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  • 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

  • Hypermobility Spectrum Disorder (HSD): What you Should Know

    “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 Male Pelvic Floor Muscles

    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

  • Rib Subluxations: Are They Real?

    “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.

  • Symphysis Pubis Dysfunction: Pain During or Post Pregnancy?

    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]

  • Attention Male Cyclists: 10 signs it’s time to speak to a Pelvic Floor PT!

    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.

  • What is a “pinched nerve”?

    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!

  • What to Know About Ehler’s Danlos Syndrome (EDS)

    “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.

  • Medial Tibial Stress Syndrome

    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!

  • Hamstring Tendinitis Vs. Hamstring Syndrome

    “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.

  • Abdominophrenic Dyssynergia and Pelvic Floor Dysfunction: A Case Study

    Jordan C’s Personal Experience with Zion Physical Therapy! Thank you Zion Physical Therapy and my physical therapist Staci Levine for all of your ongoing support. I am very grateful and excited for the opportunity to share my experiences. Physical Therapy changed my life. I hope my story will help someone else going through a similar situation and create more awareness and understanding around Abdomino Phrenic Dyssynergia (APD) and Pelvic Floor Dysfunction (PFD). In October 2012 when I was 16 years old, I had a very sudden onset of symptoms. I woke up one morning and my belly looked pregnant. The following days I began to experience constant major abdominal distention, and discomfort especially when eating, or even just drinking water. The bottom of my belly would be hard and round and I would get this squeezing feeling at the top of my rib cage that felt like I was being strangled from the inside. I felt this intense pressure around my ribcage and lower core. I felt bloated. It felt like a balloon of air and simultaneously heavy rocks were forever implanted in my stomach. I always felt full, like a Thanksgiving meal that would never go away. No matter how much I exercised, or how much or little I ate, the round pregnant-like distention would always be present to some degree and would get worse as the day would progress. I would have to wear XXL t-shirts to hide my round abdomen. I would feel sick for hours after meals. I was not able to eat a lot of solid foods and began to have a more liquid based diet that consisted of protein shakes, smoothies, and other soft foods. My diet was very limited and there was no food that didn’t make me feel sick, it was more a matter of finding what I could tolerate the most. For years this was a mystery and I saw many doctors and heard a variety of speculations. Doctors would tell me the distention and pain was because of slow GI motility, or possibly SIBO (small intestine bacterial overgrowth) or perhaps food sensitivities (I tried so many diets, although I ate very clean, nothing helped the bloating, distention, and top of the rib squeezing sensations). Some doctors accused me of having an eating disorder. I had doctors just dismiss my symptoms and tell me that it was all in my head.Other doctors would tell me to do more core exercises. One doctor even wanted to do a botox injection in my pyloric sphincter. Most doctors would just not know what to do and pass me along or hope my GI problems would get better over time by itself. There was also a question at one point if I could have MALS (Median Arcuate Ligament Syndrome) due to my symptoms and diagnostic imaging. I was diagnosed with slow GI motility and ultimately Gastroparesis back in 2012. At the time I was experiencing major constipation. There was a period of a few years where I would have up to six capfuls of Miralax every night as well as drinking two to three gallons of Golytely (a medication often prescribed to cleanse the colon in preparation for a colonoscopy) every four to six weeks just to avoid getting hospitalized for severe constipation. This led to me eventually being diagnosed and treated by the Mayo Clinic in 2014 for Pelvic Floor Dysfunction using biofeedback methods. PFD can commonly occur simultaneously with APD since the pelvic floor and diaphragm have a close pressure relationship and their synergy plays a large role in the core functioning optimally. The Pelvic Floor Dysfunction can present differently depending on the person but in my case, my pelvic floor was so tight that it was not releasing properly and would contract instead of relax. It’s worth noting that I was also diagnosed with Autonomic Dysfunction which was playing a huge role in my constipation and GI troubles and could perhaps be what caused the PFD and APD (but we will never exactly know for sure). Doctors figured that treating the Pelvic Floor Dysfunction would also solve the APD as well. But despite treating PFD and the constipation slowly improving, I still had no relief in the upper rib squeezing sensation, major distention, air in stomach, and pain and discomfort with eating. Another two years went by and doctors told me that it seemed like some of my GI symptoms could still be related in part to APD. They told me there was not a lot of research on APD and there was nothing much that could be done to treat it at this point. Simply put they said “it is what it is” and just continue to practice some diaphragmatic breathing. I just couldn’t believe that there was no way to help it, that just didn’t make sense to me. There had to be something we could do. Over the course of the next three and a half years I always had APD in the back of my mind and continued to bring it up to different doctors with the hope that someone would know something that could help. After a total of six and a half years of dealing with these symptoms all day, every day, I had a consultation with a GI doctor at Weill Cornell who had heard of physical therapy for APD. She referred me to Zion Physical Therapy in NYC. In April 2019 I started physical therapy with Staci Levine. She was so kind and patient, I quickly knew I could really trust her and she would be the absolute perfect person to help me! She made me feel comfortable opening up in detail about the struggles I went through and was living with. She listened with such compassion and not once did she dismiss my symptoms. I was so excited and grateful to have someone believe that I could feel better and be willing to work with me. For the next 12 months we constantly worked to release my