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.

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

“If You’re Struggling From Hypermobility, Don’t Wait For The Pain To Be Too Much That You Can No Longer Ignore It." Hypermobility Spectrum Disorder (HSD) is a group of conditions characterized by joint hypermobility. It can affect a few joints (localized) or many (generalized). Symptoms can span a full spectrum from asymptomatic (no pain or dysfunction) to very symptomatic. Many of my clients fall into this category, and while it seems it should be a blessing to find out you don’t fit the criteria for hypermobile EDS (hEDS), sometimes it’s just the opposite. There is an additional challenge of feeling like the disorder is not clearly defined or recognized by others, whether it be a doctor, insurance provider, spouse, or parent. The musculoskeletal symptoms from HSD can be equally severe and the challenges one faces are equally legitimate and can be just as difficult to cope with. Hypermobility means that the joint moves beyond a range that is normal, and is a primary feature in both hEDS and HSD. Joint hypermobility is often a primary cause of pain, physical trauma, and the potential decrease in the ability to function. Most often, this excessive movement causes: ● Poor coordination or difficulty balancing because the joint receptors do a bad job telling the brain what the body is doing- referred to as proprioception ● Instability, because the ligaments that provide stability to the joint are too loose; this often causes the sensation of joints “popping” but can also partially or even fully dislocate. ● Microtrauma, which is small tearing or bony degeneration that can happen over time as a result of excessive movement ● Macrotrauma, which are more recognizable injuries like when your kneecap moves out of place or the ankle sprains when you trip ● Acute Pain- after injury or dislocation ● Generalized, chronic pain that comes with time, as the body lowers its threshold to recognizing threat and increases the overall pain response Some or all of these concerns can be reported by clients with either HSD or hEDS. In the musculoskeletal system, the severity of symptoms is independent of the diagnosis. And for people who don’t look “sick,” clients often deal with anxiety from people not believing them and doctors dismissing their concerns. Something that we can do is listen and acknowledge that these complaints are valid and the pain is real. If you’re struggling from hypermobility, don’t wait for the pain to be too much that you can no longer ignore it. Go see someone who understands or is willing to learn and get the help you deserve. Seek help from your primary care physician, a physical therapist, rheumatologist, geneticist or physiatrist. A directory of physicians can be found on The EDS Society website. Physical therapists are in a unique position to help clients with joint hypermobility with techniques including: bracing recommendations, taping, neuromuscular re-education, posture retraining, gait training, strengthening, and pain management techniques. Rest assured that all of our therapists at Zion PT have a thorough understanding of connective tissue disorders. Here, you can count on having the time and attention you deserve to address your concerns with expert care and advice. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

The  pelvic  floor  consists  of several layers of muscles that cover the bottom of the pelvic cavity. These muscles have several distinct roles: To support the pelvic organs, the bladder and colon within the pelvis. To assist in stopping and starting the flow of urine or the passage of gas or stool 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 in to 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 Place a fingertip on or into the rectal opening. Contract and lift the muscles as though you were holding back gas or a bowel movement. You will feel your anal opening tighten and your penis move slightly. Watching the Muscles 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 opening and penis. Contract or tighten the muscles around the anal opening and watch for a puckering and lifting of the anus and slight movement of the penis. If you see a bulge of your anus this is an incorrect contraction and you should notify your health care provider for more instructions. Contact Zion Physical Therapy for an appointment today! Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

