Author: Dr. Wade Rinehart

The “Core” of Your Back Pain

The phrase” you’ve gotta work your core” is frequently misinterpreted. We hear this from our doctors, our trainers, and sometimes our friends regarding treating or dealing with lower back pain. Let us first define core as the central, most important part of something. The misinterpreted portion of that phrase is the word core, as it is thought to be the anterior core musculature, particularly your abs. This is only partially true! Our core musculature fully wraps around our torso and forms a type of stability blanket around our internal organs and spine. It provides a central anchoring system for our limbs to move and manipulate objects in space. The deeper posterior and lateral core musculature is most responsible for stabilizing the spine and helps to prevent low back injuries from occurring in the first place.

Low back pain can have many origins, but disc injury is one of the most serious. In disc injuries, compression of the nerve roots can occur, resulting in localized inflammation and pain that can refer to the buttocks or the leg. Even the best-trained core can sustain a disc injury due to poor lifting mechanics or movement patterns. However, the chances of injury go down as your core function goes up. In sports such as soccer, volleyball, and baseball, the core is used to stabilize the body’s center, so kicking, serving, and throwing can occur. Without a sufficiently trained core, we can fall into poor movement patterns resulting in increased risk for knee, hip, elbow, and shoulder injuries. This causes us to use muscles improperly to make up the difference for force production, resulting in more injuries over time.

The take-home is that your core plays a vital role in injury prevention locally at the spine and globally with our extremities. At First Choice, we can help improve your resiliency to injury by providing you with the tools to achieve and maintain a stronger, more functional core. It is often the center from which we begin to rehabilitate our low back pain patients and is the focus of prevention for our athletic population. Give us a call to schedule an appointment with one of our Doctors of Physical Therapy 850-248-1600.

Conquer the Day

Matthew 6:25-34, Jesus teaches us about not worrying and to not be anxious about anything.  Scripture tells us to focus on today and today only, tomorrow will take care of itself. Controlling what we can control and making the best of today, will help with your overall health, mood, and protection from illness.  Yes, be informed. Yes, be careful and safe. Yes, take necessary precautions right now but we also must remember that our mind and emotional state both have a huge effect on how our physical body responds. Get out in the sunshine, play outside with your kids, exercise at home, stay hydrated with constant water intake and remember that this is only a season of our life.  There is a time coming when COVID-19 will be behind us and we will all be stronger.  

Exercise and proper nutrition are great ways to stay healthy and improve overall metabolic health.  Choose today to eat healthier, drink more water, get more exercise and practice positive things in our life that will help physically and emotionally.  All of us at First Choice Physical Therapy are here to help you. We are open and essential. If you need to make an appointment with us we are here to help.  We are also here if you have any questions regarding home exercise programs. If you had an upcoming surgery canceled, contact us if you have any questions on what to do to prepare for the surgery once that time comes.  These are not common times, but we are not common people. Stay strong, stay positive, stay in constant prayer with the Heavenly Father and know that we are all going to get through this.  

Brannon Chester, DPT
Doctor of Physical Therapy

Fixing Lower Crossed Syndrome

What is Lower Crossed Syndrome?

Lower crossed syndrome is a common abnormal posture associated with muscle imbalances in the lower body. This muscle imbalance consists of some weak/lengthened muscles (ie. the abdominals as well as the glutes) and some tight/over-developed muscles (ie. the lower back muscles and hip flexors).

What causes lower crossed syndrome?

There are several causes of lower crossed syndrome, including poor posture and suboptimal training that can lead to muscle imbalances. A sedentary lifestyle can cause the hip flexors to remain in a shortened position for long periods of time, which can lead to tightness. When you aren’t as active, your glutes and abdominal muscles also won’t be challenged, which may lead to weakness in these muscles. Even if you are active, overworking the hip flexor muscles or lower back muscles can also cause this imbalance.

How do you fix lower crossed syndrome?

In order to fix lower crossed syndrome, you have to address the muscle imbalance. To do this, you will need to strengthen the glutes, which pull the backside of the pelvis downwards. You’ll also want to strengthen the abdominals to help pull the frontside of the pelvis upwards. But that is just half of it. You’ll also want to stretch the tight muscles. This includes the lower back muscles and the hip flexors as mentioned above. Listed below are a few exercises that can help correct this poor posture. Come into First Choice Physical Therapy for proper instruction with each of these exercises!

