COVID-19 Respiratory Recovery Program

If you or a loved one has suffered from Coronavirus, we are here to help. Brill Physical Therapy is offering assistance to patients to help ensure a strong and healthy recovery. Through respiratory exercises and practices, we will help you strengthen your lungs and your body.

After speaking with a patient who recently recovered from a severe case of COVID-19, I was made aware that there is no recovery program in place for patients after being discharged from the hospital.  In response, I decided to make this video to help those who have been affected by COVID-19 because when regaining one’s health, it is very important to restore full respiratory function proactively. Please note, this video is only for those recovering from virus at home or who have recently been discharged from the hospital. If you currently have COVID-19 or are showing symptoms of the virus, please contact your physician, and if you feel short of breath, you should go to the hospital. 

In this video, I will show you exercises and tips for taking the first steps toward a steady recovery. The most important thing is ensuring your return to health and strength. The virus attacks the lungs and the mucus thickens especially in the lower lobes. It is extremely important to work to release and loosen this mucus while working to expand your lungs back to normal. 

Brill Physical Therapy starts each patient with 4 basics and progresses as the patient recovers:

1.  Percussion and Vibration is a part of Chest Physical Therapy and is used to mobilize the phlegm from the lungs and to assure that your cough is productive.  Once the phlegm gets out, more oxygen can enter your lungs, and that will make you feel better.  

2. Breathing Deeply is critical to maximize how the alveoli of your lungs take up oxygen and to strengthen your diaphragm and intercostal muscles, which are your primary respiratory muscles.

3. Self-Manual Lymphatic Drainage is gentle sweeping massage to help assist the normal function of our lymphatic system, which is to filter out bacteria, viruses, cancer cells, and debris from our blood stream and protect our immune system.

4. Gentle Stretching and Strengthening is started to open your chest and ribcage so that you can expand your lung capacity even further, especially if you have been bedridden as you fought Covid-19.

If you have any questions or would like to schedule a one-on-one appointment via Telehealth video call, please contact me at peggy@brillpt.com.

Thank you for choosing Brill Physical Therapy to serve you.

Stay strong, stay safe, and be well, 

Peggy Brill

TeleHealth is Now At Brill PT

TeleHealth is NOW HERE at Brill Physical Therapy so we can give the best guidance remotely as we help our patients continue rehabilitation.  Each therapist is prepared to use PhysiApp or Facetime to coach you through an assessment and treatment of any of your injuries.

Just email your therapist Cliff@brillpt.com or Anthony@brillpt.com or Peggy@brillpt.com to set up a blocked 30 minute one-to-one session.

Working from home can be hard on your body and Brill Physical Therapy is here to help you get through this Covid-19 crisis by offering solutions to the common neck and back pain, or any other musculoskeletal strain.

COVID-19 Update:

Dear Brill PT friends and family, 

We want to assure you that we are open!  Brill Physical Therapy is committed to helping you with all of your PT needs, today and every day.  Our goal is to remain open as long as it is safe for our clients, staff and community. This is a very challenging time but rest assured that we are  extra diligent to make sure that we have a clean and safe environment for patients and staff. 

Please be advised:.

1. Cleaning solutions and disinfectant wipes are placed around the facility.  We have mandated that any piece of equipment be wiped down before and after every use.

2. We have requested that all staff and patients wash their hands as soon as they enter the facility and again before they leave.

3. Common areas of the gym will be cleaned multiple times per day including all counter tops, desks, tables and machines.

4. Clients that are experiencing symptoms of any kind should be advised to stay at home and not attend physical therapy.

5. We are staggering our PT staff schedules for less people in our office and offering Telehealth for those stuck at home working and with kids for prolonged time spans.

6. Brill PT also is offering home care for patients that need to get treated but cannot leave home just email reception@brillpt.com .

7. Please contact us directly by email reception@brillpt.com versus calling 212-333-7224 since we are also staggering our front desk staff and centralizing communications by email exclusively.

8. Icon Parking Lot is conveniently located across street from our office building and this offers options for patients to drive in versus taking mass transit. 

We have educated our staff on current CDC guidelines and we encourage any staff to stay home if they are not well. We all have to work together and we will succeed.

