Category Archives: Your Health

Getting Back Into Your Exercise Routine (Finally)?

Don’t Jump Into that “Deep Water” Too Soon!!!

I’m seeing a lot more of my total patients reporting generalized fatigue, lack of energy, weakness, being unsteady on their feet and maybe even a little down in the dumps.  Sometimes there are falls involved.  There can be many reasons medically as well as pharmaceutically that can contribute to the above symptoms, but it doesn’t take a rocket scientist to realize that these are all 100% explainable as the longer-term effects of having our lives contained during an extended Pandemic.  We’re not getting out as much or for as long.  We’re likely not socializing nearly as much.  Maybe we’re enjoying a little too much sitting time, whether it’s video calling friends, family, teachers, etc., or enjoying a little too much TV entertainment, many of us have been sitting a whole lot more than usual.  Our relative increase in inactivity over the past two years will not come rushing back to “normalcy” without some work on your part.

That’s right – this won’t be a passive process and the work can be extensive but does not need to be grueling misery.  I like to tell my patients, “We’re goin’ swimmin’ but we won’t jump in that deep water just yet.”  What does that mean?  It means we’re going to start slow and easy and carefully gauge the response, which then guides our way forward in terms of advancing safely and effectively.  This is the best way to get back into a fitness routine if it’s been a while for any reason – medically or otherwise.  If our bodies are not used to the uptick in activity/exercise we’re planning on, then we stand a pretty good risk of injuring ourselves or at least making ourselves more sore and inflamed than, presumably, most of us care to have to experience.

Let’s face it, the old adage, “No Pain, No Gain” is certainly pragmatically true when it comes to developing strength and stamina, which require physical work and conditioning.  Pushing those very physical boundaries involves physical challenge.  That challenge stresses our muscles and joints and our bodies push back with tenderness and inflammation as we heal and rebuild ourselves.  Regular exercise results in regularly better physical health — so you should consider this a long-term investment in your Quality of Life.  Committing with discipline is hard and it’s helpful to have some guidance if you don’t know what you’re doing.  How many times have you “started back” to your exercise routine just to have it end up being another “one and done” experience?

The fact is, you don’t want to go after it with uber-intensity as you’ll most likely develop more scar tissue than anything else, which is counter-productive to the development of good physical health in so many ways, such as flexibility and overall muscle function and capacity.  Another favorite expression of mine with patients is, “If you wanna PLAY at THIS level, you have to TRAIN at THIS level.”  So simple a concept but worth explaining a bit.  Think of a marathon runner.  That’s someone who can run for over 26 miles.  Imagine if someone who has not been engaging in any regular exercise program or progressive running program tried to run a marathon.  Maybe their adrenaline and inner drive would get them across the Finish Line, but they’re almost 100% certain to have injured themselves badly with severe damage to their muscles that will cause significant pain and inflammation that could take a few weeks or months and maybe even substantial medical attention to resolve (e.g., see “Rhabdomyolysis”).

Over-doing-it aggressively when starting out on, or getting back to, an exercise program is a common mistake, but if you think about it, you’re probably less likely to continue any exercise program that causes substantial pain and even if you do that pain is your body’s way of telling you you’re likely over-doing-it and actually injuring yourself.  So – “No Pain, No Gain” is a YES so long as the pain is minimal and easily manageable with giving yourself even time to rest/rebuild, which usually takes only a day or two, and maybe a little ice if you’re particularly inflamed or tender.  You should not be experiencing sharp or intense pain or a lot of swelling.  If you can barely move the next two days, you’ve over-done-it!  It’s not necessary!

So if you’re headed back into the garage weight room, the local gym or out on the road or trail – take my advice:  START SLOWLY and PROGRESS GRADUALLY.  You will not rebuild in a day what’s been lost over the course of two years, two months or even two weeks.  Take your time.  Consider asking your PCP about whether you’re ready to return to exercise.  Definitely consider working with a personal fitness trainer.

If you’re feeling like your balance is off or you’re just so weak that you’re having trouble with your mobility, consider seeing your doctor or a physical therapist to help guide you back toward your fitness or mobility goals without jumping in over your head.

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

When it comes to training to improve physical health and well-being, there are five essential components to address: (1) strength, (2) flexibility, (3) balance, (4) core stabilization and (5) endurance (aka, “aerobic conditioning”).  Physical therapy is an excellent choice if you need help in any or all of these areas, but today we’re going to focus on the importance of having adequate functional endurance.

