If you are experiencing musculoskeletal issues, then it is pretty commonplace that you may have undergone imaging of the area you are having trouble with. Oftentimes, when patients are seen by a physician to first investigate musculoskeletal type pain they will then be referred for imaging of the region including x-ray, MRI, and CT imaging. The results of these types of tests can many times feel very scary or provoke feelings of anxiousness. However, the good news is changes in imaging do not always mean this is the direct cause of your pain or that you are broken! This concept may be a new one for many of you as we traditionally heavily rely on this type of imaging to give as answers as to why we are experiencing discomfort. Through reading this blog, my hope is to imaging findings for all our readers!

So, you may have recently undergone an MRI or x-ray of your spine, knee, hip or shoulder — the next step is typically receiving the results of this imaging. The findings read ‘degenerative disc disease’ or ‘partial rotator cuff tear’ or ‘joint degeneration’. This verbiage can be very frightening and worrisome for many individuals, we begin to think there is something wrong or damage without our bodies. The good news is, these findings are normal as we get into the 3rd, 4th, 5th, 6th decades of life and beyond! As we age, findings on pictures we take on the inside of our bodies often reflect normal age-related changes. Just as we begin to develop wrinkles on the skin and gray hair as we age, we also develop wrinkles on the inside! Do wrinkles or gray hair cause us pain? Of course not! These ‘degenerative changes’ should be reconceptualized as ‘wrinkles on the inside’. Don’t believe me yet? Let’s talk about some statistics.

Studies show that 50% of people aged 65+ who have NEVER experienced shoulder pain or issues demonstrate partial rotator cuff tears or tendinosis on imaging 1

37% of individuals aged 20 y/o with no pain demonstrate degenerative spine changes 2

84% of asymptomatic individuals at 80- y.o. demonstrate disc bulges on imaging2

As you can see the above listed studies are performed on individuals without any pain or issues with movement, however they still demonstrate changes upon imaging. These changes mentioned previously are normal and can be reimagined as wrinkles on the inside!

References:

Gill TK, Shanahan EM, Allison D, Alcorn D, Hill CL Int J Rheum Dis. 2014 Nov;17(8):863-71. Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. Int J Rheum Dis. 2014 Nov;17(8):863-71

Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.

Have you ever discovered a cut on your hand but not remember when you bumped it? The only way you knew that you had injured your hand was by visually seeing the cut. Experiencing an injury to the issue does not always result in pain. Think about what this means. Pain and tissue injury are not synonymous, you can have one without the other. Injuries heal, but pain lasts…why is this?

Think of yourself as a measuring cup. Fear, anxiety, constant stress, job issues, family concerns, previous failed treatments and persistent pain are all aspects of life that may fill this cup. Now picture this full cup with a fire is lit under it. What do you think happens? This fire could be a change in the weather, an hour of sitting in traffic or even just bumping your knee on the kitchen table. We will learn empty this cup.

This concept does not mean that your pain is not real. When the body experiences pain for a long time, the brain’s pain map begins to change.

Do you find it more difficult to focus or concentrate? This may be because the brain begins to associate pain with all areas of the brain. The brain is working overtime to attempt to process pain causing your body’s alarm system to be extra sensitive. The beautiful thing is our brain is plastic. The good news is, you’re in the right place, I believe we can help you.

I you believe you are experiencing chronic pain, reach out to us. We want to hear your story and help you get back

Reference:

Louw A., Pain Neuroscience Education. Session 18. 2020.

I was diagnosed with Parkinson’s disease, what do I do?

If you have been diagnosed with Parkinson’s disease this means you have seen your neurologist and started to develop a plan for your future. Whether you have started on medication or not there are a lot of actions you can take with your physical activity that has been clinically proven to help slow the progression of Parkinson’s disease. We like to call this physical medicine, while it is a lot more work than taking a pill, it actually has been scientifically proven that specific exercise can help to slow the progression of Parkinson’s disease vs. just masking the symptoms with medication.

Now you know there is some action you can take. You need a plan! When you get a diagnosis like this you want to have someone who knows what they are doing in your corner. Luckily we do, and we are here to help you make that plan. At Wonsettler Physical Therapy we have therapists trained in the LSVT BIG technique. This is a high intensity amplitude based program that was specifically developed for people living with Parkinson’s disease. The program is 4 times a week for 4 weeks, not only do you perform high intensity exercises at the clinic but you repeat these exercises at home and continue them even when your journey with us is complete. This may sound daunting, but it is necessary in order to make a positive change in your physical health to help you battle this disease.

