Category: Therapy

Proper Sitting Posture

August 23, 2022

School is right around the corner, and you know what that means—It is time to swap the couch for the desk. With the plastic chairs and wooden desktops, it can sometimes seem hard to find a comfortable position to sit in. When on the couch, we have the luxury of leaning back, kicking our feet up, and resting our head on a pillow to help hold our necks in a good position. When at a desk, however, our options for comfort seem limited. We all have a tendency to rest our elbows on the desktop, place our head in our hands, and position our backs in a hunched-over position. What we don’t realize is how detrimental this position can actually be for our overall health.

                Our bodies are made to rest in proper alignment-ears in line with the shoulders, shoulders back, equal weight bearing on both sides. Any time we leave this erect position, we add undue strain on all of our muscles and joints, which can cause pain. The number one complaint we get from those that sit at a desk most of the day is pain within the neck and back. Lucky for you, we have some key rules you can follow to avoid this unnecessary pain and discomfort.

1. Keep your feet supported: It is suggested that you keep your feet firmly planted on either the floor or a step stool. Any time we sit without our feet supported, our pelvis has to shift, forcing our core to work extra hard to keep our spine in a neutral position. These small compensations at the core can create muscle imbalances overtime and begin to create pain at the low back.
2. Keep your forearms rested on the desk: With your arms properly supported, you are able to prevent stress at the top end of the chain (the neck and shoulders). Typically, as our arms raise, our shoulders do as well, which could increase tension in the region between the neck and shoulders. With our arms rested on a solid surface near waist-height, we are able to keep our shoulders low and our muscles relaxed.
3. Follow the 90-90-90 Rule: Your elbows, hips, and knees should all be bent at 90 degrees. If you look down and see your elbows are nearly straight, that may mean you need to bring your keyboard and/or mouse closer to you. If your hands are near your belly, you may need to slide the keyboard/mouse back or scoot your chair back just a little. In order to adjust the degree of flexion in your hips, simply adjust the height of your chair. Keep in mind, we need your feet supported and your knees to remain at 90 degrees of flexion as well. By adjusting the chair/seat height and height of your foot support, you’ll be able to maintain good posture for a longer period of time.
4. Place the computer screen at or just below eye level: This is one of the harder adjustments to make when it comes to desk ergonomics. Many people will use a lift under their computer stand so they can easily adjust. Others will use a good old-fashioned phone book or catalog to get the proper height. You may have to get creative with your own desk in order to get the proper screen height. This is important to keep your neck in good alignment. If we are looking down for multiple hours throughout the day, we place extra stress on the vertebrae and muscles in our neck. After years in this position, we can actually develop what is called the Dowager’s Hump. Due to the weakness in our postural muscles along the backside of the neck and shoulders, our head starts to sit more forward and creates a more pronounced curvature within our vertebrae.
5. Use a towel roll: As mentioned above, many of us prefer to lean forward onto our desktop and “lounge”. A simple towel roll can fix this habit and transform your sitting posture. All you need is a small hand towel from the kitchen or bathroom. Fold that hand towel in half and roll it up as tight as you can. You want to place it at the small of your back (belly button height). This little towel acts as a lever and automatically places your spine in a more erect position. It has the ability to take up to 400 pounds of pressure off your spine while sitting at your desk.

By keeping all of these rules in mind, you’ll be sure to find relief in your muscles and joints as you sit through your classes this upcoming school year. If you are already suffering from back pain or feel your posture is suffering due to your job or classes, give us, here at Witte Physical Therapy, a call so we can help get you straightened out!

Proper Lifting Mechanics

August 16, 2022

We all do it; most of us multiple times a day.  As it turns out, it is a common cause of back pain and something we can reduce or prevent problems with a little care and attention. Of course we are talking about lifting techniques.

Improper lifting technique can lead to back, leg, and arm pain. Poor technique can cause both acute injury, or aggravate existing back pain. Learning the right way to lift can assist a person in avoiding these problems. Most people know this, but actually taking the time to perform lifting activities properly is often forgotten.