  • Lower Trunk Rotations
  • Half-Kneeling Hip Flexor Stretch
  • Single Leg Bridges
  • Bird Dogs
  • Pallof Press

Dr. Ryan Bohn, PT, DPT

Bike Fitting to Prevent Injury

Being properly fitted to your road bike will not only make your ride more comfortable, but it will also help you maximize your efficiency, increase your speed, and most importantly prevent injury. Here are a few fundamental things to check out the next time you hop on the bike to make sure you have the best fit on your ride!

Frame Size: When standing over the bike, the top tube should be about one to two inches away from your crotch.

Seat Height: At the bottom of your pedal stroke there should just be a slight bend in your knee. There is some trial and error in finding the perfect seat height. If the seat is too high, you might feel your hips rocking while pedaling. If the seat is too low, you may start to feel some pain in your knees.

Seat Position: You will also want to check to make sure your seat isn’t too far forward or backward. To determine this, take a look at where your knee cap is when your cranks are parallel with the ground. The knee cap should be directly over the ball of your foot in this position.

Handlebar Position: The handlebars should be set to a position where your torso makes about a 45-degree angle and your arms form a 90-degree angle with your torso. However, some riders are all about maximizing speed and are willing to sacrifice a little discomfort to achieve this. Whereas other riders would rather be a little slower if it means they can be more comfortable on the bike. This can and definitely should be adjusted accordingly. The angle of the torse will be less if you are trying to be a little more aerodynamic and the opposite is true if you are looking for a more comfortable ride. Sometimes a different stem is necessary to achieve the perfect position for you.

Dr. Ryan Bohn, PT, DPT

Top 3 Exercises to Prevent Wakeboarding Injuries

Whether you are a beginner, intermediate, or a professional wakeboarder, participating in this sport definitely requires a lot of balance. Lacking balance out on the water can potentially lead to serious injury and emphasizing balance training should be a priority for all wakeboarders. Listed below are three exercises that can help take your wakeboarding skills to the next level and more importantly, minimize the major wipeouts that can leave you injured instead of ripping it up behind the boat. But before you try these exercises out, schedule an appointment at First Choice to make sure these are right for you! 

Bird Dogs. This exercise will strengthen both the glutes as well as the core musculature, which are key muscles when developing a solid foundation and optimizing your balance. To perform this exercise you will start in the quadruped position (on your hands and knees). You are going to want to maintain a neutral spine throughout this exercise, so make sure to tighten up your core by engaging the abs. Next, you will kick one leg straight back and at the same time, raise your opposite arm. Pause at the top of this movement and then lower both your arm and leg. Perform 15 repetitions on one side and then switch to the other side. 

Bosu Ball Squats. Looking for a little more air? Strengthening the quadriceps muscles will give you that extra “pop” off the top of the wake and give you that major hang time you need to land your latest trick. Once you are standing on the ball, bring your legs about shoulder-width apart. Begin the squat by bringing your hips back like you are sitting down in a chair. Pause at the bottom of the squat and then simply stand back up while making sure your knees are in line with the direction of your feet. 

Single-Leg Bridges. Cutting hard into the wake requires a powerful hip drive. This glute strengthening exercise will help maximize your speed coming into the wake, setting you up for some major air. Start this exercise by lying down on your back with both knees bent up and your feet flat on the mat. Now straighten out one leg so your leg is just slightly higher than your other knee. Engage the glutes and drive your hips up. Pause at the top and then slowly lower your hips back to the mat.

Staying Healthy and in Shape at Home During Isolation…

If you’re like me, working out and being able to lift weights is much more than just picking a weight up and putting it down.  It relieves stress, keeps your body weight down and most importantly for me decreases mental fatigue and gives you an outlet. With all of the gyms closed, for now, you might be missing the euphoric feeling that you get from working out but do not worry, there are things you can do at home with bodyweight and a little creativity that will help keep you in shape and mentally strong!

