Physical Therapist Archives

Increasing Shoulder Range of Motion

Increasing shoulder range of motion after injury or surgery is key to recovery and shoulder performance. Genya Royfman, PT, DPT is a graduate of UC Santa Barbara and received her Doctorate of Physical Therapy from Hampton University. She’s been a part of the Park Sports team for about a year now and has a passion for treating shoulder injuries. Genya, who is a former high school football player and currently an avid rock climber, has herself had multiple shoulder surgeries and experiences with PT as a patient. When it comes to shoulder issues and recovery, Genya says clearly, “I can relate.”

The Shoulder and injury.

The shoulder is a complex joint built to allow movement in many directions: forward, backward, around in a circle, and away from the body. Muscles and ligaments help keep the shoulder stable and secure in your shoulder socket. Injuries can occur whether you are an athlete, super active, or an occasionally active weekend adventurer or DIYer.

Quick overview of your shoulder.

Your shoulder joint is a ball-and-socket joint. The head of the humerus (upper arm bone) is the ball and the scapula (shoulder blade) forms the socket where the humerus sits.

The scapula and arm are connected to the body by multiple muscle and ligament attachments. The front of the scapula is also connected to the clavicle or collarbone through what is called the acromioclavicular joint.

As you move your arm around your body, your scapula must also move to maintain the ball and socket in normal alignment. Keeping this alignment steady and sturdy is a life long challenge. Injury to the multiple muscles and ligaments that keep everything functioning is quite common. Recovery is not always so simple however.

Range of Motion.

Shoulder Range of Motion or ROM is the measurement of movement around a specific joint or body part. ROM can become limited due to joint overuse, arthritis, or sudden trauma to the joint. Lack of ROM is a strong indicator of injury, not to mention, it can limit your daily functions and cause persistent pain and discomfort. Working with a physical therapist, you will increase your range of motion and strengthen your joint. This occurs through joint manipulation and specialized exercises.

Like all Park Sports therapists, Genya performs detailed research into her client’s history and current injury before any treatment begins. After Genya creates a plan for her patient’s shoulder injury treatment or post-op plan in conjunction with her patient’s surgeon, often she is initially focused on strengthening scapula involvement. “I make sure the scapula is properly engaged, people tend to forget about the shoulder blade.” There are a number of early stage treatment exercises she typically begins with. These will help work the scapula and also test early treatment ROM.

Shoulder Blade Squeezes.

It is important to engage the upper trapezius muscles at the start of treatment. Genya’s shoulder blade squeezes address the mid to lower trap muscles. As a result, they loosen the upper trap muscles. This helps to relieve neck and shoulder discomfort. Your trap muscle consists of three parts and has many different functions—lifting your shoulders, holding up your neck and head and moving your shoulder blade. When this muscle is tight, it affects your entire body. Tight traps are significant enough to influence your training, recovery, and overall well being.

Scapular Wall Slide.

The Scapular Wall Slide is another early stage exercise designed to improve scapula stabilization. Genya positions her patient in front of a wall and squeezes their shoulder blades. The patient then slides their forearm up the wall maintaining contact with the wall the entire time. Wall slides train the muscles surrounding the scapula for both dynamic and static stability – controlling the position of the scapula during arm movement.

Treatment length varies.

Treatment length varies from patient to patient depending many factors. Very recently, Genya discharged a patient that had been with her for an extended period of time recovering from a massive shoulder injury. “It was an emotional experience for both of us, lots of laughing, crying, and hard work. She now has full range of motion and a healthily functioning shoulder. She is pain free and active again. I am so proud of our work together!”

Our New Williamsburg Facility.

If you have shoulder soreness, tightness or an injury call us directly for a free evaluation. We offer free consultations and direct access to all of our facilities including our brand new state of the art center at 490 Driggs Avenue in Williamsburg, Brooklyn.

Shoulder Injuries: The Rotator Cuff

Shoulder injuries and pain are frequent complaints we encounter at Park Sports Physical Therapy. There are many factors involved in the diagnosis of shoulder pain. A skillful clinician looks at the whole picture – your posture, the entire kinetic chain including your core and lower extremities musculature, the spinal alignment and most importantly, your shoulder blade mechanics. After all, shoulder pain is most often just a manifestation of a deeper problem.

