Snow Shoveling Injury Prevention

Snow Shoveling the Correct Way to Avoid Injuries

by Meryle Richman, PT, DPT, MS

Woman Shoveling Snow

Snow shoveling is a repetitive activity that can cause muscle strain to the lower back and shoulders. Back injuries due to snow shoveling are more likely to happen to people who may not know that they are out of condition. Following these tips can help you avoid injuries.

 

● Lift smaller loads of snow, rather than heavy shovelfuls. Be sure to take care to bend your knees and lift with your legs rather than your back.

● Use a shovel with a shaft that lets you keep your back straight while lifting. A short shaft will cause you to bend more to lift the load. Using a shovel that’s too long makes the weight at the end heavier. Step in the direction in which you are throwing the snow to prevent the low back from twisting. This will help prevent “next-day back fatigue.”

● Avoid excessive twisting because the spine cannot tolerate twisting as well as it can tolerate other movements. Bend your knees and keep your back as straight as possible so that you are lifting with your legs.

● Take frequent breaks when shoveling. Stand up straight and walk around periodically to extend the lower back.

● Backward bending exercises while standing will help reverse the excessive forward bending of shoveling: stand straight and tall, place your hands toward the back of your hips, and bend backwards slightly for several seconds.

Here are some Healthy Tips for Safely Shoveling Snow

Stretches that target the trunk, legs and upper body:

Counter-Top stretch (Low back): Place your hands on your kitchen counter and walk backwards until your body makes an L-shape. Bend or hinge forward from your hips, while keeping your back lengthened your arms forward. You will feel a stretch in your back and throughout your trunk. Hold this for 10 long, deep breaths.

Heel Up On a Chair stretch (hamstrings): While holding onto some support, straighten your leg out and place your heel up on a chair, tighten that thigh, and pull those toes towards your body. Feel the stretch in the back of your leg. There’s no need to bend forward and it’s better if you don’t. Just stand up tall and keep both legs active. Hold 10 breaths. Repeat other side.

Bent Knee with Ankle in Hand stretch (quadriceps): Keep holding onto some support as you grab one foot with one hand behind your buttocks and hold it as you bend that leg. You should feel this stretch in the front of the thigh of the bent leg as you hold for 10 breaths. Repeat other side.

Core Strengthening Exercise:

● While standing, imagine pulling your belly button in towards your spine and engage your abdominal muscles without letting your pelvis tuck under. Try holding this for 5-10 seconds while breathing normally and repeat this a few times until it makes sense. This exercise uses the innermost layer of abdominal and back muscles and reminds your body where the center of your core strength is.

Mindfulness:

● As you are shoveling snow, focus on the rotating movements happening in your  hip joints. You can place your finger on the front of your hip joints (located at the top of each thigh near the groin) and practice a few sways side to side, simulating raking. Avoid letting the rotation happen at your waist—this will cause unnecessary movement around your lumbar spine.

● Continue to focus on the core strength exercise above and engage your belly  button in towards your spine as you rake, activating those lumbar spine  stabilizers. Pay attention to loosening up any stiffness in your legs and trunk muscles and you will go a long way to preventing injury to your back!

If your back hurts from shoveling snow or you have complaints of neck or shoulder pain, call to make an appointment with one of our staff of knowledgeable physical therapists for a free 15 minute consultation. Our experienced and dedicated licensed physical therapists can also help you get started with treatment. With Direct Access a prescription is not required to be evaluated. . Most insurance plans are accepted. Contact IvyRehab Briarcliff (914) 762-2222 and IvyRehab Jefferson Valley (914) 245-8807 or visit our Website —www.ivyrehab.com — to learn more about Direct Access.

Reference: http://www.moveforwardpt.com/Resources/Detail.aspx?cid=bc1413cc-3ed6-4cf9-888f-3955df4a1b13

Bike Right, Bike Fit

by Meryle Richman, PT, DPT, MS, CST, RYT

With the beginning of fall and changing of the leaves, people enjoy being outdoors riding their bicycles. The physical therapists at Ivyrehab can teach you preventative measures to avoid bike injuries.

For the average bike rider cycling involves a limited repetitive motion. At an average cadence of 90 revolutions per minute (RPM), a bicycle rider cranks out 5,400 strokes each hour. This becomes 1.5 million strokes in 5,000 miles. So you can just imagine how this can lead to a lot of wear and tear on the cartilage, ligaments and joints of the knee.

I. What you need to know about for a proper Bike Fitting:

The most common bike fitting errors include a saddle that is too high or too low, excessive handlebar reach that causes you to lean too far forward, and improper alignment of the pedal and shoe.

The American Physical Therapy Association recommends that when evaluating a cyclist for a proper bike fit the following assessment be performed:

●Foot to Pedal: The ball of the foot should be over the pedal spindle (the bar in the middle of the pedal on which the pedal “spins”). For cleat users, it is important to establish a neutral position of the cleat on the shoe. This will allow for neutral tracking of the knee through the pedal stroke.

●Saddle and Knee/Pedal Position: Saddle height should allow the knee to be slightly bent at the most extended portion of the pedal stroke. A suggested knee angle at dead-bottom-center is 30- 35 degrees while the foot is in the pedaling position.

●Saddle tilt: Saddle tilt for normal-endurance bicycling should be level. Pay close attention to the portion of the saddle that will be supporting the ischial tuberosities, or “sitting bones.” Cut out saddles allow for better tissue oxygenation. A well-fit saddle will provide the best comfort and results.

●Saddle Position in relation to the handlebars: Saddle position should allow the knee to be over the foot (metatarsal heads, ball of foot) at the 3-o’clock position of the bicycle crank-arm. The foot should be in a normal pedaling position.

●Handlebars: The position of the handlebars will affect the comfort of the hands, shoulders, neck and back, as well as the overall handling of the bicycle. For the Recreational Rider the trunk angle (trunk from horizontal reference line) should be angled between 40-80 degrees, and the shoulder angle (trunk to humerus) should be between 80 and 90 degrees. The handlebar position, should allow the hands to be slightly wider than the shoulder width. This is for comfort of the hands, arms and shoulders. For the Road Rider the trunk angle (trunk from horizontal reference) should be between 30 and 40 degrees, and the shoulder angle (trunk to humerus) should be between 90 and 100 degrees. The handlebar position should be approximately 2 centimeters (or .79 inches) wider than shoulder width for comfort of the hands, arms and shoulders.

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The ideal position of the knee in pedaling is to have the knee over the pedal and ball of the foot at the 3 o’clock position.

II. Common Overuse Injuries with Biking

● liotibial Band Syndrome (IT Band):

Possible causes are too-high saddle, leg length difference, and misaligned bicycle cleat for those who use clipless pedals. Pain is caused when the band becomes tight and rubs over the bony prominences of the hip (greater trochanter) and/or the knee (lateral epicondyle). When the knee is flexed at 30 degrees and is at the bottom of the stroke motion, there is friction on the tendon attachment. Tight inflexible lower extremity muscles may also worsen the condition. The band becomes tight and pulls at the hip and knee causing pain. In order to minimize knee and hip pain, it is important to pedal with low resistance and keep the cadence at 80-90 rpm.

● Chondromalacia:
Another common knee injury is anterior knee pain, such as chondromalacia. This involves irritation of the cartilage behind the patellar and patellar femoral tracking of the knee. If there is a muscle imbalance of the muscles of the anterior thigh known as the quadriceps, the outside muscle (vastus lateralis obliqus) becomes tight and the muscle on the inside of the thigh (vastus medialis obliqus) becomes weak. This results in lateral movement of the patellar which does not “track” smoothly in the patellar groove and results in irritation to the patellar (patellar-femoral maltracking) and anterior knee pain.

● Hamstring Tendinitis
Possible causes are inflexible hamstrings, high saddle, misaligned bicycle cleat for those who use clipless pedals, and poor hamstring strength.
● Neck Pain
Possible causes include poor handlebar or saddle position. A poorly placed handlebar might be too low, at too great a reach, or at too short a reach. A saddle with excessive downward tilt can be a source of neck pain.
● Lower Back Pain
Possible causes include inflexible hamstrings, low cadence, using your quadriceps muscles too much in pedaling, poor back strength, and too-long or too-low handlebars.
● Hand Numbness or Pain
Possible causes are short-reach handlebars, poorly placed brake levers, and a downward tilt of the saddle.
●Numbness or Pain
Possible causes are using quadriceps muscles too much in pedaling, low cadence, faulty foot mechanics, and misaligned bicycle cleat for those who use clipless pedals.

III. Prevention of Injuries with Stretching & Exercising

●Warm up for 5 – 10 minutes with gentle movement. Stretch slowly and gradually. Also do some stretching after you ride
●Exhale as you gently stretch muscles. .Develop a stretching routine for the quadriceps, hamstrings, ilio-tibial band, piriformis and calves Also, do stretching for your neck, trunk, chest, wrists and hands.