Your program will consist of a series of 7 exercises that challenge your balance, endurance, strength and awareness of your body. All things that are affected by Parkinson’s disease. This is followed by five specific exercises similar to what you do in your daily life, whether that is caring for your grandchildren, golfing or household chores like doing the dishes. It is our job to make these exercises individualized to your specific needs. This is followed by aerobic activity and tasks that incorporate multiple steps that you would encounter in your daily life.

Getting the diagnosis of Parkinson’s disease is something you never want or plan to hear.

Hopefully, after reading this you feel empowered knowing that there are actions you can take to help improve and maintain your mobility, and people here to help you do just that!

What is ASTYM?

You may have heard of instrument assisted soft tissue mobilization (IASTM) techniques or foam rolling but ASTYM is different! ASTYM stands for Augmented Soft Tissue Mobilization. This differs from foam rolling and IASTM as it utilizes handheld instrumentation to engage dysfunctional tissue with the goal of stimulating a physiological response creating resorption of the dysfunctional tissue. What does that mean? Instead of “breaking up” that tissue with friction techniques we are teaching it to heal itself and realign to how it was prior to the dysfunction. This makes ASTYM a much less painful technique than traditional friction techniques.

Why ASTYM?

ASTYM works well with tendinopathies such as lateral epicondylitis, plantar fasciitis, achilles tendonitis and rotator cuff tendinopathy. ASTYM can also be used for other orthopedic conditions whether acute or chronic such as frozen shoulder. ASTYM also does well with “old” scar tissue or with chronic conditions that have not responded well to “traditional” therapies. ASTYM also works fast! Typically you will see improvements in 3-4 treatments!

In 2014, a randomized controlled trial ASTYM showed a 78% resolution of problems in comparison to 40% resolution in the group undergoing traditional therapy for the treatment of tendinopathies. A 2018 systematic review also showed that ASTYM can help patients after a total knee replacement to improve range of motion and decrease pain. In the same review ASTYM showed to improve ROM in patients following mastectomy and improved pain and stiffness in patients with foot and ankle injuries.

If you are someone who has suffered from these chronic issues ASTYM could be just what you need! With ASTYM treatment, followed by an individualized treatment plan involving strengthening, stretching and neuromuscular re-education to help teach the new regenerated tissue how we want it to work properly we can get you back to doing what you love!

Abdominal surgeries impact the way your lumbopelvic system functions – including your low back, abdominal muscles, hips and pelvic floor. However, it is rare patients receive any post-operative treatment. Whether you’ve had a surgery a couple months ago or years ago, if you are experiencing dysfunction in this lumbopelvic system, you may be the perfect candidate for some physical therapy.

Your abdomen houses your vital organs, so this area needs to have a rich blood supply so that these organs can get the blood and nutrients needed. This is a wonderful thing because this area heal very well after surgery, however this may also lead to copious amounts of scar tissue.

Most people receiving abdominal surgeries do not receive preoperative education or post-operative care leading scars to be mismanaged or not managed at all. The appearance of a scar can be deceiving. You can think of a scar as an iceberg. On the surface the scar may look small and well healed, but under the surface the scar may contain deep adhesions wrapping around the organs and affecting the underlying fascia, skin or muscle. The research demonstrates that 50-100% of patients will develop adhesions after any abdominal/pelvic surgery. Scar tissue is a normal part of healing, however when there’s too much of it there can be limitations in mobility affecting function.

Scar tissue formation in the abdominal region can contribute to low back pain, pelvic pain, pelvic floor dysfunction (constipation, incontinence), muscular coordination issues.

This scar tissue formation does not have to be permanent! Some options include soft tissue mobilization, scar tissue massage and visceral mobilization which can all happen in the physical therapy setting. Surgery is also an option, but there is a risk of creating more scar tissue.

It’s not too late! Even if a scar is 20 years old, we can help.

References:

Aloiaet al. Reoperativesurgery: a critical risk factor for complications inadequately captured by operative reporting and coding of lysis adhesions. J Am CollSurgery. 2014: 219(1). 143-150.

Baker et al. A review of therapeutic ultrasound: biophysical effects. Physical Therapy. 2001: 81(7). 1351-1358.

Forbes. Crohn’s disease: rehabilitation after resection. Dig Dis. 2014: 32(4). 395-398.

Kannan P et al. Training Alone and in Combination With Biofeedback, Electrical Stimulation, or Both Compared to Control for Urinary Incontinence in Men Following Prostatectomy: Systematic Review and Meta-Analysis. Phys Ther2018 Nov; 98(11):932-945

Loos et al. The Pfannenstielincision as a source of chronic pain. ObstetGynecol. 3008: April 111(4);839-846

Falls are a normal part of life. I don’t think any of us expect to go through life without a couple of bumps along the road. However, as we age these “bumps” can seem more like mountains and barriers to us living our highest quality of life. Here at WPT, we are not only committed to improving the issues that brought you through the door, but to ensure these “bumps” don’t happen again.

