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

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.

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

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