Wellness

PT Better Than Surgery for Shoulder Impingement and Subacromial Pain

New guidelines for management of shoulder impingement are strongly in favor of physical therapy and away from surgery! These recent guidelines were posted in the BMJ (British Medical Journal) and you can read more here. This is exciting news supporting conservative treatment that physical therapy provides versus more invasive techniques such as surgery.

As the research was examined, the findings revealed: decompression surgery resulted in no significant differences from other approaches—including PLACEBO surgery! The lack of difference was long-term, remaining at 6-month, 2-year, and 5-year follow ups.

Shoulder impingement occurs when structure that pass through your shoulder get pinched between the humerus and acromion that compose part of your shoulder joint. This can lead to irritation, pain, and wear and tear to structures such as the bursa (bursitis), supraspinatus (rotator cuff strain, tears, tendonitis, and tendinopathy), biceps (long head of biceps strain, tears, tendonitis, and tendinopathy).

The following helpful schematic visuals presents the findings for how to management shoulder pain from rotator cuff disease/dysfunction (RCD) and subacrominal pain syndrome (SAPS).

PT better than SAD.jpg

The fact that physical therapy is the ideal way to treat these pain syndromes is not surprising given that the shoulder joint is a complex joint comprising of 4 separate joints and myriad muscles that must coordinate well. Tightness, weakness, poor endurance, control, or posture at any of these points including at the shoulder blade (scapula) can lead to narrowing at the subacromial space and thus impingement. Reversing these problems can then increase the space and reduce the strain, pain, and irritation.

Bottom line?

Having shoulder pain? Come to PT before a surgeon! Please note that these findings are for overuse and non-traumatic shoulder injuries present for more than 3 months.

Thanks for following along as we journey to: Get to the Source, and TOGETHER, get moving.

Liz

Daily Dose of PT (#dailydoseofpt)

Yep, I made a hashtag #dailydoseofpt. Why? Because everyday for 2019 I’ve committed to myself, for my own personal health to do at least one physical therapy exercise. I’m not going to limit myself to one, but I will do at least one.

After some thought, I thought": “why not bring others along?” 365 exercises is a lot and sharing them is a lot, so the daily dose of PT will be shared just on one platform. For ease of use, I’ve chosen Instagram and the live story. It’s not that you won’t find any excerpts or references anywhere else - blog, Facebook, Youtube, Google+, or newsletter, but the journey will be unfolding and evolving on Instagram live and then kept up on the story for 24 hours.

Daily dose of PT - climbing gym edition

Daily dose of PT - climbing gym edition

My hope is that my quest for personal health and well-being will be educational and motivational for you and those that stumble across it. At the time of the writing of this blogpost, I am 9 days into the challenge, with 356 to go. There are lots of opportunities to participate. To not miss out, make sure you follow @artisanpt on Instagram and even allow notifications for live posts from me.

The focus to-date of the #dailydoseofpt has been primarily shoulder, neck, shoulder blades (scapula), and postural stability. Over the course of the year, the whole body will get covered, as needed by my own personal PT intervention needs. If there are regions or parts of the body, that you would like me to focus on, let me know and I’ll do my best to incorporate them sooner rather than later.

Thanks for joining on this journey to optimize health and wellness.

Together, let’s get moving!

Liz

Finding the Perfect Pillow

Neck pain is a real problem for many people. Unfortunately for many people, their pillow is a main contributing factor. Also unfortunate is the fact that pillows are confusing. In desperation, many people will pay ridiculous amounts for a “perfect” pillow that promises to miraculously reduce their neck pain, improve sleep, and allow them to move their neck better throughout the day. All you need to do is spend $80-$200. However, many of the designs behind these pillows are flawed.

What should you look for in a pillow? You want a pillow that helps to keep your neck in neutral position. What is neutral position? Neutral position is a position that reduces the stress on your joints, muscles, ligaments, and tendons. Each joint has this ideal position. For your neck this means that when you lie on your pillow you shouldn't feel like your head is dropping down, or rotating, or getting forced up.

Find Neutral Position

This woman pictured has too much pillow & is straining her neck as she sleeps. The midline of your head should be straight with the midline of your torso to reduce stress on your body and prevent neck pain or arm numbness/pins & needles.

