top of page
zion physical therapy logo
Request Appointment

59 items found for ""

  • What Can I Anticipate After My Bladder Surgery?

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

  • Pelvic Organ Prolapse (POP)

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

  • Benign Paroxysmal Positional Vertigo (BPPV)

    When you hear vertigo you probably think of dizziness. But did you know the term “vertigo” refers to a specific type of dizziness? Vertigo is the sensation of the room spinning around you and that’s exactly how my patients describe it when I am treating them in the Westport, Connecticut Physical Therapy clinic at Sherpa Gym. While most patients experience specific spinning with BPPV, sometimes you can just feel off balance. An extensive history of the patient’s limitations and symptoms is very important for determining what the patient is suffering from. “I rolled over in bed and all the sudden the room was spinning. It only lasted a minute or so, but now I am scared to turn my head or go to sleep.” When this happens it is indicative of a condition that’s abbreviated BPPV: Benign Paroxysmal Positional Vertigo. BPPV is caused by changes in the anatomy of your inner ear (see below). When my patient came in and told me this we did an assessment to rule in/out conditions. One of them was a direct test for BPPV (the Dix-Hallpike maneuver) to confirm, and then we performed a technique (Epley maneuver) to alleviate the symptoms. She came in later that week and hadn’t had any episodes of dizziness. Sometimes all it takes is 1 visit! The actual semicircular canals are shown above on the left. The picture on the right shows what’s inside the vestibule (labeled on the left picture). As you move your head, the fluid inside the canals lags behind and moves the hairs shown. There are calcium crystals in the vestibule which help keep the hairs in place. When these get loose they can fall into the canals, causing BPPV and dizziness. BPPV is only one of many vestibular conditions that can cause dizziness. We look at your eye movements, head movements, and balance to determine what is causing your specific dizziness. See one of our vestibular physical therapists at Zion Physical Therapy to figure out what is causing your dizziness and get back to your full function. You do not need a prescription or referral prior to your visit. Call (212) 353-8693 or email schedule@zionpt.com to schedule!

  • Post Prostate Surgery Problems?

    Zion Physical Therapy Can Help! Over 165,000 New Cases Read on to find out more about Post Prostate Surgery Over 165,000 New Cases Of Prostate Cancer Will Be Diagnosed In The US In 2018 According To The American Cancer Society. That’s Nearly 10,000 New Cases In New York Alone! This Makes Prostate Cancer The Second Most Prevalent Cancer In Men In The US.* Depending on the severity of the cancer, one’s doctor may recommend different treatment options for post prostate surgery. Procedures such as a radical prostatectomy, laser surgery, radiation, TURP (Transurethral Resection of the Prostate) or laparoscopic surgery are all common options. Unlike most surgeries, the most common side effects affect your sex life and your bladder. These side effects are intimate. They can feel embarrassing. They are not often talked about, but a lot of them are common. If you experience any of the following:difficulty getting or maintaining an erection pain with orgasm urinary leaking dribbling more intense urinary urgency frequent trips to the bathroom pain in your pelvic area (penis, testicles, perineum, and even lower abdomen) Zion Physical Therapy can help! These side effects are the result of weak or impaired pelvic floor muscles. The good news: You can rehab your pelvic floor muscles just like any other muscle. What are your pelvic floor muscles you ask? These are the muscles that are responsible for healthy bladder, bowel, and sexual function. These muscles can be rehabbed just like your shoulder muscles after a rotator cuff repair surgery or your back if you experience low back pain. Pelvic floor physical therapists are specially trained to strengthen both internal and external muscles so life does not revolve around wondering where the nearest bathroom is or can I have sex tonight? They’ll guide you in internal and external workouts to strengthen your pelvic floor muscles and other muscles which support your pelvic floor so you become even stronger. In addition to training your pelvic floor muscles, your physical therapist will review diet and proper hydration which can also effect symptoms, and provide a home exercise plan just like you’d get after any other injury. Feel like yourself again, realize you are not alone, and ditch the diapers! -Francesca Warner, DPT *Key Statistics for Prostate Cancer | Prostate Cancer Facts. (n.d.). Retrieved January 08, 2018, from https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