It doesn’t matter if you’re 18 and wanting to be your best on the football or soccer field, basketball or tennis court or in the ballet theatre, or 85 and wanting to be able to keep dancing with your favorite partner, improve how far you can mobilize your wheelchair or continue playing and walking safely in the community with your favorite grandchild, you would be wise to include endurance work on a regular basis.  It’s one thing to have good strength or power. It’s another matter all together to have good functional endurance.  After all, who really cares if you can take one or two strong steps if you can’t handle the 50 steps it takes to get to your restroom in the middle of the night because you run out of steam?

You can get stronger through endurance training, but you can’t improve endurance much at all by working solely on strength and power.  To improve your endurance, your muscles need to be engaged in healthy and progressively longer bouts of aerobic conditioning, so your heart and lungs will need to be able to sustain your level of activity as well as your muscles being able to go the distance.  This does not happen overnight, and you can easily over-do-it and wind up in the ER.  I like to tell my patients, “If you want to PLAY at a certain level, you have to TRAIN at a certain level.”  So, don’t think you can go from couch potato to running (or even walking) the local marathon the next weekend – you’re very likely to hurt yourself or even suffer a stroke or heart attack.  It takes time to condition your body to have better functional endurance – so you’ll need to be patient as well as diligent

Since improving your functional endurance necessarily requires cardiovascular training, if you want to improve your endurance, you must incorporate progressive cardio challenge regularly.  Examples of this might be: (1) walking or jogging at progressively faster speeds for progressively longer distances or periods of time; (2) exercising with a stationary bike, elliptical machine, treadmill or jump rope at progressively faster speeds for progressively longer periods of time; or (3) marching in place, mobilizing your wheelchair manually or performing sit to stand exercises for progressively more repetitions or progressively longer periods of time or distance.

How many times did you see the word “progressively” in those examples?  That’s because our bodies tend to acclimate to our typical amount of activity.  Or worse yet, our bodies will progressively decline in functional endurance if we engage in less and less physical activity.  So, when you try to do more than what your body is used to doing, you feel it in the form of rapid muscle fatigue, usually along with some burning in the muscles being worked, some muscle trembling due to simple muscular fatigue and shortness of breath.  There would also be increased risk of muscle injury if you’re not doing enough to keep your muscles adequately healthy to support the intensity of the work they’re being asked to perform.  The burning is lactic acid build up in the muscles and occurs when those muscles deplete their oxygen stores, which are used as fuel that allows the muscles to expend energy and continue working.  Only through regular and progressive amounts of aerobic conditioning activity will your body train to be able to handle more physical activity without having to wave the white flag and surrender because you can’t catch your breath or take another step without potentially falling.

Improving your functional endurance does not require misery – it just requires consistency and progressive challenge.  It’s very possible to work toward your goals of improved fitness and endurance without wiping yourself out for the entire day or subjecting yourself to substantial risk of injury.  However, it’s always best to get some good advice from the experts and you should make sure you’re healthy enough to engage in a fitness training regimen.  So, if you’re interested in “going the distance” by improving your functional endurance, you should start with your doctor to make sure you’re healthy enough to exercise in such a capacity.  Once medically cleared, consider seeing your favorite physical therapist or fitness trainer to properly guide you through a strength and conditioning program.  You’ll be glad you did and will actually be able to improve your quality of life, and isn’t that the kind of return on investment we all want?

Online Resources:

“Endurance: Endurance, or aerobic, activities increase your breathing and heart rate.” (NIH: Go4Life. found online July 12^th, 2019 at: https://go4life.nia.nih.gov/exercise-type/endurance/).

“Fitness training: Elements of a well-rounded routine.” (Mayo Clinic: found online July 12^th, 2019 at: https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/fitness-training/art-20044792).

“Basics of strength and conditioning manual.” Dr. William A. Sands, Jacob J. Wurth & Dr. Jennifer K. Hewit: (The National Strength and Conditioning Association (NSCA): (found online July 12^th, 2017 at: https://www.nsca.com/contentassets/116c55d64e1343d2b264e05aaf158a91/basics_of_strength_and_conditioning_manual.pdf).

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

When I was a new graduate PT, I had endless energy and thought I could help everyone.  After nearly 30 years in practice, I’m still passionate and optimistic about what I do, but now at 50++ years old instead of 24, I recognize that I can’t change the world – at least not all by myself.

