Human Performance and Rehabilitation Centers, Inc.

Still Working from Home? Here’s How to Stay Healthy

Nearly overnight, COVID-19 created a remote American workforce, and many folks are still working from home at least some of the time. Companies and workers both report positive results from the great telework experiment, but it does come with certain downsides, including the possibility of a sore neck, shoulder or back pain from hunkering down in an “office” that looks more like the living room couch. Remote workers also may face feelings of isolation, poor eating habits and not enough exercise as the lines get blurred between their professional and personal spaces.

It’s important to take steps to ensure your work-from-home experience is productive and healthy. Keep the following tips in mind, and if you’re experiencing neck, shoulder, back or joint pain, reach out to your physical therapist.

Establish an appropriate work station

The most important thing you can do to foster wellness while working from home is to establish a work station that’s as ergonomically correct as possible. Don’t be tempted to work from your sofa, or worse yet, your bed. This is especially hard or working parents, who have had kids home during the spring quarantine and throughout the summer. But no matter what your home life is like, find a spot that allows you to focus and sit up straight, comfortably.

Protect your posture

Whether it’s the kitchen table or a proper desk, your home work station should allow you to place your feet flat on the floor in front of you. Your knees should be at the same level as your hips, creating a 90-degree angle with your planted feet. Similarly, your arms should form a 90-degree angle at the elbows. Your elbows should be positioned close to your trunk and your forearms should be straight in front of you, working at a flat, not raised, keyboard. Your spine should be straight. If you need them, place cushions or rolled bath towels between the chair and your lower back. Ideally, your computer screen is half the distance between your eyes and your keyboard, which can be hard when working on a laptop. Consider adding an external keyboard, so you can elevate your laptop. In the absence of that, be careful not to crane your neck down as you look at your screen.

Move frequently throughout the day

No matter where you work, don’t remain sitting for too long. There’s no question that regular movement fosters well-being. Every hour, take a short break, stand up, stretch and get moving, even it’s for a short period. Walk the dog, complete a chore, toss the Frisbee to your kids, or just stand and stretch. If you’re back at work, regular movement is equally important. It doesn’t take much; just a few minutes of movement between long period of sitting can be very effective at increasing wellness.

Eat well and stay hydrated

With the home kitchen close by, it may be tempting to tank up on snacks. Create a schedule for eating breakfast, lunch and snacks. Stock the fridge and pantry with healthy items. And be sure to drink plenty of water. As temperatures rise, it’s important to stay hydrated not just when going outside, but throughout the day. Keeping the body hydrated helps the heart pump blood throughout the body more easily, enabling the organs and muscles work more efficiently.

Exercise and Stretch

When you work from home, it’s important to integrate an appropriate exercise routine into your day. The advantage of telework is that it eliminates the commute, freeing up extra time to walk, run or go to the gym. In addition, there’s more fitness content online than ever, so break up the day with a virtual stretching session, Pilates or yoga class.

 

What to Expect During OT after an Amputation

Whether it is a wound that has refused to heal or you got too close to the table saw, when an amputation of a finger occurs it can be a traumatic experience. After your doctor or surgeon has deemed you appropriate for therapy, you will be set up for an evaluation. At the evaluation, your therapist will assess your affected finger(s) in several different ways: the amount of swelling, range of motion of the unaffected joints, how well your incision is healing, and if you have any involvement of the nerves in the other parts of your hand.

Usually, the first few therapy visits focus on how to take care of your incision, range of motion exercises to prevent stiffness or increase flexibility of the other joints of your hand, controlling swelling, and shaping the stump by wrapping using a certain technique.

After the incision(s) is well healed, scar massage is started. This will help the area not only normalize in appearance but prevents the scar tissue from adhering to underlying structures. Scar tissue can also interfere with achieving desired motion and cause the area to become itchy, painful, sensitive, or even raised. If you are experiencing numbness or sensitivity of the stump, a sensory program is started to retrain those nerves to communicate with the brain in a normal way instead of over- or under-reacting.

The last phase of therapy after an amputation consists of activity modifications or adaptive equipment training to safely return to doing the things that are important to you.  Whether it’s playing baseball, shuffling a deck of cards, returning to work, or making a cup of coffee, what is important to you is important to your therapist.

If you experience an amputation, please talk to your surgeon or doctor about seeing an occupational therapist for best possible outcomes from a less than ideal situation.

Learn more about Katherine Branch, OTR-L.

