Whether we are using our hands during athletics, working around the house/yard or to complete the demands of our jobs; our hands endure strain and stress on a daily basis. These daily activities can often lead to preventable injuries. Preventing hand injuries starts with knowledge and a few simple tips:

1. Perform daily stretches/warm-ups: Stretching the hands, wrists and elbows improves range of motion in the joints, increases blood flow and allows for smooth gliding of the tendons. Stretching and warming up either dynamically or statically will reduce the risk of muscle and tendon injuries. 

2. Increase Strength and flexibility: Strength training helps to improve muscle strength, endurance and flexibility. By incorporating a few hand and wrist exercises into your exercise routine you will be reducing the risk for injury to muscles, tendons and ligaments. 

3. Use proper equipment: Consider purchasing ergonomic tools in order to reduce the risk of injury. Ergonomic tools promote proper hand positioning, which results in decreased demands on the muscles and tendons. Some examples would be:

4. Be mindful of proper technique: It is important to pay attention to your body mechanics. Keep your wrists in a neutral position (not bent up or down for prolonged periods) and avoid repetitively bending the wrists. Place yourself close to the equipment you are working at to avoid awkward wrist and hand positions. And, pay close attention to proper technique with hands, wrists and elbows during sports activities. 

5. Avoid overuse: An overuse injury comes from constant repetitive movements and stress on a body part. If you are starting to feel fatigue and pain in your hands or wrists, it is important to stop and take a break. Learn to listen to your body and do not avoid these warning signs that your body is being overworked!

6. Schedule frequent breaks: As a rule of thumb, stand up and move around for at least 30 seconds for every 30 minutes that you sit at a desk job. If you are working on a repetitive task such as shoveling or raking, stop every 30 minutes for a short break.

It is important to listen to your body and pay attention to any pain you may have in your hands or wrists. If you are experiencing pain for greater than three weeks, it is a sign that you may need to seek medical assistance. Remember, pain is your body’s way of indicating that something is wrong and it should not be ignored. If hand or wrist pain persists, it is recommended that you see a hand therapist or your medical provider.

Written by Dr. John Stephen, PT, PPD, Cert. MDT, COMT
Clinic Director, Rehab Specialists

Low back pain can be a debilitating condition and it affects millions of people worldwide. While there are many potential causes of this condition, one factor that is often overlooked is the types of shoes that we wear.

The shoes we choose to wear can have a significant impact on our posture and the way we walk, which in turn can contribute to low back or leg pain. Let’s explore the connection between shoes and low back pain in more detail!

How Shoes Affect Your Posture

When we walk, our feet absorb the impact of each step we take. The way our feet hit the ground can affect the alignment of the rest of our body, including our hips and spine.

Wearing shoes with heels that are too high or too low can alter the way we walk, causing us to compensate for the lack of support. High heels, for example, force the feet into an unnatural position, putting extra pressure on the lower back. On the other hand, shoes that are too flat or lack arch support can cause the feet to roll inward, leading to overpronation, which can also cause low back pain.

Choosing the Right Shoes for Low Back Pain

If you suffer from low back, hip/knee or ankle pain, it’s important to choose shoes that provide adequate support and promote good posture. Here are a few tips to keep in mind when shopping for shoes:

1. Look for shoes with good arch support. This can help prevent overpronation and keep your feet in a neutral position. Most shoe manufacturers have groups of shoes that are meant for stability and would be a good choice for people with low or fallen arches. Look for the search bar on their websites and search the keyword “stability” to help find those options.
2. If you have a high arch or tend to supinate (walk on the outsides of your feet), it is best to choose a neutral shoe. These types of shoes provide the right amount of support and cushioning for those with high, rigid arches. Additionally, there are different levels of cushioning available in neutral shoes to suit your preferences on how responsive (low) or how soft (high) you want your ride to be.
3. Choose shoes with a low heel. While high heels may be fashionable, they can contribute to low back pain by putting extra pressure on the lumbar spine.
4. Avoid shoes that are too flat. Shoes without adequate arch support can cause the feet to roll inward, which can contribute to low back pain.
5. Consider shoes with a cushioned sole. This can help absorb shock and reduce the impact on your lower back.
6. Make sure your shoes fit properly. Shoes that are too tight or too loose can cause you to change your gait, leading to low back pain.
7. Make sure not to use the shoes for more than 1 year (everyday use).
8. Consider wearing supportive sandals while at home. 
9. Buying expensive shoes doesn’t necessarily mean that they are good for you.  
10.  A custom or off-the-shelf orthotic may be beneficial in cases where you wear a work boot, dress shoes or in shoes worn in high-impact sports.