Your chances of getting better require a lot more than just having a good PT.  It’s truly a TEAM effort, and Mother Nature (e.g., what you’ve inherited genetically, how you heal, etc.), your lifestyle choices and many other factors impact your health and capacity for improvement.  However, there are some common threads that apply to us all, and they’re very, very important. Simply put, it takes good old-fashioned teamwork to achieve success in PT.  Despite what you’ve heard, there’s most definitely an “I” in Team (me as your PT), but there’s also most definitely a “U” in Team (you as the patient getting PT). 

That’s right – let’s talk about what we each need to bring to the table in order to make Your PT as successful as possible in terms of the outcomes You achieve!!!

“TEAMWORK Makes the DREAM WORK?” 

ABSOLUTELY YES!!!

You’ve got to embrace the Team perspective in PT and understand your part, which is NOT a passive role most of the time.  It’s likewise important to understand that we’re all different and experience things quite uniquely, so Patient A is not likely going to experience a total knee joint replacement the same ways that Patient B does, even if they both have the same condition (e.g., arthritis), the same highly skilled Orthopedic Surgeon and the same awesome PT throughout the process of surgery and rehab.

So — what wisdom can I share with you after 30+ years of doing this PT thing?

When it comes to “successful outcomes” in PT, it’s been my experience that it’s pretty clear there are some key concepts in play.  Some research tells us that the patient’s attitude about their circumstances is critical, as is having a trusting relationship that’s forged between patients and their PT (NOTE: we’ll need to agree that “TRUST” is a 2-way street here!)  This trusting relationship is referred to as the “therapeutic alliance.”  Now take a deep breath because equally as important is the patient’s compliance with the overall plan you and your PT decide upon.  That’s right — you actually have to be disciplined enough and able to forge through the Process of your PT.  Perhaps the single-most important factor to having the best chance for success is this: Showing up for your appointments on time and ready to do whatever you need to do. Remember – PT is an investment in your Quality of Life!  How much you’re willing to invest plays a huge part in your chance of having successful outcomes!  Being “All In” means actually following the plan that’s been developed by you and your PT, which includes: realistic goals, a realistic time frame for achieving your goals, a rational decision about how often you should attend PT and what you should be doing outside of PT, such as a home exercise program.

If you have a negative outlook on your circumstances and your potential to improve, you’re not likely going to be successful in PT because you don’t believe in it — you’re simply not invested — therefore you’re not likely to comply with the plan and you’re certainly not likely to work very hard throughout the process.  If you don’t trust your PT and don’t believe in your heart and soul that your PT is both competent and motivated to facilitate your success, you’re not likely going to give PT much of a chance.  But even if you have a great attitude and trust your awesome PT with all your heart, if you don’t actually show up for your PT or don’t remain true to the home exercise plan (i.e., you’re noncompliant with the plan of care), then your chances of having a successful outcome are slim at best.

I would argue that there is one really, really, REALLY important “wild card” to this discussion.  Let’s face it – many patients who need PT are dealing with pain on some level.  Pain is a real you-know- what, and I don’t know too many people who like or invite pain, to be sure.  I’ve seen many instances when pain dictates everything.  More than that, I’ve seen many cases when fear of pain (i.e., expecting an activity or exercise to hurt) causes an avoidance of the activity altogether or results in pain-avoidance behaviors like excessive muscle or postural guarding, offloading (i.e., shifting yourself around to make what you really should be doing a lot easier), and excessive substitution (e.g., using muscles other than the targeted muscle to do what the targeted muscle is being asked to do, such as when a person hikes their shoulder up to try and raise their arm overhead instead of activating the primary shoulder muscles.) 

Q: Why would someone do that?  A: To avoid pain, whether real or anticipated. 

Since PT so often involves painful conditions (e.g., having a knee replacement or rotator cuff surgery, tennis elbow, Achilles tendonitis, severe neck or back pain, etc.), the extent to which these pain avoiding behaviors exist plays an extremely important part when it comes to your chances of having successful outcomes.

Your PT experience should NEVER BE MISERY and, therefore, should NEVER BE FEARED!  Your best chances for success in PT must always take this into consideration!