Yours in good health, 

Brill PT Team

Rolfing and ART at Brill PT

Brill PT offers a number of services under our orthopedic hands on skills. We’ve included them on our web page for you to learn more about these techniques that we utilize to help our clients live and perform better.

In particular we would like to highlight Rolfing and Active Release Techniques (ART). This are two techniques of myofascial release and joint range of motion to improve our body systems interaction with each other. We combine these tools with our other manual skills, full evaluation of body movement (walk, your squat, your run, etc.).

Click on here to learn more about Rolf Therapy at Brill PT

Book a visit with us today by calling 212-333-7224 or email us here @BrillPT.com

COVID-19 CORONA VIRUS AND YOUR HEALTH

Dear Brill PT Family;

In response to the current concerns of the COVID-19, commonly knowns as the Coronavirus, we would like you to be more informed about the virus and what to be aware of for you and your families.

For more information on the COVID-19 itself visit the Center for Disease Control (CDC) website for "What You Should Know?" in relation to the COVID-19. 

If you have any of the signs and symptoms for FLU that are similar to COVID-19 please call to cancel your visit. 

The symptoms are as follows from the CDC:

"Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed corona-virus disease 2019 (COVID-19) cases.

Symptoms may appear 2-14 days after exposure*:

• Fever

• Cough

• Shortness of breath"

For infection prevention: 

• Stay home when you are sick.

• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

• Avoid close contact with people who are sick.

• Avoid touching your eyes, nose, and mouth.

• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. 

• Hand Washing:

  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. 

  • Our sink has hand soap that is open for patient use as well. Remember hand washing is more preferred than hand sanitizer for infection prevention. 

  • Hand Santizer is available at our front desk and in our treatment area. 

  • Always wash hands with soap and water when hands are visibly dirty.  

For more information on hand washing techniques through the CDC: https://www.cdc.gov/handwashing/

Stay Strong, Be Well;

The Brill Physical Therapy Staff

ACL TESTING AND REHAB

By Dr. Clifford Yun, PT, DPT

An ACL (Anterior Cruciate Ligament) tear is a common knee injury for high impact sports. In particular, this time of year is dedicated to the pre-habilitation of our skiers. To evaluate if someone is at risk for knee injury we can utilize a series of functional exams known as Single Leg Hop Tests. These tests are designed to measure knee angles through various types of movement. In particular, our patients are measured by the knee that gives them pain or weakness compared to the non-injured or stronger knee.

FUNCTIONAL HOP TESTS:

Single-Leg Hop Distance Test: Measure the total distance of jump with one leap on one leg.

Single-Leg 6 meter Timed Hop Test: Measure the total distance covered for a single leg for three hops. 

Single-Leg Tripple Hop Distance Test: Measure the time to travel 6-meters by hopping on one leg. 

Single-Leg Tripple CrossOver Hop Test: Measure the forward distance covered while hopping on one leg forward and across a 6-meter line.

An additional test for hip and knee strength stability are the single leg sit to stand test and the single-leg hop down test.

For these two tests we are looking for general strength as well as the ability to maintain the knee over the middle of the foot and keep the pelvis level.

See these test in action on our youtube channel and follow our instagram @BrillPT for our #ExerciseOfTheMonth #ExerciseOfTheWeek. Every Thursday for January we’ll post exercises we use throughout an ACL recovery process.

SLAP TEAR - REHAB AND PREHAB - EXERCISES FOR THE STRONGER SHOULDER

By Dr. Clifford Yun, PT, DPT

Shoulder dislocations and shoulder general overuse can lead to a SLAP tear without strength and stabilization. This month we talk about what is a SLAP tear and what are some of the strengthening exercises that we do to bring these shoulders back to full function after surgery. These same exercises that we do after surgery can also be done prior to injury as a preventative effort to avoid SLAP tears.  With national averages for SLAP surgeries reaching upwards of $20,000 out of pocket and a 6 figure bill to insurance, it is important to invest time and quality care to your shoulder after surgery. 