  • 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

  • Training: The Importance of Rest

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

  • Top 10 Ways to Prepare for the Corporate Challenge

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

  • Your pelvic floor in the times of COVID-19

    Living in a quarantined environment due to the COVID pandemic is a challenge for us in all fronts. This can also present a challenge to look after our pelvic health, especially since that in itself within the context of normalcy is already a huge undertaking. If you’ve already been working with one of Zion PT’s skilled pelvic health therapists, please stay motivated through this time and think back on all the hard work you have put into harnessing the healing power of your own body. Below, we’ll review a few of the practices learned together in the clinic to help maintain normal length and tone in your pelvic floor during these stressful times; Diaphragmatic breathing - there’s no time like right now to keep practicing proper breathing patterns. Make sure you’re lying down in a comfortable position, propping pillows under your knees and head if necessary. Take a mental scan of your body and identify all the parts of it that hold on to tension. E.g the brow, jaw, shoulders,hands, ribcage, hips, feet. Make sure you’re slowly allowing that tension to melt away as you breathe into the diaphragm allowing your belly to rise and gently exhale. Set your timer for 5-10mins. Living in a quarantined environment due to the COVID pandemic is a challenge for us in all fronts. This can also present a challenge to look after our pelvic health, especially since that in itself within the context of normalcy is already a huge undertaking. If you’ve already been working with one of Zion PT’s skilled pelvic health therapists, please stay motivated through this time and think back on all the hard work you have put into harnessing the healing power of your own body. Below, we’ll review a few of the practices learned together in the clinic to help maintain normal length and tone in your pelvic floor during these stressful times; Diaphragmatic breathing - there’s no time like right now to keep practicing proper breathing patterns. Make sure you’re lying down in a comfortable position, propping pillows under your knees and head if necessary. Take a mental scan of your body and identify all the parts of it that hold on to tension. E.g the brow, jaw, shoulders,hands, ribcage, hips, feet. Make sure you’re slowly allowing that tension to melt away as you breathe into the diaphragm allowing your belly to rise and gently exhale. Set your timer for 5-10mins. 2. Stretching - Normalizing tone and tension in your hip muscles can help relax your pelvic floor muscles Hold the stretch steady for 30 seconds and repeat 2-3 times on each side. Some googable examples are; figure 4 piriformis stretch, supine butterfly stretch (shown below), happy baby pose and supine hamstring stretch. 3. Belly massage - for those of us with abdominal discomfort and bloating this can sometimes provide surprising relief. You can use a little lotion on your skin - or not. Make sure to be gentle in massaging your abdomen, tracing the path of the big intestine and applying a few seconds of sustained pressure to the points that feel a little denser. Breathe through it. Applying a heating pack to the abdomen for 8-10 minutes beforehand can help your body relax that extra bit, if that’s available to you. 4. Foam rolling - our other self massage tool for the home dwelling times. This one may not be as popular due to the fact that rolling out tight muscles can be a bit of an uncomfortable experience, but just think of how good it will feel when you’re done! You only need do it for 1-2 mins in total, each side. Very googable examples are; foam rolling for the glutes, foam rolling for the quadriceps, foam rolling adductors (shown below). 5. Dilators - Dilators are stretching tools for your pelvic floor, used specifically for addressing muscle tightness. Be gentle and start at the beginning. *PLEASE only complete at home if you’ve been instructed on how to use dilators by your physical therapist!!