If you’re suffering from a painful condition, consider seeing your physical therapist for an evaluation to see how they can help.  Here at Summerville PT & Balance we have everything you need to get through your Rehab and we know that it’s not a cookie-cutter approach.  We treat each patient individually according to each patient’s tolerance.  It might be challenging at times, but you can bet that we’re right there in it with you!  Your success is our success, so should you need outpatient PT, be sure to check us out to see if we’re the right match for your needs!

Online Resources:

3 Keys to a Positive Outcome in Physical Therapy; (found online Feb. 10th, 2019) at: https://3dpt.com/3-keys-to-a-positive-outcome-in-physical-therapy/

The importance of pain-related fear and pain catastrophizing in physiotherapy; (found online Feb. 10th, 2019) at: https://physiotherapy.ca/importance-painrelated-fear-and-pain catastrophizing-physiotherapy

Fear-avoidance model; (found online Feb. 10th, 2019) at: https://en.wikipedia.org/wiki/Fear-avoidance_model

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

Dizziness, vertigo (i.e., the sensation of your head spinning or the room spinning when you’re not actually moving) and even certain types of migraine headaches, which are common in cases of vestibular dysfunction, can all be caused by many things.  Sometimes there are problems with your brain or spinal cord (i.e., the central nervous system) that are the culprit, and other times it could be more of a peripheral nervous system issue such as crystals in your ears that trick your brain into thinking you’re moving when you’re not — a condition known as Benign Paroxysmal Positional Vertigo, or BPPV.  But did you know how important your DIET is when it comes to dizziness?  If you didn’t, here’s some food for thought:

Things that we eat, drink and smoke can have very significant impacts on our overall sense of balance and equilibrium by changing the manners in which our vestibular system and nervous system work.  For example, some things that enter our bodies will change the delicate pH balance or the volume or density of the endolymph – the fluid in our inner ear — and can cause abnormal function of the structures within our ears that are responsible for telling our brain what’s happening.  Our endolymph normally maintains a steady state of volume as well as chemical composition relating to potassium, sodium, chloride and other chemicals collectively called electrolytes.  Eating things that are high in salt or sugar can disrupt this important balance, as can heavy use of caffeine, nicotine or alcohol.  This probably seems pretty straightforward but did you know that a chemical in smoked meats call tyramine can actually trigger migraine headaches and dizziness?  If you love ‘ya some smoked pork and eat it regularly, maybe with a few beers or other adult beverages, don’t be surprised if these favorites are contributing to your dizziness or headaches.

You might be surprised at how powerfully our diets affect our sense of balance and equilibrium. Here’s a brief summary of the FOODS TO AVOID or at least be careful about in terms of how much and how often they’re consumed if you’re suffering with dizziness, vertigo, headaches or other vestibular symptoms:

1. Salt

2. Sugar

3. Caffeine

4. Alcohol

5. Nicotine

6. Processed food and meats

7. Bread and pastries

8. Fried foods

9. Pickled and/or fermented foods

Here are what experts suggest to EAT OR DRINK MORE OF to keep your vestibular system happier:

1. Water (be careful if you have kidney or liver issues or take a diuretic! Speak to your doctor first if you do!!!)

2. Foods rich in potassium (but be careful about over-doing it! Speak with your doctor first if you keep track of these levels!!!)

3. Foods rich in antioxidants, micronutrients and anti-inflammatory qualities

4. Ginger (but not good for patients who take diabetic or blood thinning medications! Speak with your doctor first if you do!!!)

5. Food rich in Vitamins B & C, Zinc and Magnesium (be sure to get guidance from your doctor first!!!)

There are some really great resources available online that will help you understand how your diet affects your sense of balance and equilibrium.  I’ve included four excellent resources below and strongly encourage you to review them as well as speak with your doctor about if you’re feeling dizzy, off balance or have headaches or migraines regularly.  Moreover, I’d encourage everyone to consider making changes to your diet and/or lifestyle choices BEFORE starting new medications or continuing long-term use of medications like Meclizine (an anti-histamine frequently prescribed to reduce dizziness), or anti-anxiety medications such as Lorazepam, Klonopin, Ativan, Valium or Xanax.  These are powerful vestibular suppressants that can actually prevent you from ever getting better in many cases of vestibular dysfunction.

Always speak to your doctor, nutritionist/holistic expert and/or physical therapist before you make any serious changes to your diet as they can have significant health consequences for certain people who take medications to control other problems!

Healthier diets and lifestyle choices benefit us in many, many ways.  If you’d like to discuss this topic further, please do not hesitate to ask an expert but be prepared to start making some tough choices about what you like to eat, drink or smoke!