Wikipedia, “SLAP tear or SLAP lesion is an injury to the glenoid labrum (fibrocartilaginous rim attached around the margin of the glenoid cavity). SLAP is an acronym for "superior labral tear from anterior to posterior".

https://www.shoulder-pain-explained.com/images/xSLAP-tear-shoulder.jpg.pagespeed.ic.wllN81E3XW.jpg

ANATOMY

 The shoulder is made of a ball and socket joint. This means the ball of the humerus bone inserts into the socket of the scapula (shoulder blade).

SLAP tears occur when the stability of the ball in the socket is compromised due to a weak rotator cuff, overuse from repetitive motion, or a traumatic fall. If someone has had several shoulder dislocations they are at higher risk of having a SLAP tear compared to the average person that injures their shoulder complex. 

https://www.verywellhealth.com/thmb/tPfhzs5AlWOnnrqUUois0jhKsJI=/1500x1000/filters:no_upscale():max_bytes(150000):strip_icc()/the-rotator-cuff-2696385-FINAL1-474e476cc4554dbd97995610f4402577.png

The rotator cuff is comprised of four muscles that function to support the labrum and move the humerus (upper arm bone) in the glenoid foss (socket of the shoulder blade). Primarily the rotator cuff move rotating externally (outward), rotating internally (inward), and out to the side (abduction). 

When we get all these parts moving with the other muscles that attach to the shoulder blade and arm we get strong and stable shoulder joint.  Multi-Million dollar contract and sponsorship not included...

https://media0.giphy.com/media/xUOwFZBaaiZmXOlXsQ/source.gif

Strengthening:

Rotation in more than one angle is important because the arm has to rotate below and above our shoulder height for daily function. Scapular (shoulder blade) strengthening is also important. This month’s #BrillPT #ExerciseOfTheMonth goes through multi-directional exercises to improve, prevent, or rehab the unstable shoulder.  See the 1st of 4 videos this month on Instagram or at our YouTube channel below:

The Power of our Core and Glutes when we Run

By Anthony Tripodi, PT, DPT

In honor of the TCS New York Marathon (Good Luck Runners!), Brill PT is celebrating November with exercises for runners to challenge their core and glutes together.  Far too often, strengthening and stability is overlooked in training plans. This can lead to decreased performance on race day, increased injury risk and development of pain.  At Brill PT, we have 4 exercise suggestions that include your core and glutes so that you can stay strong without having to sacrifice too much time in your busy schedule.

First, let’s review the role of our core and glutes when we run.  Core muscles provide stability that allow force generation and motion in the lower extremities.  This assists in distributing impact forces and allow for controlled and efficient body movements.  As we run, our core engages in conjunction with our glute muscles. If we have weak glutes, the core will try to compensate causing increased strain on the back and increased forces will be placed on the knee and ankle.  With a weak core, the glutes will not have enough stability from the spine above to produce an efficient movement. This is why at Brill PT, we use exercises that simulate the coactivation of these muscle groups when running. 

http://therunningpts.com/running-gait-analysis/

When we refer to the glutes, we are referencing two main muscles: Gluteus Maximus (hip extensors) and Gluteus Medius (hip abductor and pelvic stabilizer).  As we land when running, our Gluteus Maximus works hard to control the speed at which we land to slowly absorb the forces throughout our body. Meanwhile, whenever we are on a single leg, the Gluteus Medius is working to keep our pelvis leveled and maintaining alignment. This is all happening while our core is engaged to allow our glute muscles to do what they do best.

When any of these muscles are not working together, we see a variety of gait alterations that can lead to uneven forces throughout the spine and lower body:

1. Pelvic Drop

2. Excessive trunk rotation

3. Excessive trunk extension

4. Knee valgus

5. Crossing midline

6. Excessive foot pronation

These gait abnormalities, lead to a variety of conditions that we commonly see in our runners at Brill PT:

http://yuriinahurry.com/common-running-injuries-infographic/

1. Low Back Pain

2. Hip Pain

3. Knee Pain

   1. Patellofemoral Pain Syndrome

   2. Iliotibial Band Syndrome

4. Foot Pain

   1. Achilles Tendinitis

   2. Arch Pain

   3. Shin Splints

Exercise 1. The Single Leg Bridge

https://betterbuttchallenge.com/best-butt-exercises-one-legged-glute-bridge/

This exercise engages our core to keep our back neutral, our Gluteus Maximus to perform the bridge and our Gluteus Medius to stabilize the pelvis.  At the final execution of this exercise, all the muscles are working together to stabilize and maintain this position. 