Simple bodyweight exercises such as air squats, lunges, push-ups, and pull-ups are a great way to get your heart pumping and hit all of the major muscle groups.  A way to mix it up and include your pets is for every time you throw the ball for your pup, you perform 10 push-ups while they are bringing it back to you. Challenge yourself and your pet to see who gives up first. Spoiler alert: you will lose!  I challenged my chocolate lab and after 10 sets I was throwing in the towel and he was just getting his 4 legs loose.  

It is important in these uncertain times that we do something for our mental well being.  Turn off the news, turn off social media, put the phone down and get a workout in whether it be in your garage, back yard or go on a walk and have some quiet prayer time.  Stress and worry are thieves to happiness and both mental and physical well being. Control what we can control and that starts with our health.  

First Choice Physical Therapy is committed to not only the physical well being of our patients but also the mental and emotional well being of our patients.  We are doing all we can during this time to make sure all of our patients and staff are safe while we continue to provide essential and necessary care to everyone.  We are also committed to promoting and teaching healthy lifestyles at home. If you need suggestions on what to do at home for a safe and effective exercise plan then please feel free to email one of our therapists for help.    

Brannon Chester, DPT
Doctor of Physical Therapy
First Choice Physical Therapy

Upper Crossed Syndrome

What is upper crossed syndrome?

Upper crossed syndrome is a common abnormal posture associated with muscle imbalances in the upper body. This muscle imbalance consists of some weak/lengthened muscles (ie. the deep cervical flexor muscles and the lower trapezius) and some tight/over-developed muscles (ie. the pectorals or chest muscles and some of the muscles in the back of the neck including the upper trapezius and levator scapulae and cervical). 

What causes upper crossed syndrome?

There are several causes of upper crossed syndrome, but one of the most common is from poor posture while sitting at a computer or looking down at your phone. Over time, this can cause the muscle imbalance that leads to the rounding of the shoulders and forward head posture, where the head is shifted forward.

What is the ideal posture of the head and neck area?

When looking at the ideal posture in the sagittal plane (from the side) of someone standing up, one should be able to draw an imaginary line going down the external auditory meatus (AKA the ear canal) through the midline of the shoulder.¹

How do you fix upper crossed syndrome?

In order to fix upper crossed syndrome, you have to address the muscle imbalance. To do this, you will need to strengthen the deep cervical muscles and lower trapezius and other periscapular musculature. You’ll also need to stretch the pectorals, upper trapezius, and levator scapulae. Listed below are a few exercises that can help correct this poor posture. Come in to First Choice Physical Therapy for proper instruction with each of these exercises!

  • Chin tucks
  • Doorway stretch
  • Prone IYT’s
  • Rows
  • Upper trapezius stretch
  • Levator scapulae stretch

Call today, and let’s get your problem solved! 850-248-1600 – Dr. Ryan Bohn, DPT

References:

  1. Harrison, A. L., Barry-Greb, T., & Wojtowicz, G. (1996). Clinical Measurement of Head and Shoulder Posture Variables. Journal of Orthopaedic & Sports Physical Therapy, 23(6), 353–361. doi: 10.2519/jospt.1996.23.6.353
  2. Upper Crossed Syndrome. (n.d.). [Photograph]. Retrieved from https://images.app.goo.gl/Df3D6G9psvGqHMeP6

Choosing the Right Running / Walking Shoe For You!

Do your feet hurt during your morning jog or evening walks around the neighborhood? Does your calf, knee or hip hurt every time you get a mile into your run?  As a runner or distance walker, choosing the right pair of shoes can be the difference in developing a running/walking injury versus having an enjoyable, injury-free trip. Many people assume that comfort when trying on shoes in the store is the best way to choose a shoe. While comfort level is part of the process in choosing the right shoe, there are many other factors one should consider before making the final decision.