ONLINE RESOURCES:

VERTIGO DIET – UNDERSTAND AND TREAT CONDITIONS SUCH AS MENIERE’S DISEASE AND VESTIBULAR MIGRAINE; found online (November 20, 2018) at: https://www.vertigotreatment.org/post/vertigo-diet-menieres

HERE’S A DIET TO HELP YOU WITH YOUR VERTIGO!; found online (November 20, 2018) at: https://www.neuroequilibrium.in/diet-to-help-you-with-your-vertigo/

DIETARY CONSIDERATIONS – Does Diet Really Matter?; found online (November 20, 2018) at: https://vestibular.org/understanding-vestibular-disorders/treatment/vestibular-diet

ALCOHOL INTOXICATION ON VESTIBULAR FUNCTION; found online (November 20, 2018) at: https://www.dizziness-and-balance.com/disorders/medical/etoh.html

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

When I was completing my physical therapy education way back in 1990, I developed a terrible case of plantar fasciitis while on my final clinical rotation.  Fortunately for me, I was surrounded by excellent clinicians who quickly diagnosed the problem and told me exactly what I needed to do to fix things and I was able to resolve matters in a few weeks.

Plantar Fasciitis (PF) is one of the most common causes of heel pain and is a very painful condition of the feet that typically presents as sharp, knife-like pains in the bottom of your foot, usually involving your heel and sometimes your arch.  Every step you take can be quite painful – especially first thing upon arising from bed or after extended periods of standing still or inactivity — and it’s a real nuisance.  The condition is caused by either a shortening of the plantar fascia in your foot or repetitive stress that causes tears and inflammation in the plantar fascia.  Avid joggers often experience PF, as do folks who are overweight and sedentary.  PF is also a very common “weekend warrior” injury, wherein folks who haven’t been training consistently irritate their plantar fascia after engaging in more explosive activities their bodies aren’t quite ready for (e.g., jumping activities, plyometric exercises or that game of flag football you and your buddies play every year at Thanksgiving!)  If you like to walk barefoot a lot, you are at higher risk as well — especially if you have flat arches to begin with.

Don’t ignore the signs of PF as they can develop into chronic foot pain syndromes as well as cause you to walk differently, which may cause additional problems for your feet, ankles, knees, hips and back.

The plantar fascia in our feet is essentially connective tissue that, under normal, healthy circumstances, poses no problems and serves importantly as shock absorbing supportive tissue and weightbearing support in your feet.  It runs from your heel to your toes on the bottom surfaces of these bones and their respective joints.  Diagnosis of PF is pretty straightforward and usually does not require expensive diagnostic studies like Xrays, etc.  Your doctor or your physical therapist will typically be able to identify the problem for you and physical therapy is a great idea for getting you back on track.  In severe cases it is sometimes helpful to get a steroid injection to cool off the injured tissues so you can tolerate Life a bit easier and get through your PT.

Wen not as severe, your treatment usually involves a combination of temporary rest to allow the inflamed tissue to quiet down, along with daily stretching exercises and activities oriented to loosening up the plantar fascia (e.g., rolling the sole of your foot over a massage ball or using a kneading style foot massager on the bottom of your foot).  Using ice really helps, as does cautious use of anti-inflammatory drugs like Aleve, Advil or Motrin, etc.

You’ll eventually need to incorporate some healthy-foot-promoting stretching and strengthening exercises into your routine to minimize the risk of PF from developing again but you’ll be happy to know that PF is easily corrected if you commit to doing what you need to do.

Should you be bothered by plantar fasciitis, ask your doctor for help and consider physical therapy to effectively and efficiently address the problem.  You’ll be back on your feet before you know it!

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

I bet if I asked if you’ve ever heard of the term “Direct Access” you’d likely say no.  Even if you did,  you’d likely not know exactly what it meant.

Don’t feel bad – you’re not alone!

As a physical therapist with nearly 30 years of experience, I’ve personally witnessed many changes in laws governing the practice of outpatient physical therapy.  Some of these changes are state specific and some affect things on a more national level.  Many of these changes have profound implications relating to the quality and integrity of the profession while others impact consumers’ access to physical therapy care on an outpatient basis (i.e., when you go to an outpatient PT practice, either located within a hospital or, more commonly, when you go to an outpatient clinic at a separate physical location).