Exercise 2. Side Plank with Clams

https://www.pinterest.cl/pin/5348093284849795/?nic=1a

This exercise targets our obliques which are crucial to stabilize the spine from rotation as we run.  Our Gluteus Medius is engaged with our obliques when performing the clamshell portion of this exercise. 

Exercise 3. Single Leg Squat

http://www.optimalphysio.co.uk/single-leg-training-and-anterior-knee-pain/

On the way down, this exercise simulates the initial contact phase of running, where the Gluteus Maximus and core need to work together to slowly lower our body and absorb the impact forces when running.  Meanwhile the Gluteus Medius is also working to ensure our pelvis stays level which keeps our back and lower body in proper alignment. 

Exercise 4. Single Leg Deadlift.

https://eunicakes.wordpress.com/2014/05/21/exercise-of-the-week-single-leg-deadlift/

This exercise engages our core to maintain a neutral spine, while our Gluteus Medius is working to keep our pelvis leveled and the Gluteus Maximus is controlling our body as is it lowering toward the ground. 

The Magical Time of Pregnancy

By Peggy Brill, PT

October is National Physical Therapy Month and Brill Physical Therapy is celebrating Women During The Magical Time of Pregnancy!

Pregnant with Pain:

From Parents.com

Too often women suffer with low back pain or groin pain during their pregnancy and since these complaints may be so common that it’s assumed that these aches and pains are normal, but Brill Physical Therapy will tell you that suffering can be avoided.

The amazing hormones that soften your ligaments so that your pelvis and ribs may open for your growing baby, may be partly responsible for the pains of walking, sit to stand or even rolling in bed, but all too often, the cause is an underlying muscular imbalance that your skilled physical therapist at Brill PT can diagnosis and properly treat with manual techniques (beyond massage) and advanced therapeutic exercises.  Your problem causing the pain DOES have a solution.

Sometimes women blame their Scoliosis for their pain and yet many of our patients with scoliosis at Brill PT move through their advancing pregnancy with decreasing pain after treatments.  Women with Scoliosis need special guidance to elongate their spine, maximize their breathing with rib cage expansion, and find new positions to proper strengthen their transverse abdominis.  The transverse abdominis is a vital muscle to support the growing belly, support the spine, and to assist in delivery and promote recovery.

Often this pain during pregnancy offers a fantastic opportunity to become stronger and wiser than before.  Each woman becomes her own healer and has a customized Brill PT home program and strategic movements to get rid of pain when, and if it recurs.

Preparing for Motherhood:

https://www2.hse.ie/conditions/child-health/back-ache-and-pain-in-pregnancy.html

As a mother of two daughters, I adore treating pregnant women because I am super-excited about these women becoming Mothers.  It is the most wonderful and rewarding job and an honor to raise a child.   Brill Physical Therapy celebrates with each new Mom as we get rid of their pain, usually to their delightful surprise, and then continue to strengthen them for labor and delivery and carrying and lifting their soon-to-be newborn.

Postural training is very important to be able to successfully continue working throughout their pregnancy since it requires endurance to sit at a computer for long hours each day.

Dynamic training will continue as the pregnancy progresses, so that, caring for a newborn is easier on the Mother’s body as she recovers.  Bonding with your newborn is critical and a new Mom should not have to be distracted with unnecessary aches and pains.  Brill Physical Therapy also has a pelvic floor specialty and uses this knowledge to teach pregnant women how to optimize regaining musculature control of their pelvic floor muscles soon after delivery.  Pelvic floor conditioning allows for bladder and bowel control.

Returning to your prenatal level of exercise may require some smart care by our trained physical therapists and your goals become our goals too.

Giving Your Baby Proper Tummy Time:

From years of treating hundreds of babies, Brill Physical Therapy also trains both parents about the importance of attended tummy time for babies and all the various positions that are healthy for your newborn and will work together to build the baby’s developmental strength.   And our babies at Brill PT love their workouts!  These workouts are proven to correct congenital muscular torticollis and now we incorporate each baby with these playful positions.

