Let’s Revisit Balance! – September is Balance Awareness Month

Here are a few facts about falls to start:

  • 1 in 5 falls results in serious injuries such as broken bones or brain trauma
  • People over the age of 65 have a 1 in 4 chance of experiencing a fall each year.
  • More than 95% of hip fractures in older adults (>65yrs) is caused by a fall.
  • Falls are the most common cause of traumatic brain injuries.

Now that we have seen some statistics about falls and injuries, let’s talk about how to PREVENT these from ever happening to you! Balance can be compromised by a number of different issues such as weakness in the trunk, hips, and legs, vision changes, sensory changes, vestibular dysfunction, stroke, or other injuries. Balance is technically a skill like being able to dribble and basketball or paint a picture – this means it can be improved with practice. Therefore, practicing activities that directly work on challenging balance and staying upright is essential to improving. But before you start practicing, here are a couple of quick and easy ways to assess how good your balance is, and what aspects of balance need to be worked on.

First, try standing with feet together. Once you’re stable there, close your eyes. If you can do that for 30 seconds, try turning your head side to side with your eyes closed. You might notice some wobbliness here. If it is difficult with eyes open, that is a good starting point to work on. If it is difficult with eyes closed, start there. If all those are easy, try this.

Take your right foot in front, left foot directly behind. This is called a tandem stance. See if you can stand here for 30 seconds. Then repeat as above. If stable, close your eyes for 30 seconds. If stable there, add in head turns as well! That’s where things get pretty shaky for me!!

Another good way to test balance is to see how long you can stand on one leg – if you can’t stand on one leg for at least 30 seconds, it means you should work on it!

So wherever you had trouble in these exercises, take that activity and work on it. Do it everyday for 3-4 sets of 30 seconds each. Do this next to a counter or corner of a wall for safety. Then retest this assessment in 1-2 weeks and see the improvement!

Now, there are much more assessments, activities, and aspects that relate to balance and preventing falls, but this is a great starting point for most people regardless of what level you may be at. I hope you found this useful and if you are ready to prevent falls in the future, take my Balance Class on Mondays and Thursday’s at 10 am or book a 1 on 1 session with one of our experienced Physical Therapists!

I have included a list of references if you’d like to find out more about falls, fall prevention, and why working on balance is so important!

Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. DOI: http://dx.doi.org/10.15585/mmwr.mm6537a2

Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare Population. Am J Prev Med 2012;43:59–62.

O’Loughlin J et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American journal of epidemiology, 1993, 137:342-54.

Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.

Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma-Injury, Infection and Critical Care 2001;50(1):116–9

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 5, 2016.

Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int, 1999;65:183–7.

Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Academic Emergency Medicine 2000&359;7(2):134–40.

My Hips and Feet are Connected?!

The foot is our base to our body and our direct connection to the world. But many people find themselves having foot problems or just do simply not know how to care for and control their feet. Well if you have feet, you need to learn how your hips directly affect your feet. The musculature around the hips (the glutes) helps rotate the lower extremity outward (we call it external rotation). Learning how to activate these muscles in the hips while the feet are on the ground will actually help the feet become stronger.

As PT’s, we see weakness in the external rotators of the hips quite often, and this weakness in the hips is often in combination with poor arch control or flat feet. It is important to note that foot shape alone does not dictate whether they are weak or inactive. However, the glutes can assist the intrinsic musculature of the foot to activate. Here’s how: 

  1. Stand with your feet underneath your hips barefoot on the floor. 
  2. Slightly sit your hips back and create a slight bend in the knees – this is a small hinge position. 
  3. Start by gripping the ground lightly with your feet – think suction cupping your foot to the ground. (you should already feel some activation on the bottom of your foot with this technique). If you don’t feel it here, no worries…. Here’s where the hips come in. 
  4. Without letting your feet move, think about rotating or “corkscrewing”  your feet into the ground by driving your knees outward toward the side edges of your feet. 
  5. You should see your arches rise. Be careful not to rotate the knees out too far where the base of your big toe comes off the ground. Then relax the knees. 