* Lie down on your side or back in a comfortable and private setting. When in doubt, start with the smallest size dilator and insert into the vagina with lubricant only as far as your body allows with comfort. Hold it there for a few mins (5-10) until your body relaxes and is comfortable. You may insert further, but only as far as your body comfortable allows- this is most definitely NOT a “no pain no gain” situation. Always listen to your body and never push further than what feels comfortable. A total of 20 mins of dilator work each day will suffice to allow for maintenance and progress. Through these times it is important to be self-sufficient in terms of setting a schedule for ourselves, to be able to properly fulfill our self-care duties. Write out a little program for yourself for the things you will do on a specific day for your pelvic floor. Eg.- Mon @6pm; 8 mins of diaphragmatic breathing, 10 mins of dilator work, figure 4 stretch and butterfly stretch. If you are a current patient, don’t give up on all the progress you made in the clinic!! Remember that ultimately our work together is meant to capitalize on your own body’s ability to heal and COVID-19 or not, that power always lies within you. As always if you need guidance with your current program, or would like to speak to one of our skilled Doctors of Physical Therapy via Telehealth or in-office visits, call (212) 353-8693 or email schedule@zionpt.com. As a somewhat random note, I included Queen Elizabeth II's address to the world because I found it comforting and inspiring. Just a little tidbit to keep the love alive. https://youtu.be/2klmuggOElE 2. Stretching - Normalizing tone and tension in your hip muscles can help relax your pelvic floor muscles Hold the stretch steady for 30 seconds and repeat 2-3 times on each side. Some googable examples are; figure 4 piriformis stretch, supine butterfly stretch (shown below), happy baby pose and supine hamstring stretch. 3. Belly massage - for those of us with abdominal discomfort and bloating this can sometimes provide surprising relief. You can use a little lotion on your skin - or not. Make sure to be gentle in massaging your abdomen, tracing the path of the big intestine and applying a few seconds of sustained pressure to the points that feel a little denser. Breathe through it. Applying a heating pack to the abdomen for 8-10 minutes beforehand can help your body relax that extra bit, if that’s available to you 4. Foam rolling - our other self massage tool for the home dwelling times. This one may not be as popular due to the fact that rolling out tight muscles can be a bit of an uncomfortable experience, but just think of how good it will feel when you’re done! You only need do it for 1-2 mins in total, each side. Very googable examples are; foam rolling for the glutes, foam rolling for the quadriceps, foam rolling adductors (shown below). 5. Dilators - Dilators are stretching tools for your pelvic floor, used specifically for addressing muscle tightness. Be gentle and start at the beginning. *PLEASE only complete at home if you’ve been instructed on how to use dilators by your physical therapist!!* Lie down on your side or back in a comfortable and private setting. When in doubt, start with the smallest size dilator and insert into the vagina with lubricant only as far as your body allows with comfort. Hold it there for a few mins (5-10) until your body relaxes and is comfortable. You may insert further, but only as far as your body comfortable allows- this is most definitely NOT a “no pain no gain” situation. Always listen to your body and never push further than what feels comfortable. A total of 20 mins of dilator work each day will suffice to allow for maintenance and progress. Through these times it is important to be self-sufficient in terms of setting a schedule for ourselves, to be able to properly fulfill our self-care duties. Write out a little program for yourself for the things you will do on a specific day for your pelvic floor. Eg.- Mon @6pm; 8 mins of diaphragmatic breathing, 10 mins of dilator work, figure 4 stretch and butterfly stretch. If you are a current patient, don’t give up on all the progress you made in the clinic!! Remember that ultimately our work together is meant to capitalize on your own body’s ability to heal and COVID-19 or not, that power always lies within you. As always if you need guidance with your current program, or would like to speak to one of our skilled Doctors of Physical Therapy via Telehealth or in-office visits, call (212) 353-8693 or email schedule@zionpt.com. As a somewhat random note, I included Queen Elizabeth II's address to the world because I found it comforting and inspiring. Just a little tidbit to keep the love alive. https://youtu.be/2klmuggOElE

