip extensors, and hip rotators. Here are some exercises you can do to at home to help you find some relief and get you working those hip muscles in a better way to reduce compensations Kneeling Hip Flexor Stretch — helpful for opening up the front of the hip and creating more length in the hip flexors and quads for hip extension movements and arabesque. Caution if you have knee pain. Make sure to use a cushion, towel or rolled up yoga mat underneath the knee during the stretch. The stretch should be primarily felt along the front of the thigh and hip. If you experience any knee pain, stop. Clamshells with Develope — This exercise is meant to help strengthen the abdominals and the external rotators of the hip — the muscles you should be using to turn out your legs and to help you balance on one leg in a turned out position. You want to keep your abdominals engaged when performing this exercise and make sure you can place a hand under your waist line when lying down on the mat. During the exercise, only the hip is rotating outwards and the work should be felt deep into the back of the hip. When performing the develope make sure you are not sinking into the mat and or hiking the hip up to get the leg higher — keep the torso lifted and long and maintain space in the hip when reaching the leg up. Shin Box — this exercise is meant to stretch the internal rotators of the hip and then get those same muscles to fire up. Start off by sitting into the shin box position (90 degrees from hip to knee in the front; 90 degrees from hip to knee in the back) and see if you can get equal weight into both sit bones. When you achieve that, begin to shift your weight forward slightly maintaining a neutral spine and lift your back foot off the mat.. Keep the back knee in contact with the mat. As you can see, my mobility and control is pretty limited and something I am working on. A progression of this exercise would be to use less assistance from your hands and to lift the lower leg higher. Hip Controlled Articular Rotations –This exercise is meant to teach you how to control and increase your symptom free available range of motion in the hip without compensating. You want to make sure you are not creating any symptoms as you range the hip – no clicking, pinching or hiking up of the pelvis to get the leg higher. You can see I am holding onto a couch to help me focus solely on lifting the leg as high as I can. A progression of this exercise would be to go hands free, lift the leg higher and finally to add a kettlebell into the hand of the moving leg. Give these a go and see how they feel! When you’re ready, call (212) 353-8693 to seek out a physical therapist who understands a dancer's needs to help you get to the next level. Natalia Rodriguez, DPT References: Huang R, Diaz C, Parvizi J. Acetabular Labral Tears: Focused Review of Anatomy, Diagnosis, and Current Management. The Physician and Sportsmedicine. 2012;40(2):87-93. doi:10.3810/psm.2012.05.1968. Hunt D, Clohisy J, Prather H. Acetabular Labral Tears of the Hip in Women. Physical Medicine and Rehabilitation Clinics of North America. 2007;18(3):497-520. doi:10.1016/j.pmr.2007.05.007. Mayes S, Ferris A-R, Smith P, Garnham A, Cook J. Similar Prevalence of Acetabular Labral Tear in Professional Ballet Dancers and Sporting Participants. Clinical Journal of Sport Medicine. 2016;26(4):307-313. doi:10.1097/jsm.0000000000000257. Neumann G, Mendicuti A, Zou K, et al. Prevalence of labral tears and cartilage loss in patients with mechanical symptoms of the hip: evaluation using MR arthrography. Osteoarthritis and Cartilage. 2007;15(8):909-917. doi:10.1016/j.joca.2007.02.002.

  • About Constipation 

    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

  • Am I Peeing too Much?

