Reduce Your Risk of Osteoporosis: Learn Preventative Exercise Tips

May 19, 2016 by Liz

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

Prevention of Golf-Related Injuries

February 11, 2016 by Liz

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

February 8, 2016 by Liz

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

Prevent Skiing – Knee Injuries on the Slope

January 19, 2016 by Liz

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

Five things you can do to help prevent childhood obesity

August 14, 2014 by Liz

habits begin early
habits begin early
Did you know that one in five children is overweight or obese by age 6?
You can help.

As parents, your role as a mentor and educator for your child are essential influencers in their lives. Help them learn habits that prevent childhood obesity and can keep them healthy for life.

Focus on a few goals:

1. Physical Activity: Provide 1-2 hours of physical activity throughout the day, including outside play when possible.
2. Screen Time: Try and limit screen time to no more than 30 minutes per day.
3. Food: Incorporate fruits or vegetables at every meal and eat foods closest to the original form
Ex> potato instead of mashed potatoes, or potato chips.
4. Beverages: Provide access to water during meals and throughout the day, and don’t serve sugary drinks. For children age 2 and older, serve low-fat (1%) or non-fat milk, and no more than one 4- to 6-ounce serving of 100% juice per day.
5). Sleep: Be sure children get adequate sleep. It is essential for proper functioning. At least 8 hrs. Per night.

If you are looking to get your children involved in sports, fitness and other great activities that will keep them active, visit Programs for infants, kids and teens at Club Fit Jefferson Valley and Programs for infants, kids and teens at Club Fit Briarcliff for information on some of the things we offer.