●Hold stretches for 15 – 20 seconds; 2 – 3 repetitions

●Gradual resistive exercise for back musculature, abdominals, legs and arms

●Progress to closed chain exercises

●Progressive functional activities and agility skills

●Partial squats, step – ups and step – downs, lunges

●Proprioceptive training – balancing exercises

●Cross training: spinning, jogging, swimming

IV. Choosing a Correct Helmet

When you are choosing a helmet, fit is very important. For a helmet to protect you it must fit correctly. Other factors to know about a proper hat fit are:

●Make sure the helmet fits on the top of your head and does not tip backwards or forwards. It should be parallel to the ground. There should be about 2 fingers breadth between your eyebrow and the edge of the helmet
●The helmet should not move when you shake or move your head from side to side or up and down.
●Straps should always be fastened and fit snugly. It should also meet certain safety criteria. Look for “Snell Certified” or Meets ANSI Z904 Standard” on the box or on the helmet itself.
●There should be no cracks inside the helmet

Whether you are a beginning bicyclist or advanced rider and have and have an injury that is “holding you back from riding” our experienced and dedicated licensed physical therapists can help you get started. With Direct Access a prescription is not required to be evaluated. Contact Ivyrehab Briarcliff (914) 762 – 2222 and Ivyrehab Jefferson Valley (914) 245 – 8807 or visit our Website: www.ivyrehab.com to learn more about Direct Access.

Reference: www.apta.com

biking

biking

Better Balance Now!

Ivy Rehab
Fall Prevention
Meryle Richman, PT, DPT, MS, CST, RYT

As we age the ability to maintain balance becomes more difficult. Many factors influence good balance, some of them are biological; and some we are able to influence and are able to improve. Balance and stability are important factors for aging adults to maintain a healthy lifestyle. Loss of balance is the primary factor in falls, which often results in serious injuries.

Good balance is dependent on sensory input form the eyes, the correct functioning of the balance system in the inner ear, posture and center of gravity and our ability to sense the position and movement in our feet, legs and arms. Vision affects the balance system, as the eyes send messages to the brain telling us where objects are in space.

Aging adults are affected by a loss of muscle mass and strength. This is associated with an increased risk of falls and hip fractures. It also has a great affect on maintaining a healthy lifestyle. Weakness in the ankle musculature may cause difficulty in recovering lost balance more quickly. Strong quadriceps muscles are necessary for good balance and walking. Evidence shows the strength and aerobic training can lead to a reduction in falls.

Loss of flexibility occurs with age. This may lead to difficulty climbing stairs, transferring from sit to stand and or getting out of bed without difficulty. Much of the loss of flexibility is due to inactivity. Flexibility exercises, stretches, gentle yoga will help improve flexibility of major muscle groups and therefore improve ones ability to complete everyday activities.

Postural changes develop as people age but not because they age. Rounded shoulders, forward head postures, increased thoracic curves in the spine are common postural changes. These changes affect the center of gravity in the body moving it forward. With changes in the center of gravity, older adults are more prone to loss of balance and an increased risk of falls.

Medications also contribute to the deterioration of the balance system. Research has shown that adding new medications in the previous two weeks increases the risk for falling.

There are many ways we can adapt to the changes in our bodies as we age. Some helpful tips include:

1. Promote safety in the home by using non-skid surfaces, eliminating area rugs & improve lighting in the home

2. Get a yearly eye exam

3. Proper nutrition and hydration

4. Know the side effects of your medication

5. Use caution with pets running around in your home

5. Different forms of exercise, such as strengthening exercises, flexibility and stretches, postural exercise, yoga, tai chi, and aerobic exercise such as walking, will all contribute to decreasing the risk of falls and improve your balance.

Guidelines from The American College of Sports Medicine suggest that:

1) Healthy adults under the age of 65 should aim for:

– Moderate intense cardiovascular exercises 30 minutes a day (aerobic exercise), five days a week or vigorous intense exercises 20 minutes a day, 3 days a week and strengthening-exercises twice a week

– Flexibility or stretching exercises are also recommended a minimum of 2-3 days a week

2) Healthy adults 65 years or older:

– Low-to-Moderate aerobic exercises, 30 minutes a day, 5 times a week and gentle strengthening-exercises (very light weights), 2- 3 times a week

– Flexibility or stretching exercises at a minimum of 2-3 times a week

Types of Aerobic and Low-to-Moderate Exercises:
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If you want to determine your fitness level, refer to the reference guide from The Centers for Disease Control and Prevention.

For beginners, you can simply start out by learning the basics of the talk test, which is a rule of thumb for doing moderate-intensity activity and you can still talk, but not sing during an activity. However, if you are doing a vigorous-activity you would want to learn how to find your target heart rate and determine what intensity range you should be exercising at for optimal cardiac performance.

Check out the Stay Healthy Website to determine a simple way to find your target heart rate at: www.cancer.org/healthy/toolsandcalculators/calculators/app/target-heart-rate-calculator. Once you find your target heart rate, wearing a heart rate monitor will make it easier to monitor your desired rate.

If you would like to improve your current level of fitness, but still have questions about how to begin a safe exercise program if you had an injury or illness, our experienced and dedicated licensed physical therapists can help you get started. With Direct Access a prescription is not required to be evaluated. Contact Ivyrehab Briarcliff (914) 762 – 2222 and Ivyrehab Jefferson Valley (914) 245 – 8807 or visit our Website: www.ivyrehab.com to learn more about Direct Access.

References:
(1) Exercise: Designing a Cardiac exercise Program. New York-Presbyterian Hospital. Retrieved September 2, 2011 from http://nyp.org/health/cardiac_exercis3.html
(2) American College of Sports Medicine Position Stand. Retrieved September 2, 2011 from http://www.mhhe.com/hper/nutrition/williams/student/appendix_i.pdf

Which Athletic Shoe Should I Buy?

Meryle Richman, PT, DPT, MS, CST, RYT
Senior Director at Ivyrehab Briarcliff and Ivyrehab Jefferson Valley

Buying an athletic shoe involves multiple considerations!

It is important to wear proper footwear to avoid ankle and foot pain or injury. Factors that should be considered in determining which shoe is right for you include:

The activities that will be performed, the construction of the shoe, what surfaces you will be on and the type of foot you have. Each sport or activity involves different movements or jumping and shoes are designed to fit the activity. Running, for instance, primarily involves movement in a straight line. Basketball and aerobics involve jumping and time spent on the forefoot. For example, playing tennis which involves side – to – side movements in a shoe with supports for straight movement could result in an ankle sprain. In addition, if you are involved in weight training activities for the lower extremities, wear different shoes than you use for impact sports. The extra weight from training compresses the cushioning and affects the shock absorption of the shoe. Cross trainers should only be used for short distance running (less than two miles). Some activities are similar so it may not be necessary to buy different shoes for each activity.

Uneven surfaces cause increased movement in the foot and ankle. This makes the ankle joint and the foot more vulnerable to injury. For example, running on rough terrain calls for an athletic shoe that is wider. This increases medial and lateral stability and decreases the risk for ankle injury.

Important tips to know before purchasing an athletic shoe:

● It is important to evaluate shoe construction prior to making a purchase

● Bend the shoe from toe to heel. It should not bend in places that your foot does not. In addition, if you push it down, it should not rock

● Place the shoes down and look at them from behind to assure the shoes are symmetrical

●You should also check wear patterns because this will tell you when to buy a new shoe

● There are 2 basic foot types: pronators and supinators:
(a) Pronator type foot is: limited big toe mobility, a heel that appears to turn out and the inner border appears to flatten when stepping. This type of foot requires a” motion control” athletic shoe. These shoes have firmer heels and a straight seam down the middle of the sole.

(b) Supinator type foot is: high and rigid arches and a heel that turns to the inside. This type of foot requires a shoe with more cushioning especially if you plan on using it for running. The sole of the shoe usually has a curved seam down the middle.

In summary, no two feet are alike even on the same person. However, by using basic guidelines, you can reduce the risk of injury.

For a free 10 minute screening, contact Ivyrehab Briarcliff at (914) 762 – 2222 or Ivyrehab Jefferson Valley at (914) 245 – 8807. With Direct Access a prescription is not required to be evaluated and treated. Visit our Website: www.ivyrehab.com to learn more about Direct Access.

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References:

1. Athletic Footwear and Orthoses in Sports Medicine – INDER https://www.google.com/search?q=D.G.+Sharnoff+Matthew+B.+Werd%2C+%E2%80%8EE.+Leslie+Knight+-+2010+-+%E2%80%8EMedical&ie=utf-8&oe=utf-8

Who needs Back Exercises?

By Meryle Richman, PT, DPT, MS, CST, RYT

We all do- whether we have a healthy back or a problem with our back. In order for your back to stay healthy and less prone to injury, you need strong, flexible muscles to support the spine’s natural curves.

Why all the fuss about back problems?

Statistics have shown that backaches are second only to the common cold as a cause of missed workdays. It’s estimated that 8 out of 10 Americans will have a back problem at some time in their lives. A large part of this is due to the neglect of their backs. Back disorders are the accumulation of months or even years of poor posture, faulty body mechanics, stressful living and working habits, loss of flexibility as general lack of physical fitness.

A balanced back is a healthy back:

It is time to take a new look at the prevention of back injuries rather than the treatment of back problems after they have occurred.

Back problems can be avoided by understanding what the problems are, how to prevent them and what to do if they do occur. It involves self-responsibility and a desire to have a healthy back

Basic Anatomy:

In order for your back to be healthy, there are three natural curves that must be in balanced alignment. This should occur at all times i.e., sitting, standing, lying down or moving. These curves are the cervical (neck), thoracic (middle back), and lumbar (lower back).