By rotating your knees out, you activate the glute and the intrinsic muscles of the foot in conjunction with one another.

Check out our social media posts and videos of some other activities to help activate your feet and glutes together!

Hip Stretches for Upcoming Travel Plans

Sitting on a plane, train, or automobile shouldn’t hurt. Hip pain can have causes including trauma, lying on a side for a prolonged period, overuse, muscle stiffness, sitting in an awkward position, sprains, or strains.

Watch as Dr. Maya Bizik shows some brief stretches you can do to ease your pain and prevent it going forward.

Lower Back Pain While Traveling? Read This.

Have you scheduled any upcoming travel plans? Here are some things to consider when traveling.

One of the issues that we hear most people talk about during travel is low back pain and hip tightness from the increased amount of sitting in the airport, on the plane, or in the car. There are so many things to consider when traveling, i.e., where to sit on the plane, traffic, waiting in line at airport security, carrying heavy luggage, lay-overs in the airport, etc. When thinking about all these variables it can be stressful and it is important to be prepared.

The first thing that I want to stress in order to avoid pain is not to stay in the same position for too long. Make sure to take stretch breaks or do gentle range of motion exercises throughout your travel to prevent increased pain or discomfort. We will discuss these exercises and stretches in more detail below. Sitting in a slouched position or leaning too far back can put a strain on the discs (fluid-filled cushions that protect the vertebrae from rubbing together) within your spine and over a prolonged period may cause muscle imbalances. Habitual poor standing postures can also contribute to low back pain.

Below is a diagram of what muscle imbalances may develop:

So… you must be asking yourself; how do I treat or prevent these imbalances from happening? There are a few stretches and exercises that we recommend doing before, during, and after your trip.

First, let’s discuss the hip and low back stretches:

  • Hip Flexor Stretch (1/2 kneel or standing position)

Starting Position: Begin in half-kneeling. To stretch your right hip, kneel on your right knee.

Movement: Before shifting your weight forward, tilt your pelvis posteriorly (or tuck your tailbone) by engaging your core and your right glute muscle. Make sure to keep your hips square. Then, gently shift your weight forward.

Standing Position: Take a big step forward with one leg into a “lunge” position, engage your glute muscles by squeezing and then push your hips forward to feel a stretch in front of the hip of the back leg. Hold for 30 seconds and repeat 3 times on each side.

  • Seated hamstrings stretch

Starting Position: Sit at the edge of the chair and straighten the leg that you wish to stretch in front of you so that the knee is straight, and the heel is resting on the ground. 

Movement: Slowly lean forward, placing your hands on your thigh. You should feel a stretch in the back of your leg. Hold for 30 seconds and repeat 3 times on each side.

  • Seated piriformis stretch

Starting Position: Begin sitting near the edge of a chair so that your hips and knees are parallel 90/90 degrees to the floor. 

Movement: Perform the stretch by crossing one leg over the other at the knees. Rotate your body to the opposite side and use your arm to pull the crossed leg towards the opposite side. You should feel a stretch in your glute and hip area. Hold for 30 seconds and repeat 3 times on each side.

  • Standing prayer stretch

Starting Position: Begin standing with both hands resting on a table or top of a chair with your arms straight.

Movement: Keeping your hands in the same place, slowly step backward, which will cause you to bend your trunk forward. Continue until a stretch is felt along the shoulder and back. Hold for 30 seconds and repeat 3 times.

  • Standing quad stretch

Starting Position: Stand in front of a stable surface to hold onto if needed.

Movement: Grab your foot and bring your heel on the side you wish to stretch towards your buttocks and hold it their with your hand.  Hold for 30 seconds and repeat 3 times on each side.

Lastly, let’s discuss core, pelvis, and hip range of motion and strengthening exercises:

  • Seated pelvic tilts

Starting position: Sitting

Movement: Position your pelvis in a posterior pelvic tilt, draw your belly button back toward your spine and tuck your tailbone underneath. Perform a quick pelvic floor contraction (Kegel), followed by immediate relaxation. Repeat while maintaining posterior pelvic tilt.