Some facilities are owned by the hospital system, while others are owned by physician groups or investors, and some are owned privately by independent physical therapists or groups of PT clinicians.  Direct access affects all of these.

For the longest time, you needed to be referred to a physical therapist by your doctor or dentist. Then that evolved to include nurse practitioners and physician assistants (i.e., “physician extenders”).  Some states limit whether chiropractors may directly refer their clients to a physical therapist (but they should have a conversation with them, if indicated, about how PT could help them and suggest they investigate on their own or via their primary care physician).

However, due to the importance of physical therapy as it relates to optimizing independence and recovering fully from an accident like a fall or sports related injury, or after a stroke or joint replacement, or from a newly diagnosed progressive condition like Parkinson’s Disease or an acute flare of Multiple Sclerosis, access to physical therapy has transformed from the referral only requirement to the Direct Access allowance.

DIRECT ACCESS to Physical Therapy is What’s Up!!!

By the way, physical therapy doesn’t always have to be “progress oriented” and another recent transformational change affecting physical therapy was a formal clarification during the Obama Administration specifying that PT is appropriate to manage chronic conditions that, in the absence of skilled PT services, would likely cause a progressive decline in functional independence or quality of life.  Thus, outpatient PT is very appropriate in cases involving chronic conditions when “progress” may be less likely.  Examples of this include weakness on one side of the body remaining after an older stroke or when battling progressive conditions like Ankylosing Spondylitis, Parkinson’s Disease or Multiple Sclerosis.

Here’s what you need to know about your rights to access outpatient physical therapy in South Carolina:

• South Carolina adopted Direct Access with special provisions in 1998. This means you do not need a referral to be evaluated by a PT or to start receiving treatment in PT;
• In the absence of a valid referral, your PT must refer you to a licensed medical doctor or dentist if providing PT services to you beyond 30 days after your initial evaluation;
• Your PT must refer you to a licensed medical doctor or dentist immediately if your condition is beyond the scope of Physical Therapy.

Every state has some form of direct access these days. 

• Some states are much more restricted than others, so if you’re reading this and are not from SC, you can find what your state allows by reviewing the American Physical Therapy Association’s (APTA) summary of direct access by state (Direct Access by State: found online (2/20/2018) at: https://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_Access/DirectAccessbyState.pdf).

• Should you feel you might benefit from outpatient physical therapy care, you can still ask your doctor for a referral, but know that it’s not mandatory unless required by your insurance plan.  You can go to any outpatient PT that accepts Direct Access cases – it’s YOUR choice – so choose wisely and get started on the path to FEELING better, MOVING better and LIVING better!

Summerville Physical Therapy & Balance Rehabilitation for Adults

679 Orangeburg Road | Suite D | Summerville, SC 29483|  843-209-6375

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

How  Physical Therapy Can Help After a Stroke

Treatments for stroke depend on many factors, including what kind of stroke is involved and how long it lasted.  The sooner you can seek help after a stroke, the more likely you’ll have a better recovery.  Rehabilitative therapies, including physical, occupational and/or speech therapies, are critical after a stroke.

Physical, Occupational and Speech Therapies After Stroke are ESSENTIAL to Optimizing Outcomes

The goals of stroke rehabilitation are to help stroke survivors live as independently as possible while adjusting to new limitations.  Strokes can cause problems with movement, coordination and balance.  Paralysis or weakness is common after stroke — especially on one side of the body.  Physical therapy can help stroke survivors regain strength, coordination, balance, and control of their movements.

Things that were once easy to do, such as basic walking, sitting upright with adequate balance, or getting into/out of bed, may be extremely difficult or even impossible following a stroke.  Physical therapy can restore one’s capabilities in these areas and improve one’s overall capacity to remain independent or at least minimize the amount of caregiver assistance needed following a stroke.  To the latter end, PT also involves training caregivers on how best to care for an individual after a stroke.

If you’re ever in need of physical therapy after a stroke, your doctor should order physical therapy.  PT can occur in the hospital right after a stroke, at your home, in an outpatient setting, at an inpatient rehabilitation hospital, at a nursing home or at an assisted living facility.

Balance Training with PT in an Outpatient Setting

You can reduce your risk of having a stroke by staying active, maintaining a healthy diet and keeping your weight and blood pressure under control.  Talk to your doctor about other ways you can reduce your risk of having a stroke.