I suggest getting an inexpensive, soft, yet supportive pillow. Soft, yet supportive, is tricky. You want soft, but sufficiently full so that it gives support. Get a pillow too fully packed and it's no longer soft and adaptable to your head and your body position. Get a pillow that's too flat and it will not be appropriate for lying on your side. To get your neck and corresponding joints into their neutral position, you need the pillow to be just right, so do not be surprised if it takes time to find the right pillow for the size and weight of your head and the proportion of your body. For example, when lying on your side, you need the pillow to be the right size to take up the space between your head and the bed, created by your shoulder and torso. Too big relative to your body and your head will get pushed up, compressing the top side of your neck and pulling the lower side. Too small and your head will dip down, similarly causing strain to your neck but in the opposite pattern of too big a pillow.

I have a little trick for how to take any garden variety pillow from your favorite inexpensive store and make a winner, comfortable, soft, yet supportive pillow and look forward to sharing that with you in a future post and possibly even in video format. In the meantime, please save your money and don't buy that expensive pillow promising to save the world, starting with curing your neck pain and insomnia.

Questions? Comments? I'd love to hear them.

Liz

Awesome, Effective Advanced Shoulder Stability Exercise

Looking for an excellent, if not awesome, way to strengthen your shoulder.? We've got an exercise for you including a video demo! Here is one of Liz's favorite exercises that she is incorporating into her March daily fitness challenge - which is alternating between the hip and shoulder stability and strength.

The shoulder joint is a "ball and socket" joint. It has a lot of freedom to move in a variety of directions, which is means it needs stability and strength in multiple directions. This exercise is a constant isometric force into external rotation pushing out with the wrists which strengthens and challenges two of the rotator cuff muscles, in particular, the teres minor and the infraspinatus. As you push constantly out through the band you will simultaneously raise your arms overhead which works additional shoulder muscles including shoulder blade (scapular) muscles responsible for upwardly rotating it. These muscles include the serratus anterior and the lower trapezius, which when weak can lead to shoulder impingement, bursitis, and rotator cuff tears and injury. 

This is not an exercise to perform when your shoulder is very weak. For that you want to exercises that place less demand on your shoulder. If you missed it, a video we created for that is this:

Mixing things up with "easy" and "hard" exercises is good for a healthy shoulder. I've been doing exercises from each of these videos as I seek to have an even stronger and healthier shoulder than I already have.

Have you started a daily fitness challenge? If so, what are you trying?

Not started yet, but thinking about it? What are you considering? Even the considering, is a step forward and progress! The planning stages count for fitness and health.

Stay tuned for next month's daily fitness challenge which will be headstands and handstands! April is almost here. Would you like to join me? At this time, May is scheduled to be ankle and foot stability, so reach out with any questions or suggestions for that if that provokes some interest from you. This is particularly meaningful for those of you with "weak" ankles, foot and ankle pain, history of ankle sprains or foot/ankle fractures (broken bones). 

Let's Get to the Source, and TOGETHER, Let's Get Moving

Liz

March Daily Fitness Challenge - Hip & Shoulder Stability

I'm pleased to say that the daily fitness challenge that began in October of last year has continued, with a different theme every month. So far we have attempted daily running, seven minute workout, pull-Ups, 8 minute abs, and now.... drum roll please...

BOSU overhead ball toss.jpg

This challenge this month, as the title of the blog post indicates, is hip and shoulder stability. I'm excited about this month because they are very important and foundational to so many activities and preventing injury as well as rehabilitating injuries. I've had my fair share of injuries over the years and they have left they're mark. Now if I had been better about doing all my rehabilitation exercises for these various injuries, I don't think I'd be in the same place. I'm excited of the possibility that the asymmetries I have from side-to-side could diminish, and even, completely resolve!

 Doing all the exercises that your body needs is a lot of work. Can I get an amen? It takes a lot of time, a lot of motivation, and a lot of knowledge. I have the knowledge and a good bit of motivation, but not always enough time in the day. Anyone else have a hard time finding enough time in the day? These monthly-themed daily exercises that I'm exploring are an avenue for me to rotate throughout the body and pay attention to each area and hopefully be better off than the intermittent and sporadic exercise provided otherwise.

Unstable hips or, in other words, hips that lack the strength, endurance, and coordination to control themselves in space, can lead to problems from the low back all the way down to the big toe. Yes, even the big toe! You think you inherited that bunion from your family? Where you born with it? Is it rather from how you've moved and used your body over time? Let's take a look at your hip stability and then let's talk about it.

