It’s no secret that COVID-19 has challenged our healthcare system in some negative ways, but what about some of the positive changes it has brought on? Telemedicine was seemingly only performed for mental health consults and visits whereas now it seems as though most healthcare providers have found a way to communicate with and treat their existing patients AND new patients via HIPAA compliant Telehealth platforms! But what about Physical Therapy? What can a Physical Therapist do via a Telehealth session for both current patients AND new patients/referrals? A profession that prides itself on being able to diagnose and treat with the use of our skilled observation and palpation/manual skills in addition to therapeutic exercise, neuromuscular re-education and modalities performed in office? Glad you asked!! Let me assure you there is plenty we can do… 10 Things Telehealth for CURRENT patients can accomplish! Progress your established PT exercise program via real-time PT demonstration and patient observation and trial Ergonomic assessment of your home office space with suggestions to improve as needed! Provide guidance on proper posture and ergonomics on activities performed in your home (bathing your kids, cleaning, cooking etc.) Provide guidance on how to stay active and safe in your home with your current injury Teach a spouse, significant other or roommate how to perform simple manual or muscle energy techniques to perform when necessary Provide flexible scheduling around your commitments to be able to prioritize your health and well-being Communicate with your PT regarding other healthcare professionals you’ve spoken with and test results regarding your current injury Maintain continuity of care to ensure maintenance and improvement on progress thus far Assess and provide guidance and referrals on new issues/injuries that may arise as a result of our temporary “new normal.” Provide breathing techniques, stretches and app recommendations to decrease stress during this trying time. 10 Things Telehealth for NEW patients can accomplish! Provide an opportunity to get care you need NOW vs waiting for social distancing restrictions to be lifted! Take a thorough history of the issue/injury and have a complete dialogue with your PT on how to move forward Enable information exchange and proper communication between referring healthcare providers and your PT Provide guidance on proper posture and ergonomics on activities performed in your home (bathing your kids, cleaning, cooking etc.) Provide potential referral out and recommendations if other healthcare providers need to be involved in your care Perform general posture and range of motion assessment Begin basic exercise program to address impairments via real-time PT demonstration and patient observation and trial of exercises Provide a home exercise program to start with Recommend products which could be useful for a home workstation or support of a joint Recommend self-care management via use of heat/cold/compression/elevation and frequency with which to apply If you’d like to make a Telehealth appointment with a skilled PT to continue your plan of care or schedule an evaluation, please call (212) 353-8693 or email schedule@zionpt.com, or request an appointment online.