The first thing to determine when choosing the right shoe is the level of support you need. Most reputable running shoe companies will provide many different styles of shoes with different levels of support to accommodate their customers. You will generally have 4 levels of support to choose from; minimalist, neutral, moderate support, and maximum support. The salesperson should be able to tell you what level of support each shoe provides. If they are unable to provide this information, you need to find a different salesperson or move on to the next store.  The best way to determine the level of support needed is by looking at your arches while standing with your feet separated about 6-8 inches. Those with flat feet, where the arch is diminished or non-existent, require a shoe with moderate to maximum support depending upon body weight and how far your arches have fallen. Those of you with normal to high arches do not need as much support because you already have plenty of support that comes from the natural cantilever provided by your arch. Thus, a neutral shoe is ideal for those of you with normal to high arches.

After determining the level of support that is best suited for your feet, determining the quality of the shoe structure and design is paramount. Making this determination is done in 3 steps. The first step is to make sure the sole of the shoe has the proper combination of stability and mobility to allow your foot to bend at the toes when pushing off as you propel your body forward. A properly designed shoe will allow the toes (especially the big toe) to extend back in the proper fashion while providing support to the remaining portion of the foot. To test this combination, hold the shoe at the heel with the toes pointed down to a flat surface. Gently press the shoe into the ground and see where the shoe breaks down. A properly designed shoe will stop breaking down at the point where the toes meet the body of the foot just in front of the arch. See Fig 1.

Fig 1

A poorly designed shoe will break down completely into the midportion or arch of the shoe (see Fig 2) causing excessive stress on the midfoot. 

Fig 2

The next test to perform on the shoe tests the medial and lateral support of the shoe which helps with your balance.  This test involves twisting the shoe in both directions while holding the sides of the toe box with one hand and the heel of the shoe without your other hand. A quality shoe will give just a bit but should resist the twisting motion in both directions. A poorly constructed shoe will rotate excessively in on or both directions See Fig 3 and 4.

Fig 3
Fig 4

If the shoe passes both of these tests, it’s time to check to see if the shoe has any more defects. Even good quality designed shoes can have defects. Some estimates say roughly 5% of shoes will come out of the factory with a defect of some sort despite inspections. The most common defect is in the sole of the shoe which can be uneven on the horizontal axis. To check for this defect, place the shoe on a level surface. Looking from the back of the shoe (looking from the heel forward) at eye level, place your index finger on the outside edge of the heel tab and gently press down. See Fig 5. 

Fig 5

Each shoe should move slightly or not a all but, most importantly, should be symmetrical. If any excessive wobbling or asymmetry is noted, the shoe is defective and could likely cause you to develop a running/walking injury. I have had several patients in my 22 years as a physical therapist that developed knee, hip, or ankle pain while running or walking that was a direct result of this type of defect.  

Now it’s time to try on the shoe. A few factors should be taken into consideration before making your final decision. Obviously, the main factor is comfort. You must note whether the shoe crowds your toes, midfoot, or heel. Does the shoe provide an adequate balance of cushion and support for your entire foot?   Also, determine whether or not the sole of the shoe provides full coverage of your entire foot. A common error I see clients make is purchasing shoes in which the sole does not provide full coverage of the midfoot, heel, and arch. If your foot is wider than the sole, the shoe will not perform the way it was designed and can lead to foot, knee, hip, or even back pain. If the shoe “checks all the boxes” then it is time to purchase the shoe. However, purchasing the shoe is not the final step in determining if this shoe is the one for you. I always encourage my patients to take the shoes home and wear them in the house or go walk somewhere indoors for a couple of hours and see how the feet respond. I encourage my runners to run 15-20 minutes on the treadmill to see how their feet, knees, and hips respond. Any unusual pain or soreness in these areas indicate the shoe may not be a good fit and should be returned. Mild soreness in the feet is not necessarily a sign of an improper fit and is sometimes simply because the shoes are new and your feet are not used to the support a new shoe provides. 

If you develop a running or walking injury or just need a consultation to determine if you have the proper footwear for your feet, come see our Doctor’s of Physical Therapy at First Choice Physical Therapy.

Call today, and let’s get your problem solved! 850-248-1600 – Dr. Brett Frank PT, DPT

Knee Pain

Do you suffer from knee pain during an activity? Have you tried every brace, cream, footwear, and gimmick out there? Are you ready to get better by strategically attacking the cause instead of looking for a quick fix? See our Doctors of Physical therapy, let us perform a detailed assessment to identify your problem, and implement a treatment plan geared towards helping you get where you want to be.