  • Seated trunk rotations

Starting position: Sitting in an upright posture, feet flat on the ground in front of you and hands crossed over across your chest.

Movement: Begin the movement by slowly rotating at your waist to your side and then to the other side of your body. Make sure to keep your abdominals tight throughout the exercise. Repeat for 3 sets of 10 repetitions.

  • Seated trunk flexion

Starting position: Sit at the edge of a steady chair with your feet well apart and your arms resting between your legs. 

Movement: Bend your trunk forward and touch the floor with your hands. Return to the starting position. Try to bend down a bit further with each repetition.  The exercise can be made more effective by holding on to your ankles with your hands and pulling yourself down further.  Repeat 10 repetitions with a 10-15 second hold.

  • Standing hip extension

Starting position: Standing on flat ground.  Place one hand on a railing or back of a chair for stabilization. 

Movement: Lift the leg to be exercised backward while keeping the knee straight.  Do not lean forward or arch your back.  Slowly lower back to the starting position.  Repeat for 3 sets of 10 repetitions.

  • Standing hip abduction

Starting position: Standing on flat ground.  Place one hand on a railing or back of a chair for stabilization. 

Movement: Lift the leg to be exercised out to the side while keeping the knee straight and toes pointed forward. Keep the trunk and pelvis pointed forward.  Slowly lower back to the starting position.  Repeat for 3 sets of 10 repetitions.

References:

  1. Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol. 2001; 13: 128–134. pmid:11224737
  • Braga AB, Rodrigues AC, de Lima GV, de Melo LR, de Carvalho AR, Bertolini GR. Comparison of static postural balance between healthy subjects and those with low back pain. Acta Ortop Bras. 2012;20(4):210-212. doi:10.1590/S1413-78522012000400003

Learn a Proper TRX Row in 17 Seconds

Did you know that swimming is a low-impact exercise that manages to work every muscle in the body?! That’s part of why we love it so much, but that doesn’t mean it’s 100% safe.

Strength training to the rotator cuff, scapular stabilizers, and core muscles will enable a more powerful and safe stroke, and TRX rows are a great way to do that!

Watch this video from Dr. Maya Bizik where she shows how to strengthen these muscles with TRX rows.

  • TRX Bent Knee Row
    • Complete 3 sets of 10 repetitions
    • Starting position: hang shoulder under handles with arms straight, back and hips straight with knees bent and feet flat on the floor.
    • Movement: Pull body up so sides of chest make contact with handles while keeping the body straight. Return until arms are extended straight and shoulders are stretched forward. Repeat as directed.

References:

1. Tovin BJ. Prevention and treatment of swimmer’s shoulder. N Am J Sports Phys Ther. 2006;1:166–175.

2. Improving your front crawl technique. Swimming.org website. Published on November 24, 2014. Accessed October 22, 2020.

If you need more help maintaining injury prevention, inquire about our virtual classes or virtual 1 on 1 physical therapy and wellness services (exercise training also available!) Call (619) 260-0750 today!

5 Tips for Preventing Injury During Swimming

Swimming is a low-impact exercise that works all the muscles in the body. Even though swimming is the preferred type of exercise to maintain fitness and rehabilitate certain injuries, there is still a risk of swimming injuries, commonly shoulder injuries, if you are not using the proper swim stroke technique.

Here are some key components to consider when swimming:

  1. Bilateral Breathing This is the ability to breathe comfortably on both sides resulting in equalizing muscle development and symmetry
  2. Posture Tightness in chest musculature or rounded shoulders can put you at risk for shoulder impingement
  3. Kick Your kick should originate from the hips with a slight bend in the knee at all times.
  4. Catch and Pull “Catch” is when hand enters the water and your thumb should NOT enter the water first to prevent internal rotation at the shoulder. “Pull” is the sweeping phase when arm pulls through the water to move the body forward. During the “pull”, the arm should NOT cross midline or reach out too wide.
  5. Body Rotation I.e. as the right arm enters the water, the body should rotate slightly toward the left and vice versa.