One problem we often see concerns shoulder injuries to the Rotator Cuff.

Rotator Cuff Tendinitis

Shoulder injuries to the Rotator cuff such as Rotator Cuff tendinitis affects the tendons and muscles that help move your shoulder joint. It is often preceded by the shoulder impingement syndrome, when the tendons of the rotator cuff get “squeezed” by the bony elements. It is a result of faulty mechanics during shoulder elevation, which leads to irritation and inflammation of the tendon and eventually to tendinitis. This condition usually occurs over time and reflects a certain athletic lifestyle or profession that requires repetitive arm and shoulder movement.
Sometimes rotator cuff tendinitis can occur without any known cause. Most people with rotator cuff tendinitis are able to regain full function of the shoulder without any pain.

Symptoms

The symptoms of rotator cuff tendinitis tend to get worse over time. Initial symptoms may be relieved with rest, but the symptoms can later become constant. Symptoms that go past the elbow usually indicate another problem.

Some symptoms include:

Pain and swelling in the front of your shoulder and side of your arm
pain triggered by raising or lowering your arm
a clicking sound when raising your arm
stiffness
pain that causes you to wake from sleep
pain when reaching behind your back
a loss of mobility and strength in the affected arm

Rotator Cuff Tears

There are two kinds of rotator cuff tears. A partial tear is when the tendon that protects the top of your shoulder is frayed or damaged. The other is a complete tear. A complete tear goes all the way through the tendon or pulls the tendon off the bone.

Physical Therapy Treatment

If you have a shoulder injury to the rotator cuff such as rotator cuff tendinitis or a rotator cuff tears, you’re not alone. It happens to millions of people every year. It’s a common cause of shoulder pain. The right treatment can make you feel better, keep a small injury from getting worse, and help you heal. For many people, physical therapy (PT) is the answer. It may be all you need to treat an injured rotator cuff.

At Park Sports our program includes personalized exercise, monitored application of ice and heat, detailed massage from a trained specialist, and specific equipment to help return your shoulder back to its normal range of motion. Our role is not just to treat your pain. We want to help you get back to doing the things you enjoy pain free and with a new understanding of how your body functions to help reduce future injury.

According to WebMd, “one study shows that people who got PT for a rotator cuff tear did just as well as those who had surgery.”

Surgery

If nonsurgical treatment isn’t successful, your doctor may recommend surgery. Most people experience full recovery after having rotator cuff surgery. We also treat many patients after rotator cuff surgery to help them recover quickly and in a way that sustains their health and the healthy future of their rotator cuff.

Please contact us for more information about Park Sports and rotator cuff injuries.

Park Sports PT is a Participating Member of the Hospital for Special Surgery Rehabilitation Network.

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Pelvic Floor Therapy

Pelvic Floor Therapy and Dysfunction.

Pelvic Floor Therapy can be an important part of a healthy life. So when it comes to posture, comfort, intimacy, and wellness, a healthy pelvic floor is one of the most vital parts of your body. Many women face daily discomfort, lack of intimacy, physical pain, and more due to a dysfunction of the muscles, ligaments, and nerves that support the pelvic region.

A healthy and re-energized pelvic region can greatly restore your well-being and help to eliminate symptoms that are negatively effecting your life.

Pelvic Floor Dysfunction (PFD) may be brought on by a variety of reasons. These include pregnancy, childbirth, menopause, prior surgery or radiation, heavy lifting and straining, obesity, and congenital weakness. This can lead to vulvar pain, localized pelvic discomfort, prolapse, low back pain, leakage, incontinence and much more. Most do not seek advice from a physical therapist. Those who do however, can see life changing results.

At Park Sports, we are dedicated to life changing results.

Park Sports Therapy Approach to Pelvic Floor Dysfunction.

What to Expect When Getting Started.

At Park Sports, we understand the seriousness of your decision to seek help. We offer evidence-based and individualized treatment plans backed by a wealth of knowledge and a history of success.

