Attention Holiday Shoppers!

With all the hustle and bustle of holiday shopping we tend to forget about the "little" things such posture, proper lifting techniques, etc.

Here are some tips to keep in mind in order to prevent injury:

1. Proper footwear: If you know you will be out all day shopping make sure you have shoes that are comfortable. Try to avoid heels if possible, however if you MUST wear heels then make sure they are 1-2 inches or less and are made of a material that has some give to it, such as rubber. If you are wearing boots or shoes with no support in them you can buy an arch support at your local pharmacy and place it inside the shoe for added support (if possible, take the insole out of your shoe and then put the arch supports in).

2. Carrying bags: When carrying bags, pocket book, baby, etc. make sure that you even the weight out on each shoulder. Do not carry all of the weight on one side of your body. This will directly affect your posture and may cause serious injury to your back.

3. Lifting: When lifting always remember to "activate your core" first by drawing in your belly button towards your spine before you perform the lift. Remember to bend at the knees and hold the object as close to your body as possible. If you are taking presents/bags out of your shopping cart and/or trunk first activate your core, move the object as close as you can to the edge of the cart/trunk, then lift object as close to your body as possible. Do not pull the bags/presents out of the car by tugging and rotating your spine. This may cause a serious injury to the back and prevent you from completing the rest of your shopping!

4. Wrapping: When wrapping presents have your gifts and wrapping supplies placed directly in front of you. Sit at your dining room table, stand at a high counter, or tall kneel at the side of your bed (that's if the bed isn't positioned too high). Remember to always "activate your core" and keep it activated. Sitting on the floor will place your body in a compromised position which you might regret later.

These helpful tips will help save you some unwanted post-holiday discomfort. I hope you find these helpful and I hope you remember them this holiday season and in the future.

HAPPY HOLIDAYS!

Tendinitis vs. Tendinosis

There is a common misconception regarding the term we commonly hear called "tendinitis" and a term we don't hear as often called"tendinosis". However, the latter is far more common than most of us think.

Tendinitis is an inflammation of the tendon. Tendinosis is degeneration within the tendon caused by repetitive microtrauma, decreased blood supply to the tendon, or the natural aging process.

When a tendon is repetitively stressed or "overused" microtears form on the tendon in turn igniting an inflammatory process, which is called tendinitis. The inflammation can usually last anywhere from 7-10 days. It can be decreased if treated promptly with rest and anti-inflammatory agents such as ice and anti-inflammatory medications (NSAIDS, OTC Ibuprophen such as Advil, Motrin, etc.).

However, if the tendon is continuously placed under stress for an extended period of time the condition can no longer be called tendinitis and is now termed tendinosis. The reason for the name change of the condition is due to the physiological changes of the tendon. Due to increased stress, the tendon becomes ischemic meaning there is decreased blood supply to the tendon. If the tendon is ischemic for an extended period of time the collagen (that all tendons are made up of) begins to die. Once the collagen dies there is no longer a presence of inflammatory cells. If there are no inflammatory cells that means there can be no inflammation (aka tendinITIS) and therefore, NO PAIN. I am sure no pain sounds great to all of you, but this is very bad. If there is a lack of pain there is no way for your body to tell you if and when the tendon has been overly stressed again. Hence, there is a very high chance that the tendon will rupture or tear completely as in when an individual tears their Achilles' tendon.

Collagen can regenerate if the proper treatment is rendered. If the tendinitis has become tendinosis it is much harder and it takes longer, but it can still be done. So if you think you have tendinitis, please do not wait for the pain to go away because with the proper treatment it will not turn into tendinosis. It doesn't hurt to get it checked out, right?

What is the best cardiovascular exercise to do if you have knee pain?

Choosing the right cardiovascular machine that prevents further damage to your joints is so important and will save you pain in the long run. The best cardiovascular exercises for your knees are the ones that put the least amount of stress on your joints. Two of these exercises include the stationary bicycle (recumbent or upright) and swimming. The exercise bike is a great way to burn calories and to build strength in your leg muscles without putting excessive stress on your lower extremity joints. When you set up your bike you want to make sure that when seated your knees are slightly bent. Also, when you extend your leg at the fullest rotation your knee should still have a slight bend in it. You also want to make sure your knees are not bent too much (greater than 90 degrees). Hint: When your knee is bent at the proper angle you should still be able to see your toes. Excessive bending in the knee will increase the stress on the patella (knee cap) located in the front of your knee. Swimming is also another great way to burn calories and increase muscle strength throughout your whole body without putting excessive stress on the your joints. If you suffer from bad knees and a bad back, swimming is a great exercise. You can burn up to 450-900 calories per hour. Sounds good to me! I have found a website where you can figure out caloric expenditure during various exercises based on your body weight. Go to http://www.nutristrategy.com/activitylist3.htm.

Some helpful advice:

1. If you have back pain as well as knee pain the recumbent stationary bicycle may be a better fit for you.

2. If you have shoulder pain and you want to swim try using the breaststroke. The breaststroke does not require rotation of your shoulders which can cause excess shoulder pain. If the breaststroke still causes pain then stick to the stationary bicycle for the cardiovascular portion of your workout and do you weight training in the pool.

Pain in the foot...