In addition to the above tips mentioned, strength training to the rotator cuff, scapular stabilizers and core muscles will enable a more powerful and efficient stroke.

  • TRX Bent Knee Row
    • Complete 3 sets of 10 repetitions
    • Starting position: hang shoulder under handles with arms straight, back and hips straight with knees bent and feet flat on the floor.
    • Movement: Pull body up so sides of chest make contact with handles while keeping the body straight. Return until arms are extended straight and shoulders are stretched forward. Repeat as directed.
TRX bent knee row
  • Shoulder Extension with Theraband (Speed Skiers)
    • Complete 3 sets of 10 repetitions
    • Starting position: Anchor an elastic band to a secure object at top of the door. Grab ahold of both ends of the exercise band and place your arms straight out in front of you.
    • Movement: Extend your arms backward while keeping your elbows straight and squeezing your shoulder blades down and back. Return to the starting position. Repeat as directed.
Shoulder extension with theraband
  • Medicine Ball Slams
    • Complete 3 sets of 10 repetitions
    • Starting position: standing with a medicine ball in both hands.
    • Movement: Take medicine ball overhead, slam straight down, catch the ball, and repeat.
    • Tip: Stance may be a little wider than normal.
Medicine ball slams
  • Shoulder Internal Rotation with Resistance Band
    • Complete 3 sets of 12-15 repetitions
    • Starting Position: Begin by placing an exercise band at chest height securely in a door jam.  Standing perpendicular to the doorway with the arm you wish to exercise closest to the doorway.  Place a towel roll between your elbow and your side and bend the elbow to be exercised to 90 degrees. 
    • Movement: Slowly bring your hand towards your stomach, keeping your elbow bent and arm at your side.  Repeat as directed.
Shoulder External Rotation with resistance band
  • Shoulder External Rotation with Resistance Band
    • Complete 3 sets of 12-15 repetitions
    • Starting Position: Begin by placing an exercise band at chest height securely in a door jam. ­Standing perpendicular to the doorway with the arm you wish to exercise furthest from the doorway. ­ Place a towel roll between your elbow and your side and bend the elbow to be exercised to 90 degrees. ­
    • Movement: Slowly pull the band away from you, keeping your elbow bent and upper arm at your side. ­ Repeat as directed.
Shoulder External Rotation with resistance band
  • Pectoralis stretch
    • Hold the stretch for 30 seconds and complete 3 sets
    • Starting position: Begin standing with a doorway about 1-2 feet in front of you.  Bend the elbows of both arms to 90 degrees, raise both arms so the upper arms are parallel to the floor, and place your forearms on either side of the doorway. 
    • Movement: Step forward with one foot so that it’s on the other side of the doorway.  Slowly shift weight onto the front foot until you feel a stretch in your chest. Hold as indicated.
Pectoralis stretch

References:

1. Tovin BJ. Prevention and treatment of swimmer’s shoulder. N Am J Sports Phys Ther. 2006;1:166–175.

2. Improving your front crawl technique. Swimming.org website. Published on November 24, 2014. Accessed October 22, 2020.

If you need more help maintaining injury prevention, inquire about our virtual classes or virtual 1 on 1 physical therapy and wellness services (exercise training also available!) Call (619) 260-0750 today!

WATCH: How to Fix Knee Cave While Squatting

Knee cave is a common health issue that can contribute to knee pain and injury. Resulting in the knees moving inward during activities such as squats or climbing stairs, knee cave is frustrating but solvable.

Watch along as Dr. Joe Wong shows three exercises to reduce this issue.

Have some questions? Give us a call at 619.260.0750

Innovative Physical Therapy, “Solutions in Motion”

info@innovativept.net

How to Fix Knee Cave While Squatting

Does your knee move inward while climbing stairs? Do you become knock-kneed while squatting? This inward collapse at the knees is called dynamic knee valgus. This position of the knee can contribute to knee pain and injury, including MCL strains, patellofemoral pain syndrome, ACL injuries, and more.