“As I Tell All My Clients, It’s Important To Trust Your Instincts. No One Can Feel Or Understand Your Body The Way That You Do” Rib dislocation is a matter of debate. Most doctors will tell you that it is nearly impossible. For the population of patients who have Ehlers-Danlos Syndrome (EDS), I find the idea to be extremely likely. Anatomy: There are 12 ribs with varying amounts of stability. The “true ribs” include ribs 1-7, as they are connected to the sternum, or breastbone. Ribs 8-10 are considered “false ribs”, in that they are connected only to the cartilage in the front. Ribs 11 and 12 are also called “floating ribs”, since they are only connected to the thoracic spine and then float in space. Most documented cases of “slipping rib syndrome” involve ribs 8-12. Since collagen makes up two-thirds of cartilage, it makes sense that the connection of the ribs in clients with EDS might be even more unstable than in the general population. Another reason that the ribs can be a source of pain is due to the nature of their attachments to the spine. The head of the rib, attaches to two vertebral bodies, one above and one below. This is called the costovertebral joint and is reinforced by ligaments. It is a planar joint which means that it allows for sliding motion. There is a second attachment which is the tubercle of the rib attaching to the transverse process of the adjacent thoracic vertebra and this is called the costotransverse joint. People with EDS are more likely to have rib subluxations because: They might have spinal instability and have significantly more joint play at these attachment sites They have decreased proprioception throughout the thoracic cage which results in uncoordinated movement of the ribcage and less effective breathing patterns They have a higher prevalence of scoliosis and may be at a structural disadvantage Rib subluxations mean that the rib slips out of place but does not fully dislocate; it maintains some contact with the joint. Rib dislocation would mean that the rib completely separates from the joint. They can both be very painful. The pain associated with subluxations and dislocations usually comes in the form of muscle spasm. True, because it is difficult to “diagnose” these rib injuries, most doctors will conclude that it is only a muscle spasm. The image below is one a patient of mine brought in. There was no evidence of a rib dislocation on the radiology report and the doctor had never mentioned it. She, however, noticed it on first glance and recognized it as a long-standing source of her pain. Rib Subluxation Physical Therapy Treatment: If you’re suffering from what you believe to be rib subluxation or dislocation, there are a few things you can do to minimize your pain. These include slow, controlled breathing for pain management and relaxation, using heat to relax the muscle spasm, and/or gently massaging the area to try to relax the tissues and reduce the tone surrounding the joint (you may need to employ a friend or family member in this area). Often times, hypermobile joints will slide in as easily as they slide out. If not, your physical therapist may be able to assist with muscle energy techniques, gentle joint mobilization, or taping techniques. Physical Therapy would then follow with stabilization exercises aimed at preventing recurrence, as well as some training of the diaphragm for better, more effective breathing. As I tell all my clients, it’s important to trust your instincts. No one can feel or understand your body the way that you do, even if your proprioception is impaired. If you want more information about Ehler-Danlos Syndrome specifically, please check out our EDS resource page and contact Zion Physical Therapy to set up an appointment. The therapists at Zion PT have extensive knowledge treating EDS and hypermobility syndromes and can help get you the treatment you deserve.

Did You Know Symphysis Pubis Dysfunction Has Been Reported In Over 30% Of Pregnant Women?! Some Studies Even Suggest Up To 60%! Symphysis Pubis Dysfunction, aka SPD, is a condition typically associated with pregnancy or diagnosed postpartum, in which the patient may experience a cluster of the following symptoms: Pain in the groin area Pain at the pubic bones Low back pain Lower abdomen pain Pain in the inner thighs, buttocks, or hips Pain going up and down stairs Pain while walking Pain sitting or standing for a while Pain when moving her legs apart (or widening her stance) Pain can vary in intensity but it is often described as “shooting, radiating, stabbing, or aching” (ouch!). What is the Pubic Symphysis? The pubic symphysis is a cartilaginous joint between your right and left pubic bones. The joint can become less stable and can even separate resulting in SPD. Why might cause SPD? Hormones such as Relaxin increase during pregnancy which may lead to laxity of the ligaments around the symphysis pubis joint and in the pelvis Muscle weakness in pelvic floor muscles Biomechanical straining of the ligaments in region Fetal and pregnancy associated weight gain Tearing of the fibrocartilagenous disc during delivery Data even suggests that stress, cortisol, and lack of sleep may act as culprits! Good News! Pelvic floor PT can help! Pelvic Floor Physical Therapy can help with SPD in the following ways: Strengthen and Stabilize! Your physical therapist will guide you through exercises to help your muscles function optimally and gain stability. This may include strengthening exercises for those weak muscles in hips, glutes, pelvic floor, and core