https://stock.adobe.com/search?k=ergonomics+lifting&asset_id=515612279

Steps to Ensure Proper Lifting Position and Technique

1. Plan ahead before lifting. Knowing what you’re doing and where you’re going will prevent you from making awkward movements while holding something heavy. Clear a path. If you are lifting with another person, make sure both of you understand the plan.
2. Lift close to your body. You will be a stronger and more stable lifter if the object is held close to your body rather than at the end of your reach.  This also reduces the physical load on the back muscles by reducing distance that increases the torque load on the body.
3. Feet should be shoulder-width apart. Having a solid base of support is important while lifting. Placing your feet too close together will be unstable, while if they are too far apart it will hinder movement.
4. Bend your knees and keep your back straight. Practice the lifting motion before you lift the object.  Focus on keeping your spine straight. Raise and lower to the ground by bending your knees rather than bending at the waist or hips.
5. Tighten your stomach muscles. Tightening your abdominal muscles will hold your back in a good lifting position and will help prevent excessive force on the spine.
6. Lift with your legs. Your legs are many times stronger than your back muscles. Again, lower yourself to the ground by bending your knees, not your back.
7. Don’t twist or bend. Face in the direction you are walking. If you need to turn, stop, turn in small steps, and then continue walking.
8. And remember, if you’re straining, get help. If an object is too heavy, or awkward in shape, make sure you have someone around who can help you lift.

Its Fair Time!!!!

August 9, 2022

One of my favorite times every year is the when the county fairs get going in early August. I have fond memories of my time in 4H and spending time at the county fair. I really enjoyed getting to see my 4H friends, getting to show off my animals, and having the opportunity to spend so much time and do some many things at the fairgrounds. As I am now an adult I get the relive some of those experiences. Last week I spent an afternoon at the Dodge County Fair and this week I plan to spend some time at the Cass County Fair (where our Louisville and Plattsmouth clinics are located). While I will not be showing any animals, the fair still provides an opportunity to see a lot of people and to reconnect with them and some found memories. 

Being in 4H provides so many wonderful opportunities and experiences for our youth. Perhaps one of the best things that it does is to teach them about responsibility, project and time management. These are all things I still use as a physical therapist and that our patients can use to get better. It is important to have and take responsibility and ownership in what we are doing. Our therapists take responsibility in making sure that they are doing their due diligence and absolute best to get our patients what they need. This ensures that we are providing the best, most efficient and individualized care as possible. 

Project and time management are also important attributes for our therapists and patients. It is important for our patients to understand that “project management” occurs in two forms. One, as a member of their healthcare team in the clinic, and two as their own project manager outside the clinic. When our patients work to doing their home exercise program, improve their movement quality, and make routine adjustments to their daily life they are often improving much more efficiently. This efficiency leads to better time management in the clinic and at home. 

4H and the county fair has provided me with many attributes and memories that are still present with me today. These things have had tremendous carry over into other aspects of my adult life. I hope everyone can get out to their county fairs this summer, see the exhibits, meet the vendors, enjoy the food and fellowship, and reflect on what these fairs mean and how their values can be applicable to all aspects of our lives. 

https://www.cassfair.com/

School Backpacks: How to choose and wear them properly

August 2, 2022

As summer begins to wind down, we all must start thinking about what we need to buy and gather for the new school year. Pencils, pens, folders, and notebooks are all items that seem to make the supply list every year. We tend to look for the ones that draw our eye and suit our personal taste. Maybe we need something bright with a fun design. Maybe we look for something simple and solid. Either way, we want it to match our personality so we can feel excited to use it!

This “personalized” approach to supply shopping may work just fine for the small, essential items we need, but what about when it comes to backpacks? While a backpack may look like it suits us based on the color or pattern, it may not be the best for us. It is important to find a bag that is comfortable, durable, and has all the features to offload the bundle of books we will be dragging around. There are a few tips we need to keep in mind when finding and using the proper backpack.

1. Choose a bag with two straps: While a duffel bag provides more room to carry your items, they are made with one long strap. This is going to place the full weight of your school items on only one shoulder. As we continue to overload one half of the body and not the other, we cause a lot of strain on our muscles. This can disrupt the balance in our muscles and joints and potentially create pain within the neck, shoulders, and upper back. By splitting the weight of the bag between both shoulders, we keep the muscles working evenly and in sync with each other. It also places the center of the bag at the center of your back, allowing for your large back and core muscles to support the weight as opposed to the smaller neck and shoulder muscles.
2. Make sure the straps are wide: Wide straps on a bag will ensure the weight is distributed throughout the entire muscle it is resting on. A skinny strap places a lot of undue stress on a very small portion of the muscle belly. When pressure occurs in a small area such as this for a longer period of time, it has the potential to cause swelling or bruising in the area, both of which are indicative of tissue irritation and damage.
3. Do not overload the backpack: While it may seem efficient to carry a full days’ worth of books around with you, it can become very taxing on your body. Excess weight sitting atop your shoulders will strain not only the muscles your straps are on, but also the muscles in the mid and low back. This downward pressure from the backpack combined with typical pressure from gravity could cause spinal issues. The weight tends to pull your spine, or posture, downward and forward, rounding out your trunk. This position allows for shortening and tightening of your front side and increased tension or stretch on the backside. Joints will then shift and create misalignment, which ultimately leads to pain that could require therapeutic or surgical intervention.