Taking a run outdoors during a pandemic can be a saving grace for your mental health. In fact, research has shown that regular exercise may reduce the risk of developing acute respiratory distress syndrome, a major cause of death in patients with the COVID-19 virus. However, during a time when we’re all supposed to stay inside, it might seem ironic that there are more people now, more than ever, flooding parks and outdoor spaces to run. First off, is it safe to run outside right now? Yes, if the appropriate measures are taken to ensure safety. The best plan for running right now is to go out for a solo run, in non-crowded areas. You should time your run for when you know the route will be less crowded, especially in a place like Manhattan where crowds seem to be impossible to avoid in our favorite parks. While running solo, it’s important to still maintain at least six feet of distance from others. Generally speaking, germs dissipate very quickly outdoors, however, that doesn’t mean you should abandon social distancing orders. How do you prepare yourself to run outdoors? CDC guidelines recommend “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain.” If you’re running solo in an area where you won’t encounter others, it’s likely not necessary. But, if you’re running in a crowded area which is likely in Manhattan, NY, it’s a precaution you should take. While wearing a formal face mask may be uncomfortable, a secondary option is to wear a Buff gaiter, which is a tube of fabric that runners wear on their necks for extra warmth but might be more comfortable due to its sweat wicking capability. Yes, face masks are annoying when you’re breathing heavy while running. But, you should still wear them to prevent spreading the infection to other people and avoiding inhalation from the infected to yourself. Don’t overtrain! Runners tend to demarcate time by race seasons. So, how do you continue to meet your goals as a runner, regardless of the level you are used to training at? The key is to stay in shape across the physical spectrum! If the fall race season materializes, you can still be ready. It may not be PR ready, however, you can still pick up a race in a healthy manner. Now is NOT the time to push your body to the limit and train like you want to run a PR. Running will create a stress-response, which in normal times is good for your health and longevity, but is a dangerous response right now because it could affect your body's ability to handle infection. Try not to place anxiety or stress around hitting a certain mileage or pace. Ask yourself after you complete a run; are you feeling energized or depleted? Running should feel restorative right now during a time of high stress. So what is the appropriate running prescription right now? The Physical Activity Guidelines for Americans recommend at least 150-300 minutes per week of moderate-intensity aerobic physical activity and 2 sessions per week of strength training on separate days to help your immune system keep viruses at bay. For seasoned runners I recommend: 3-4x/week of running for a maximum duration of 60 minutes/run. 2x/week of strength training, with at least 24 hours in between a run and strength session so that you can run on fresh legs. Remember! Running more than 60 minutes, at an intensity > 75% of your personal max intensity, could in the short term weaken your immune system and make you more susceptible to sickness. So, for right now, it might not be the best decision to go for those long, intense runs. What if you are new to running? I recommend starting with an alternating run/walk combination: 2-3x/week of running, starting with 1:1 ratio of run to walk. Progress one level per week until you reach the goal that you set for yourself. Stay within that 60 minute window, however, if you are only able to go for 10 minutes at first- that’s ok! It’s important to be patient and kind to your body right now and build up in a way that feels right to you. For all levels of runners, while we are battling a pandemic; keep yourself at a conversational pace to avoid overstressing the system. If you’re not sure what that means, it’s simple! You should be able to talk comfortably throughout the duration of your run. Rest days!! Your “rest days” should be restorative and can include alternative exercise such as yoga, pilates, walking, stretching/mobility, OR complete rest if that is what you need. At minimum, I recommend 1-2 rest days. It can be tempting to pick up running 7x/week while there is more free time than usual, however, it’s crucial to avoid acute or overuse injuries to stay healthy right now. Don’t forget sleep! It is important to get at least 7-9 hours of sleep per night for both physical and psychological recovery. If you are sick with any cold or flu symptoms or at-risk of spreading the virus, you shouldn’t go out for a run. Normally, the general rule of thumb is if it is above the neck, run through it. Not in these times! Err on the side of caution. The bigger concern is spreading it to those who are at high risk, such as the elderly or immunocompromised. Now is the time to focus on making yourself a better runner. How? Focus on your limitations as a runner. Not sure what they are? Consult a Physical Therapist! A Physical Therapist can provide a detailed musculoskeletal evaluation which will include a running analysis to identify any biomechanical faults. Common areas that are important to work on to improve quality and longevity as a runner is single leg stability, core strength, hip strength (especially the gluts!), and mobility. A Physical Therapist can provide a creative plan of care addressing your personal limitations to compliment you as a runner. You can make yourself bulletproof toward injury from running by focusing on your limitations right now, especially if you are looking to be fall race season ready or are brand new to running! Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