Now, look at your shoes. Are they wearing out more on one side or near the heel? 

Imagine your car’s tires wearing unevenly. If you replace your tires without aligning or balancing them, they will wear out faster. If you have been suffering from foot/ankle, knee, or hip pain, have a professional look at your foot alignment before getting new shoes. 

In conclusion, the shoes we wear can have a significant impact on our posture and the way we walk. Choosing shoes that provide adequate support and promote good posture may help alleviate low back and leg pain and prevent future pain episodes. If you have low back pain that has lasted more than two weeks, do not ignore it. Most low back issues may resolve within a week with activity modifications and NSAIDS (anti inflammatory medications like ibuprofen or naproxen).  If you suffer from chronic low back pain, it’s important to speak with a healthcare professional who specializes in the spine to determine the underlying cause and develop an appropriate treatment plan. 

Blood flow restriction therapy is a recent “hot topic” in Physical Therapy. Blood flow restriction or BFR is a type of training technique that blocks blood flow to a muscle which, through cellular processes, creates protein metabolism and muscle hypertrophy or growth. 

One of the greatest benefits to using BFR is the fact that one can achieve clinically significant strength improvements. These improvements are traditionally seen through high intensity/high volume training, but can be achieved with low intensity exercise when in combination with BFR. In the physical therapy world, this can be a useful tool for those who may be unable to tolerate high load, but require strengthening or stabilization to aid in pain reduction such as those suffering from chronic pain. 

At this time, there are multiple different indications for using BFR in rehab such as post-operative recovery including knee replacement and ACL reconstruction. Blood flow restriction has even been shown to be beneficial in rock climbing! Rehab Specialists therapists are active in learning the evidence based research on BFR to be able to provide safe and effective treatment to their patients.

Additional Resources:
https://eds.b.ebscohost.com/eds/detail/detail?vid=2&sid=d3836fea-a074-4e3c-8ea4-dcb45b4234be%40sessionmgr101&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=144916605&db=ccm

https://www.physio-pedia.com/Blood_Flow_Restriction_Training

https://www.youtube.com/watch?v=R96Ir3GoLqo

Millions of people every year are diagnosed with a Brain Injury.  Brain Injuries can be classified as Traumatic or Non-Traumatic.

Traumatic Brain Injuries can result from:

• Falls
• Assaults
• Motor Vehicle Accident
• Sports Injuries

Non Traumatic Brain Injuries can result from a result of lack of oxygen, exposure to toxins or pressure from tumors etc.

• Stroke
• Aneurysm
• Tumor 

No matter how mild or severe the symptoms are many people will experience visual disturbances of some kind.  These may include: 

• Blurry vision
• Double vision
• Eye strain, eye fatigue or headaches from reading or doing close work
• Words move around or appear to float when doing close work
• Lose your place when reading; skip words or the entire line
• Frequently bump into objects on one side of the body or fail to see an object on one side of the body (visual field deficit)
• Feeling anxious in crowded environments

An Occupational Therapist trained to evaluate your visual concerns can work with you to develop a treatment plan to help you improve on your daily activities.  The therapist may make recommendations on adaptations and changes to the environment such as increase the lighting in the room, enlarge the print on the computer, choose larger print books.  In the case of a visual field deficit (impairment to the peripheral field) the therapist can teach you compensatory strategies to improve on your visual search skills to prevent you from bumping into objects. Many strategies and exercises can be utilized to improve on reading skills and up close work as well.   The therapist may also recommend you see either an Optometrist or an Ophthalmologist for corrective lenses or prisms to reduce double vision, blurry vision or improve on how clearly you are seeing near or distant objects. 

 I have 20 years experience working as an Occupational Therapist and have extra training in this area of working with visual deficits following a Brain Injury.  I would love to help you return to doing the activities that are so meaningful to you.

By, Courtney Huver, DPT

Having urinary leakage pre and post childbirth is common, but it is definitely not normal! This includes leakage with coughing, sneezing, laughing, and exercising, and yes even jumping on the kids’ trampoline. About 1 in 4 women have reported this common pelvic floor dysfunction and reports keep getting higher with more awareness of this issue. Pregnancy and giving birth puts increased tension throughout the pelvic floor muscles which increases the urge to urinate and decreases the amount of control you have of the muscles around your bladder. The good news is that pelvic floor physical therapy is able to help eliminate and prevent issues such as urinary leakage- this means no more crossing your legs every time you cough and sneeze or wearing a pad “just in case.” Traditionally, after having a baby people were told to “keep doing your kegels”… however, research is showing that kegels are no longer the only answer and can actually increase the risk of urinary incontinence. It is recommended that after your 6 week postpartum follow up that you get checked by a pelvic floor physical therapist to see if you have any dysfunction that could be eliminated early on. You can even see a pelvic floor PT years down the road after having kids or if you have similar issues and have never given birth.