So now, when you head to the store to pick out that perfect backpack for your new year at school, don’t automatically choose the fanciest or brightest or biggest one you can find. Take a good look at it and ask yourself a few questions. Can I fit a couple books at a time in this bag? Does it have two straps that can be adjusted to fit around both of my shoulders? Are the straps wide enough to sit comfortably on my shoulders without causing pain? The answer to these will surely lead you to a smart choice that works best for you!

Fibromyalgia – What to Do When the Fibro Ignites

July 26, 2022

As we head into the dog days of summer, the weather is heating up. For the nearly 5 million people in the United States with Fibromyalgia, they might experience a different kind of heat – the burning pain that typically comes along with this diagnosis.

What is Fibromyalgia?

Fibromyalgia is a chronic condition that can cause a wide range of symptoms throughout the body. It’s usually diagnosed between the ages of 30 and 50, and 80% to 90% of the people affected are women.

The most common symptoms are:

• chronic pain all over the body
• fatigue
• memory problems
• sleep disturbances
• depression or anxiety.

How Does Physical Therapy Help?

Because of the wide range of symptoms, fibromyalgia can be a debilitating condition. It is not uncommon for people to begin avoiding activities altogether because of pain and fatigue. This begins a cycle of deconditioning that not only impacts the person’s overall health, but also makes the symptoms of fibromyalgia worse. The cause of fibromyalgia is currently unknown and there is no cure, so physical therapy treatments are designed to reduce and manage the symptoms. This requires a multi-pronged approach. Common treatments include:

Education

The first step in treating fibromyalgia is often helping people understand what’s going on, and what they can do about it. Research has shown that people who are knowledgeable about their condition have better outcomes, more confidence, and cope better.

Decrease Pain and Improve Range of Motion

Physical therapists are movement experts with a lot of tools and techniques to help with the pain and stiffness caused by fibromyalgia. A PT might use gentle manual therapy or massage, prescribe specific stretches, or a simple yoga routine. They might also use modalities like electrical stimulation, biofeedback or in states where it is allowed, dry needling.

Exercise

Once patients understand the condition and are able to move a little better with less pain, exercise often enters the treatment picture. Research has shown that low to moderate intensity aerobic exercise like walking, biking, or swimming is important in managing fibromyalgia symptoms. It can help with pain, fatigue, sleep disturbances, depression, and more. Physical therapists and patients work together to find the right type of exercise and the right intensity to best manage fibromyalgia. They often have to start slow, and make adjustments along the way.

Each physical therapy session is tailored to the needs of the patient and will vary depending on the severity of their symptoms. Despite there still being no cure for fibromyalgia, physical therapists can help with pain management, strength, mobility, fatigue and function to help patients find relief from their symptoms.

How to Start A Walking Program

July 19, 2022

Now that the summer months are here, many of us try to spend ample amounts of time outdoors. We slowly return to life after being cooped up during the cold, winter months. This is the time to get out and moving again! Typically, when it is cold and dreary outside, we are less likely to exercise. It tends to slip on the priority list, and we make every excuse we can to avoid the workout regimen. As the weather warms, it is much easier to feel motivated, and maybe even excited, to get back at it! Whether you are 10 or 75, generally active or a couch potato, athletically inclined or clumsy and uncoordinated, everyone could benefit from a walking program.

                Walking doesn’t only increase your heart rate and improve your endurance. There are many other benefits as well. As you walk, your muscles must activate and work, improving strength within them. And we all know the greater the strength in the muscles, the less stress on the bones and joints. As your blood begins to pump through the body, your organs learn to run at this accelerated rate. They need the exercise just as much as your muscles and joints do! Walking is one of the greatest exercises to help lower blood pressure, decrease your risk of heart disease, and can even decrease your risk of stroke. Another big benefit is weight loss. Many of us may think we need to run in order to drop those extra holiday pounds, but that is not true! With a proper walking regimen, you can promote weight loss and feel better overall. But what is a proper regimen? How do we know how long or fast we should be walking for?