Our pelvic floor therapist Lacey Salberg PT, DPT has received extensive training from the Herman & Wallace Pelvic Rehabilitation Institute, a leader in pelvic floor education and awareness. Lacey will take the time to discuss your health concerns. She will also fully evaluate your condition and create personalized plan, uniquely designed for your comfort level, your lifestyle and your body. You will receive one-on-one sessions in our private treatment room as she coaches you towards your health goals.

Working Together.

We consider your health a team effort. Part of your therapy will include an at home exercise program that will help you progress through your treatment plan. As you make advancements, it is possible that your initial plan may need some adjustments. Your therapist will listen carefully to your body and closely monitor your functional gains. If necessary, she will discuss modifying your treatment plan to better achieve your health goals.

Long-Term Planning.

Once you reach your goals, your therapist will provide an at home plan. This plan will help you maintain your new functional gains and pelvic floor health. Of course we will always be available to provide advice and assistance. As your health and wellness partner – our goal is your long-term happiness.

Park Sports Pelvic Therapy Floor Services.

Our practice offers a full range of services for Pelvic Floor Dysfunction including:

Comprehensive musculoskeletal and orthopedic evaluation, including assessment of the pelvic floor muscles and hip alignment.
External and/or internal manual therapy techniques such as myofascial release, soft tissue mobilization, neuromuscular facilitation, and scar massage.
Biofeedback for muscle re-training and recruitment.
Bowel and bladder training and diaries.
Therapeutic exercises such as postural re-education, muscle relaxation, core stabilization, and flexibility exercises.
Home exercise program instruction.
Self-management techniques to improve overall quality of life.

Contact Park Sports.

Contact us today to learn more about Pelvic Floor Therapy at Park Sports and to schedule an initial appointment. Let’s meet and discuss your questions, concerns and needs. We offer a premiere service with proven life changing results and we look forward to serving you.

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Spinal Stabilization Exercises and Their Role in Alleviating Lower Back Pain

By Boris Gilzon, PT, DPT, OCS, CHT

The Effectiveness of Spinal Stabilization Exercises for Back & Neck Pain

There is no standard approach treating chronic lower back and neck pain. Although this may be unfortunate for many patients to hear, the good news is that there are many conservative methods to alleviate pain.

While conditions like degenerative disk disease, spondylolesthesis, lumbar and cervical radiculopathy are rarely cured completely by conservative measures alone, physical therapy does offer a fair amount of pain relief in the long run.

By utilizing spine stabilization exercises, our physical therapists are able to help patients reduce back and neck pain. This is an active form of treatment requiring the patient to perform exercises to strengthen the muscles and improve the stability of the spine.

Patients suffering from chronic spinal pain should be leery of physical therapists who mainly offer passive modalities. Examples of passive modalities include heat, electrical stimulation, and massage. Patients should be aware that passive therapeutic modalities do not have sufficient evidence to support their use in chronic spinal conditions.

Spinal stabilization exercises offer the empowerment of the patient and have plenty of research and evidence to support their effectiveness.

Pilates offers an excellent variety of spine stabilization exercise.

Extensive benefits in treating the spine of those who suffer from lower back pain have been discussed extensively in medical literature. Physical Therapists specializing in the spinal disorders are trained in recognizing the factors that affect spinal stability.

Components Affecting Spinal Stability

The concept of spinal stability is relatively new with research beginning during the 1970’s.

There are three components that affect spinal stability.

The first component is the passive spinal element: the bone and ligamentous structures. Studies of the cadaver spine in which the bones and ligaments are intact but the muscles were removed showed to buckle under about 20 pounds.