When your ear, shoulder, and hips line up straight, then the three curves are balanced and you have achieved “good posture”. To test whether your curves are in their natural alignment, imagine a line beside the mid-part of your body. If your ears, shoulders, pelvis, knees and ankles line up on this line (plumb line), your three curves are in their correct position. In order to maintain a balanced back you must also have strong and flexible muscles and joints:

●Muscles: A healthy spine is supported by a strong and flexible back, abdominals, hip and leg muscles. Muscles that lack strength and flexibility cannot maintain your back’s natural curves, which can lead to back problems, and possibly injury.

●Joints: Strong and flexible hip, knee, ankle, and back joints help balance your back curves ad allow movement. Joints that lack strength and flexibility fail to support your spine, and this can also contribute to back problems.

Other important structures to understand about the back:

●Vertebrae and facet joints: the vertebrae (or bones) provide the structural support for your back. The facet joints, which are located on the outside of the vertebrae, control the amount and direction of movement.

●Ligaments: These are tough and non-elastic bands that hold the vertebrae together. They connect to the discs and vertebrae, lending support and stability to the spine.

●Disc: The discs act as shock absorbers and allow normal motion to take place. The center of the disc is jellylike and is composed of water and fluid. It is surrounded by tough rubber-like bands that are attached to the vertebrae.

●Nerves: Provides the energy to make the muscles work. Once the goals of a well back are achieved the individual should follow up with a regular exercise program that includes an aerobic activity, such as walking or swimming.

Here are some tips that will prevent low back pain or its recurrence:

● Always bend with the knees, not from the waist when lifting

● When sitting, place at least one knee higher than your hips; either by crossing your legs or putting your legs with knees bent, on something like a foot stool

● When standing place one foot on a stool to keep the back straight

● Standing is better than sitting, and lying down is better than either; sitting puts 40% more pressure on the discs than standing and 75% more than lying

● When driving adjust the seat so you can sit closer to the pedals with the knees bent and back supported

● Avoid exercises that put excessive strain on the lower back. These include straight leg exercise such as leg raises, toe touching, or sit-ups with the legs straight on floor

● Additional suggestions include: changing the type of chair used at work, taking exercise breaks to stretch tight muscles and finding ways to handle stress.

Learn how Physical Therapy at Ivyrehab can help you:

For those individuals that suffer from prolonged back pain, the first goal of physical therapy is to reduce pain. The next step is to determine which muscles are tight and need to be stretched and which muscle groups are weak and could be strengthened. An evaluation of the individual postural and work habits should then follow. Based on all this information, corrective measures, which are tailored to the individual can then be recommended.

Other physical therapy measures can consist of any one of a combination of moist heat, ice, modalities, aquatic therapy, soft tissue massage, mobilization, stretching and gradual core and strengthening exercises.

If you would like to be seen right away for learning how to set-up an exercise program, prevent an injury or chronic pain under Direct Access (no prescription is required), contact us at: Contact Ivyrehab Briarcliff (914) 762 – 2222 and Ivyrehab Jefferson Valley (914) 245 – 8807 or visit our Website: www.ivyrehab.com to learn more about Direct Access. Ivyrehab accepts most insurance plans (which our office obtains pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy. With one-on-one care this permits the therapist to construct a personalized program for the individual. After all, when it comes to rehabilitation, “It’s all about the people”.

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Reduce Your Risk of Osteoporosis: Learn Preventative Exercise Tips

by Meryle Richman, PT, DPT, MS, CST, RYT
Ivy Rehab

Osteoporosis is a disease affecting approximately 10 million men and women in America. It is the progressive loss of bone mineral density. With bone loss over time the bones become weak and brittle leading to the increased likelihood of fractures, and bone deformation. The cost to our nation’s economy can be as much as 13 billion dollars per year in lost productivity and health care costs.

Who is at Risk for Osteoporosis?

Eighty percent of those with Osteoporosis are women. Women over 65 years of age are at much greater risk than men for Osteoporosis. Anyone diagnosed with Osteopenia, low bone density and a precursor to Osteoporosis is at greater risk. Other risk factors include women who are white or Asian, postmenopausal, cigarette smoking, sedentary lifestyle and some medication. Also women who have had long-term menstrual problems or have mineral absorption problems may also be at risk.

What can happen if you have Osteoporosis?

Osteoporosis causes a hunched forward posture and the formation of a hump, in the middle back and decreasing height. Poor posture and muscle tension due to the hunched posture can contribute to the increase of falling because the person’s center of gravity is shifted forward. Weak and brittle bones increase the likelihood of fracture during falls or fractures of the spine.

Some symptoms that may be caused by Osteoporosis include back pain, poor posture, lost height and decreased mobility. Anyone over 65 or postmenopausal women should be screened for osteoporosis even if symptoms are not present. Doctors will perform bone density scans to rate the persons bone density and determine their diagnosis based on that scan.

Tips on how Physical Therapy can help Osteoporosis:

1. Physical therapy can be utilized to manage to progression of Osteopenia, Osteoporosis and their symptoms. The patient’s goals include prevention of bone loss and increasing bone density.

2. According to the American Physical Therapy Association (APTA), “The right exercises and good habits can keep bones strong and prevent or reverse the effects of osteoporosis. Weight-bearing exercise, such as walking, is an important way to build and maintain healthy bones. Muscle strengthening exercises have been found to stimulate bone growth and can help prevent and treat osteoporosis. These types of exercises are best if started early in life and done regularly. However, it is important to remember that you can begin exercising at any age and still reap great benefits”.

3. Avoid exercises and daily activities which round the spine, such as sit-ups, crunches, bending down to tie your shoes, certain exercise machines that involve forward bending of the trunk, and even movements and sports that round and twist the spine. Instead, hinge forward from your hips, while keeping your back straight.

4. Practice balance exercises (even at a wall or holding on) to reduce falls and resulting fractures. An individualized program may include a walking regimen, Tai Chi, yoga, Pilates and other exercises geared toward conditioning, balance, and coordination.

5. The APTA recommends: Using proper posture and safe body mechanics during all activities protects the spine against injury. Here are some tips:
– Keep your back, stomach, and leg muscles strong and flexible.
– Do not slouch.
– Use good body positioning at work, home, or during leisure activities.
– Ask for help when lifting heavy objects.
– Maintain a regular physical fitness regimen. Staying active can help to prevent injuries.

6. Always consult with your physician or physical therapist before beginning an exercise program, if you have osteoporosis, are at high risk for a fall, fracture, or have a medical condition that might affect your ability to exercise.

If you would like to be seen right away for learning how to set-up an exercise program, prevent an injury or chronic pain under Direct Access (no prescription is required), contact us at: www.ivyrehab.com.

Ivyrehab accepts most insurance plans (which our office obtains pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy.
With one-on-one care this permits the therapist to construct a personalized program for the individual. After all, when it comes to rehabilitation, “it’s all about the people”.

References:
1. National OP foundation, www.nof.org/osteoporosis.
2. Meeks, Sara Walk Tall. Triad Publishing Company (FL); 1st edition (June 15, 1999).
3. Bassey E. Joan, Exercise for prevention of osteoporotic fracture. Age and Aging. Nov. 2001: 29-31.
4. Rahmani, Poupak, Morin, Suzanne. Prevention of osteoporosis-related fractures among post menopausal women and older men. CMAJ. 2009:181; 815-820.
5. American Physical Therapy Association, Bone Health.http://www.moveforwardpt.com/Resources/Detail/bone-health-2

ACL: Injury, Treatment & Prevention

Come and meet Dr. Dhar and Brian McLean, DPT on April 28th at 6:30 PM inside the lobby of Club Fit Briarcliff. Attend the lecture from 7:00-8:00 PM (upper conference room).

ACL treatment with Dr. Yasmin Dhar

Dr. Yasmin Dhar will offer advice on treating ACL injuries

Collegiate and High School females are 9-10 times more likely to suffer a non-traumatic Anterior Cruciate Ligament (ACL) injury than males in similar sports. This is the result of an anatomical increased angle at the knee in women, also known as a “Q” angle, which puts more pressure on the inside of the knee . However, according to Dr Yasmin Dhar, “It is more common to tear the ACL from a noncontact injury, like hyperextending or landing and twisting the knee, than a direct contact injury.”
Does a torn ACL have to be fixed with surgery?

From Dr. Yasmin Dhar’s experience with ACL tears, “The ACL cannot heal on its own, but not all tears of the ACL need surgery; treatment can depend on your activity level and amount of instability in your knee. People participating in sports or activities where they plant their feet, and twist or cut are susceptible to having an unstable knee and may be better off with surgery. Also if they are unable to modify their activities and desire an unrestricted lifestyle, they should consider surgery to have the best chance of returning to their pre-injury functional level. On the other hand, people who do not perform many cutting or pivoting activities, have no feeling of looseness in their knee, or lead a sedentary lifestyle may be able to function well with physical therapy to strengthen the leg, and possibly a brace. However, even sedentary people can experience giving way with simple activities such as going down stairs or stepping off a curb. When there is instability or giving way with simple life activities or sports, surgery is needed to restore normal kinematics and stability to the knee, preventing further damage to other structures in the knee.”