So you just had a baby...congratulations! It’s about 6 weeks post-partum and you’ve been cleared to exercise again by your OB or midwife. Great. But where do you start? Good question! During pregnancy, the body’s hormones allow the abdomen and pelvic girdle to stretch and shift to accommodate the little person growing inside of you. This is all truly amazing and necessary however what happens after you give birth? Does it matter whether you’ve given birth vaginally or whether you’ve had a C-Section? Does everything immediately go back to your pre-pregnancy state? Not necessarily. After having a vaginal delivery, there may be trauma to the pelvic floor in addition to laxity in the abdomen from pregnancy. After a C-Section, all of the abdominal muscles under the umbilicus are cut in order to access the uterus and then are repaired. How do we get these muscles working again? Sit-ups? Planks? Running? NOT YET!!! FIRST, we have to isolate, re-engage and create proper coordination of the deeper core muscles in order to re-establish a solid base to support our spine and extremities during activities of daily living and return to sport. This video offers a 4 step exercise progression for getting back in touch with your deepest core muscle, the transverse. The fifth exercise adds a final layer which is a bridge, shown in this video. It is important to work with a trained pelvic health physical therapist to ensure you are performing these exercises correctly without compensation. Every woman post-partum starts out at level after delivery unique to their body and a full evaluation of the abdomen and lumbar spine/pelvis and hips should be completed to make sure the exercises being done are appropriate for you. An individualized exercise progression can then be prescribed as well to help you meet your goals! If you have questions or would like to schedule an appointment to have one of our pelvic health specialists evaluate you, please call 212-353-8693! It’s never too soon or too late to get the proper help to get your back to doing what you love best! -Dr. Staci Levine, PRPC

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

You just started working out more and now the front of your knee hurts. Most likely scenario? It’s patellofemoral dysfunction. Let’s break this down: The patella is the kneecap. It’s a floating bone that lives in the tendon of your quadriceps. The femur is your thigh bone. The patellofemoral (PF) joint is where the two come together. Your kneecap slides up and down your femur as your knee bends. In a perfect world, this is a pain-free motion, but for many people, it’s not. The first question to answer- is it structure or function? A thorough examination will reveal if there is an alignment issue in the leg or if there is a muscular dysfunction (or both). Determining the cause is always the most important to ensure effective treatment. In most cases, quadriceps weakness and/or tightness is the main culprit. However, a thorough exam also requires looking at the joint above and below the knee. Both hip weakness and ankle/foot weakness have been shown to add stress to the knee and aggravate PF symptoms. One of my favorite functional tests to evaluate all three of these options is the step down test. When the hip abductors are weak, the pelvis won't stay level and the opposite side drops. This collapse creates increased stress to the inside of the knee. Similarly, a weak foot or ankle may cause excessive pronation which encourages the tibia to roll in, also stressing the inner knee. As the knee crosses toward the middle, the patella is no longer able to track in a straight line in the groove and starts to create friction in the joint. With repetitive loading, as in running, this can quickly become painful. So what to do? Perform your own step down test and see if you can uncover where your form might be failing. If you notice a hip drop, aim for gluteus medius exercises like band walks. If it seems to be your ankle wants to roll in, try these easy theraband exercises. And if your form is great, but your quad feels shaky, practice these heel taps to improve your eccentric strength. At Zion PT, we are experts at honing in on the cause of your pain instead of using a band-aid approach to temporarily cover up symptoms. If you’re having trouble getting to the bottom of your PFPS, let us help. With additional mobility and strength testing, we can define what muscles are weak and throwing off your form. We can then create a home exercise program individualized to your needs that will prevent injury down the line. Don’t wait - races aren’t going to run themselves. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

“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

You are experiencing lower back pain. You are experiencing lower back pain. You are leaking urine upon exertion or when your bladder is full and you have to urinate. You want to get back to your pre-pregnancy exercise routine. You have pubic symphysis pain. You have a separation of your abdominal muscles known as Diastasis Rectus Abdominus. You still “feel 3 months pregnant.” You have pain with transitional movements ie. getting in and out of bed, sit to stand, lifting your baby. Your scar is tender, uneven or lumpy. You experience urinary urgency/frequency, pain with sex, or constipation. You feel fine but want to make sure you are on the right path to recovery!! Did you know that in France, a pelvic health physical therapy evaluation is standard at 6 weeks post-partum? Why don’t we do that in the US? At Zion PT, we are trying to bring awareness about all of the symptoms that could present themselves after a vaginal or C-Section delivery that could impact a woman’s quality of life and that she may think is “normal” or “will go away eventually”. Take charge and schedule an evaluation with one of our highly specialized pelvic health therapists today! If you’d like to make an appointment, please call 212-353-8693!