I am just getting over a bad bout of plantar fasciitis. For those of you who are unfamiliar with this painful and ruthless foot condition, it is an inflammation of the fibrous band of tissue that runs along the bottom of the foot from your heel to the ball of your foot. When inflamed it can become extremely (did I say extremely?) painful causing one to limp or have to use an assistive device, like a cane or crutches, to walk. So, I have been limping around on the ball of my foot (sometimes with straight cane in hand) due to plantar fasciitis. I am positive that many of you are wondering “How did a physical therapist let herself get to this point?” Well, I am as guilty as many of you and I ignored my pain. I thought ‘Oh, it’s not so bad…it will go away tomorrow. I can deal with the pain.’ Well, it did go away…and then it came back with a vengeance! So, for the past 8-10 days I have had to treat myself like a patient and even become a temporary patient of Dr. Yoo’s. After 8 days of consistent treatment I am finally step on my heel with minimal pain and today (day 12) I have hardly any pain! I cannot explain how amazing it feels to be able to finally step on my foot without wincing in pain.

Prevention is the solution! The human body is a kinetic chain; everything is connected! Over time, poor mechanics of one part of the body will affect another part of the body somewhere up or down the chain. Shoes, shoes, and more shoes! I cannot stress enough how important footwear is when it comes to preventing injury. I own great shoes that are wonderful for my feet and I own shoes that even though they may look good they are terrible for my feet. When I wear my great shoes, my foot doesn’t bother me at all, however when I don’t I suffer tremendously. I understand that footwear can be pricey, but it is even pricier down the road for treatment of injuries caused by poor footwear. If you have proper footwear it may prevent you from having to purchase orthotics. Some individuals may even do well with over-the-counter arch supports (i.e. Dr. Scholl’s, Spenco). These can be purchased at your local pharmacy, Road Runners (on Route 4 West in Paramus), and/or On Track (Englewood, NJ). However, some individuals depending on the severity of the condition or foot positioning may need to be fitted for orthotics by an orthotist in order to permanently correct the problem.

I hope this blog has helped save you from some unwarranted pain. I will continue to treat my condition until my foot feels 100% better and I will take preventative measures so this does NOT happen again.

Dr. Murphy on lower back pain...

Being the mother of an 11 month old little girl, I understand the mental and physical demands of a full-time job and having less “me time” to take care of myself. I am also realizing that mid and lower back pain is often a common occurrence when you are caring for a little one. The repetitive bending from picking up baby Ava and toys off the floor, holding her on one hip while you try to get things done around the house, lifting and carrying the car seat, leaning over the crib patting her on the back or stomach trying to get her to sleep and rocking her to sleep at all times of the day (including the middle of the night). It all started when I was nursing and pumping. I had such bad ache and pains in my neck and mid to upper back from looking down at her while she was feeding. I would have to do stretching at home on my floor after each feed to help the pain subside. Then the lower back pain kicked in once she started crawling. I was constantly bending and squatting on the floor picking up her and her toys up or just stopping her from breaking the family vase that has been in the family for 75 years (don’t worry I have since then childproofed my house).

Repetitive bending, whether it be looking down for extended periods of time during the day or bending down to picking objects up off the floor, puts a tremendous strain on the structures of your lower back. A daily proper stretching and core stabilization routine can be the answer to all of your problems. Stretching can be done anywhere; sitting, standing, or lying down. There is no excuse not to stretch. I know we are all guilty of saying things like “I don’t have time” or “I’ll do it later.” I catch myself saying these things sometimes. But, once I take a few minutes to do some stretching I am so happy and relieved that I did! Essential muscles to stretch and strengthen to prevent lower back pain are the hamstrings located in the back of the thigh, hip flexors located in the front of the thigh and deep in your trunk, and the glute or buttock muscles.

Six tips from Dr. Murphy for preventing low back pain:

1. Whatever you are doing you should always start with drawing in your belly button towards your spine. If you are about to lift an object, tighten your core by drawing in your belly button towards your spine and then lift the object.
2. Don’t sit for too long! Take small breaks every 15-20 min. Get up and walk around. Reach your arms up over your head and stretch. Anything…just don’t stay seated! Research has shown that the brain can only retain information what it learns in 20 minute increments. So, even more of a reason to take that break!
3. When lifting an object keep it as CLOSE to your body as possible. This is includes anything from boxes to babies. The further away the object the more strain it puts on your lower back. Babies put even more strain on you because they are mobile unlike a box!
4. When you walk squeeze your glutes! Many people tend to shift their hips from side to side (the infamous model walk) or rotate their lower back and pelvis too much when they walk. Think about squeezing your glute (or buttock) muscle on your push off leg with EVERY step. Your heel should strike the floor first and then you should push off with your toe. Draw your belly button in towards your spine, stand up straight with your shoulders back and walk with purpose; no more strolling.
5. When you stretch make sure you hold the stretch, no bouncing! Hold all stretches for 30 seconds or longer and repeat three times. You should stretch twice a day, EVERY day.
6. For the females: Decrease your time on heels! I’m not saying don’t wear heels (because we all know that’s not going to happen) just decrease your time wearing them. If you’re still shaking your head NO WAY! then another option is to decrease the height of your heels and/or wear a heel that has more give to it in order to absorb the shock from the floor (which will travel right up to your back!). Heels place your body in a more forward position and it order to maintain an erect posture your joints and muscles need to work overtime against gravity.

So after a good 10 minute stretch I am good to go again (until tomorrow when I need to repeat my stretching again from my daily duties a mother.). Best of luck with your stretching and hopefully some of my tips will come in handy.
Sara

Dr.Sara Murphy
Physical Therapist [Maven Sports Medicine]