and lengthening exercises for muscles that may be too tight as they compensate for weak muscles elsewhere Safety First! Your PT can *safely* guide you into a fitness routine, tweak your old one, and enable you to walk down the street pain free What to EMBRACE or AVOID! The PT will direct you to avoid certain exercises, postures, and movements which may worsen pain or even the separation such as high impact exercise, twisting, wide stance, heavy lifting, and especially moving your legs apart Tools and Tips! Pelvic Floor Physical Therapists have loads of suggestions to get you more comfortable! Such as: sleeping with a pillow between your legs, proper body mechanics (how to safely pick up your baby and how to get out of bed), or a pelvic support belt and how to wear it! Breathe! Your PT will teach you proper breathing habits and Meditation tips to calm your whole system to release overall muscle tension Hands On! Your PT will perform Manual Soft Tissue work to release tight muscles and teach you and even a friend to perform it on you Remember: It is not normal to be in intense pain during or post pregnancy! I treat a lot of postpartum women who say “I was in excruciating pain when I left the hospital and they told me it was normal”. Trust your body. Repeat after me: Trust MY body, and speak to a pelvic floor PT if you are experiencing these symptoms. Call 212-353-8693 or email schedule@zionpt.com to make an appointment with one of our skilled Pelvic Health Physical Therapists today! 1. Depledge J, McNair PJ, Keal-Smith C, Williams M. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Physical Therapy. 2005;85(12):1290–1300 2. Borg-Stein J, Dugan SA. Musculoskeletal disorders of pregnancy, delivery and postpartum. Phys Med Rehabil Clin N Am. 2007;18(3):459–476. [PubMed] [Google Scholar] 3. Leadbetter RE, Mawer D, Lindow SW. The development of a scoring system for symphysis pubis dysfunction. J Obstetrics Gynecology. 2006;26(1):20–23. [PubMed] [Google Scholar] 4. Nilsson-Wikmar L, Holm K, Oijerstedt R, Harms-Ringdahl K. Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Spine. 2005;30(8):850–856. [PubMed] [Google Scholar]

1. You feel like you are peeing....A LOT 2. You feel like you’re sitting on a golf ball 3. You feel burning and/or numbness in your Perineum (aka the Taint, Grundle, Gooch, it’s that area between the shaft of your penis and your rectum) 4. Your libido is decreased 5. Your erections aren’t as strong as they used to be...or not happening at all 6. Your genitals look like one side or both are retracted or “just look different” 7. Pain in your glutes and/or inner thighs 8. Burning or hot/cold sensation in your penis or testicles 9. When you have to pee, you can barely hold it in 10. You are constipated but haven’t changed your diet, meds, or lifestyle What the heck is a pelvic floor and how do you rehab it? Your pelvic floor is a sling of muscles in your pelvis responsible for healthy bladder, bowel, and sexual function. If these muscles are too tight, too weak, or have experienced trauma, you can experience bladder, bowel, and/or sexual dysfunction. The good news is that they can be rehabilitated like any other muscle. It is no different from the diagnosis of other common cycling injuries, such as Achilles Tendonitis or knee pain. What is the connection between your pelvic floor and cycling? When you are cycling, you are literally sitting on your pelvic floor. The way in which you engage your hip/ab/back extensor/leg/ glute muscles and your posture may actually be causing muscle pain and tightness. This can impact the internal muscles just as much as the external ones, which can lead to potential decreased blood flow and nerve compression. You may also be compensating with those internal muscles due to a weak core which can also cause these symptoms. What to expect: Your PT will walk you through a thorough evaluation to determine range of motion, muscle strength or weakness, quality of movement, and pain. You will receive comprehensive patient education which may include exercises to do and exercises to avoid, lifestyle modifications, and optimal posture and positioning during sitting, walking, cycling and everything in between. Soft tissue mobilization in the office and at home can release muscle tension and guided exercise can stretch the muscles that need lengthening or can strengthen the muscles that are weak. Pelvic floor physical therapists are specially trained to assess both internal and external muscles. They’ll guide you in internal and external workouts targeted for your pelvic floor muscles and other muscles which support your pelvic floor so you feel better and can keep on going! Next Steps: Consult a pelvic floor PT who can help resolve your symptoms, discuss proper cycling posture, and perhaps a specialized seat so you don’t have to give up the sport you LOVE! I f you’d like to make an appointment with a Pelvic Health Physical Therapist, please call Zion Physical Therapy at (212) 353-8693 or email schedule@zionpt.com.