Whether you’re working from home or just spending more time on the couch these days, do you find your neck or back aching from how you’re sitting? Chances are you don’t have the same ergonomic setup at home that you do at work, so here are a few things you can try to avoid pesky neck and back aches! Sit with your weight over your pelvic floor and hips higher than knees. This means not sitting back on your “sit” bones, but slightly forward so that your weight is balanced between your sitting bones in the back and your pubic bone in the front. You can try tucking and tilting your pelvis (anterior and posterior pelvic rocks) in sitting in order to find the middle and what feels like your neutral spine. Your hip/knee angle should be about 100-110 degrees (hips higher than knees). Your rib cage should be balanced right over your abdomen, which should be balanced right over your pelvic floor. Now your core is primed and ready to fire at a moment’s notice! If your back is not already touching the back of the chair or couch that you are sitting on, add some back support. Place a pillow, blanket, sweatshirt, etc. behind your lower back until it feels supported all the way from your upper back to your lower back. 3. Next, make sure your feet are supported. If they are not flat on the ground, place a book, pillow, blanket, etc. under your feet. This will help prevent excess strain to your low back. 4. Lastly, let’s support your arms. If you are sitting at a table or desk and are sitting up high enough that your forearms can be supported on the desk - great! If not though - maybe you are sitting on your couch - you can use pillows or rolled up blankets/towels on your lap to support your forearms while working on your computer. Having support under your arms will help to relax your neck. Experiment with different positions and levels/types of support while sitting on your couch or in different chairs in your home using the above guidance. One size does not fit all. Ideally, you should feel comfortable and able to relax. If something feels off, try adding or taking away support. Do what feels best for your body. And don’t forget to add some movement throughout your day as well - your body and mind will thank you. If you’d like to make a Telehealth or in-person appointment with a skilled PT to evaluate your sitting or standing workstation at home, please call (212) 353-8693 or email schedule@zionpt.com

Last May, the American College of Obstetrics and Gynecologists (ACOG), came out with an article about redefining the postpartum visit in order to better serve women. In the article, the ACOG writes about how postpartum care should be an ongoing process and not just a single visit to the doctor’s office. This process can begin right after birth and can last for the duration of the first 12 weeks after birth, which is why these weeks are being dubbed the “4th trimester”: three trimesters before birth and a trimester for the mother to recover and take necessary steps to heal. The ACOG state that the comprehensive postpartum visit should include a full assessment of physical, social and psychological well-being. The ACOG article has a list of components of postpartum care which includes but is not limited to the following: Mood and emotional well being Infant care and feeding Sexuality, contraception, birth spacing Sleep & Fatigue Physical Recovery from birth Chronic disease management Health maintenance Just one important aspect of postpartum care should entail going to see a physical therapist who specializes in women’s health or pelvic floor dysfunction. Working with a physical therapist will incorporate diastasis assessment, pelvic floor assessment, body mechanics to help carry or lift your baby and modalities or manual therapy for pain relief. Pregnant and postpartum women are at risk for abdominal muscles separating, which must be assessed 6 weeks postpartum to determine if the abs are split or not. Exercises should be progressed safely in order not to make the separation worse. Women may also experience bladder control issues, incontinence or pelvic pain, all of which can be addressed with a specialized physical therapist. Although this article was written last May, it is important to spread the word and inform as many women as you know. In France, every woman who has a baby is covered by insurance to go to PT after giving birth just to make sure everything is working as it should be. America should be doing this as well! Pelvic floor physical therapy is just one part that should be incorporated in the 4th trimester. The ACOG took the first necessary steps to start redefining the normal care of pregnant and postpartum women, and now it’s time for us to spread the word. ”Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists.” Obstet Gynecol 2018;131:e140–50. Accessed March 25, 2019. Request an appointment with Zion Physical Therapy today!

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.

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/

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.