Come and learn more about ACL injuries and treatment options from Dr Dhar. www.YDharMD.com

Ways to Prevent and Minimize Knee Injuries

In order to prevent or minimize knee injuries, Brian McLean, DPT and Director at Ivyrehab Briarcliff will discuss the ACL Screening & Prevention Program that is currently being performed at Ivyrehab Briarcliff and Ivyrehab Jefferson Valley. By using a video analysis of the athlete’s knees in several positions of jumping (start position, before and after jumping), suggestions are made on the athlete’s exercise program, which is recommended to be done 3 times weekly for 6 weeks.

The ACL injury prevention program consists of an exercise program that includes: (1) warm-up exercises for maximum efficiency and conditioning, (2) integrating the components of ACL injury prevention for muscle and joint preparation with (3) combining flexibility and strengthening exercises and (4) plyometric exercises and agility drills that can facilitate a quick transition into practice activities.

Dr Yasmin Dhar is the Sports Medicine and Arthroscopic Surgery Specialist for Specialty Orthopedics in Harrison, New York. She completed her orthopaedic training at Westchester Medical Center, a level 1 trauma center, and her Sports Medicine fellowship at University of Pennsylvania. She is board-certified in orthopedic surgery as well as sports medicine. An avid athlete herself, her clinical practice focuses on the prevention and treatment of sports-related injuries of the shoulder, elbow, hip and knee.

She currently serves as the Chief of Sports Medicine at Montefiore New Rochelle Hospital, Assistant Clinical Professor of Orthopedic Surgery at New York Medical College, an affiliate physician for the LPGA tour, team physician for a number of local schools, and an Associate Master Instructor for the Arthroscopy Association of North America. http://www.ydharmd.com/

For additional information about attending this presentation please contact Ivyrehab Briarcliff at 914-762-2222.. You can also visit our website at www.ivyrehab.com.
Space is limited so call or stop in the register.

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Prevention Tips for Soccer Injuries

By Meryle Richman, PT, DPT, Senior Director at Ivyrehab Briarcliff & Jefferson Valley

Youth soccer injuries (ages 2 to 18) suffer around 120,000 injuries each year which are serious enough to require a trip to a hospital emergency room. The total number of soccer-related injuries, including those treated outside of a hospital ER, is estimated to be nearly 500,000 per year.A significant number of these injuries could be prevented if parents, athletes and soccer organizations employed the following safety measures:

Reduce injuries through proper strengthening and conditioning exercises, (especially building up hamstrings and inner quadriceps muscles) and teaching girls to pivot, jump, and land with flexed knees and employ a three-step with the knee flexed instead of a one-step stop with the knee extended have been shown to prevent some of these injuries. Stretching, particularly of the groin, hip, hamstrings, Achilles tendon, and quadriceps, during warm-ups before practices and games and during the cool-down after playing, is particularly vital in reducing the risk of strains and sprains.

To further reduce injuries properly maintaining the field, wear proper shin guards, and reduce injuries from goal post collisions with padding.

Stretching Tips:

Perform 3 repetitions of each stretch and hold 20-30 seconds

●Two Leg Hamstring Stretch
1. With both feet together and legs fully extended, hinge forward from your hips and reach forward with both hands towards your toes.
2. Tuck your chin towards your chest to increase the stretch. 3. Keep your toes pointed towards the sky.

●Hamstring Split Stretch
1. Bending on one knee, extend the other leg out in front of you.
2. Reach with both hands towards your outstretched foot.
3. Keep your toes towards the sky and tuck your head to increase the stretch. Remember to breathe!
4. Repeat for the opposite side.

●Lying Quadriceps Stretch
1. Lying on one side grasp your ankle and pull your heel towards your buttocks.
2. Keep your back straight and the other leg bent.
3. Do not grab your foot. Grab just above the ankle joint (the bottom of your leg).
4. Keep the thigh in line with your body. To increase the stretch push your hips forward (only a slight movement).
5. Repeat for the opposite side.

●Standing Groin Stretch
1. Stand with your legs wider than shoulder width apart.
2. Shift your weight onto one side as you bend your knee.
3. Reach with one hand towards your outstretched foot.
4. You should feel the stretch right down the inside of your outstretched leg.
5. Repeat for the opposite side.

●Sitting Groin Stretch
1. Sit with knees bent at 90 degrees.
2. Place the soles of your feet together to ‘splay’ your knees outwards.
3. Gently use your hands or elbows to push your knees downwards

●Lower Back Stretch
1. Sit with the legs straight out in front of you.
2. Bend the right knee so the sole of your foot is flat on the ground.
3. Turn your upper body towards your right knee and place your right hand on the floor for support
4. Place your left forearm on the outside of your right knee and gently pull your knee towards you
5. Resist with your knee and left hand to feel the tension in your lower back.
Repeat for the opposite side.

●Standing Calf Stretch
1. Using a wall or bar to support you, place one leg outstretched behind you.
2. Keeping the other leg bent lean against the wall to apply pressure to your beg leg.
3. Make sure you keep your back heel flat on the ground.
4. Repeat for the opposite side.

●Chest & Back Stretch
1. This stretch can be performed kneeling or standing. Take your boots off if you kneel.
2. Clasp your hands behind your back, keeping your arms as straight as possible.
3. Try to straighten your arms and raise them.
4. From this position bend forward from the waist also tucking your head towards your chest.
5. Hold this position for the recommended amount of time.

● Shoulder Stretch
1. Place one are outstretched across your chest.
2. Place the hand or forearm of your other arm on your outstretched elbow to apply pressure.
3. Gently pull your outstretched arm closer to your chest, keeping it as straight as possible.

Call to set up a free appointment if you would like to attend this free Soccer Screening at Ivyrehab Jefferson Valley (914) 245-8807 on March 16, 2016 from 8:15-8:45 PM. In addition, if you would like to be seen right away for an injury or chronic pain under Direct Access (no prescription is required), contact us at or Ivyrehab Jefferson Valley (914) 245-8807 or Ivyrehab Briarcliff at (914) 762-2222. You can also visit our website at: www.ivyrehab.com.

Ivyrehab accepts most insurance plans (which our office obtains pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy.

With one-on-one care this permits the therapist to construct a personalized program for the individual. After all, when it comes to rehabilitation, “it’s all about the people”.

Reference:
http://www.momsteam.com/sports/soccer/ten-ways-to-reduce-or-prevent-soccer-injuries

Free Soccer Injury Prevention Screening
March 16, 2016 from 8:15-8:45 PM with Jacek Golis
inside Ivyrehab Jefferson Valley
(Located inside Club Fit Jefferson Valley)

Ivy Rehab

Prevention Tips for Tennis Injuries

By Meryle Richman, PT, DPT, MS, Senior Director at Ivyrehab Briarcliff & Jefferson Valley

Tennis elbow (lateral epicondylitis) typically affects middle aged (40 to 60 years of age) adults and only 1 in 20 play tennis. If you have pain and/tenderness on the inside of your elbow, that is not going away it could be caused by different reasons such as improper techniques, poor physical conditioning, weight of the tennis racquet, too much tension on the strings of the racquet, balls are too heavy, type of court surface you are playing on and the grip size of the racquet. Other causes for lateral epicondylitis come from repeated forcible extension of the wrist such as using a screwdriver, heavy lifting and shoveling snow. Overuse of the muscles that extend the wrist usually has no pain at rest, but will increase with activity.

Treatment of tennis elbow focuses on relieving pain, controlling inflammation, promoting healing, improving local and general fitness and controlling force loads and repetitive movements with the wrists. Physical therapy uses a variety of modalities to relieve pain and decrease inflammation, massage and soft tissue mobilization techniques to heal the tissues. In addition, the following stretching and exercises are also recommended:

NOTE: the recommended stretching and exercises should not cause any increase pain. In the event that they do, you should stop immediately and consult with your physician.

Stretching Tips

Forearm stretch:
Hold arm straight out, fingers pointed towards the floor. Use your opposite hand and pull the fingers towards the body until a stretch is felt. Hold 10 seconds, repeat 3 times.
Repeat same as above, but fingers are pointed towards the ceiling. Use the opposite hand to fingers towards you. Hold 10 seconds, repeat 3 times.

Racquet stretch:
Stand with your feet shoulder width apart. Hold your racquet at the top of its frame with the right hand behind your head. Grasp the grip of the racquet with the left hand and slowly pull the racquet down the back. Hold 15 – 20 seconds. Repeat 3 times. Switch hands and do in the opposite direction

Scapular Stretch:
Cross the right arm in front of the left shoulder letting the elbow bend so that the hand droops over the left shoulder. With the left hand on the right elbow, push your arm in towards the back of the room. Hold for 15 – 20 seconds. Repeat 3 times.

Arm overhead stretch:
Take your left hand over your head. Bend it at the elbow, so that your left hand is over your head near your right ear. Then take the right hand and push the left elbow with it more toward the right. Hold for 15 – 20 seconds. Repeat 3 times

Hands behind the back stretch:
Grasp your hands behind your back while holding them at the wrist. Pull your left hand more towards the right and then do in the opposite direction. Hold 10 – 15 seconds. Repeat 2 -3 times

Recommended Strengthening Exercises

Ball Gripping: Use a soft ball and repetitively squeeze to strengthen the forearm muscles. Do 100 – 200 times a day.