Spinal Ligaments - Medical Illustration Originally Sourced from Kenhub.com — Ligaments of the thoracic spine: posterior (a), anterior (b), lateral (c) and posterior with vertebral arch removed (d). 1, anterior longitudinal ligament; 2, posterior longitudinal ligament; 3, intervertebral disc; 4, ligamentum flavum; 5, intertransverse ligament; 6, supra- and interspinal ligament; 7, radiate ligament; 8, costotransverse ligament.
Originally sourced from: https://musculoskeletalkey.com/anatomy-of-the-thorax-and-abdomen/

The second component of spinal stability are the muscles that surround the spine. The muscular component provides a necessary ‘stiffening” of the spinal segment. In a healthy spine, a very modest level of muscular activity can create a sufficiently stable joint. In a degenerative disk disease, for example, there is more demand on the surrounding musculature. More strength and endurance reserve is needed to overcome an injury and pain.

Deep Muscles of the Back. Medical Illustration originally sourced from: https://pulpbits.net/7-deep-muscles-of-back-anatomy/the-deeper-muscles-of-the-back/

The third component of spinal stability are the neural elements: the central nervous system and peripheral nerves. They are akin to an orchestra conductor, coordinating the performance of various muscles, making sure they are firing at the right time, at the right amount of force.

Spinal Cord Nerves Originally Sourced from Health Jade — Spinal Cord and Nerves – Medical Illustrations originally sourced from https://healthjade.com/spinal-cord/

Multiple studies have shown patients with lower back pain make a “repositioning error” in which their spine would resume to its original position causing pain after performing a certain movement more than patients with a healthy, stabilized spine.

In physical therapy language, we call it a poor postural control.

Specific physical therapy exercises and treatment has shown effectiveness in treating chronic spinal pain.

Lumbar stabilization exercises improve muscular function which can, in turn, compensate for the structural damage to the spinal segment. A thorough dynamic assessment of the spine helps identify postural deficits.

A thoughtful exercise program is designed for each individual by the physical therapist based on their initial testing and evaluation. The most tangible benefit of a lumbar stabilization is that it gives a patient the tools to control their pain.

Interventional Pain Management

Going beyond the scope of physical therapy, interventional pain management is another passive option for chronic spinal pain. This approach serves as a temporary source of relief for patients dealing with low or medium levels of lower back pain. These techniques include performing procedures directly at the level of your dysfunction.

A pain management physician gains access to the areas causing lower back or neck pain by penetrating the surface of the skin. There is a plethora of interventional pain management options for the diagnosis and treatment of the spinal pain.

Epidural steroids are the most common example of the interventional spine management. However, the accuracy and effectiveness of interventional methods in managing lower back pain are not always clear.

In the comprehensive review article published in Pain Physician, 2013 Apr:16, the authors conducted a systematic review of literature in order to collect evidence for the effectiveness of various interventional pain management techniques in the treatment of chronic spinal pain.

The author came to the conclusion that the evidence was fair to good in 52% of therapeutic interventions. The evidence for diagnostic value fared slightly better at 62%.

One significant drawback of all passive techniques is that they do not require a participation of the patient. Without an active engagement of the patient, there is a limited self-control and independence in managing their own condition.

Do you suffer from chronic neck or back pain? Our therapists can help. Schedule your appointment today.

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What We Can Learn From Angels Pitcher Shohei Ohtani’s Elbow Injury

Written by Boris Gilzon, PT, DPT, OCS, CHT and Alex Ariza

If you’re a fan of baseball you may have heard that New Los Angeles Angels pitcher, Shohei Ohtani, has a damaged Ulnar Collateral Ligament (UCL) in his pitching arm.

This is bad news for Ohtani, as his career relies heavily on the function his elbow. Although reports show that Ohtani only has a first-degree sprain, consistent use of his elbow can present serious problems down the line.

In the world of physical therapy, elbow pain does not get enough exposure and is often ignored. More often than not, people continue performing their daily activities that can exacerbate injury to the elbow and cause damage to the joint and ligaments.

Ulnar Collateral Ligament (UCL) Injury

As Physical Therapists, we see sports injuries in a different light, especially when they make the news. This post will share some of the intimate knowledge we possess from years of treating a number of injuries and conditions that athletes may face.

The Ulnar Collateral Ligament, located in the elbow, is a complex structure consisting of three bands. It is challenged more when the elbow is in flexion. During full elbow extension, the bony congruity provides additional stability.