Brill Physical Therapy advocates for you to to have a happy, healthy, and prosperous family!

Posture Basics

By Dr. Clifford Yun, PT, DPT

What is good posture?

At first thought when we think of posture we think of sitting up straight. We can hear one of our parents or a teacher telling us to sit up in our chair. But posture is more than just sitting upright. Posture is about finding a center of gravity, maintaining it and then remembering to come back to posture when we forget about it.

There are different types of posture. Static and Dynamic. Static posture is the staying still posture and Dynamic posture is our body’s position with activity. 

Posture is all about positing the landmarks of the body in the right order and position from the ground up. This is important to prevent back and joint pain from when we’re sitting, standing or walking all day. Regardless of if your day is spent sitting or moving around posture starts with where you’re attached to the ground. 

Static Sitting Posture:

Feet: Start with your feet flat on the floor at about hip width apart. The arch of your feet should be right under your knee. 

Hips: You hips should be slightly higher than your knees with equal weight on each side of the pelvis. 

Spine: Your spine should stack on top of your pelvis in the following order. Pubic Bone (front of pelvis) + Navel (belly button) + Sternum (chest bone)+ Chin.

Shoulders: Roll the shoulder blades back then down to prevent them from rounding forward

*Fig 1. Posture image form https://theacidrefluxsolution.com

Static Standing Posture:

Feet:  Again the feet are flat and hip width apart but the knees should be slightly bent,  relaxed and not locked straight or falling outward or inward. The knee should be in-line with the middle of the foot.

 Hips/Pelvis: Pelvis should be level. If the pelvis is down on one side then chances are the hips are not active or strong enough to keep them stable. 

Spine: Again the spine should stack on top of each other in the mid-line: Pubic Bone (front of pelvis) + Navel (belly button) + Sternum (chest bone)+ Chin.

Shoulders: Rolled back and down 

*Fig 2. Standing Posture Image from https://www.olympiabenefits.com

Schroth, Scoliosis & Pilates

In scoliosis the spine starts to twist (rotate) which leads to a curve in 1 or more sections of the spine. This asymmetry of the skeleton is mirrored in in the muscles: some muscles are overstretched and in a constant state of tension, other muscles are underworked and may become shortened.

Creating more length between the vertebrae/in the spine starts an untwisting of the spine, which is the first step in managing scoliosis shared by Schroth and Pilates. The untwisting makes it easier to bring the muscular-skeletal system back towards symmetry.

As you can see in the video I am trying to keep equal distance between my lower ribs and hips on my right and left sides, while maintaining that equal distance throughout the entire exercise. You can also see one side is more challenging for me than the other.

Loi Kail, Certified Pilates Instructor

Watch the video described above!

Get Ready for Gardening!

With spring around the corner, many people are beginning to think of planting their gardens. Between lifting heavy bags and spending prolonged periods of time in awkward positions, gardening actually puts tremendous stress on the human body.  So Brill Physical Therapy is here to offer some pointers!

• Gardening should be treated like exercise. Remember to warm up for 10-15 minutes before you start. This will help loosen your muscles.

• Remember to take lots of rest breaks. Human beings really aren’t meant to stay in one position for prolonged periods.

• Drink lots of water! As the weather starts to warm up and we exert ourselves, it’s essential to stay hydrated to keep our tissues healthy.

• Maintain your posture. Slouching can lead to back pain, so remember to sit up tall and move from your hips, rather than your back.

• When kneeling in order to plant your flower beds, consider using a foam kneeling pad in order to decrease pressure on your knees. This will minimize compression on your knee caps and help decrease knee pain.

• When lifting heavy bags of soil, remember to bring the items close to you, and lift with your knees. Also consider using a cart or a wheelbarrow to decrease the amount of time you’re lifting large, heavy, or bulky items.

• Lastly, remember to cool down when you’re done. Take some time to gently stretch when you’re done.

If you have any residual pain after gardening, don’t hesitate to contact your therapists at Brill Physical Therapy for an evaluation. Gardening can and should be enjoyable, and doesn’t have to hurt!

What Does Your Back Pain Mean?