The most common causes of falling typically involve something called a “functional fall”. A functional fall typically includes an obstacle in your way that would otherwise not seem so scary. This can include loose rugs, wet floors, our even our adorable cuddly pets. These innocent obstacles can be cause for a major injury. Our goal is to give you the tools to ensure a little slip doesn’t turn into a trip to the hospital or broken bone.

How is your balance? Do you think you can stand on 1 leg for a minute? 30 seconds? 10 seconds? Even 5 seconds? Balance is one of those things that we don’t test as often as we did when we were young. We used to slide across the ice and unstable surfaces. Where now we make an effort to walk around those. We may not ever purposefully get those ice-skates back on but we want you to gain the confidence in your legs and yourself!

Studies show that some things linked to falls involve muscle weakness, foot pain, poor footwear, deficits in balance and gait, decreased range of motion, and issues with blood pressure put you at risk for falling. Therefore the best way to prevent falls is to continue to stay physically active!

Our goal in improving muscle strength is to improve a stable base for extremities. This will help us move more efficiently, provide a stable base to move more effectively, and improve anticipatory and reactive strategies.

If you have been following WPT on our social media (linked below), then you know that we have been working through the book Atomic Habits by James Clear. This book has been helpful for us because it is helping us establish a framework for fostering existing habits and creating new habits in a healthy, impactful way.

We want to continue to demonstrate our commitment to our patients by having resources that can help you establish and work on your own goals. Resources like these will help institute the positive behavior changes that are necessary for improving your health and well-being.

In this book there are four outlines. These outlines are:

1. It needs to be obvious.
2. It needs to be easy.
3. It needs to be attractive.
4. It needs to be satisfying.

Today we are going to talk about making it easy. The best way to do this is by using something called “implementation intention”. To break it down, an implementation intention is an “if-then plan” with the ultimate objective of leading to better goal attainment. The way it does this is with habit and behavior modification. This tool is used to portion out when, where, and how this goal-directed behavior is going to happen.

The research for this topic speaks for itself. In 2001, researchers in Great Britain conducted a study with 248 people in an effort to build better exercise habits over a 14 day period. These test subjects were divided into three different groups. Group one was the control group, their task was to track their current exercise habits with no exterior motivation. The second group was called the “motivation group”. This group was not only asked to track their habits, but also read content that focused on the benefits of exercise as it relates to coronary heart disease. The third group had the same specifications as the second group, with one added element. The third group was asked to make an exercise plan for the next two weeks. They followed a specific template, “During the next week, I will partake in at least 20 minutes of vigorous exercise on [DAY] at [TIME] in [PLACE].”

The results were as follows. 38% of participants in group one exercised at least one time a week, 35% of participants in group two exercised at least one time a week, and 91% of participants in group three exercised at least one time a week. So what does this mean? Simply put, by writing down their intentions, group three had a framework for what their plan was and how they were going to do it. Because they manifested this goal, it was easier for them to make it happen.

By completing implementation intention, you can start to make changes in your life that can help you with your goal. Understanding whether something is serving you well is the first step. In order to help assist you in identifying your habits, we have free worksheets that you can download here.

Stay tuned for more habits content!

Source: https://jamesclear.com/implementation-intentions

If you have been following us on our social media (linked below), then you know that we have been working through the book Atomic Habits by James Clear. This book has been helpful at WPT because it is helping us establish a framework for fostering existing habits and creating new habits in a healthy, impactful way.

We want to continue to demonstrate our commitment to our patients by having resources that can help you establish and work on your own goals. Resources like these will help institute the positive behavior changes that you want to see that are necessary for improving your health and well-being.

In this book there are four outlines. These outlines are:

1. It needs to be obvious.
2. It needs to be easy.
3. It needs to be attractive.
4. It needs to be satisfying.

Today we want to focus on making it obvious. The most essential way to make something obvious is to be aware of the habits that you currently have and understand if those habits are serving you well in the long term. Here is an example:

In this instance, the theoretical goal is weight loss. The work ahead of you is pretty obvious. You need to diet and you need to exercise. Before you can set out the parameters of a meal plan and a gym regimen, you need to assess your current habits. Let’s say everyday at work you drink a can of coke and every night before bed you have a bowl of ice cream, addressing these habits can help you lose weight. One way to change this is to switch the can of coke for a mug of tea or a beverage with less sugar. One of my favorite ways to add a bit of flavor to water is with a Nuun tablet. For the ice-cream, maybe try having it 2 hours before bed instead of right before bed. If you eat right before bed, your body isn’t working to get the sleep it needs because it is digesting food. Not getting enough sleep can contribute to a plateau in weight-loss and in some cases, weight gain.