Ulnar Collateral Ligament Anatomy

Ulnar Collateral Ligament injury is common in many overhead sports. The forces that can lead to injury on the elbow are generated when the elbow goes from flexion to extension at a high velocity. In Ohtani’s case, this would be frequently pitching at a consistent speed of 100 mph.

This injury occurs from repetitive valgus (a condition in which the bone segment distal to a joint is angled outward) stress on the medial (inner aspect) of the elbow. This kind of elbow sprain commonly occurs in baseball pitchers. It is less frequent in racket sports, volleyball, and hockey, but can still occur in athletes playing those sports.

Damage to the ligament can be caused by sudden trauma or a gradual stress. The most typical sign is a pain in the inner elbow while performing a physical activity. Patients commonly describe an elbow sprain as a twinge or sharp pain when pushing up, such as getting up from the chair.

If a ligament is compromised a patient may develop:

A sense of looseness or instability in the elbow.
Irritation of the ulnar nerve (aka the “funny bone”): This is felt as a tingling sensation or numbness in the small finger and ring finger.
Decreased ability to throw a baseball or other object overhead.

Treatment for Ulnar Collateral Ligament Injury

Ulnar Collateral Ligament injury can happen to anyone at any age. Parents and coaches should be aware of the issue and be alert if the child complains of the pain in the elbow.

Physical Therapy is the best first line of defense following this diagnosis. At Park Sports Physical Therapy, our Physical Therapists are skilled and experienced in treating elbow instability and ulnar collateral ligaments tears.

The treatment approach is based on thorough examination and biomechanical analysis of the activity that caused the condition.

It includes:

Strengthening weak muscle group
Activity modification.
Manual therapy and therapeutic modalities.

Post-Surgical Recovery

In cases of severe damage and instability, the ligament is reconstructed in what is commonly known as a Tommy Johns procedure. Physical Therapy treatment in this case follows an established post-surgical protocol. Our therapists work closely with an Orthopedic Surgeon to optimize post-surgical recovery and achieving the highest functional outcomes.

Do you suffer from Ulnar Collateral Ligament Injury? Take the first step to get out of pain by scheduling your appointment.

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Introducing Our New Pelvic Floor Therapist

Written by Alex Ariza & Irene Hernandez, PT, DPT

At Park Sports Physical Therapy we are always on the lookout for talented specialists who will be able to help our patients dealing with specific conditions and injuries.

We would like to introduce you all to our newest pelvic floor therapist, Irene Hernandez, DPTPark Slope location – 142 Prospect Park West.

Your pelvic floor plays a major role in controlling urination and bowel movements. For many women, incontinence, or the inability to control the bladder releasing urine, is a common problem, especially after childbirth. Unfortunately, due to the nature of this condition, many people do not address pelvic floor dysfunction. New mothers, expecting mothers, and men living in Brooklyn will now have access to Pelvic Floor Therapy.

Our Pelvic Floor Therapist can help patients suffering from the following:

Pregnancy: pelvic and/or back pain, pubis symphisis dysfunction, swelling and varicosities in legs and genital area

Post-partum: treatment of episiotomy and tears, rehabilitation of the strength and function of pelvic floor muscles after child-birth, re-training of the abdominal wall to close diastasis rectus abdominis

Bladder dysfunction: incontinence of urine, excessive frequency and / or urgency of urination, painful or difficult urination (start stop, incomplete)>

Bowel dysfunction: incontinence of feces or gas, constipation due to tightness and not associated to dietary of GI problems

Ongoing pain in your pelvic region, genitals, or rectum.

Endometriosis pain: A disorder in which tissue that normally lines the uterus grows outside the uterus.

Pain during or after intercourse in male and female: vaginismus, vulvodyinia, vestibulodynia, pain with erection or ejaculation, erectile dysfunction caused by muscle tightness

Prolapse of female organs: descend of uterus, bladder or rectum into the vagina

Post-opt prostatectomy: rehabilitation of pelvic floor for men

If you want to learn more about pelvic floor therapy and if you would like to know if you need this specialized form of care, please contact us by calling us at (718) 230-1180 or filling out the form below.

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