    Do you find yourself constantly running to the bathroom? Do plan your trip around the city based on the nearest public restrooms? Do you find yourself running straight to the bathroom as soon as you get home? Do you always urinate before leaving the house? Are you waking up throughout the night to use the bathroom? If you answered yes to any of these questions, it might be time to see a pelvic floor physical therapist! First, let's learn what “normal” bladder and urinary functions consist of: Frequency Normal urinary frequency is considered 4-6 times per day, although this can vary depending on activity level and liquid intake. You should be able to hold your bladder for 2-4 hours. Quantity Many people don’t count how long it takes to empty their bladder, but give it a try next time you are in the bathroom. Urination should last 8-10 seconds (8-10 ounces). If you find yourself counting anything less than 8 seconds, your bladder may not have been full, even if you had a strong urge. Nighttime Voiding If you are under the age of 65, you should be urinating 0 times per night. If you are over 65 years old or are pregnant, it is common to urinate 1-2 times per night. Urge When you get the first urge to urinate, you should be able to ignore the urge and carry on with what you are doing. You should NOT have pain or feel the need to immediately get to the closest restroom when you feel the first urge. If you do not meet the “normal” expectations, it may be time to seek help from a pelvic floor physical therapist. Other signs and symptoms that are common, but not normal: Urinary Symptoms Urinary frequency Urinary urgency Hesitancy/Slow stream Feeling of incomplete emptying Incontinence Bladder pressure Pain Symptoms Pelvic pain Pain with bladder filling Pain/burning with urination Painful intercourse Painful bowel movements Low back, hip, or tailbone pain How can physical therapy help me? At your first appointment, you and your physical therapist will discuss your symptoms and any pain or dysfunction that may be occuring. Your therapist will perform a thorough examination which will likely include an external examination of your joints, muscles, and posture. It is common for pelvic floor physical therapists to perform an internal (vaginal or rectal) examination to assess the pelvic floor muscles. Based on your symptoms and presentation on examination, your physical therapist will determine what treatments will be most effective for you. Treatment may include bladder retraining techniques, myofascial release, visceral/bladder mobilization, joint mobilization, nervous system uptraining or downtraining, therapeutic exercise, specific stretching, etc. All treatments are performed in a private treatment room where you are 1-1 with your physical therapist. Come in and let us create an individualized treatment program based on your needs! Jessica Nielson PT, DPT, CSCS Fill out an Appointment Request Form Today!

  • Should My Child Be Strength Training?

    Lifting weights and strength training is an activity that is an essential part of a healthy lifestyle and beneficial for safe and healthy aging. It is recommended that adults strengthen major muscle groups 2x/week to maintain lean muscle mass and prevent loss of muscle and strength as we age. When it comes to children high school aged and younger, there is more hesitancy around strength training. Often there is concern about injury or “stunting growth.” However, no such issues occur from supervised strength training in the younger population. Strength training in the younger population is beneficial for maintaining bone health, helps minimize risk of injury in youth sports, and provides a great base of knowledge and training experience as the child grows up. With the current climate of youth sports and early specializing, there have been higher incidences of youth sports injuries. These can include something as common as an ankle sprain, and can also be as serious as a broken bone or an injury to the growth plate. An injury to a growing bone can be more complex because as we are actively growing and not fully mature yet, our growth plates need to stay open to allow for that growth. An injury to the growth plate can potentially impact growth of the bone if not treated and is important to determine early on in the injury process. When a child gets injured, Physical Therapy focuses on restoring movement and strength around the injured area and providing a structured, specific routine to help the child prevent future injuries and move more efficiently as they continue to grow. It also is a great entry point into the concept of strength training and learning optimal form of exercises that are often performed in a group setting with kids, either at practice or in gym class. Strength training aids in proper development of the child and can make them more resilient to injuries as well as perform better in sports, or even just running around the yard. It is also a great way to bond with a younger child and becomes another activity that the child and parent can perform together, learn, and grow with. If you have questions about how to safely introduce your child to strength training, if they have suffered an injury, or if you are looking to provide your child an injury prevention program for their favorite sport, Zion Physical Therapy is your resource. Zion specializes in orthopedic injuries, pediatric sports injuries, return to sport, and hypermobility/EDS. Call today, 212-353-8693 or email schedule@zionpt.com. Pediatric and exercise https://pubmed.ncbi.nlm.nih.gov/20463500/ Injuries https://pubmed.ncbi.nlm.nih.gov/34509211/

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