Knee injuries ranging from patellofemoral pain, runner's knee, ACL tears, meniscal injuries can all arise from a lack of hip stability. Lack of hip strength and control or endurance can also lead to ankle injuries such a sprained ankles and fractures and down the chain into the foot with overpronation, plantar fasciitis, shin splints, or achilles or posterior tibialis tendonitis or tendinopathy.

Shoulder stability is also really important and isn't straightforward. Think of all the motions that your shoulder can do and that is a sign that keeping it healthy will similarly take a lot of work. The shoulder joint or complex is actually made up of four joints: 

  • Glenohumeral joint
  • Scapulothoracic joint
  • Acromioclavicular joint
  • Sternoclavicular joint

All of these are controlled by muscle. So once again the strength, the endurance, and the coordination of these muscles results in the control surrounding those joints. In terms of stability, the most important muscles are the rotator cuff and scapular muscles. You can think of your shoulder blade, or scapula, as the foundation of your shoulder. If the foundation is crooked or unstable, this has consequences for the areas attached to it.

As I work on shoulder stability this month, I am emphasizing the rotator cuff - all four of the rotator cuff muscles - and the scapula thoracic muscles - think rhomboids, trapezius, serratus anterior - as well as the scapulohumeral muscles. If these muscles are strong, can work for long periods of time, and can turn on and off at the right time, there should not be clicking in my shoulder with movement, nor am I very likely to injure myself. Bear in mind that as I strengthen these muscles, I will also need to stretch them because strengthening increases the tone of the muscles and often the stiffness of the muscles and sometimes shortens the length of the muscles. And tight muscles can lead to injury and dysfunction.

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Because it is unwise to strengthen the exact same area day after day, I will alternate between hip stability and shoulder stability, doing one one day and the next the other day. Want to learn a great routine to do for these areas, reach out and we can schedule either a visit or a remote consultation for you fitness, wellness and health goals.

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Stay tuned for April's daily fitness challenge of headstands and handstands...

Let's Get to the Source - and TOGETHER - Let's Get Moving

-Liz

8 Minute Abs

Last month I did a daily physical challenge of running every day - with the goal of being healthy. Success! This month the physical challenge is "8 min abs". I've spent everyday of November (one day to go) targeting abdominal strength, endurance and control for 8 minutes. Now this isn't about aesthetic or beach body abs. Being able to do crunches and sit-ups are important but have been over-emphasized in the fitness industry for years. Having healthy appearing abdominal muscles - a 6 pack - doesn't mean you are in fact healthy. More specifically, it doesn't mean you are preventing injury. Abdominal strength and stability in combination with low back and hip strength and control make up what we physical therapists call "lumbopelvic stability" or "lumbopelvic control." This is something we emphasize in helping and rehabilitating persons with low back pain, sciatica, SI joint (sacro-iliac joint) pain, lumbar radiculopathy, herniated discs, DJD (degenerative disc disease), arthritis in the joints of the back, and stenosis. The back is connected to the pelvis, which is connected to the hips/thigh/femur. I often sing  to my patients and clients about the wisdom of the children's song: "the back bone's connected to the hip bone. the hip bone's connected to the thigh bone" (They love it, as you can imagine).

So me spending on this focused time on this region wasn't just sit-ups and crunches. In fact, it was much more perform leg and arm motions without letting my back move. I spent 8 minutes each day this month emphasizing a variety of challenges to lumbopelvic stability to promote and preserve a healthy back. I brainstormed a list of exercises and invited a friend to join me with this month's challenge. My list is long and varied. I challenged my abdominal muscles - all of them (rectus abdominus, internal and external obliques, and very importantly the transverse abdominus). I rotated through 48 different exercises these 30 days! There's no reason to get bored. And as we strongly recommend here at Artisan PT - variety is good and very healthy for us. 

Want an example of how to train the transverse abdominus? The transverse abdominus is the most important abdominal muscle to prevent back injury and recover from a back injury or back pain. Learn more in our video on a starter transverse abdominus exercise. PS - Side effects of this exercise include flatter stomachs! PPS - I won't be posting pre- and post- 8 min ab challenge photos, but will be enjoying the results.

 

Watch should the next challenge be? December is right around the corner!

Let's Get to the Source, and TOGETHER, Let's Get Moving!