So commonly I hear patients say something along the lines of “my neck hurts and I have some tingling in my hands. My doctor said I have a pinched nerve”. Ever wondered what this really means? And most importantly, how can physical therapy ease the symptoms and help you get back to what you love doing? The expression “pinched nerve” is a term used to indicate what we know as radiculopathy. It most commonly refers to the clinical description of when a nerve root is irritated, and as a result of this irritation you can experience pain or tingling along the course of nerves coming from that specific nerve root. A radiculopathy can result in numbness, weakness of some muscles or changes in reflexes, and all these symptoms can occur anywhere from the neck into the shoulder, arm, hand, or fingers. Good news is that the majority of patients with cervical radiculopathy get better over time and do not need treatment. However, for some people, pain still persists and a pinched nerve can really get in the way of living your regular life. Pain might stop you from working, from sleeping well, from playing an instrument, playing with your kids or cooking. Because of pain you might move less and the lack of moment can make the neck even more sensitive and less prepared for everyday activities. That’s when physical therapy can help! The main focus of physical therapy for a person experiencing symptoms of cervical radiculopathy is decreasing the pain and disability. Because there are other pathologies that have the same or similar signs and symptoms of radiculopathy, your physical therapist will conduct a thorough examination (assessing range of motion, strength, joint mobility, reflexes and functional movements), ask you about your experience with this pain and also possible past experience with neck pain and create an individual treatment plan based on your symptoms and needs! Treatment can vary greatly and usually entails a combination of hands on techniques to decrease sensitivity of the neck joints and muscles, such as Maitland, mobilization with movement, nerve gliding techniques. Exercises are also a key component of rehab, to improve the range of motion and strength. Every patient and every story is different, so it is important to evaluate your specific situation to understand what the contributing factors might be! If you are experiencing neck pain and you have questions, give us a call at (212) 353-8693!

“For The Majority Of People With Hypermobile Ehlers-Danlos Syndrome (EDS), It Will Take An Average Of 10 Years To Be Diagnosed. We Can Do Something About It” Ehlers-Danlos Syndrome (EDS) is a group of hereditary connective tissue disorders that which causes a change in the protein, collagen. Collagen gives structure to our connective tissue and maintains the integrity of most organ systems in our body, from our heart to our skin, to our ligaments, tendons, and muscles. May is EDS awareness month, and awareness is essential to improve treatment for those with this condition. Low awareness and understanding of EDS means that many will be told that their pain is all in their head while others undergo unnecessary medical treatments and surgeries. Education will help, so I wanted to share some important information on this rare condition. The most prevalent type of EDS, of which there are 13, is hypermobile EDS (hEDS). In clients with abnormal collagen, the ligaments are weak and lack stiffness and tendons are subject to tearing, compromising the stability of the joints. Treatment should be provided and exercise prescribed with this in mind. The most commonly recognized symptom of hEDS is joint hypermobility with symptoms of musculoskeletal pain and complications of joint instability such as recurrent subluxations or dislocations. The disorder also comes with a host of associated co-morbidities, such as dysautonomia, gastrointestinal dysfunction, and mast cell activation disorder to name just a few. As physical therapists, we focus on the musculoskeletal dysfunction but need to make an effort to learn about each client’s medical history and how it plays a role in the overall care of the person. For instance, with postural orthostatic tachycardia syndrome, changes in body position may significantly impact the cardiovascular system, so the therapist may want to limit the positional changes within the session or reduce standing time. The other important thing to consider is that symptoms and associated conditions vary widely between patients, and the severity of symptoms might be vastly different from one person to the next. Also, note that the clinical presentation changes with age as the pain from hypermobility and instability is exchanged with stiffness and joint degeneration. Physical therapy plays an essential role in managing the chronic pain and musculoskeletal dysfunctions associated with Ehlers-Danlos Syndrome. A physical therapist can help you to strengthen weak muscles and stretch tight ones, as well as teach you how to modify your activities of daily living to reduce the impact of the condition. At Zion Physical Therapy, we specialize in the assessment and treatment of joint hypermobility, posture, and stability. We can help you manage fatigue, improve balance and coordination, and reduce the risk of injury. With the help of your physical therapist and other healthcare providers, you can learn to manage the physical challenges of EDS and live your life to its fullest. To find a specialist in your area, visit The Ehler-Danlos Society directory. Please see the below Beighton Score chart to help you assess the condition.