Am I Sore or Am I Hurt?

Starting a new exercise routine can be uncomfortable.  However, the long-term payoffs are greater than the initial aggravation of getting up early, changes to your normal “comfortable” routine, and soreness of muscles you have not used in a long time.  The rewards of exercise are great.  Starting an exercise routine can provide some immediate results: improved flexibility, increased mental clarity, and weight management effects can be seen shortly after starting a new routine.  But the long-term effects are even more powerful.  The American Cancer Society published a study that shows that too much time sitting and being sedentary is associated with an increased risk of death from various health conditions, including type 2 diabetes, high cholesterol, high blood pressure, and heart disease.  The good news is that exercise of any type will help reverse the effects of a sedentary lifestyle and it does not matter what type of exercise you do; the main thing is to get up and get moving.

So, now that you are moving and starting to use those muscles that you have not used in a while, what can you expect.  Soreness is more than likely going to happen.  Think about doing yard work.  You may be used to cutting the grass with your push mower and weed-eating the edges, but say you go to the nursery and buy 10 new bushes to plant along the front of your house.  Now you are lifting, bending, digging, planting, moving dirt, and watering for an entire day.  You are tired at the end of the day, but you feel great and your house looks amazing.  But the next morning, well that is a different story, is it not?  The same thing can be true for starting a new routine, soreness is expected, pain is not.  But how do you know the difference?

Soreness:

Soreness after or during activities can be completely normal.  Typically, soreness sets in the day after activity and will usually resolve in a few days.  Soreness occurs from muscle exertion that causes micro tears in the muscle fibers. This micro tearing forces your muscles to adapt and remodel to handle the increased stress from the exertion.  This is what allows your muscles to get stronger and have greater endurance to complete various activities.  Therefore, soreness is a normal response that your body has to doing exercise and a normal process of adapting the body to handle increased activity levels.

Soreness will typically present in the following ways:

  • Onset: During exercise but can be 24-72 hours after exercise before soreness starts.
    • Lasts 2-3 days.
  • Presents in the muscles only.
    • During exercise: tender to touch, tires easily, and a burning feeling.
    • At rest: tight with a dull achy feeling
    • Gets better with stretching, movement, and appropriate amounts of rest.
    • Gets worse with inactivity.
  • You should continue to move after appropriate amounts of rest and recover.
    • Activities should be different than the activities that you did to cause the soreness

Pain:

If discomfort persists and does not improve beyond the 3-4 days that is typical for soreness, then it may be time to be concerned about an injury.  Delayed onset muscle soreness (DOMS) will typically present in 1-2 days post workout and resolve in another 2-4 days.  Any pain, tenderness, achiness, discomfort, etc. that persists beyond 1 week needs to be looked at further.  Also, soreness will always be in a muscle, if discomfort is noted in a joint, then always suspect an injury.  If an injury is suspected, then you can start using ice immediately, especially if you see swelling.  Ice should be used exclusively for 7-12 days.  Heat should be reserved for old, chronic injuries.  When using ice, make sure to leave the ice one for 15-20 minutes but no longer.  Any longer than 20 minutes and you run the risk of injuring tissue from the prolonged cold.  Also, if you are using a chemical cold pack (other than ice) you need to put a layer of some type (i.e. towel, pillowcase, etc.) between you and the cold pack.  Most chemical cold packs get extremely cold and stay at the extreme temperatures longer than ice does and cause skin and tissue damage much faster than ice.  If swelling is present or an injury is acute remember RICES (Rest, Ice, Compression, Elevation, and Support).  For an injury such as a sprained ankle:  rest can be decreasing activity and staying off the injured ankle as much as possible, using ice for 15-20 minutes every hour, for compression use an ACE wrap or sleeve to apply compression, for elevation you can lie on your back with your ankle above your heart, it is best to do this every time you ice, and support would be the use of an ankle brace during activity to allow the injured ligaments to heal.

Pain will typically present in the following ways:

  • Onset: During exercise or up to 24 hours following activity.
    • Typically, does not resolve on its own and becomes a linger issue.
  • Presents in the muscles and/or joints.
    • Gets better with ice, rest, and gentle/pain free movements.
    • Gets worse with return to activity after recovery and appropriate time off/rest.
    • During exercise: Sharp ache to pain.
    • At rest: Sharp Ache
  • You should seek the advice of a medical professional (i.e. family doctor, orthopedic surgeon, and/or physical therapist) if pain persists >1-2 weeks or comes back with resuming activity.