Knee and hip pain are common complaints amongst runners. However, pain in one area does not always mean there is an injury in that same area. Our bodies are all connected and this is amplified with running due to the high level of impact involved in this sport. 

There are 5 main classifications of running impairments as described by RunDNA. These include: Collapser, Weaver, Bouncer, Glute Amnesiac, and Over Strider. Individuals may fall into one or multiple different categories. Determining which classification you may be can be done  through gait analysis. This is beneficial to treating your specific pain and re-training correct running mechanics. 

While there are hundreds of muscles essential to running, there are certain ones that are “extra” important for both stabilizing and moving. Physical therapy aids in assessing weak muscle groups, reveals any abnormal length/tension relationships, and can find range of motion deficits needed for efficient and pain-free running. 

If you are a runner and struggling to maintain or reach your goals due to pain, Rehab Specialists can offer a free consultation or evaluation today (call 269-459-6212 to schedule!).

You’re probably reading this because at some point in your life you’ve had shoulder pain, or maybe because you have shoulder pain now that hasn’t gotten better.

Shoulder pain is very common among adults of all ages. Persistent shoulder pain can result from bursitis, tendinitis, rotator cuff tear, adhesive capsulitis (frozen shoulder), impingement syndrome, avascular necrosis, osteoarthritis (OA), other causes of degenerative joint disease or from a current or past traumatic injury.

The rotator cuff of the shoulder is made up of four muscles. Tendons of these muscles come together to form a cuff around the head of the upper arm bone (humerus) and top of the shoulder. The rotator cuff muscles are important stabilizers and movers of the shoulder joint. As the name implies, the rotator cuff functions to allow you to rotate your shoulder and lift your arm.

Some shoulder conditions may have complex causes, but they can usually be diagnosed on the basis of medical history, a physical examination consisting of special tests including range of motion and strength tests. Although a $3,000 MRI may confirm that you have a partial tear, it is not always necessary as it will not change the outcome.

Rotator cuff tendonitis is the inflammation of the rotator cuff tendons and muscles that help move your shoulder joint. This injury typically occurs over time, usually as a result of keeping your shoulder in a single position for a prolonged period (such as sleeping on your shoulder every night or keeping your hand under your head), by doing repeated overhead work-related activities, or repetitive athletic activities such as basketball, baseball, wrestling, tennis, etc.

A rotator cuff tear can be either partial or complete. A partial tear is when one of the tendons of the rotator cuff is frayed or damaged. A complete tear (also called a full-thickness tear) is when the tendon is severed in half or pulled completely off of the bone. Rotator cuff tears can occur over time from repeated wear and tear or as an acute traumatic injury such as a fall on the arm/shoulder, heavy lifting, car accidents, starting a lawnmower, or sudden reaching behind to grab something from the back seat.

Another common cause of shoulder pain that is often missed is that your shoulder pain may be coming from your neck. If that’s the case, your shoulder x-ray and MRI would look normal which can lead to more frustration, especially when a medical provider tells you that there is nothing wrong.

Physical therapy is a clinically proven conservative method of treating shoulder and neck issues. Multiple studies validate the effectiveness of PT for shoulder pain and how it can prevent unnecessary surgeries. A good physical therapist should be focused on treating the root cause of the pain rather than just treating the symptoms.

Experiencing shoulder pain? Try doing the exercise in the picture below:

1. Take the arm on the affected side and reach over your head and behind your neck to touch your shoulder blade on the opposite side.
2. Next, take the arm on the affected side and reach below your neck and behind your back to touch your shoulder blade.

If you are not able to reach all the way or if the pain is preventing you from doing so, it is indicative of possible rotator cuff injury.

Now try moving your shoulders up, sideways, and try bending your neck down… if the pain in your shoulder increases, it’s possible that your neck may be the cause of your pain.