It is estimated that up to 84 percent of adults have low back pain at some time in their lives [1,2]. For many individuals, episodes of back pain are self-limited. Patients who continue to have back pain beyond the acute period (four weeks) have subacute back pain (lasting between 4 and 12 weeks) and may go on to develop chronic back pain (persists for ≥12 weeks) [3]. Rarely, back pain is a harbinger of serious medical illness.

 The intensity and manageability of pain are very different for every person. For example, one person may have a large herniated disc and experience no pain at all, and another individual may have a simple muscle strain that can cause excruciating back pain and difficulty moving but will heal on its own in a few days.

 Also, with some conditions, the pain can flare up from time to time and then subside, only to flare up again after a few weeks or months and gradually intensify over time. Because only you know your level of pain, your treatment will most likely be more successful if you proactively participate in making decisions about your medical care.

 There are many interconnected and overlapping structures that make up the spine are capable of producing back pain. Moreover, the spine is prone to injury because it is subject to many different forces: twisting, sudden jolts, and daily stresses (such as sitting too much, moving in the same direction repetitively, poor posture) [4]. Common anatomical causes of back pain include:

• The large nerve roots that go to the legs and arms may be irritated

• The smaller nerves in the discs may be irritated

• The large paired back muscles that support the spine may be strained

• Any of the bones, ligaments, or joints throughout the spine may be injured

There is a lot of overlap of nerve supply to most of the anatomical structures in the spine (discs, muscles, ligaments, etc.), which often makes it impossible for the brain to distinguish between injury to one structure versus another. For example, a torn or herniated disc can feel identical to a bruised muscle or ligament injury [4].

The type way you describe your pain, the area of distribution of the pain, and any related symptoms are important to determine a back pain diagnosis, and the treatments will usually be different depending on the diagnosis [4]. Three common classifications of back pain include:

• Mechanical pain. Also called axial pain, may be described in a number of ways, such as sharp or dull, constant or comes and goes, etc. Specific motions bring about this pain. A muscle strainis a common cause of mechanical/axial pain.

• Referred pain. Often characterized as dull and achy, referred pain tends to move around and vary in intensity. As an example, in the lower back degenerative disc disease may cause referred pain to the hips and posterior thighs. Stenosis will present in both legs and thighs versus degenerative disc disease may occur in only one leg.

• Radicular pain. Often described as deep and searing pain, radicular pain follows the path of the nerve into the arm or leg and may be accompanied by numbness or weakness. This type of pain is caused by compression, inflammation and/or injury to a spinal nerve root. Other terms for radicular pain are sciaticaor radiculopathy, and can be caused by conditions such as a herniated disc or spinal stenosis, or spondylolisthesis.

Ultimately, participating in the decision-making process about your medical care should definitely help you have a better outcome, and understanding your pain is an important element of this process. Come in for a visit today so we can help you understand, evaluate, and treat your low back pain.

1. Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976) 1987; 12:264.

2. Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 1998; 23:1860.

3. Chou R. In the clinic. Low back pain. Ann Intern Med 2014; 160:ITC6.

4. Burke S. Understanding different types of low back pain. 2016. Available at: https://www.spine-health.com/blog/understanding-different-types-back-pain

The Core Program For Musicians

When people think of physically demanding jobs, they most commonly think of industries like construction, plumbing, or electrical.  However, professional musicians must endure tremendous amounts of physical strength in order to hone their craft. 

In particular, pianists and string musicians are susceptible to a wide variety of tendinitis, nervous, and postural disorders due to the long hours spent in specific positions.  Overall, 50-76% of professional musicians will experience a musculoskeletal injury, 70% will experience some sort of instrument-related injury, and 33% will find themselves unable to play for some amount of time over the course of their career.  Because of this, it is essential to learn how to stay strong and flexible before injuries become a problem.

Symptoms can include: pain at a single site that stops and starts with playing; pain at multiple sites that persists, accompanied with loss of coordination; weakness, stiffness, or cramping; neck/back pain; and carpal and/or cubital tunnel, accompanied by numbness and tingling.

In developing her Core Program, Peggy Brill realized that it could be adapted to help musicians play longer, with decreased risk of injury. In less than 10 minutes a day, physical therapy can help teach you how to make your body work better and keep you pain free.