Wrist curls: Support your forearm on a table and stabilize your wrist with your other hand. Hold a 1 – 2 pound weight and bring your wrist up toward the ceiling and then back down. Now turn your palm up and once again bend your wrist toward the ceiling. Do 10 times/ 3 sets. Increase in 1/2 pound increments.

Broom – Handle Exercise: Take a stick and hang a 1 – 2 pound weight from a string to the stick. Keep the arms held out in front, with the palms down and attempt to roll the weight up and then back down. Repeat with palms up. Do 10 times/3 sets.

Call to set up a free appointment if you would like to attend this free Tennis Screening at Ivyrehab Jefferson Valley (914) 245-8807 on February 23, 2016 from 7:15-7:45 PM. In addition, if you would like to be seen right away for an injury or chronic pain under Direct Access (no prescription is required), contact us at or Ivyrehab Jefferson Valley (914) 245-8807 or Ivyrehab Briarcliff at (914) 762-2222. You can also visit our website at www.ivyrehab.com.

Ivyrehab accepts most insurance plans (which our office obtains pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy.

With one-on-one care this permits the therapist to construct a personalized program for the individual. After all, when it comes to rehabilitation, “it’s all about the people”.


Free Sport Readiness and Injury Prevention Screening
Location: Inside Ivyrehab Jefferson Valley
February 23, 2016 at 7:15 -7:45 PM with Deborah Cohen, MSPT

Ivy Rehab

Prevention of Golf-Related Injuries

Meryle Richman, PT, DPT, MS, Senior Director of Ivyrehab Briarcliff and Jefferson Valley

“Golf is a game now enjoyed by over 29.3 million golfers of all ages, shapes, and levels of physical fitness”. Although most people would agree that golf is not a rigorous sport, there is a wide range of musculoskeletal ailments associated with the full golf swing. Contrary to the slow nature of the game, the explosive action of the full swing places significant stress on shoulder, elbow, and wrist joints as well as producing high torque forces on the low back and hip structures.

Golfers of all levels could benefit from an effective golf-training program that serves a dual purpose of improving performance and reducing the risk for injury. Golfers have learned that it is much easier to make a mechanically correct swing when the body is strong and flexible. Golf fitness should include three major components: (1) maintaining and improving flexibility, (2) improving golf specific strength, and (3) improving postural balance and stability.

Flexibility & Strengthening Exercises:

Pre-season is a good time to begin a generalized stretching and strengthening program for your neck, back and extremities. For example, increasing joint flexibility can lengthen your swing; thus increasing the club head speed and result in longer shots. Increasing golf specific muscle strength requires an integrated, multi-joint strengthening program to allow for coordinated actions of major muscle groups of different body segments. The golf swing can also inherently create postural imbalances, which can lead to injury.

The most common injuries are discussed with stretching and exercise tips can help to prevent or reduce pain and/or injuries resulting from the repetitive nature of the golf swing coupled with the high velocity forces:

(1) Medial epicondylitis, or “golfer’s elbow”:
This ailment involves increased inflammation and pain on the inside of the right elbow (for right-handed golfers). Exercise Tip: A proper conditioning program will include wrist flexion/extension and supination/pronation (rotation of wrist clockwise and counter-clockwise) strengthening and stretching.

(2) Shoulder tendonitis, or “rotator cuff tendonitis”:

This can be a chronic problem for those with tight shoulder internal/external rotators and weak shoulder girdle stabilizers. Exercise Tip: The golfer who has concentrated his efforts in developing maximum strength and flexibility of the levator scapulae, rhomboids, sternocleidomastoid, rotator cuff muscles, and trapezius muscles will enjoy the greatest success.

(3) Low back pain:
This can affect most golfers at one time or another. The golf swing combines “unnatural” spinal movements of bending forward, bending backward, bending sideways, and rotating. Exercise Tip: A preventative-conditioning program will incorporate multi-directional stretching and strengthening 2-3 times a week with an 8-minute warm-up routine before playing. For example, a before round warm-up exercise routine would include knee to chest, modified squats, back extensions, shoulder stretch, and low back/neck rotations and sidebands. All exercises would be done in sets of five performed in a smooth, controlled manner.

(4) Neck Pain:
One important aspect often overlooked when striving for the pain free neck is unrestricted cervical spine rotation. The ability to “retract” your neck (or slightly tucking your chin) and fully rotate your chin to the left is necessary to achieve a good “top of back swing position” (for the right-handed golfer). Any limitation in flexibility in either plane of motion can cause muscle strain/or nerve pinching. The shearing and rotational stresses occurring at the lower neck at the top of backswing will be minimized with good muscle flexibility. Exercise Tip: Gentle rotation and side bending neck stretches done two times daily for duration of twenty seconds each will help eliminate pain and restriction.

Another reason for neck pain is mechanical in nature, often caused by overstretching of ligaments due to postural stresses. The golfer who spends countless hours practicing with the head in a forward, protruded position will always be at high risk to develop cervical (neck) pain. The walker versus the cart rider has far greater neck support as the postural muscles hold the head directly over the vertebral column, receiving maximum muscle support. The golf cart rider sits and relaxes in a cart approximately 75 times during a round. Exercise Tip: To avoid and minimize the forward head position, slightly tuck the chin and do this 2-3 times and hold for several seconds, while sitting in the golf cart.

Posture awareness and physical preparedness are key elements to pain free golf. If you have questions concerning screening examination or treatment of golf-related injuries feel free to contact our office and speak to a physical therapist.

Call to set up a free appointment if you would like to attend this free Golf Fitness Screening located inside Ivyrehab Briarcliff at (914)762-2222. In addition, if you would like to be seen right away for an injury or chronic pain under Direct Access (no prescription required), contact us at Ivyrehab Briarcliff at (914) 762-2222; or Ivyrehab Jefferson Valley at (914) 245-8807. You can also visit our website at www.ivyrehab.com.

Ivyrehab accepts most insurance plans (which our office obtains pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy.

With one-on-one care this permits the therapist to construct a personalized program for the individual. After all, when it comes to rehabilitation, “it’s all about the people”.

References:
1) http://www.statista.com/statistics/227420/number-of-golfers-usa/
2) Batt, M., A Survey of Golf Injuries, British Journal of Sports Medicine 63-65, 1992
3) www.livestrong.com

Free Golf Screenings held inside Ivyrehab Briarcliff with Brian McLean, DPT, Director:
Monday, March 7, 2016 4:00- 7:00 PM
Tuesday March 8, 2016 9:00-11:00 AM
Wednesday, March 9, 2016 4:00-7:00 PM

Ivy Rehab

Prevent Skiing Knee Injuries on the Slope

BY: Meryle Richman, PT, DPT, Senior Director of Ivyrehab Briarcliff and Jefferson Valley

As the cold weather approaches, many of us turn out thoughts and energy to the ski slopes. With this ever increasing interest, we gathered information to enhance conditioning for downhill skiing to help prevent common knee injuries.

The most common skiing injuries that occur in the lower limb, as a result of collisions and falls, are knee sprains/tears, which include Medial Collateral Ligament (MCL) and Anterior Cruciate Ligament (ACL) sprains/tears. With new advances in ski equipment today such as releasable bindings, the statistics have changed to decreasing leg fractures to 90% and 30% for knee injuries.

According to the American Physical Therapy Association, (http://www.moveforwardpt.com/resources), (1) Medial Collateral Ligament (MCL) injuries are more common in the beginner and intermediate skier when the ski tips are pointed towards one another in a snow plow positon, when the skier is trying to slow down or stop.

Prevention Tips for MCL injuries:

● Make sure your weight is balance when you are in a snowplow position
● Stay on comfortable terrain

(2) Anterior Cruciate Ligament (ACL) injuries occur when the skier lands from a jump with their weight back on the boot. This causes a significant force on the back of the boot and the force pushes on the calf, which results in spraining or tearing the ACL

● Another common ACL tear is the “phantom foot” phenomenon. This occurs when the skier tries to stand up in order to prevent a fall. All the weight goes on the outside of one ski, and the arms and trunk rotates away from that leg.


Prevention Tips for ACL Injuries:

● Land safely with your weight forward. Start with simple jumps and gradually advance to more difficult jumps
● Do not try to stand up and go with the momentum of the fall and maintain good ski technique

Tips for Preparing for the slopes:

1. Make sure you have the proper equipment and take a skiing lesson if you have not skied in a while. Prepare yourself to three to four weeks before you go skiing with the recommended flexibility, strengthening and endurance program recommended below:

2. A safe and enjoyable ski season begins with a pre-slope program designed to promote adequate flexibility, strength and endurance. The scope of the conditioning program is dependent upon the physical condition of each individual.

Flexibility is among the most vital components of an effective conditioning program. Primary consideration should be given to maximizing the flexibility of the quadriceps, hamstrings, gastrocnemius, soleus, trunk rotators, shoulder girdle and low back musculature. Long, slow static stretching of these muscle groups is recommended.

Strength is another consideration. The quadriceps muscle group is of primary concern to the heavy demand placed on it when downhill skiing. Strengthening of the gluteals, hip adductors and the arms are also recommended. Inadequate strength affects ski technique and increases injury risk.

Endurance should also be addressed in a ski conditioning program. As with the other components of strength and flexibility, the amount of endurance training is relative to the fitness level of the individual. One can choose from running, swimming, cycling, rowing and Elliptical trainer. Endurance workouts may also incorporate a plan that strengthens the muscles used in skiing, as well as increasing endurance. Examples of ski- oriented training are: traverse running; box jumping.