Either way, pain is the body’s way of telling you that something is wrong. I often find
people trying to diagnose their pain by using google, which can often lead to people making mistakes that may make their pain worse. The biggest mistake people make is to ignore the pain or to alter it by taking pain killers, narcotics, or steroid injections. By seeing a specialty-trained physical therapist right away, you may prevent costly surgeries, worsened injuries, or permanent damage to your shoulders.

By, Julianne Bomia, SLP

Advances in neuroscience have provided neurobiological and behavioral evidence supporting the positive impact of exercise-based protocols in people with Parkinson’s Disease.  LSVT LOUD is an evidence-based Speech Therapy program that has strong potential to improve quality of voice and overall intelligibility for people living with Parkinson’s Disease.  It has been scientifically researched for the past 25+ years and has documented improved impact on multiple levels of functioning in people with Parkinson’s following treatment.

Benefits experienced after treatment include:

• Increased vocal loudness
• Improved articulation and speech intelligibility 
• Improved intonation (the rise and fall of the voice in speaking)
• Improvements in facial expression 
• Changes in neural functioning related to voice and speech 

The LSVT program consists of 60 minute sessions, four times per week for four weeks.  This combined with a home exercise program one to two times a day, helps clients with Parkinson’s to better improve their skills.  The goal is for clients to use their “LOUD” voice automatically in everyday living and for long term carryover of increased intelligibility. As with all of our therapies, sessions and schedules can be tailored to best accommodate the needs of the patient. 

LSVT BIG is a Physical Therapy or Occupational Therapy program for Parkinson’s Disease and is used to improve major motor skills for activities like walking, limb movement and balance or fine motor skills such as writing and other ADLs (activities of daily living).

Rehab Specialists has Speech Therapists, Occupational Therapists, and Physical Therapists certified in both LSVT LOUD and LSVT BIG for maximal results in treating many Parkinson’s Disease symptoms.

If you’re interested in learning more about LSVT for Parkinson’s Disease, call our office at 269-459-6212 to learn more or to set up a free consultation with one of our certified therapists.

The role of the Occupational Therapist is to determine what activities of daily living skills (ADL’s) you are having difficulties with and establish goals to improve on your level of independence in these areas.

What are ADL’s?  ADL’s include but are not limited to:

• Dressing skills (including manipulating clothing fasteners, tying shoes)
• Grooming and hygiene (brushing teeth, washing face, applying makeup, brushing hair)
• Bathing/Showering
• Feeding yourself
• Household chores
• Work
• Handwriting, computer skills

The Occupational Therapist will interview you and assess your skill levels.  The OT will identify your strengths and weaknesses.  Based upon your symptoms and strengths the OT will teach you strategies to allow you to continue to do those ADL’s that are important and meaningful to you.  Often, the OT will focus on arm movements and fine motor skills to help improve on your ADL’s.

There are also specific exercises that are highly recommended in order to help maintain and improve on your mobility.  One of these specific programs is called the LSVT BIG  program.  At Rehab Specialists we have several PT’s, Physical Therapist Assistants and 1 OT all trained in the LSVT BIG program.  This is a specific movement based program to help improve on balance and mobility for those individuals with Parkinson’s Disease.  As part of this program the patient can be seen by both OT and PT in a joint effort to improve on both upper extremity and lower extremity movement.  The goals are tailored to the individuals needs and wants and are very specific to the patient.

At Rehab Specialists we do offer free consultations.  If you would like to discuss your concerns with an Occupational Therapist please feel free to call and schedule a consultation.  You may also discuss with your Primary Care Doctor or Neurologist the option to obtain a script for Occupational Therapy.

Did you know that dancers suffer an average of 1 injury per year? Between 14-77% of those injuries are in the foot and ankle. Another fun fact: the foot and ankle consist of 26 bones in the foot and 2 lower leg bones! The foot and ankle complex is extremely important for dancers to propel themselves through space and create long, beautiful lines with their legs. 

Common dance injuries include ankle sprains, tendinitis, and hallux valgus also known as bunions. Most dancers will experience an ankle sprain at some point in their careers and a lot of them will work through an ankle sprain if it isn’t too severe. It is important to seek out care even for minor sprains to maintain the extreme ranges of motion and strength needed in a dancers foot. 

A dancer may benefit from an orthotic or heel cup to be used in street shoes while not dancing to support the foot and aid in healing. Prior to full return to dance, a dance physical therapist may recommend gradual return to dance by doing barre work in tennis shoes with supportive orthotics to ease the feet back into dance activities. For more information about how to manage foot and ankle conditions in dancers, or if you have foot and/or ankle pain, contact Rehab Specialists and ask to be scheduled with our dance specialist.