By identifying these habits you can start to make changes in your life that can help you with your goal. Understanding whether something is serving you well is the first step. In order to help assist you in identifying your habits, we have free worksheets that you can download here.

Stay tuned for more habits content!

Habits are the topic of todays post. We’ve been working through a book called Atomic Habits by James Clear, which is a great read and helps clarify how to create great habits that serve you well, and break the ones that are holding you back from who you want to become.

The section we would like to go over today focuses on the 1% rule. Simply put, 1% change each day will add up over the course of time. 1% is all you need to make a new habit stick. If you relax and give yourself permission to only improve a little each day, then you will begin to see big strides towards your goal. To give you an example, we want to talk about the British cycling team.

In 2002, Sir Dave Brailsford became the head of British Cycling. At that point in time, British cycling had only won a single gold medal in its 76 year history. Brailsford knew that the task of making this team a winning staple in the olympic community was no easy feat, but he was up for the challenge. He believed that if they improved each area of their training by 1% each day, the aggregate of this plan would produce incredible results. Brailsford and his coaches on the team began by making incremental adjustment. A few examples are as follows:

1. They redesigned the bike seats to make them more comfortable.
2. They rubbed alcohol on the tires in order to provide a better grip.
3. They asked riders to wear electrically heated overshorts to maintain ideal muscle temperature while riding.
4. The team was supplied with biofeedback sensors to monitor how each athlete responded to a particular workout.
5. The team tested various fabrics in a wind tunnel and had their outdoor riders switch to indoor racing suits.
6. The team was taught proper hand washing techniques in order to prevent sickness among the players.
7. They trailer that held their bikes was painted white in order to see any dust that can potentially interfere with the gear.

The list goes on and on, but the important thing to note is the success of this philosophy. At the 2008 Beijing Olympics, the British Cycling team won 7 out of 10 gold medals available in track cycling, and then did the same at the London Olympics four years later. The team has also won three of the last four Tour de France events.

Building habits is important, but even more important is understanding that change does not happen overnight. If you are trying to achieve a goal, learn something new, or form a better habit, you need to understand that it is going to take time. Figure out what you want to change in your life and establish an incremental plan to get there. Recognize that it is just going to take some time and then start kicking butt! In the following blog posts related to habit formation, we’re going to provide you a very specific framework you can use to build those positive habits incrementally, and shed the ones that aren’t helping you become the best version of yourself!

Pilates is an exercise method that was developed by Joseph Pilates and his wife Clara in the early 1900s. According to Raels book called Pilates Anatomy “Pilates is a system of physical and mental conditioning that can enhance physical strength, flexibility, and coordination improve mental focus reduce stress and improve overall wellbeing”. Joseph Pilates developed the system of exercise by reviewing yoga text books and studying animal movements while as a prisoner of war in an internment camp during world war I. Joseph believed bad posture and general sickness could be attributed to lack of movement, lack of muscle development and lack of mental engagement therefore he developed a movement system that he thought would cure all ailments. He believed that there is an interrelated connection between mental and physical health.

What to expect:

1. The exercises are typically low-impact that focuses on strengthening global musculature while improving postural alignment and flexibility.
2. Pilates focuses on body control as well as stability. The exercise’s main goal is to improve core strength, move the spine in all directions with emphasis on breathing, and motor control
3. Pilates can be performed with or without equipment
   • Typical equipment you could see would be Pilates rings, Pilates balls, including but not limited to dumbbells
4. It also could be performed on the floor on a mat or on a reformer.
   • Mat exercise offer the ability to use body weight or some of the above-mentioned equipment to improve mobility and function
   • A reformer is a specifically designed equipment with springs, sliding platform with the goal to strengthen specific muscles

Can I participate if I have pain?

1. There have been studies that show Pilates to be effective in helping with flexibility, pain, balance and strengthening
   • In some patients with low back pain there is found alterations in muscle activation and sequencing in trunk muscle activation
2. Pilates could offer assistance in improve lumbopelvic control, facilitate breath control, as well as engage abdominals and pelvic floor muscles
   • Pilates has even shown beneficial effects on mental health.
3. A Meta-analysis in 2018 found a reduction of depression, anxiety, fatigue, and increase in energy in those who practice Pilates