  • Anterior Hip Pain/Snapping Hip Syndrome in Dancers

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

  • Physical Therapy after Breast Cancer Surgery

    Breast Cancer. We all seem to know a friend or family member who’s had it, or have had it ourselves. We also seem to be familiar with the methods associated with treating it...chemotherapy, radiation, medications, diet modification...but what about physical therapy? When you break a bone or sprain a ligament and are immobilized for a period of time you are automatically prescribed PT, why not when you are post-op breast surgery? We’ve asked the same question. Possible surgical procedures with diagnosis of BrCA: Sentinel Lymph Node Biopsy (SNLB) Axillary Lymph Node Dissection (ALND) Lumpectomy Mastectomy Reconstruction (Expanders, Silicone or Saline implants, TRAM flap, LDF flap, gracilis flap, DIEP, SIEA, GAP) Possible activity restrictions after surgical procedures: No lifting arms above 90 degrees No driving No heavy lifting > 5lbs for several weeks No lying on stomach No wearing bras No stretching anywhere from 1-6 weeks depending on procedure as per surgeon No strengthening anywhere from 2-12 weeks depending on procedure as per surgeon While these surgical procedures can be extremely helpful in addressing the cancer itself, any of these surgical procedures and the precautions that immediately follow can affect how well you can move your shoulder and arm while performing your daily activities. Activities like dressing, bathing, combing your hair, taking care of your kids and working out can be difficult from resulting pain, stiffness and weakness. Focus tends to be on the resolution of the cancer, however oftentimes the residual physical impairments are not addressed! So, what can physical therapists do to help? Manual Soft Tissue Mobilization: addresses neck, shoulder and upper back range of motion and flexibility loss secondary to soft tissue restrictions in muscle and connective tissue Joint mobilization: Restore proper joint motion to shoulders, cervical spine, rib cage and thoracic spine to normalize motion Scar work: decreases restrictions and sensitivity through gentle scar mobilization Flexibility and strengthening exercises to address shoulder range of motion loss and weakness Education regarding proper posture with activities of daily living and protection of surgical site Assess and treat lymphatic cording Recommend compression garments and provide referral to lymphedema specialist when necessary What is an Initial Evaluation and treatment session at Zion PT like? Your physical therapist will introduce themselves and take you into a private treatment room where you will discuss your past medical history, interventions thus far and any restrictions recommended by your surgeon. You therapist will then do a physical evaluation performing the following: Circumferential measurements of the upper extremities to determine presence of lymphedema Scar closure and mobility assessment Posture assessment Upper body Range of motion testing Upper body Strength testing An in depth conversation regarding individual patient goals Outline a plan of care, frequency of treatment and foster communication with your surgeon/oncologist Following the evaluation, individualized manual therapy and exercises to achieve all ROM, strength and function goals will be outlined and performed and you will be sent home with follow-up exercises and a plan of care at a frequency agreeable to both you and the PT based on your needs! We at Zion Physical Therapy are focused on optimizing quality of life for all of our patients! If you’d like to make an appointment with one of our skilled physical therapists, please call (212) 353-8693 or email schedule@zionpt.com

  • Are You an A+ Pooper?

    Take this Quiz to find out: By Brooke David, DPT Recent reports show that constipation rates are high all over the world--which leads me to ask--why? There are all sorts of factors that play a part in successful defecation such as: hydration, a well balanced diet, activity levels and of course different medication can always have an impact on our normal bathroom routine. But--how do you know if you are pooping correctly? Did you know your form and how you are going can also contribute to constipation? Answer these questions below to help better understand if you are going to the bathroom like a pro or if you need a few lessons. When do you decide it is time to poop? When I get the urge to go When I wake up in the morning after having coffee After work before I shower I need suppositories to flush me out Do you find yourself out of breath during or after pooping? No Yes Sometimes Not sure What is your stool’s normal consistency? Soft banana Sausage type & Lumpy Hard pellets All liquid How long are you sitting on the toilet? 5 mins or less--who has time? 10-15 mins --I like to read the news too 15-30 mins -- gotta play one game of candy crush 30-60 mins+ --just waiting for as long as possible What does your posture & form look like while pooping? Feet on a stool, leaning forward with legs open and space for the belly to expand Straight up nice & tall with feet on floor Slouched with feet on floor or stool--depends on the bathroom I have no idea I have never thought about this! If you answered all #1 then you get an A+! If you answered anything but 1, here are some basic tips to consider to help improve the defecation process: Go when you get the urge--don’t delay if possible! While defecating, open your mouth and exhale--you can grunt or sing as well! Aim for poop to be soft like a squishy banana so it is easier to pass A squatting position relaxes the pelvic muscles so using a stool or squatty potty can help Drink as much water as possible Lead an active lifestyle These are some simple lifestyle changes that can be made to improve your ability to defecate. If you have questions or feel there is more to the problem, then you should come see a pelvic floor specialist at Zion for further help. Phone: 212-353-8693 • Fax: 347-507-5510 • Office Email: frontdesk@zionpt.com

bottom of page