If you are a recreational or professional musician, contact the team at Brill Physical Therapy to help get your best body.  Playing in pain doesn’t have to be a fact of life.

Rock Climbing Injury Prevention

Indoor rock climbing- perfect way to get a great body and brain workout, all while staying warm inside! With the increase of climbing gyms, we’ve seen an increase in climbers and wanted to cover ways to prevent injury!

We recently worked with Steep Rock Bouldering (https://www.srbnyc.com) to present an injury prevention clinic to their climbers, here are a few things we covered that could help improve your climbing and prevent injuries-

Core Strength          

Climbing challenges our bodies to reach in multiple directions so it is important that the base of our appendages that are doing the reaching is strong.

• A strong core does not mean a solid six-pack or sculpted abdominal muscles, what it means is being able to maintain good stabilization in the core and appropriate breathing techniques. For example, “turning on” your abdominals before reaching or taking a breath out when reaching vs. holding your breath. These techniques will decrease pressure on the pelvic floor and help to provide a more stable “core”/base to move from.

Balance Training

When we think of balancing, we typically think of balancing while standing on a flat surface. For climbing, balancing means being able to keep your body balanced against a vertical surface. Since you’re moving up or down in various directions, climbing gets a little bit tricky.

• You want to use physics to your advantage by thinking about maintaining good tension in your body when appropriate.

  • While pushing with one arm or leg, you can pull with the opposite appendage or vice versa to create the amount of stabilization you need to climb.

Mobility 

• In addition to the good upper body flexibility that climbers need in their fingers, shoulders, and neck, there needs to be good mobility in the hips, knees, ankles, and toes.

We have a few exercises to introduce you to that will address all of the elements above-

Brill Chicken

Tuck in chin, pull head back to elongate the back of your neck. Pinch shoulder blades together. Bend arms, keeping elbows close to the torso with wrists pulled back.

6 seconds hold x 6 every 2 hours

Quadruped Lift Off

Align hands underneath shoulders and knees underneath hips on all fours. Tuck your toes under, lift your knees and hover 6" off the ground.

Hold x 10 seconds x 5 reps x 2 sets.

Deep Squat

Hold the inside of a door frame with your arms at shoulder height. Squat down as far as you can as your hands slide down the door frame (heels must remain flat to the floor).

Hold 10 seconds

Infant Positioning and Physical Therapy

Infant positioning and physical therapy

As new parents, we quickly figure out that our babies don’t come equipped with owner manuals.  So when we hear about the importance of tummy time for newborns and young infants, it can be overwhelming to understand what this actually entails.

The problems with infant positioning

Because babies spend nine months in a fetal position, they aren’t born with sufficient control of their back muscles.  Since the introduction of the Back to Sleep campaign in the mid 1990’s, infants will spend most of their time on their backs.  While this did a wonderful job of decreasing the risk of SIDS, it has led to an increase in positional deformities and weakness in infants, because they don’t get sufficient time on their stomachs, which will help them develop their back muscles.

Why is proper positioning important?

When a baby spends excessive time on their backs, they are at risk of skull deformities.  Either the back of their skull can flatten, or they might flatten the side of their skull if they prefer to keep their head turned to one side.  If left untreated, these deformities can become permanent.  In order to prevent this from happening, it is recommended that babies spend at least one hour supervised per day on their stomachs.  This will help them develop their back muscles, and ultimately facilitate them learning to sit, stand, and walk.

 What can I do to help my child?

If you continue to notice that your infant has a side preference, or you feel uncertain how to help your child engage the world while on their stomach, Brill Physical Therapy is here to help you.  Our therapists are trained in the treatment of infant positioning and muscular tightness, and can help guide you to best help your child.  Physical therapy will often consist of guided stretching, strengthening, and play. 

Everything you need to know about Patellofemoral Pain Syndrome (PFPS) aka Runner’s Knee

Patellofemoral pain syndrome or “runner’s knee” translates to kneecap pain.  It’s the most common overuse injury among runners, but it’s important to highlight that it can occur in athletes from nearly every sport and even in non-athletes who stress the knee in their daily activities as well.