diaphragm and pelvic floor, retrain the muscles coordination, and strengthen my core muscles. The goal was to make sure the diaphragm and pelvic floor were both releasing as effectively as possible, this way we could coordinate their functioning. With PT my pelvic floor started to release with more ease and began functioning better than ever. Treatment included abdominal/colonic massage, internal rectal muscle releases in coordination with proper relaxation of the pelvic floor, core activation exercises and core strengthening, posture education and taping to re-educate neuromuscular control. We also worked to relax my very tight upper back muscles and increase mobility in my thoracic spine. This helped loosen around my rib cage which created more freedom for my diaphragm to fully release. Staci was able to loosen my diaphragm with manual release techniques. When my diaphragm released properly, it was like a magic trick! I would go from having a round pregnant-like stomach to a flat stomach in minutes. I couldn’t believe it!!! I then immediately knew this was the missing piece to the distention and squeezing all along. This was a matter of the body not functioning cohesively. I went to PT twice a week and then was compliant with our home exercise program which consisted of: diaphragm release techniques, abdomen massages, stretches, foam rolling (for my back), and strengthening exercises on my own multiple times throughout each day. I would work to specifically focus on strengthening my lower core, obliques, and upper back. In the morning upon waking, after meals, and if I remained sedentary for too long were the main factors that increased the abdominal tightness and squeezing (in my rib cage and lower core area), so I did have to continually implement the techniques I learned in PT to manage my diaphragm throughout the day. I would spend a lot of time practicing breathing with a focus on expanding my rib cage, rather than breathing to expand my belly or shallow chest breaths. In the past doctors would often recommend the relaxation breathing technique of expanding the abdomen and filling it with air on inhale, and then feeling the abdomen retract on the exhale. Personally, this type of breathing actually made my symptoms worse because it further reinforced the pattern of my abdominals over expanding instead of contracting to compensate for the diaphragm getting stuck and pushing down on my abdominal wall. It took awhile for my diaphragm and core to learn how and get used to functioning in a “new” way. Normally the diaphragm releases, the core maintains contraction, and the pelvic floor relaxes. For those with APD and PFD the diaphragm is stuck in contraction which forces the abdominals to relax causing the distention. The pelvic floor also contracts when it is supposed to relax causing constipation. When I first started PT my stomach would often, as I call it “pop”, go back to bulging and wasn’t able to keep the proper neuromuscular pattern. Sometimes within 15 minutes of leaving PT my abdomen would return to bulging. After several months my stomach began to hold for a day before it would pop, then a couple days, in late July 2019 in held flat for a week! The diaphragm just slowly started staying and holding the correct position for longer increments of time as we continued our sessions reminding it of what it was supposed to do. There would be periods of “setbacks” where my body didn’t always respond in the way I hoped it would, but I knew it was overall slowly moving in the right direction so I felt hopeful! At just about a year into PT in March 2020, I stopped having the daily extreme pregnant looking distention all together. Staci helped me address all the ways I was compensating from living in this dysfunctional way with APD for so many years. She would put two pieces of Kinesio-tape from my ribcage down to my hip bones. The tape would act as a cue to help remind me to stand properly and try to maintain my lower core engagement (when we were able to get my diaphragm to release) rather than giving into the urge to relax my lower core muscles as they were so used to naturally doing. I would wear the tape around in my daily life often. My normal posture inclination was to lean back, standing up straight felt like I was leaning very far forward. I had to learn how to stand in proper alignment. As we were able to start getting my diaphragm to release, I had to relearn how it felt to engage my core muscles properly. Especially early in the PT process, my core muscles would tremble and shake, and feel weak because they were not used to being able to fully contract. It felt like a whole new way of existing. I had to go back to the basics and slowly build my core strength and learn how to move utilizing my newly capable core rather than compensating and using other muscles. For years my upper back and neck were chronically very tight and caused me a lot of daily pain and headaches from which we believe were partly due to the fall out of compensating for so long and having the diagram tightness. Staci works on rehabilitating my back and neck muscles so this way they are able to release, gain more mobility, and be able to handle a fuller range of motion. My headaches and constant neck pain have improved dramatically. I have always been an active person, exercise has really helped me especially since becoming chronically ill in 2012. Even though working out when feeling sick can feel very counterintuitive at times, I’ve always believed in consistent movement and the importance of keeping my body as strong as possible to give it the best chance at recovering. I am a dancer so personally, exercise was key for my APD recovery. I make a point to do some form of movement along with my PT exercises everyday otherwise I’d feel an increase in tightness in my abdomen. Dance classes along with pilates, yoga, strength training, and HIIT workouts helped me tremendously with keeping the diaphragm from tightening and retraining the core engagement. Although I learned I have to avoid crunches and upper abdominal contracting motions often seen in Pilates (when in craniocervical flexion when lying supine position). These crunching type motions irritated my diaphragm and would cause an increase in the squeezing sensations which would then at times even lead to my abdomen going back to bulging. Alongside eating very clean, I have small nutrient dense meals throughout the day (combination of solid food and soft foods) with a lot of hydration. Large meals can really irritate and cause squeezing sensations and a lot of pressure around my stomach area. Before starting PT, I used to eat just to get it over with. I am now working to practice eating more mindfully by eating slowly and