Dynamic knee valgus is characterized by hip adduction (thigh bone coming closer to the midline) and internal rotation (twisting inwards). In the picture above, the athlete’s knees are collapsing into dynamic knee valgus.

Strengthening the glute muscles can improve your ability to avoid knee cave and prevent potential injury to your knees. The athlete below demonstrates proper knee position with hip, knee, and feet correctly aligned.

Below are some exercises from easy to more difficult that can help strengthen the glutes in order to avoid dynamic knee valgus.

Clamshells 2-3 sets of 8-12 reps

Banded glute bridge 2-3 sets of 8-12 reps

Lateral band walks 2-3 sets of 6-10 steps, each direction

Glute kickbacks 2-3 sets of 8-12 reps, each leg

Have some questions? Give us a call at 619.260.0750

Innovative Physical Therapy, “Solutions in Motion”

info@innovativept.net

WATCH: Try These Eccentric Hamstring Exercises for Injury Prevention

What is Eccentric Exercise?

Eccentric exercise refers to muscle activation that focuses on lengthening. If you have taken up running in quarantine, you should focus on strengthening your body so it embraces this new form of exercise and Eccentric motions are a great place to start.

Decreased hamstring strength can lead to injury, and a hamstring strain can be a nagging injury and predispose athletes to future hamstring strains.

Watch this video from Dr. Joe Wong to learn his favorite Eccentric Hamstring exercises.

Have a nagging hamstring injury? We can help! Give us a call at 619.260.0750.

Innovative Physical Therapy, “Solutions in Motion”

info@innovativept.net

Eccentric Hamstring Exercises for Rehabilitation and Injury Prevention

What is Eccentric Exercise?

Repetitive motions consist of a concentric and eccentric portion of the exercise. The concentric portion refers to muscle activation while the active muscles are shortening—an example is the portion of the curl when the elbow is bending (the bicep is active and shortening). The eccentric portion of an exercise refers to muscle activation while the active muscles are lengthening—with the bicep curl example, the portion of the exercise in which the elbow is straightening (bicep is active and lengthening).

Eccentric Exercise in Hamstring Injuries

During the pandemic, many athletes have turned to running as their primary form of exercise. While running is excellent exercise, it’s important that our body be strong enough to accept our new activities to avoid injury. Hamstring strength is important for running and, in particular, for sports with sprinting, acceleration, and change of direction. Decreased hamstring strength can lead to injury, and a hamstring strain can be a nagging injury and predispose athletes to future hamstring strains— having a previous hamstring strain increases the risk of a future hamstring strain between two and six times.1,2 Reinjury typically takes significantly longer to recover from than a first-time injury.1 Research has shown that including eccentric training of the hamstring is beneficial for both rehabilitation of hamstring strains and prevention of future hamstring injury. Below is a progression of some eccentric hamstring exercises, from easy to advanced.

  1. Bridge fall-out with slider (2-3 sets of 8-12 reps)

2. Swiss Ball Eccentric hamstring (2-3 sets of 8-12 reps)

3. Eccentric SL RDL (2-3 sets of 8-12 reps)

4. Nordic Hamstring (2-3 sets of 6-8 reps)

Have a nagging hamstring injury? We can help! Give us a call at 619.260.0750.

References:

  1. Schmitt B, Tim T, McHugh M. Hamstring injury rehabilitation and prevention for reinjury using lengthened state eccentric training: a  new concept. Int J Sports Phys Ther. 2012; 7 (3): 333-341.

  2. Lorenz D, Reiman M. The role and implementation of eccentric training in athletic rehabilitation: tendinopathy, hamstring strains, and ACL reconstruction. Int J Sports Phys Ther. 2011; 6 (1): 27-44.

Innovative Physical Therapy, “Solutions in Motion”

info@innovativept.net