Liz

3 Simple Strengthening Exercises to Prevent Climbing Shoulder Injuries

Today we have a guest post from a friend and fellow colleague on preventing shoulder climbing injuries. Dr. Jared Vagy - The Climbing Doctor - out of Los Angeles, California works with high level climbers and teaches at USC. The following is an excerpt from his blog post

"It is the end of the day. You are tired and beat, but you decide to give it one last go on your project. You get to the crux move and give it everything you’ve got. Suddenly you feel a sharp pain in your shoulder. You know that you likely injured your shoulder. What happened and what could you have done to prevent this?

The tendons in the shoulder slide through a very narrow passageway and attach to the shoulder bone. Impingement occurs when the space between the bones in this passageway is reduced. This can occur from repetitively moving the shoulder into a stressful or suboptimal position. When this occurs, the bones in the shoulder pinch down on the tendons and cause shoulder impingement. You should be aware of the dangerous movements that can lead to shoulder impingement. These movements include hanging on your arms during rest stances, climbing with a hunched posture and strenuous overhead reaching."

Bent over T's, Y's, and L's:

Dirtbag tip - use items you have around: cans, bottles to provide the weight.

Dirtbag tip - use items you have around: cans, bottles to provide the weight.

These should not cause any shoulder pain! 

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Climb INJURY-FREE

Dr. Vagy just released another book! 

You can find it on Amazon now.

Thanks, Dr. Vagy for the helpful content.

Any questions? Comment below. 

Preventing Rock Climbing Hand & Tendon Injuries: Part 2 - Techniques For Open Grip Strengthening

People are often injured by trying to progress too quickly and this is very prevalent in rock climbing. People fall hard for the sport and enjoy the challenge of pushing their limits, but lack the knowledge needed to stay healthy, prevent injury, and thus climb for a lifetime and not have to take months and month off due to tendon or pulley injuries in their hands or forearms.

In this video you'll learn the how-to principles of hand strengthening to cross train to improve open grip strength and reduce hand pulley and tendon injuries for rock climbers. Climb better, climb harder, climb longer. Climb for a lifetime.

For a personalized assessment, contact us at our Portland office.

If you have injured this area, make sure to give sufficient rest and see your local PT who specializes in manual therapy & treating climbers to learn how to get back to your prior level and incorporate this open hand strengthening to improve your grip and reduce compensatory strategies that overload your pulleys. Also find out how shoulder weakness, for example, can influence which grip you choose. 

This is Part 2 of a 2 Part series, with the possibility of a Part 3 adapted to interest, questions, and feedback from the first 2 Parts. Watch Part 1 to learn why hand strengthening matters to prevent injury and the important of incorporating into your climbing routine. Questions? Should we do a Part 3?

Let's Get to the Source, and TOGETHER, Let's Get Moving!

Quick Yoga Sequence for Runners: Stretching with Some Core

New video out!

In this video, Doctor Elizabeth (Liz) Bottrell PT, DPT, FAAOMPT of Artisan Physical Therapy in Los Angeles, CA demonstrates a quick and effective yoga sequence for runners. Whether running your first 5k, training for a marathon, triathlon, or an ultra, you need to stretch. Stretching takes time and knowledge. In this video, you'll learn a quick vinyasana or flow yoga sequence that efficiently stretches your hamstrings, calves (gastrocnemius & soles), and hip flexors (Iliotibial band and iliopsoas) to maximize your time, as well as incorporating abdominal strengthening and control and cross training strengthening for the pectoral muscles and triceps. This fast routine, also trains balance, breathing, and improves motion in your back and abdominal muscles!

You can repeat and hold longer as needed. Do not hold your breath!

Pay attention in the video because you need to make sure you know which muscles to stretch. Follow-up videos will show specifics for a few other essential muscle groups for runners to stretch.

Try it and let us know what you think.

6 Effective Tips to Less Back Pain with Sitting

Do you have difficulty completing work due to back pain with sitting?

Does your low back pain limit your social life with things like sitting at a restaurant, driving, and sitting through a movie.

Low back pain with sitting is common with disc and muscle injury.