(Adapted from: “What Are the Different Types of Strokes?” found online at: https://www.healthline.com/health/stroke-types#Overview1; Dec. 21^st, 2017)

Frequent Asked Questions Regarding Strokes:

Q:  What is a stroke?

A:  A stroke is a medical emergency that happens when the blood flow to your brain is interrupted. Without blood, your brain cells start to die.  This can cause serious symptoms, lasting disability, and even death.  There are basically three main types of strokes, each type with their unique symptoms and, subsequently, unique treatments.  Physical Therapy is CRITICAL following a stroke regardless of the type.

Q:  What are the different types of strokes?

A:  There are three main types of stroke. The vast majority of strokes – about 87 percent of all strokes — are ischemic in nature.

• Transient ischemic attacks:  TIAs occur when a blood clot temporarily blocks blood flow to your brain.  The blood clot and TIA symptoms last for a short period of time and usually resolve completely within 48-72 hours.  Ischemic strokes occur when a blood clot keeps blood from flowing to your brain on a permanent basis.  The blood clot is often due to atherosclerosis, which is a buildup of fatty deposits on the inner lining of a blood vessel.  The deposits can break off and block blood flow in your brain — similar to what happens when you have a heart attack where a blood clot blocks blood flow to a portion of your heart.
• Ischemic stroke: An ischemic stroke occurs when a blood clot keeps blood from flowing to your brain.  The blood clot is often due to atherosclerosis, which is a buildup of fatty deposits on the inner lining of a blood vessel.  A portion of these fatty deposits can break off and block blood flow in your brain.  The concept is similar to that of a heart attack, where a blood clot blocks blood flow to a portion of your heart.
• Hemorrhagic strokes:  A hemorrhagic stroke results when a blood vessel in your brain ruptures or breaks, spilling blood into the surrounding tissues.  There are two types of hemorrhagic strokes: The first is an aneurysm, which causes a portion of a weakened blood vessel to balloon outward and sometimes rupture.  The other type is due to deformed blood vessels.  If a deformed vessel ruptures, it can cause a hemorrhagic stroke.

Q:  What are the symptoms of a stroke?

A:  The different stroke types cause similar symptoms because each affects blood flow in your brain.  The only way to determine what type of stroke you may be having is to seek medical attention.  A doctor will order imaging tests (e.g., CAT scans or MRIs) to view your brain.

The National Stroke Association recommends the acronym “FAST” to help identify the warning signs of a stroke:

Face: When you smile, does one side of your face droop or one eyelid stay partially closed?

Arms: When you raise both arms, does one arm fall/drift downward?

Speech: Is your speech slurred?  Are you having trouble talking?

Time: If you experience any of these symptoms, call 911 immediately.

Additional symptoms that don’t fit into the FAST model may include:

• sudden confusion, such as difficulty understanding what a person is saying;
• difficulty walking, sudden dizziness, or loss of coordination;
• sudden, severe headache that doesn’t have any other known cause;
• difficulty seeing in one or both eyes; and
• choking or coughing when swallowing foods or liquids

A TIA will cause these symptoms for only a short amount of time.  However, you shouldn’t ignore stroke symptoms, even if they go away quickly.

Q:  What other complications can a stroke cause?

A:  A stroke is a medical emergency for a reason — it can have life-threatening complications.  Examples of complications may include:

• Behavior changes:  Having a stroke can contribute to depression or anxiety.  You also may experience changes in your behavior, such as being more impulsive or more withdrawn from socializing with others.
• Speech difficulties:  A stroke can impact areas of your brain having to do with speech and swallowing.  As a result, you may have difficulty expressing yourself verbally as well as difficulty with reading, writing, or understanding other people when they’re speaking.

To read more:: https://www.healthline.com/health/stroke-types#Overview1;

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

The Importance of Flexibility to Proper Posture and Pain-Free Healthy Function

When my patients ask me what the most important contributors are to feeling good and moving well throughout Life, I always talk to them about proper posture and the importance of having good flexibility.  Flexibility in this respect refers to having your muscles and other soft tissues in our bodies at their intended, optimally healthy length.  In other words, we’re not too tight or too loose in our muscles.  Correct flexibility is, simply put, critical to so many things we need to do well in order to feel well.