The patella (kneecap) is a sesamoid bone located within the tendon that connects the quadriceps muscle to the lower leg bone (tibia). Its function is to improve the forces through the tendon as it crosses the joint, and also to protect the tendon from wear and tear.

The pain and stiffness it causes can make it difficult to climb and descend stairs, kneel down, and perform other everyday activities. 

Causes

Overuse – In many cases PFPS is caused by vigorous physical activities that put repeated stress on the knee. It can also be caused by change in physical activity, such as increasing the number of days you exercise per week, increasing your mileage, or time you’re spending with running, etc.

Patellar Malalignment – It translates in plain language as abnormal tracking of the kneecap. In this case, the patella is pushed out to either side of the femoral groove as you’re bending your knee. This abnormality causes increased pressure between the patella and the trochlear groove, irritating the soft tissues all around. This can be caused by problems with the alignment of the legs between the hips and ankles, as well as by muscular imbalances.

Other contributing factors could be improper training technique or equipment, or change in shoes or running/playing surface.

Symptoms

• Dull, aching pain in the front of the knee, increasing with stair climbing, squatting or jumping

• Pain after sitting for a prolonged period of time

• Popping, or crackling sounds in your knee when climbing and/or descending stairs, or standing up after prolonged sitting 

How Can I Prevent It?

First and foremost, keep mileage increases less than 10 percent per week, and gradually increase hill work in your program. Visit a specialty running shop to make sure you're wearing the proper shoes for your foot type. It’s also important to stay strong and flexible. Brill Physical Therapy’s exercises and tips are going to help you to succeed at these.

1. Loosen up - Myofascial release of the surrounding tissues is an important component in order to relieve pain and reduce the pressure and tension through the joint. Use the foam roller for the larger muscle groups such as the quadriceps, gluteal region, hip adductors and abductors, etc.

2. Strengthen

   1. Bridges on a Physioball
      

   2. Side Steps
      

   3. Forward and Reverse Monster Walks
      

   4. Heel Raises
      

   5. Single Leg Deadlifts
      

3. Be mindful - At the first sign of pain, cut back your mileage. Take a day off, or cross train. Consider orthotics if new shoes don't fix the problem. See a doctor and a physical therapist if pain persists, to rule out any other conditions, and to start a targeted rehabilitation program tailored for your personal needs.

1. Bridges on a Physioball

2. Side Steps

3. Forward and Reverse Monster Walks

4. Heel Raises

5. Single Leg Deadlifts

The inflammatory process and how to use it to our benefit

Dealing with the inflammatory process, and using it to our benefit at Brill Physical Therapy

What is inflammation?

Inflammation in the most general form is actually the first stage of the body’s natural healing process. When injury occurs, the body releases chemicals that cause swelling to protect the area, and inflammation that brings cells to promote healing. The inflammatory process brings white blood cells to help break down potential infection, and cells known as “phagocytes” to help break down damaged tissues. After this occurs, healing and repair of the damaged areas can begin.

The problem occurs when the body gets stuck in this cycle, and cannot move past the inflammatory stage. Chronic, low grade amounts of inflammation and swelling will remain in the tissues, impairing the body’s ability to heal. This is when doctors like to employ the use of anti-inflammatory medications in order to help the body heal and reduce pain. This is also why physical therapists like to use modalities such as ice to help promote healing chronically inflamed areas.

How can we use inflammation to our benefit?

As physical therapists, Brill Physical Therapy will use certain manual techniques to introduce low-grade amounts of inflammation to specifically irritated areas to help promote the breakdown of congested or scarred tissues. These techniques will introduce a controlled reaction to help encourage the start of the body’s natural healing response. While we like to finish many of our sessions with ice to help control post-treatment discomfort, you will notice that these sessions will never finish with ice. Ice is used to help prevent inflammation; in these situations, we actually need a controlled inflammation response to yield the desired result. Generally, Brill PT will recommend avoiding the use of ice or anti-inflammatory medication for several hours to allow the inflammatory reaction to break down the desired scarred areas.

How do I know if this type of treatment is right for me?

Here at Brill Physical Therapy, we are highly trained in a variety of manual treatments, and will carefully evaluate our patients to see when this type of therapy might be beneficial. Treatments might vary by session, and we will be careful to thoroughly explain how this process applies to you specifically.