chewing more fully. Mindful eating helps me better manage the pain around my rib cage that comes from eating. And here I am today! No more wearing XXL tees to hide my distention. No more excruciating pain everyday from wearing sports bras. No more planning my days around getting my daily to do list done before the distention and discomfort and back pain becomes too much to bear. My abdomen no longer gets filled with large amounts of excess air. Eating, drinking water, breathing, feels so much better. My GI motility rate is also significantly better compared to a few years ago! And I even burp now, for years I never burped. Before PT, everyday I used to dread eating food and even just drinking water and my low back was always in terrible pain from the distention. My low back pain is gone. I no longer struggle with constipation. I go to the bathroom fully everyday and I don’t use any laxatives! I am in complete awe of my progress. My daily quality of life has completely changed. I continue to go to PT twice a week and do all the work outside of the sessions everyday since the muscles still get tight and I get some bloating and air. My abdomen still gets a little more distended at times than the average person but I am able to help it by implementing my PT techniques to help the muscles to relax. Overall my stomach does stay consistent with my flat stomach ‘after picture’. Since I had APD untreated for so many years I knew I had to be patient, consistent, and dedicated to this process for the long haul. I made a promise to myself to give this rehabilitation my all. I did my best to look past the hard days and focus on the big picture and being positive and seeing the promise in every small improvement. I am committed to treating this as long as it takes. Based on my current progress I believe it will just keep getting increasingly better and I will eventually be pain free and healed as I continue my daily practices. My diet in between these before/after photos did not change at all! Exercise and dancing feels so much more free now that I can fully engage my core correctly. I look back and can now realize why there always felt like a disconnect from what my body was doing versus what I deep down knew it was capable of doing. It feels like huge missing pieces have finally clicked and I understand why so many aspects of dancing and workouts were such a struggle. I am continuing to learn how to move while maintaining core engagement and I feel stronger than ever. It's truly unbelievable the difference I feel! I couldn’t believe how much daily pain and discomfort I had lived with and normalized. After eight years I had my breakthrough! So many doctors gave up on figuring this out, but I’m so glad I never gave up when in my gut I always knew there had to be an explanation and a solution. I hope my account helps bring more understanding to the hurdles people with these types of conditions often face everyday. I went to such great lengths to hide my struggles and my stomach distention in my daily life. I forced myself to push through life, and tried my best to cope and be positive. But it was miserable everyday consistently being in physical pain and extreme discomfort. I forgot what it felt like to feel pain free. It got to the point where for years I didn't know any different than to be in discomfort. I gave it my all to try and rise above and manage but my symptoms dictated a lot of aspects of my life. It felt like a never ending nightmare. This was not something that would have gone away on its own and no doctor was specifically addressing treating APD. If it hadn’t been for me pushing and questioning all this time it’s likely I would have continued on with this for years when it was treatable all along. I am very grateful and feel so lucky that I happened to have a consultation with a GI doctor who knew I could go to PT for APD and knew where to send me. It should be noted that APD and PFD are only one aspect of my long and complicated medical journey. I am diagnosed (by the Mayo Clinic) with Dysautonomia -specifically Autoimmune Autonomic Ganglionopathy which causes a whole host of other symptoms and problems I’m currently still working through. My body has been through a lot over the years. At times I have felt discouraged and concerned about how sick and physically weak I have been. While I always wanted to be hopeful, a part of me wondered if it was realistic or even possible to truly feel better after consistently struggling for such a long period of time. My comeback with APD reminded, reassured, and helped me to realize that given the right treatment, the human body can be very resilient, capable, and strong and it is possible to make big recoveries from complex health adversities. My APD breakthrough was backed by a lot of consistent hard work, patience, optimism, and belief. It feels like a miracle and the greatest gift I could ever have hoped for. Much of my health journey over the years I have often kept private. But I want to be more vulnerable about my experiences because we all have insecurities with our bodies and I think it is important to talk about these things, it is nothing to be ashamed of. After so many years of hardship with this, I knew I would find freedom in having the courage to own my story and all its truths. APD is slowly becoming more recognized but there is still a lot to be learned about it. I want to share my story because I know there are many people like me out there with this being misdiagnosed or don’t know that there is treatment for APD. I think it is also very important that Pelvic Floor Dysfunction is talked about more freely, because it is something many people struggle with. I don’t want patients to feel alone or self conscious so that was a big reason why I decided to share my story. I first googled Abdomino Phrenic Dyssynergia back in 2014 and hardly anything came up about it. I am writing the article that I wish had popped up. Learning about someone else’s experience and perspective would have given me a direction to look into and potentially saved me many years of daily suffering. For anyone going through this, there is hope and it is not too late! I know it can feel defeating going through all this but keep searching for answers! Lastly I want to say a big thank you to Zion PT for helping me share my story. Thank you to my physical therapist Staci!!!! I am forever incredibly grateful to Staci for believing and inspiring me, and for changing my life. Written by Jordan C. If you are dealing with symptoms like this, come see one of the pelvic floor specialists at Zion Physical Therapy so we can help get you back on track to living life the way you want to! Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