Similarities exist between soreness and pain, which is why people have some confusion as to what they may have going on.  It is always best to listen to your body and back off the exercise routine for a few days.  If your discomfort subsides in a few days, more than likely, you just over did it and you had a bad case of muscle soreness.  But, if your discomfort persists for a week or more, comes back when you resume exercise after rest,  is a sharp instead of a dull ache, and/or is in a joint and not just in a muscle; then you need to seek out the advice and expertise of a medical profession such as a physician or physical therapist to further evaluate your condition and help you manage your condition appropriately.

Learn more about the author of this article, Paul L. Padgett, PT, ATC, CSCS.

Sources:

https://patient.info/news-and-features/what-are-the-long-term-benefits-of-exercise

Tips To Avoid Injury For Runners

Running is a great way to improve your cardiovascular fitness and get some fresh air! Unfortunately, injuries such as shin splints, runner’s knee, muscle strains, plantar fasciitis, and stress fractures can plague runners. Whether you are just starting out or you are an experienced runner, you want to do all you can to prevent an injury which could interrupt your training and your daily life. Here are some tips to help you achieve healthy running.

Wear proper footwear

It is important to wear shoes that were meant for running, fit you well, and are designed for your foot type. Runners who overpronate when running need a shoe with more stability and support, while runners who supinate require a shoe with more cushioning. If you are not sure what type of shoe you need, a physical therapist or knowledgeable shoe salesperson will be able to help. It is important to keep track of the miles on your running shoes and replace them regularly. Even if there are no visible signs of wear, you should retire your running shoes after a maximum of 500 miles.

Do a dynamic warm-up

Warming-up is important in order to get your muscles and joints ready for a run. You can walk or jog for a few minutes to get your muscles warm. You can also do some high knee marching and some exercises bringing your heel to your bottom (“butt-kicks”) to stretch the backs and fronts of your legs. Long duration static stretches are better to do after your run.

Vary your running surface

Paved roads are a very convenient running surface, but they are not very forgiving. If you are running a lot of miles, you may not want to log all of them on concrete. Doing some of your miles on a track or dirt surface results in less of a pounding on your legs. A treadmill is another great option, especially on days with poor weather. If you are running on the road, running on the left side of the road facing traffic is typically the safest way to run to avoid being hit by a car. If you are in an area where you can easily be seen, you may consider alternating between the right and left sides of the road due to the beveling of roads.

Increase distance gradually

Runners who are trying to increase their distance should do so gradually. An increase of about 10% per week is a good guideline. For example, if you currently average 10 miles per week, try for 11 miles next week. If you are training for a specific event or distance, be sure to plan ahead and give yourself ample time to ramp up your mileage safely.

Listen to your body

Perhaps the most important advice to avoid injury is to listen to your body. If you are developing a nagging ache or pain with running, respect it. It is better to take a few days off than to let a little nagging pain turn into a serious injury. You can cross train by biking or swimming to give your body a break from running while maintaining your fitness. It is also a good idea to seek a physical therapy evaluation to address any muscle imbalances or mechanical issues that you can correct to resume pain-free running.

 

Brittany McLeod, PT, DPT, is a licensed Physical Therapist with HPRC St. Francis Main Campus since 2013. She received her Doctorate in Physical Therapy degree in 2012 at Upstate Medical University in New York and her BS degree in Heath Science at SUNY Brockport New York in 2009. Brittany is a member of the American Physical Therapy Association, Orthopedic Section.

Constipation: Understanding it and finding relief

Constipation is the most common digestive complaint presented to doctors, estimated to affect more than 4 million people in the U.S. While common — and perhaps a little difficult to discuss – it can be treated.  The good news is a pelvic physical therapist can help.  Pelvic Physical Therapy is a specialty that focuses on the muscles of the pelvis that relate to the bladder, bowel and sexual dysfunction. A Pelvic PT will take a thorough history of your problem and perform a clinical exam of the musculature of the pelvic floor for tone, tenderness, contraction and relaxation. There are a number of techniques employed in the practice to help you regain control. The first and most important is basic education.

Let’s define constipation. Having a BM three times a day to three times a week is considered normal. If you are having a BM less than three times week, you have met one of the criteria for constipation. Do you strain to pass a BM more than 25% of the time? Are your stools hard or lumpy more than 25% of the time? Do you feel that your stool is blocked, or that your BM is incomplete 25 % of the time? Do you have to manually assist to complete a BM? If you answered yes to two or more of the above questions, you are constipated.