Knee pain is common among all age groups and genders. The pain can be caused by a variety of biomechanical factors that are causing your dysfunction. In fact, knee pain tends to be a multifactorial problem commonly associated with strength deficits throughout the posterior chain (muscles in the back of your leg). These deficits can create an improper angle at the hip in relation to the knee or simply create muscle imbalances with increased shear forces on specific structures of the knee. Our bodies were made to move, and it will find ways to move even if the proper muscles are not being utilized, which creates compensatory movement strategies. If this occurs over a long period of time or through a repeated functional task such as walking, running, or climbing stairs, then these maladaptive movements are magnified, and you can end up with pain.

Another plausible cause to knee pain is the type of footwear and the support it offers in relation to your native anatomy, more specifically, the arch of the foot and position of the heel to the lower leg. Footwear can be a two-sided coin depending on whether the shoe offers too much or too little support. The position of the foot during weight acceptance, mid stance, and push-off are similar to how the angle of the hip affects the knee. It does so by the way the forces are transferred up the chain through the knee.

The big picture here is that many different factors can cause knee pain. Sure, you can have arthritis and tendonitis, but what is the cause of this? How do you know where to start? That’s where the experts at First Choice Physical Therapy come in. Let us analyze your problem so that we can help you get better.

Call today, and let’s get your problem solved! 850-248-1600 – Dr. John Gray PT, DPT

Ice or Heat?

It’s Saturday afternoon and after working in the yard your lower back is sore and tight, what do you do? Do you lie on a heating pad or do you brave the cold and lie on an ice pack? We get asked on a daily basis, “Which is better? Ice or heat?” That is a loaded question. In my opinion, you can never go wrong with ice. Applying ice to the affected tissue will vasoconstrict the blood vessels which will decrease inflammation, numb sore tissues, acting as a local anesthetic, and slows down the pain messages being transmitted to the brain. Ice is also best utilized during the acute phase (0-48 hours after injury) while heat may be best used for chronic pain.

A good rule of thumb to go by is that you can never go wrong with ice. So after any physical activity, applying an ice pack to the affected area will be your best bet for avoiding increasing pain. If your pain persists or even gets worse, then you may want to come see us and let one of our Doctors of Physical Therapy perform an extensive examination of the injury.

Brannon Chester, DPT
Doctor of Physical Therapy

Does your neck pain prevent you from…

Traveling, give you headaches, interrupt your daily activities, or interfere with sleeping through the night? Your pain can be brought on by a few different sources but can often be alleviated by addressing one key factor. That key factor is posture, and it can alter the length of muscles and create changes in spinal curvature, affecting the biomechanics of the cervical spine. The classic case of postural deficits creates what is referred to as “upper cross syndrome.” The diagram used to depict this syndrome is an X drawn over the head, neck, and shoulders of an individual as you examine them from the side. Each axis indicates the muscles that are weak or lengthened and those that are tight or shortened. Commonly the muscles lengthened are the deep neck flexors underneath the chin and the scapular (shoulder blade) adductors or rhomboids and middle trapezius. In contrast, those that become tight are the pectorals (chest muscles) and the suboccipital group (small muscles at the base of your skull). These changes create that classic forward head and rounded shoulder appearance we see all too often. If you stretch the muscles that are tight and strengthening, those that are weak, you can alleviate your symptoms. However, repetitive activities or sustained postures likely create these postural abnormalities in the first place. Among the top of the list of activities to avoid is sitting at a desk for a long duration. Self-treatment strategies would include a doorway stretch targeting the pectorals and performing resisted rowing exercises targeting the scapula adductor group. In addition to focusing on those major muscle groups, chin tucks or head lifts would be ideal for helping address the deep intrinsic neck flexor tightnesses. We understand that this can be confusing, especially when you don’t know the anatomy-much less the physics involved.

Let our Doctors of Physical therapy help diagnose the source of your neck pain and develop an individualized treatment plan to get you back to living a pain-free life. Call today to get started! 850-248-1600 – Dr. John Gray PT, DPT