To get yourself feeling better, try these 6 simple tips:

  1. Use the back rest on your chair
    • Sitting up is hard! 
    • Give those muscles a rest by allowing your back to use the support of the backrest.
    • Don't sit at the front of your chair
    • Keep your chair close to what you are working on, so you can stay all the way back in the chair.
  2. Use an extra and portable back support
    • Chairs are often not designed ergonomically for ideal posture.
    • Chairs are not one size fits all! Our bodies differ wildly in shapes and sizes from one person to the next.
    • You should maintain the same amount of curve in your back while sitting that you have while standing.
    • To assist with this, I recommend some thing like the Wonder Roll, which you can find online at www.wonderroll.com. It changes support quickly and easily while being portable, yet can stays in place on your chair with a simple strap.
  3. Take frequent breaks
    • Let your body heal and get stronger, by planning and not sitting longer  that your back can tolerate. 
    • If it starts every 30 min, get up every 25 minute, etc.
  4. Make sure your hips are flexible
    • Remember the song you sang about the human body? "The back bone's connected to the hip bone, the hip bone's connected to the thigh bone..." (You get the point).
    • Stretch the back side of your hips both the muscle and joint, so your back isn't being strained.
  5. Increase the strength and endurance of your low back muscles
    • If your back muscles are tired, they will do one of two things.
      1. They will start to complain and be your source of pain.
      2. They will stop working and let you go into poor posture thus putting bad stress onto the passive structures in your back: discs, ligaments, and joints.
  6. Watch your posture
    • If you saw your posture from an outside perspective, you might be horrified!
    • Set regular reminders in your calendar and alarms on computer and phone to remind you even when caught up in tasks and projects requiring your full mental attention.
    • Give permission to those around you to remind you when you are sitting with poor posture, so you spend less time there and thus strain your disc, ligaments, and muscles less.

Thanks for reading. If we get enough interest, we will make some videos about how to sit with less back pain. Leave a comment about how it works for you and what tips you use.

Let's Get To the Source, and TOGETHER, Let's Get Moving!

 

 

Do you say sorry too often?

I came across this blog post via some friends on Facebook. It's specifically from the perspective of a mountain biker, but it's a good universal principle and good attitude shift towards appreciation versus self deprecation. This switch could make a big change in your physical fitness and health goals and even throughout your life. The jist? Don't apologize for being slow, instead thank your companions for their patience.

http://www.sydschulz.com/mountain-biking/stop-saying-sorry

Free Personal Advice!

Come out this Saturday, Feb 13th for your free 15 minute consultation with a movement & injury rehabilitation specialist. This is the next installment of "PT Days with Liz Bottrell" at Fleet Feet - a great and friendly running store in Burbank, California. If you're keen, join in the weekly 3 or 5 mile run beforehand. To sign up, use this link from their website.  Liz is looking forward to venturing out of Echo Park to chat it up with the running community.

Can't make it? Subscribe to the newsletter by Sunday the 14th and get your free transformative Runner's Stretching Guide delivered directly to your inbox.

Let's show ourselves some self-love this month & spend a little extra time taking care of our physical health.

5 Best Neck Posture Exercises

Have you noticed a prominence or lump developing in your upper back and wondered what it was, and if you can do anything about it?

A friend of mine last week asked a question. What is this lump on the back of my neck? When I heard the word "lump," I was not hopeful that this was something a physical therapist could help with. A quick examination revealed that his spine was changing shape over time and he was developing a bony prominence where his neck and upper back meet. Why? This often takes place from repeated stress on the area over time. The forward slouched sitting posture so many of us find ourselves throughout the day while we are doing activities such as studying, working on the computer, driving, and reading.

Think about the elderly person with the stooped posture and rounded upper back. This didn't happen over night but was from poor sustained postures that resulted in progressive stiffness and weakness that eventually prevented them from sitting and standing with a straight back and neck. I like to say the body adapts to what we do to it and the spine is like wet cement that is hardening - what position do you want it to stiffen into?

(Disclaimer: Some people with stooped postures (aka excessive kyphosis) have pathological conditions in their spines that lead to these deformities, not simply due to impaired posture).

What can be done about it? My friend wanted answers! He might not be able to change his "lump" that is already there due to bony changes that have already occurred but maybe we can help it from increasing by working on some posture exercises to improve the flexibility of the thoracic and cervical spine and improve the strength of the muscles that hold these positions. Fortunately for him, His condition isn't painful yet. Doing some simple posture exercises can prevent painful conditions from forming in his neck and shoulders and even reduce headaches.

Subscribe to the blog and get access to the to 5 Best Neck Posture Exercises delivered to your inbox! Who doesn't love free professional advice?

Comment below for any questions you have for a physical therapist and Liz may answer your question in a future blog post!