                Getting set up on a proper regimen may require a few steps. Generally, if you have any medical conditions or a history of medical conditions, you always want to check with your primary doctor first. They will be able to assess your past and current status, the medications you are on and how cardiovascular exercise may affect those, as well as recommend the best pace or distance to begin your walking regimen. There are also a couple questions you need to ask yourself. “Am I walking to lose weight?” “Am I walking to improve my endurance and overall health?” “Do I want to decrease my pain?” Depending on your answer to these questions, your walking regimen may appear different than someone else’s.

It is recommended to reach at least 10,000 steps a day if you are aiming to lose weight. This equals roughly 5 miles. Now, it may seem overwhelming to go out and walk 5 miles straight—don’t stress! Break it down into quarter or half mile increments if that sounds a bit more manageable for your fitness level and timeframe. Pace will vary depending on your weight, fitness level, and medical conditions. There are ways, however, to be sure you keep within a tolerated level of activity. By calculating your target heart rate, you can get an idea of how hard your body should be working in order to receive max benefit without overstressing the system. To figure your target heart rate, you want to take 220-your age. You will then multiple this number, first by .5, then by .85. This will give you your range in which you want your heart rate to stay within as you exercise.

Walking to simply decrease pain, improve your mental health, or feel better overall does not have to be quite so regimented. 3-5 times a week at this 10,000 step goal is still recommended; however, you don’t need to be quite as vigorous with it. Take your time, moving at a steady pace that will keep the heart rate on the lower side of the spectrum, but still higher than your resting rate. Think of this more as a daily stroll through your neighborhood or local park. Enjoy the walk, but make it productive at the same!

                If you’re like me, the thought of walking the same path every day may seem boring and decrease your motivation to go. Don’t be afraid to get creative with your walking regimen. Hills will encourage your cardiovascular system to work a bit harder and, in turn, will help the body burn more calories. Find a hiking trail or a riverwalk along some new terrain. This will keep you engaged with your regimen and excited to move again tomorrow! It will also challenge your muscles and joints in a new way, improving your overall strength and stability.

                Are you still unsure of exactly how to start? Reach out to your local therapist or primary care physician. We have the knowledge and background needed to help you get started on the right path today. We can assess your current status, help you set personal goals, and create a regimen tailored specifically to your needs. Call us today at 402.234.3333 if you’d like a physical assessment and help beginning your new fitness journey!

Its Summer, Let’s Hit The Pool!!!

July 12, 2022

                Now that summer is upon us, the heat can seem unrivaled most days. This will drive all of us to the nearest watering hole for some relaxation and cool-down. While the pool is a great way to cool off and have some fun with family and friends, it can also be a chance for us to get in some exercise! There are many benefits to aquatic therapy and various reasons why doctors may prescribe it.

Aquatic therapy refers to exercise performed in a pool for the purpose of rehabilitation for troubled muscles or joints. Due to the buoyant nature of water, pressure no longer rests on the joints when they are submerged, opposite of what we find to be true on land. This provides relief, allowing for a greater tolerance to strengthening and stability exercises. Exercise within a therapeutic pool is also known to decrease edema, or swelling, which will allow for improved joint mobility. Water provides a good resistance against the joints and muscles, improving strength without having to use weights or bands. This could save you money you may feel pressure to spend on equipment. If you have access to a therapeutic pool, the water sits at a higher-than-normal temperature, soothing sore muscles and decreasing pain. Water exercise is also known to decrease spasticity in muscles, helping to improve function and motor control with daily activities. There is a wide range of patient populations that may benefit from aquatic therapy. These include but are not limited to those diagnosed with arthritis, fibromyalgia, spinal cord injuries, vestibular deficiencies, and total joint replacements.

Here at Witte Physical Therapy Louisville, we have a state-of-the-art aquatic therapy pool in our clinic. The temperature rests at 93 degrees and has an underwater treadmill to assist in functional movement and gait training in a gravity-assisted environment. We have skilled therapists on-site and ready to guide you through a personalized plan of care set forth by the evaluating therapist. We provide the tools and exercise regimen needed to help you succeed. We will also help you set goals, create a plan to reach those goals, and help you progress back to your prior level of function. If you are looking for a different treatment option or are interested to learn more about our therapeutic pool, give us a call today at 1-402-234-3333.