  • 5 Tips to Relieve Plantar Fasciitis

    A great running friend has struggled with plantar fasciitis for years on and off. She eloquently refers to exacerbation of pain as “the Planted Fascists” drilling into her foot. This always makes me laugh thinking of angry politicians banging sharp tools into her foot- clearly not what is happening, but certainly an apt description of this pathology’s pain! If you struggle with this very frustrating, often chronic, foot ailment - here are 5 tips to calm down the ‘Foot Fascists’: Stretch your calf muscles -- All 3 (2 leafs of the gastrocnemius and the soleus) calf muscles contribute to tightness in the posterior lower leg, which then pull on the Achilles tendon which then yanks on the plantar fascia; loose calf = happy foot! Roll your foot on a ball -- the most effective tends to be a frozen golf ball, but anything small and hard to get into the firmest parts of the plantar and relieve knots; if it hurts you’re probably in the right spots! Think about how you sleep: is your foot pointed? If so, try to avoid this! It leads back to tip #1. There are socks that help you avoid doing so, some that provide compression to the medial foot/assist in correct ankle position and others that actually hook/strap so your foot remains more neutral as you sleep. Burn all your thong sandals… kidding, sort of...make sure your footwear has a good supportive arch and that your foot is secure in the shoe. Sandals that only go around your toes and slap when you walk are the worst for plantar problems, followed by very flat shoes, and of course/sadly -- high heels. Seek physical therapy! From soft tissue massage to the plantar surface, to ankle stretching, to hip mobility - PT can assist in changes throughout the kinetic chain to make foot strike and functional mechanics more agreeable for all parts of your body, including the bottom of your feet.

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