Skiers should also prepare themselves with an adequate warm-up of stretching the upper extremities and the back before getting the skis on in the morning and can even include jumping jacks or jogging in place. Due to the nature of the physical demands of the sport, a run or two on an easier slope is recommended as a final warm-up.

Fatigue is inherent in a full day of skiing. Studies have shown that injury rates are increased toward the end of the day. Beginners should consider skiing a half day until their endurance improves. Care should be taken to monitor physical status and pacing your runs on the slopes with adequate food and water breaks in order to have a safe day.

Recommended Flexibility Program:

• Standing quadriceps stretch – pull heel toward buttock until a stretch is felt in front of thigh, hold 30seconds, repeat on opposite side.
• Standing hamstring stretch – Place heel on a bench. Slowly lean forward reaching down towards your shin until a stretch is felt at the back of the thigh. Keep the knee straight and back straight, hold 30 seconds, repeat on opposite side.

• Calf stretch – Keeping back leg straight, with heel on floor and turned slightly outward, lean into wall until a stretch is felt in calf, hold 30 seconds, repeat on opposite side.

• Standing trunk rotation stretch – Turn shoulders to one side while keeping hips forward, hold 30 seconds, repeat on opposite side.
• Standing trunk lateral flexion stretch – Reach over and upward while sliding opposite arm down leg, hold 30 seconds, repeat on opposite side.

Recommended Strengthening Exercises:

• Circuit training
• Free weights
• Isometric strengthening in the “downhill position”

Have fun on the slopes!
Ivy Rehab

Prevention Tips for Tennis Injuries

By Meryle Richman, PT, DPT, MS, Senior Director at Ivyrehab Briarcliff & Jefferson Valley

Tennis elbow (lateral epicondylitis) typically affects middle aged (40 to 60 years of age) adults and only 1 in 20 play tennis. If you have pain and/tenderness on the inside of your elbow, that is not going away it could be caused by different reasons such as improper techniques, poor physical conditioning, weight of the tennis racquet, too much tension on the strings of the racquet, balls are too heavy, type of court surface you are playing on and the grip size of the racquet. Other causes for lateral epicondylitis come from repeated forcible extension of the wrist such as using a screwdriver, heavy lifting and shoveling snow. Overuse of the muscles that extend the wrist usually has no pain at rest, but will increase with activity.

Treatment of tennis elbow focuses on relieving pain, controlling inflammation, promoting healing, improving local and general fitness and controlling force loads and repetitive movements with the wrists. Physical therapy uses a variety of modalities to relieve pain and decrease inflammation, massage and soft tissue mobilization techniques to heal the tissues. In addition, the following stretching and exercises are also recommended:

NOTE: the recommended stretching and exercises should not cause any increase pain. In the event that they do, you should stop immediately and consult with your physician.

Stretching Tips

● Forearm stretch:
Hold arm straight out, fingers pointed towards the floor. Use your opposite hand and pull the fingers towards the body until a stretch is felt. Hold 10 seconds, repeat 3 times.
Repeat same as above, but fingers are pointed towards the ceiling. Use the opposite hand to fingers towards you. Hold 10 seconds, repeat 3 times.

● Racquet stretch:
Stand with your feet shoulder width apart. Hold your racquet at the top of its frame with the right hand behind your head. Grasp the grip of the racquet with the left hand and slowly pull the racquet down the back. Hold 15 – 20 seconds. Repeat 3 times. Switch hands and do in the opposite direction

● Scapular Stretch:
Cross the right arm in front of the left shoulder letting the elbow bend so that the hand droops over the left shoulder. With the left hand on the right elbow, push your arm in towards the back of the room. Hold for 15 – 20 seconds. Repeat 3 times.

● Arm overhead stretch:
Take your left hand over your head. Bend it at the elbow, so that your left hand is over your head near your right ear. Then take the right hand and push the left elbow with it more toward the right. Hold for 15 – 20 seconds. Repeat 3 times

● Hands behind the back stretch:
Grasp your hands behind your back while holding them at the wrist. Pull your left hand more towards the right and then do in the opposite direction. Hold 10 – 15 seconds. Repeat 2 -3 times

Recommended Strengthening Exercises

● Ball Gripping: Use a soft ball and repetitively squeeze to strengthen the forearm muscles. Do 100 – 200 times a day.

● Wrist curls: Support your forearm on a table and stabilize your wrist with your other hand. Hold a 1 – 2 pound weight and bring your wrist up toward the ceiling and then back down. Now turn your palm up and once again bend your wrist toward the ceiling. Do 10 times/ 3 sets. Increase in 1/2 pound increments.

● Broom – Handle Exercise: Take a stick and hang a 1 – 2 pound weight from a string to the stick. Keep the arms held out in front, with the palms down and attempt to roll the weight up and then back down. Repeat with palms up. Do 10 times/3 sets.

Call to set up a free appointment if you would like to attend this free Tennis Screening at Ivyrehab Jefferson Valley (914) 245-8807 on February 23, 2016 from 7:15-7:45 PM. In addition, if you would like to be seen right away for an injury or chronic pain under Direct Access (no prescription is required), contact us at or Ivyrehab Jefferson Valley (914) 245-8807 or Ivyrehab Briarcliff at (914) 762-2222. You can also visit our website at www.ivyrehab.com.

Ivyrehab accepts most insurance plans (which our office obtains pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy.
With one-on-one care this permits the therapist to construct a personalized program for the individual. After all, when it comes to rehabilitation, “it’s all about the people”.

Ivy Rehab

Free Sport Readiness and Injury Prevention Screening

Location: Inside Ivyrehab Jefferson Valley
February 23, 2016 at 7:15 -7:45 PM with Deborah Cohen, MSPT

Prevent Skiing – Knee Injuries on the Slope

Screen Shot 2016-01-19 at 12.37.05 PMBY: Meryle Richman, PT, DPT, Senior Director of Ivyrehab Briarcliff and Jefferson Valley

As the cold weather approaches, many of us turn out thoughts and energy to the ski slopes. With this ever increasing interest, we gathered information to enhance conditioning for downhill skiing to help prevent common knee injuries.

The most common skiing injuries that occur in the lower limb, as a result of collisions and falls, are knee sprains/tears, which include Medial Collateral Ligament (MCL) and Anterior Cruciate Ligament (ACL) sprains/tears. With new advances in ski equipment today such as releasable bindings, the statistics have changed to decreasing leg fractures to 90% and 30% for knee injuries.

According to the American Physical Therapy Association, (http://www.moveforwardpt.com/resources), (1) Medial Collateral Ligament (MCL) injuries are more common in the beginner and intermediate skier when the ski tips are pointed towards one another in a snow plow positon, when the skier is trying to slow down or stop.

Prevention Tips for MCL injuries:
● Make sure your weight is balance when you are in a snowplow position
● Stay on comfortable terrain

(2) Anterior Cruciate Ligament (ACL) injuries occur when the skier lands from a jump with their weight back on the boot. This causes a significant force on the back of the boot and the force pushes on the calf, which results in spraining or tearing the ACL

● Another common ACL tear is the “phantom foot” phenomenon. This occurs when the skier tries to stand up in order to prevent a fall. All the weight goes on the outside of one ski, and the arms and trunk rotates away from that leg.

Prevention Tips for ACL Injuries:
● Land safely with your weight forward. Start with simple jumps and gradually advance to more difficult jumps

● Do not try to stand up and go with the momentum of the fall and maintain good ski technique

Tips for Preparing for the slopes:

1. Make sure you have the proper equipment and take a skiing lesson if you have not skied in a while. Prepare yourself to three to four weeks before you go skiing with the recommended flexibility, strengthening and endurance program recommended below:

2. A safe and enjoyable ski season begins with a pre-slope program designed to promote adequate flexibility, strength and endurance. The scope of the conditioning program is dependent upon the physical condition of each individual.

Flexibility is among the most vital components of an effective conditioning program. Primary consideration should be given to maximizing the flexibility of the quadriceps, hamstrings, gastrocnemius, soleus, trunk rotators, shoulder girdle and low back musculature. Long, slow static stretching of these muscle groups is recommended.

Strength is another consideration. The quadriceps muscle group is of primary concern to the heavy demand placed on it when downhill skiing. Strengthening of the gluteals, hip adductors and the arms are also recommended. Inadequate strength affects ski technique and increases injury risk.

Endurance should also be addressed in a ski conditioning program. As with the other components of strength and flexibility, the amount of endurance training is relative to the fitness level of the individual. One can choose from running, swimming, cycling, rowing and Elliptical trainer. Endurance workouts may also incorporate a plan that strengthens the muscles used in skiing, as well as increasing endurance. Examples of ski- oriented training are: traverse running; box jumping.

Skiers should also prepare themselves with an adequate warm-up of stretching the upper extremities and the back before getting the skis on in the morning and can even include jumping jacks or jogging in place. Due to the nature of the physical demands of the sport, a run or two on an easier slope is recommended as a final warm-up.

Fatigue is inherent in a full day of skiing. Studies have shown that injury rates are increased toward the end of the day. Beginners should consider skiing a half day until their endurance improves. Care should be taken to monitor physical status and pacing your runs on the slopes with adequate food and water breaks in order to have a safe day.