A number of different issues can cause constipation, including:

Poor diet

The American diet is generally low on fiber. The USDA recommends 25 grams of fiber for women, and 38 grams for men under the age of 50. Over the age of 50, the recommendation is 21 grams for women and 30 grams for men. Some fibers add bulk to your stool, which helps to regulate a BM. Adding other fibers helps to prevent heart disease, lower cholesterol, and even helps to regulate blood sugars. These are definite benefits for us all. Keeping a food diary for two to three days can help you track the amount of fiber you are consuming. Fiber is best obtained with food but supplements are available and helpful. It’s important to increase fiber slowly, and to increase your water intake at the same time. Generally, your water intake should be close to ½ your body weight in ounces, depending on how active you are. Fiber-rich foods to incorporate into your diet include cooked beans, bran, whole grains, fruits, vegetables and high fiber nuts.

Medications

Some medications, including opioid pain medications, antidepressants, urinary incontinence meds and others can cause constipation. When taking these drugs, it’s important to increase your intake of fiber-rich foods and water. Talk to your doctor if you think your medication is contributing to your constipation.

Dyssynergic Defecation

In about 50% of chronic constipation cases, the cause is a condition called dyssynergic defecation, or the inability to coordinate the diaphragm pelvic floor and the abdominal muscles. If your symptoms include a feeling of incomplete evacuation, straining and bloating your pelvic floor muscle, it may be what we term “non relaxing.” It might seem odd to tell you that you must learn how to have a BM, but long-term straining leads to poor coordination of the ability to evacuate the bowel. Dyssynergia occurs when your pelvic floor muscles contract instead of relax and lengthen to pass a BM.  Biofeedback and neuro-muscular education will help get you back on track. One of the simple solutions here is to use a foot stool. A well-known one is called the Squatty Potty. It’s a foot stool that brings your knee into a position that is higher than your hip (the squat position), and it creates relaxation in the pelvic floor musculature.

Rectocele

A rectocele is one type of pelvic organ prolapse. A rectocele can occur in women secondary to pregnancy and childbirth. The risk of rectocele increases with age. It is generally caused by a weakening of the support structures (muscles and ligaments), and it can become worse with chronic straining during a BM, and even heavy lifting.  A pelvic physical therapist can assess for prolapse. A large rectocele and inability to empty the bowel may require surgery. Surgery restores the anatomy, but it does not correct the dysfunctional strategy that occurred to manage the rectocele. Physical therapy is appropriate 4-6 weeks after surgery to improve defecatory function.

Rules to Poop By:

While each cause of constipation requires its own therapeutic strategy, there are several good rules to follow to improve constipation and to keep it from returning.

  • Don’t push for a bowel movement if there is no urge to push.
  • Don’t ignore the urge to have a bowel movement when you feel it.
  • Create a regular time to have a bowel movement, preferably first thing the morning, or 20 –30 minutes after a large meal.
  • MiraLAX is best taken just after your evening meal, so that it can help to produce a morning BM.
  • Four ounces of prune juice with pulp taken at bed time, also helps to produce a morning BM.
  • Elevate your knees when sitting on the toilet. Use a footstool preferably at least seven inches high so that your knees are higher than your hips. This places you in a squatting position and allows the posterior pelvic floor muscles to relax.
  • Use diaphragmatic breathing throughout your day.
  • Learn how to coordinate the diaphragm, abdominal and pelvic floor muscles in order to eliminate straining.
  • Exercise regularly.

 

Constipation is a frustrating condition. Pelvic physical therapists may use neuromuscular education myofascial release, biofeedback, relaxation/strengthening exercises, joint mobilization, abdominal massage and pelvic floor muscle massage amongst their many tools to help you regain control.

Joanne O’Connor PT, PRPC is a licensed physical therapist employed with HPRC since 2001. She is a certified Pelvic Rehab Practitioner through the Herman and Wallace Institute since 2016. Joanne received her Bachelor of Science degree in Physical Therapy from the University of Connecticut in 1978.  Her clinical interests include the Spine and Women’s Health. She welcomes all diagnoses related to the spine and women’s health inclusive of pregnancy, postpartum urinary and fecal incontinence, constipation and pelvic pain. She is a member of the American Physical Therapy Association Women’s Health Section. Joanne is also a member of Pelvic Guru and the Global Pelvic Health Alliance