For example, let’s say we’re tight in our hamstrings.  It follows, then, that we will most definitely have bad posture as it relates to the position and movement of our pelvis, hips and low back.  TRANSLATION:  Having tight hamstrings means unhealthy pulling on our pelvis so that we’re sitting too much toward or directly on our tailbones instead of sitting upright with good posture.  This in turn leads to a flattened low back curve (aka, a flattened lordosis), which in turn reduces our spinal mobility.  All of this together usually leads to chronic low back pain, reduced hip and trunk mobility, trigger points and other assorted muscular aches and pains, and maybe even skin breakdown on our tailbones (not fun at all and may even lead to a bad infection that knocks us down for good!)

So – even if you don’t read further, the take home message is this: Endeavor to improve your flexibility — you’ll feel better and live a healthier Life!

Staying active and stretching regularly help prevent a general loss of mobility.  Healthy mobility preserves independence as we age.  Our muscles need to be at their intended proper length in order to function at their best while providing the best possible joint support.  This helps reduce destructive forces on our joints, which preserves joint health further into life so that you’re less likely to need medical interventions such as steroid injections and corrective joint surgeries.  It also means that you’ll walk, run, play out in the yard with your kids, their kids and their kids’ kids, golf or play tennis, hike trails or climb mountains, or do whatever it is you love to do – LONGER and MORE COMFORTABLY as you get older!!!

You don’t need to take my word for it as a physical therapist with 30+ years in the clinic treating adults of all ages – but then again, maybe you should.  There is clear scientific evidence showing that we are a lot less likely to have an injury when we include flexibility training into our daily routines.  This is due to the fact that we can move more freely through a fuller range of motion at our joints.  However, an exception exists when we have excessive flexibility, which results in more instability at our joints.  This problem may increase the likelihood of injury.  So, when used appropriately, regular flexibility training allows us to become more “in tune” with our bodies, which facilitates better mental and physical health, injury prevention and recovery after an injury.

There are different ways to stretch and different schools of thought on the matter.  One source online that does a great job at describing these different ways, their pros and cons, and some other really important aspects of stretching can be found at the Human Kinetics webpage (found at: humankinetics.com).  There you’ll find information about technique, such as how intensely to stretch, how long to hold stretches and how often you should stretch, as well as what is meant by static versus dynamic stretching along with the pros and cons of each.

Physical Therapists Can Identify Flexibility Dysfunction & Help You Understand Your Signs & Symptoms

A good PT will help you right away with stretching exercises and sometimes strengthening exercises to complement your flexibility efforts.  You really can’t simply do an adjustment and correct poor flexibility or muscle imbalance, but sometimes these issues cause significant spinal malalignment.  Thus, PT and/or Chiropractic care can be helpful when you need a neck, back or other joint adjustment.

If you’re not sure whether your flexibility is good or bad, here is a great test you should do (YES — RIGHT NOW) to determine if you have proper and healthy hamstring length.  It’ll only take a few seconds:

1. Sit flat on either the floor or top of your bed mattress;
2. Be sure to sit on your “sit bones” (the bones you feel in the deep muscle of your buttocks.  You usually take note of these bones after sitting on a hard flat bench for too long);
3. Be sure to “sit tall” with your back totally vertical (i.e., like a Marine stands when at “Attention!”)  Suck in your gut and brace your abs to hold that tall sitting position;
4. Try to put both legs totally straight out in front of you (this is called the “Long Sitting” position), making sure your knees are completely straight and that your knees and toes are pointing “due North;”

***RESULTS & INTERPRETATION:  If (a) you CAN’T sit tall properly when you have your legs out in front of you in the proper long sitting position, or (b) you CAN sit tall but you CAN’T get your knees flat down and in proper long sitting position, then your hamstrings are almost definitely TOO SHORT.  If this is the case for you, you likely have been having low back pain and possibly have had some irritation of the skin over your tailbone at one time or another.  Both of these problems are easily corrected by some really good physical therapy where you’ll learn the extent to which you are limited and how to fix it so you feel better fast.  You’ll also be taught how to keep it from happening again.  You’ll end your PT feeling much better and knowing how to manage your flexibility independently.

Should you feel that you might need some expert help with your flexibility, consider calling us at Summerville PT & Balance at 843-209-6375 or just let your doctor know you’d like to be referred to Summerville PT & Balance for some help with your flexibility.   You’ll soon be experiencing a healthier, more active and pain-free Life!

(Adapted from, “The importance and purpose of flexibility” (Oct. 2017); found online at: http://www.humankinetics.com/excerpts/excerpts/the-importance-and-purpose-of-flexibility)