New to running? Or thinking of running your first marathon even though you haven’t run further than 5k before? You could possibly be at risk of developing Medial Tibial Stress Syndrome (MTSS), commonly known as shin splints. What is MTSS? Medial Tibial Stress Syndrome is a very common overuse injury where pain is felt along the inner part of your leg during and possibly after activity. I see a lot of patients with this pathology during the start of a new sport season and/or a drastic increase in their amount of running. Most commonly, people who are at risk for getting shin splints are young individuals with higher body mass index (BMI) and low bone density. Low bone density is most commonly found in women with a history of osteoporosis but can also be found in young women athletes. Activities that require a lot of running and activities on hard surfaces also increase the risk of developing MTSS. Anatomy and Physiology The lower leg is made up of 2 bones, the tibia and fibula. In MTSS, the periosteum of the inner part of the tibia is affected. The periosteum is the outer layer of the bone in which muscles attach. Inflammation and pain occurs due to repetitive pulling of the muscles on the periosteum. The most common muscles involved in MTSS are the posterior tibialis, flexor digitorum, and soleus muscles. These muscles primarily help stabilize the lower leg and foot and aid in pushing off while running. Another muscle commonly involved is the tibialis anterior muscle. This muscle primarily helps lift the foot off the ground. Diagnosis Medial Tibial Stress Syndrome is typically diagnosed by clinical symptoms. The primary symptoms include pain that is brought about with activity and tenderness to touch along the tibia. An MRI can be used to help rule out any more serious pathology such as a stress fracture or compartment syndrome. A stress fracture, although a separate injury, can develop if MTSS is left untreated. Your injury may have progressed to a stress fracture if you feel your pain even at rest and not just with activity. Compartment syndrome occurs when there is too much inflammation in the leg which then starts to compress the nerves and blood vessels that go to the foot. This is also accompanied by numbness in the foot and severe weakness in the leg. The severity of the injury depends on the amount of symptoms in correlation with the amount of activity that is performed. In the beginning stage, pain only occurs with activity and is resolved at rest. As the pathology worsens there is more intense pain with activity and discomfort lasts longer after exercise is stopped. In the final stage, pain occurs even at rest without activity and can indicate a more serious pathology. Medial Tibial Stress Syndrome Treatment Immediate rest is recommended right after the onset of pain. However, when returning back to activity it is beneficial to work with a physical therapist to gradually increase intensity. In the clinic, I like to use a set of guidelines depending on the pattern of pain and activity to successfully return my athletes back to their sport. Abdominal, low back, and hip strengthening can also help to alleviate the work of the lower leg muscles and in turn, decrease the stress on the tibia. Stretching and joint mobilization is also beneficial to decrease the forces on the tibia. Once my patients are feeling a low amount of discomfort, I do a gait/running analysis to see if there can be any changes made to the way they walk/run. This is crucial in preventing future injury. Shoe-wear while exercising is also important. If you are running in the same shoes as last season, you should consider getting a new pair. Sneakers that support your arch and have more shock absorption will help reduce the strain on the muscles of the leg. Also, I like to implement various taping techniques and modalities as necessary to facilitate healing. If you start having any shin pain with running, you should try and run on a softer surface (i.e. dirt versus concrete). If you are experiencing any discomfort during exercise or hit a plateau in your workout, contact us at Zion Physical Therapy at to help you reach your goals!