Recommended Flexibility Program:
• Standing quadriceps stretch – pull heel toward buttock until a stretch is felt in front of thigh, hold 30seconds, repeat on opposite side.

• Standing hamstring stretch – Place heel on a bench. Slowly lean forward reaching down towards your shin until a stretch is felt at the back of the thigh. Keep the knee straight and back straight, hold 30 seconds, repeat on opposite side.

• Calf stretch – Keeping back leg straight, with heel on floor and turned slightly outward, lean into wall until a stretch is felt in calf, hold 30 seconds, repeat on opposite side.

• Standing trunk rotation stretch – Turn shoulders to one side while keeping hips forward, hold 30 seconds, repeat on opposite side.

• Standing trunk lateral flexion stretch – Reach over and upward while sliding opposite arm down leg, hold 30 seconds, repeat on opposite side.

Recommended Strengthening Exercises:

• Circuit training

• Free weights

• Isometric strengthening in the “downhill position”

Have fun on the slopes!
Ivy Rehab

Hip Pain in the Athlete . . . meet the Doctor!

Screen Shot 2016-01-14 at 12.31.45 PM
Anterior hip pain or “hip flexor” pain is a very common complaint among active individuals. There are only a few, very common reasons for anterior hip pain. It is very important to diagnose these causes correctly so the right treatment plan can be implemented. According to Dr Michael Gott, “The Top 3 Causes of Hip Flexor Pain include:

1. Hip flexor muscle/tendon strain
The hip flexors are the group of muscles that work in conjunction to elevate your leg and thus flex your hip.

These muscles originate on the pelvis or on the lumbar spine and insert onto your thigh bone or femur. An acute injury, and most overuse injuries to these muscles can present as pain in the groin or in the front of your hip.

Mostly patient have groin pain or hip pain with activities, and no pain at rest.

2. Hip labrum injury
This hip labrum is a rim of cartilage that encircles the acetabulum. The acetabulum is the socket portion of your hip, which is a ball and socket joint.

It acts to deepen the socket and provide a suction effect to keep your hip in place. The hip labrum frequently is injured in athletes who participate in sports requiring deep flexion of their hips, or extremes of range of motion, like dancers.

The hip labrum can be injured acutely during a trauma to the area or over time which may be caused by impingement between the ball and socket of your femur joint. Many times a patient who has been treated for a long time for a hip flexor strain and is not getting better will have an injury to their hip labrum.

3. Hip arthritis
Arthritis is the loss of articular cartilage in a joint.

Cartilage is the smooth surfaces on the ends of the femur bone and in the socket of the hip joint that allows the hip to glide through a smooth and painless range of motion. When this cartilage wears away, or degenerates it can cause pain in the front of the hip near the hip flexor.”

Come to Dr Michael Gott’s free lecture on January 28, 2016 from 7-8 PM and learn helpful tips for hip pain at Ivyrehab Jefferson Valley, located inside Club Fit Jefferson Valley. You can also stop by and meet Dr Gott from 6:30-7:00 PM in the lobby at Club Fit Jefferson Valley. Call to sign up at (914) 245-8807 as space is limited. Dr. Michael Gott is a Westchester orthopedic surgeon who is fellowship trained in sports medicine. e has also been an active member of the National Ski Patrol as well as a Member of the Windham Mountain Ski Patrol for 18 years.

Printed with permission from Dr. Gott: http://www.westchestersportandspine.com/the-top-3-causes-of-hip-flexor-pain/

Stop by and meet Dr. Michael Gott, Orthopedic Surgeon from Westchester Sports and Spine on Thursday, January 28, 2016 from 6:30-7:00 PM in the lobby at Club Fit Jefferson Valley, as well as for his lecture on “Hip Pain in the Athlete”, from 7:00 – 8:00 PM in the Conference Room.

Dr. Michael Gott is a fellowship trained orthopedic surgeon from Albert Einstein College of Medicine after graduating from Emory University. He completed his Orthopedic Surgery Residency at Northshore/Long Island Jewish Hospital System and Sports Medicine Fellowship at the American Sports Medicine Institute – St. Vincent’s in Birmingham, Alabama. Dr. Gott specializes in conditions of the shoulder, elbow, wrist, hip, knee and ankle including traumatic and sports related injuries as well as arthritic conditions. He focuses on conservative, non-operative treatment for most conditions. In addition to his practices in Yorktown, Katonah and White Plains, Dr. Gott is the head team physician for the Yorktown High School athletics. He is also an active member of the Windham Mountain Ski Patrol, as well as their orthopedic advisor.

For additional information and to sign-up for this free presentation contact Ivyrehab Jefferson Valley at (914) 245-8807. You can also visit our website at www.ivyrehab.com, 600 Bank Road, Jefferson Valley, New York 10535.
Ivy Rehab

ACL Injury Prevention

WHAT: Free ACL injury screening video analysis for high school and college athletes

WHO: Performed by Patrick Laliberte, PT, DPT, CSCS, TPI-CGFI Physical Therapist and Director from Ivyrehab Freehold, New Jersey; Brian McLean, DPT, Director of Ivyrehab Briarcliff and Meryle Richman, PT, DPT Senior Director of Ivyrehab Briarcliff

WHERE: Sign-up at Ivyrehab Briarcliff (located inside Club Fit Briarcliff)

WHY: To identify athletes that may be at a higher risk for ACL injuries, and teach strategies to help reduce their risk.

WHEN: January 11, 2016 (Monday), from 10:00 AM – 1:00 PM

How: Precise measurements will be taken during athletic movements using video analysis. Each person screened will get a copy of these measurements with an explanation of significant findings.

Sign-up inside Ivyrehab Briarcliff 584 North State Road, Briarcliff Manor, New York 10510

Collegiate and High School females are 9-10 times more likely to suffer a non-traumatic Anterior Cruciate Ligament (ACL) injury than males in similar sports. This is the result of an anatomical increased angle at the knee in women, also known as a “Q” angle. This puts more pressure on the inside of the knee which can result in ACL injuries.To minimize knee injuries, Ivyrehab has been successfully using the Sportsmetrics program to find injury risks before they occur. Sportsmetrics has been designed, studied and validated by the Cincinnati Sports Medicine Center to screen and determine the increased likelihood of non-traumatic ACL injuries. Ivyrehab therapists use video analysis to objectively evaluate each participant and utilize these findings for teaching an injury prevention exercise program and to be able to closely monitor and assess progress. The skills taught will promote the athlete to say healthy and in their game. Suggestions will be made on your exercise program, which is recommended to be done 3x weekly for 6 weeks.

In addition to the above free event, if you would like to be seen right away for an evaluation and treatment for an injury contact Ivyrehab Briarcliff at (914) 245–8807; or Ivyrehab Jefferson Valley at (914) 762–3444. You can also visit our website at www.ivyrehab.com. Ivyrehab accepts most insurance plans (which our office obtains pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy.

With one-on-one care this permits the therapist to construct a personalized program for the individual. After all, when it comes to rehabilitation, “it’s all about the people”.
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What Direct Access Means For You!

If you recently experienced an injury or suffer from chronic pain that just will not go away, no referral or prescription is necessary to be seen right away by a physical therapist.

Currently, in forty-eight states and the District of Columbia, government ruling has enabled patients “direct access” for Physical Therapy services. In other words, individuals are allowed to go directly to a physical therapy clinic of their choice, and receive the resources and treatment they require for their rehabilitative treatment.

Direct access empowers an individual to take back control of their health, by allowing them to choose an approach that will best suit their needs in their recovery and rehabilitation. The laws also enables the Physical Therapist the right to establish a plan of care and design a treatment program for their patient. This direct method creates an atmosphere of one-on-one care; permitting the therapist to construct personalized recommendations for the individual. After all, when it comes to rehabilitation, “it’s all about the people”.

Ivyrehab accepts most insurance plans (which our office gets pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy. Individuals that have Medicare, No fault or Workers Compensation Insurance will require a prescription to be seen for their first office visit.

For additional information and to be seen right away for an evaluation and treatment contact Ivyrehab Briarcliff at (914) 762-2222; or Ivyrehab Jefferson Valley at (914) 245-8807. You can also visit our website at www.ivyrehab.com.

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Healthy Aging and Exercising for a Healthier Lifestyle

EXERISE MAY BE THE CLOSEST THING WE HAVE TO THE FOUNTAIN OF YOUTH!

For many of us, working work full time, sitting at jobs all day, commuting to work or being busy taking care of children and/or family, leaves little time to take care of ourselves and not enough time to exercise. How can you make fitness part of your life, improve your health, feel better about yourself and help you to lose weight? How do you begin?

Here are some tips to help you get started:

● Before starting a daily exercise program consult with your doctor if you have a current medical condition, disability or have not been exercising and would like to start. Ask if you should take any special precautions when you exercise.

● Start slowly and set realistic goals for yourself. Start gradually with exercising for 15 minutes twice a week, and then add another session. Also, slowly increase your training times by a few minutes each session.

● Plan ahead and make yourself a priority. Set time for yourself on a daily basis as to when you will exercise.