Common Hand Injuries

July 5, 2022

It is (was) fireworks season. Unfortunately the hand surgeons and therapists never look forward to this time of year because inevitably accidents will happen that will cause injuries to hands, bodies and face due to fireworks. While these injuries are not overly common, it does give us a great platform to discuss the most common hand injuries.

OVERUSE INJURIES

These injuries in the hand tend to be directed more towards nerves and tendons. Carpal tunnel syndrome, cubital tunnel syndrome, medial or lateral epicondylitis, and De’Quervein’s syndrome. These can all be treated with activity modification, physical therapy interventions, and medications. Physical therapy will help you adjust your activities, regain your ROM and strength, and decrease you pain so that you can return to your normal life without issues. 

DEFORMITIES

These injuries tend to occur due to tendon or ligament dysfunction or rupture. Swan Neck, Boutonniere, Mallet, Trigger, and Depuytren’s are all issues that can cause a finger deformity. These issues often need splinting or surgery to be corrected. Physical therapy tends to be indicated after surgery to help regain normal function and strength. Physical therapy can also help with bracing, activity modification, and pain/swelling management.

MISC INJURIES

These can be caused by nerve dysfunction (such as peripheral neuropathy, hypo/hypertonicity) or traumatic injuries (fractures, burns, sprains, amputations). The physical therapy treatment for these items can vary depending on what is going on and its severity. However an individualized treatment plan can be developed to meet your wants and needs and contain a variety of interventions to help you reach your goals.

No matter the hand  injury, physical therapy can and  should be an integral part of your rehab. An evaluation by a physical therapist can get your started on the right path to decrease your pain and improve your function to get you back to work, back on the course, or just back to taking care of yourself. The quicker you start this path the quicker you will be back to being you!

Why Doing Your Exercises At Home Is VERY IMPORTANT

June 28, 2022

If you’ve been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you’ll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flare-ups with less positive outcomes long term. Even though they’re important, adherence to home exercise programs is terrible. It’s estimated that only 40 to 50% of patients do their exercises the way they’re supposed to. What can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.

Plan ahead

Think about what’s going to get in your way – your schedule, that you’ll forget, or that you don’t have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they’re no longer problems.

Address pain and beliefs

You’ll need to work with your PT on these. If your exercises cause pain, you’re not going to do them. When your PT prescribes your exercises, try them out. If there’s pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that the exercises won’t help, or that they’re a waste of time, you won’t do them. Again, work with your PT to understand why they’re prescribing those exercises, and what they’re meant to do. Once you know why you’re doing those exercises, you’re more likely to do them.

Get support

People who have social support are more likely to do their exercises. This is why CrossFit and group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you’re doing your exercises, and how they’re going. This will keep you accountable and more likely to do them.

Use Technology

If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you’ve exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.

Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you’re one of the 50% of the people who do their home exercises consistently to get the best outcomes.

References:

https://pubmed.ncbi.nlm.nih.gov/32669487/

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

Tommy John Surgery

June 21, 2022

It is Baseball Season and we have all been hearing about “Tommy John” issues. Throwing athletes such as baseball players and more specifically pitchers often injure or tear a ligament in their elbow called their ulnar collateral ligament. This ligament is located on the inside of your elbow, and it helps to secure your elbow joint. The repair of this ligament gets its name from a baseball player who was a baseball pitcher and was the first person to successfully return to sport following repair in 1974.

Causes of injury could be due to improper throwing mechanics, a fall into your arm, weight bearing activities such as gymnastics, repetitive throwing without adequate rest breaks or throwing at high speeds. Common symptoms of a UCL tear or injury are feeling a pop in your elbow, pain on the inside of your elbow, increased difficulty with throwing motion and decreased range of motion of your elbow. Diagnosis often requires a physician visit and in some cases imaging.

Depending on the severity of injury non-operative options include physical therapy, rest and activity modification. Full thickness tears may require surgical repair. Following surgical repair, you are often placed in a brace to limit how much you can move your elbow and depending on your doctors’ recommendations you may begin physical therapy right away or wait a few weeks to allow healing and recovery. Most often patients attend physical therapy to improve their elbow motion and strength before they are cleared to return to their sport or job.

You can help to prevent injury by performing proper warm up and cool downs, avoiding throwing until your body has fully rested and recovered from your previous throwing activity, focusing on your mechanics and improving any muscle imbalances.

References:

https://sportsmedicine.mayoclinic.org/condition/ligament-injuries/

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tommy-john-surgery-ulnar-collateral-ligament-reconstruction