“Two Conditions That Cause Similar Symptoms Are Hamstring Syndrome And Hamstring Tendonitis. Distinguishing Between The Two Is Important Because The Treatment Is Different." Anatomy The hamstring muscle group is made up of three different muscles, the biceps femoris, semitendinosus and semimembranosus. Two of these muscles (biceps femoris and semitendinosus) insert on the ischial tuberosities, the bottom part of the pelvic bones, commonly referred to as the sits bones. The hamstrings run all the way down the posterior thigh, crossing the knee joint and inserting onto the bones of the lower leg. They assist with bending the knee and extending the hip. Chronic microtears of the hamstring caused by inefficient running gait, muscular imbalances, or overuse can cause inflammation of the tendons where they attach leading to hamstring tendinitis. This injury is commonly seen in athletes and runners who have too long of a stride. Hamstring Tendonitis vs. Hamstring Syndrome Hamstring syndrome has more neural involvement and can be caused by chronic or acute hamstring injuries. While the pain is similar to Hamstring Tendonitis, the cause is MUCH different. In hamstring syndrome, the tendon that is attached to the sits bones become inflamed and form bands of tissue that can surround the sciatic nerve. This nerve begins at the spine and runs through the buttock and down the posterior thigh. It runs just outside of the sits bones and is very close to these hamstring attachments. Movements or activities that compress, stretch or irritate this nerve can cause severe pain. Most often, symptoms are felt when sitting because the sciatic nerve is being stretched (due to the flexed position of the hip), and compressed, (due to the close relationship to the sits bones). Pain when sitting is an important clinical symptom that helps to distinguish hamstring syndrome from hamstring tendonitis, but there are also some clinical tests that can help determine if the pain is caused by muscular or neural impairments. Physical Therapy Treatment Identification of the cause of hamstring pain is important because the treatment for these two injuries is different. Initially, both conditions will respond well to rest and decreased loads on the muscle. Hamstring tendonitis is treated by gentle stretching to relieve tension, cross friction massage to the tendons to stimulate healing, and strengthening of the lower extremities to address any weakness or muscular imbalances. Dry needling has also been shown to be effective to relieve any trigger points in the muscle bellies. Since tendonitis is a chronic issue, the patient’s mechanics when running, walking, or exercising also need to be addressed. Often, a shorter stride and increased cadence when walking and running can decrease the amount of tension and prevent further inflammation. With Hamstring syndrome, treatment initially focuses on reducing the tension and resting. Stretching of the muscles is not recommended because it will place increased tension on the sciatic nerve and will, often, cause increased pain and inflammation. Sitting on a wedge with the higher part positioned in the back, allows the hips to be flexed less and can provide some short term relief. Improving the mobility of the sciatic nerve can also be helpful. Since this nerve has such a close relationship to the gluteal and hamstring muscles, activities such as walking, squatting, and sitting require the nerve to move with the muscles. When it becomes stuck in one position, any movement that stretches or compresses the nerve can be very painful. Exercises can be given in an attempt to break up this tissue and gently glide the nerve up and down restoring mobility and relieving symptoms. Similarly to tendonitis, walking and running mechanics play an important role and both will be addressed in the later stages of treatment to prevent exacerbation and further injury to the tissues. Pain with sitting is the number one sign that can differentiate hamstring tendonitis from hamstring syndrome but there are several clinical tests that can also be performed. These tests place the muscles and nerve in different positions to determine the source of a patient’s pain. In severe cases, both may be present. It has been shown that chronic hamstring injuries can lead to tendinitis AND hamstring syndrome, making individual assessment and treatment very important for full relief of symptoms. Do I Need To Schedule An Appointment? Patients who are compliant with activity cessation and prescribed exercises but who do not experience resolution and healing may be candidates for surgical release to alleviate the pressure on the sciatic nerve. Hamstring injuries can be very confusing and frustrating because they can happen in many different ways and can be difficult to resolve if not treated correctly. If you want more information about hamstring syndrome specifically, think you have hamstring syndrome, or want information about other types of hamstring injuries please contact Zion Physical Therapy to set up an appointment. The therapists at Zion PT have extensive knowledge regarding hamstring issues and are able to tease out the important signs and symptoms to get you on the right rehab track.