● Reward yourself: Set achievable goals for yourself. Start with small goals and when you achieve them reward yourself.
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Guidelines from The American College of Sports Medicine suggest that:

1) Healthy adults under the age of 65 should aim for:
– Moderate intense cardiovascular exercises 30 minutes a day (aerobic exercise), five days a week or vigorous intense exercises 20 minutes a day, 3 days a week and strengthening-exercises twice a week.
– Flexibility or stretching exercises are also recommended a minimum of 2-3 days a week

2) Healthy adults 65 years or older:
– Low-to-Moderate aerobic exercises, 30 minutes a day, 5 times a week and gentle strengthening-exercises (very light weights), 2- 3 times a week

– Flexibility or stretching exercises at a minimum of 2-3 times a week

Types of Aerobic and Low-to-Moderate Exercises:

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If you want to determine your fitness level, refer to the reference guide from The Centers for Disease Control and Prevention: http://www.cdc.gov/physicalactivity/everyone/measuring/index.html.

For beginners, you can simply start out by learning the basics of the talk test, which is a rule of thumb for doing moderate-intensity activity and you can still talk, but not sing during an activity. However, if you are doing a vigorous-activity you would want to learn how to find your target heart rate and determine what intensity range you should be exercising at for optimal cardiac performance. Check out the Stay Healthy Website to determine a simple way to find your target heart rate at: www.cancer.org/healthy/toolsandcalculators/calculators/app/target-heart-rate-calculator. Once you find your target heart rate, wearing a heart rate monitor will make it easier to monitor your desired rate.
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If you would like to improve your current level of fitness, or have had an injury or illness, but still have questions about how to begin a safe exercise program our experienced and dedicated licensed physical therapist can help you get started. We also offer a free 10 minute screening at IvyRehab Briarcliff (914) 762 – 2222 and IvyRehab Jefferson Valley (914) 245 – 8807 Check www.ivyrehab.com. Medicare and most insurances accepted.

Here’s to a healthier lifestyle and healthy aging!

Meryle Richman, PT, DPT, MS
IvyRehab Briarcliff
IvyRehab Jefferson Valley
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References:

(1) Exercise: Designing a Cardiac exercise Program. New York-Presbyterian Hospital. Retrieved September 2, 2011 from http://nyp.org/health/cardiac_exercis3.html

(2) American College of Sports Medicine Position Stand. Retrieved September 2, 2011 from http://www.mhhe.com/hper/nutrition/williams/student/appendix_i.pdf

(3) Centers for Disease Control and Prevention. Retrieved September 2, 2011 from http://www.cdc.gov/physicalactivity/everyone/measuring/index.html

(4) American Cancer Society. Stay Healthy. Target Heart Rate Monitor. Retrieved September 2, 2011 from:
www.cancer.org/healthy/toolsandcalculators/calculators/app/target-heart-rate-calculator

National Physical Therapy Month is Celebrating Healthy Aging

By Meryle Richman, PT, DPT, Senior Director
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National Physical Therapy Month (NPTM) is hosted by The American Physical Therapy Association (APTA) each October to recognize how Physical Therapists help transform society by restoring and improving motion in people’s lives. This October the focus is on Health Aging.

As movement experts, the goal of the Physical Therapists at IvyRehab Briarcliff and IvyRehab Jefferson Valley, which are now located inside Club Fit, will be offering free 10 minute screenings and advice to its’ club members to overcome pain, gain and maintain movement, and preserve their independence-without the need, in many cases, for surgery or long-term prescription drug use.

If treatment is required individuals now have the opportunity under the Direct Access Law in New York State to be evaluated and treated without a prescription for 10 visits or treatment within 30 days before seeing their physician.

Exercise may be the closest thing we have to the fountain of youth. The right type and amount of it, prescribed by a physical therapist, can help prevent or manage many age-related health conditions.

Stop by the lobby at Club Fit Briarcliff on the following days/times to learn tips on aging well and about Direct Access. You can also sign up for a 10 minute free screening for sports, balance and/or spinal screening by our Licensed Physical

Therapist:
10/05/15 9:00 – 10:30 AM (Monday) Meryle Richman, PT, DPT, Senior Director
10/15/15 8:30 – 10:00 AM (Thursday) Meryle Richman, PT, DPT, Senior Director
10/19/15 9:00 – 10:30 AM (Monday) Meryle Richman, PT, DPT, Senior Director
10/29/15 5:00 – 6:00 PM (Thursday) meet our NEW Director Brian McLean, DPT

OR Stop by the lobby at Club Fit Jefferson Valley:
10/01/15 7:30 – 8:30 AM (Thursday) Jacek Golis, PT
10/06/15 9:00 – 10:00 AM (Tuesday) Meryle Richman, PT, DPT, Senior Director
10/12/15 9:00 – 10:30 AM (Monday) Meryle Richman, PT, DPT, Senior Director
10/22/15 4:00 – 5:00 PM (Thursday) Deborah Lenihan, PT, Director
10/26/15 9:00 – 10:30 AM (Monday) Meryle Richman, PT, DPT, Senior Director

At either location fill out a free raffle and win a chance for a free gift ($75.00 Basket/gift card), when you stop by to say hello and learn more about how the staff at IvyRehab can help you. Any questions please contact us at IvyRehab Briarcliff (914) 762 -2222 or IvyRehab Jefferson Valley (914) 245 – 8807. Visit our website at www.ivyrehab.com.

Learn how to prevent changes in balance for a fall-free future

Learn how to prevent changes in balance for a fall-free future.
Practice exercises to improve your balance!

Debbie Lenihan
PT Director
Physical Therapy at Jefferson Valley

As we age the ability to maintain balance becomes more difficult. Balance and stability are important factors for aging adults to maintain a healthy lifestyle. Loss of balance is the primary factor in falls, which often results in serious injuries.

Many factors influence good balance. Some of them are biological and some we are able to influence and improve. Good balance is dependent on sensory input from the eyes, the correct functioning of the balance system in the inner ear, posture and center of gravity, and our ability to sense the position and movement in our feet, legs and arms. Vision affects the balance system, as the eyes send messages to the brain, telling us where objects are in space.

Aging adults are affected by a loss of muscle mass and strength, and have an increased risk of falls and hip fractures. Weakness in the ankle musculature may cause difficulty in recovering lost balance more quickly. Strong quadriceps muscles are necessary for good balance and walking. Evidence shows that strength and aerobic training can lead to a reduction in falls.

Loss of flexibility occurs with age. This may lead to difficulty climbing stairs, transferring from sit to stand and/or getting out of bed without difficulty. Much of the loss of flexibility is due to inactivity.

Postural changes can develop as people age which includes rounded shoulders, forward head postures and an increased thoracic curve in the spine. These changes affect the center of gravity in the body, moving it forward. With changes in the center of gravity, older adults are more prone to loss of balance and an increased risk of falls.

There are many ways we can adapt to the changes in our bodies as we age. Different forms of exercise, such as strengthening exercises, flexibility and stretching exercises, yoga, tai chi, and aerobic exercise, such as walking, will all contribute to decreasing the risk of falls and improving balance.

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Join Physical Therapy at Club Fit Jefferson Valley for a free lecture: “Use it or Lose it” on March 31!

If you would like to attend this free presentation contact Physical Therapy at Jefferson Valley at (914) 245 – 8807 to reserve a seat. Space is limited to 10 participants.

Physical Therapy at Briarcliff Welcomes Back Lynn Culbertson, DPT!

Lynn Culbertson, DPT

Lynn Culbertson, DPT

Here’s what Lynn has to say, “I am so glad to be back at Physical Therapy at Briarcliff located inside Club Fit. The staff is always so warm and welcoming. It has been a long road back and along the way I have acquired many skills that I am excited to share with the entire Club Fit community.

My career as a Physical Therapist and Yoga Instructor has inspired me to study Women’s Health Physical Therapy and Osteopathic techniques. As a Women’s Health Physical Therapist, I am able to provide women help and treatment with a variety of musculoskeletal disorders of the pelvic region. Conditions that are often difficult to treat and even to discuss include chronic pelvic pain, sexual pain and dysfunction; and incontinence. Some of these pain conditions severely interfere with a patient’s entire life and cause problems with work, relationships and self-esteem. However, with treatment, these conditions can be helped and a patient can return to a normal daily life.

In addition to my love for Yoga; knowledge of energy systems, mindfulness and each individual’s ability to heal from within, this has inspired me to learn and incorporate Osteopathic techniques with my patients. These techniques include: 1) Visceral manipulation, which helps improve the organ’s mobility by using a very gentle pressure to the organ being treated, and allows the body to function more efficiently; 2) Craniosacral therapy for balancing the nervous system and to reduce chronic pain and relieve tension caused by stress or chronic medical conditions; 3) Myofascial Release techniques which work gently on the fascial tissues of the body; and allow for subtle areas of tightness or restrictions in the body to release; and 4) Reiki techniques to balance the body’s energy imbalances and restore positive energy back into the body. This is accomplished by utilizing “zero balancing” to energize or relax the patient depending on what the patient needs at each session.

These techniques have been shown in studies to improve bowel and bladder dysfunction and decrease musculoskeletal pain. I work strictly on the “Whole” person approach to Physical Therapy, finding where the dysfunction is coming from. Whether you come to me for knee pain, back pain or pelvic dysfunction your story and your body leads to your healing.”

For more information and to schedule an appointment please call Physical Therapy at Briarcliff (914) 762 – 2222. www.ptrehab.com. Most Insurance plans accepted.