Monday, August 27, 2012

Perform Better by Relaxing More!

While the title of this blog is absolutely true, I chuckle as I suspect that the benefits of relaxation it promises might appeal to New Yorkers living a fast-paced lifestyle. My colleagues agree that while many of our clients report having difficulty relaxing, many also confess great relief taking a break to focus on their body.
According to the Mind/Body Institute at Harvard University, 60-90% of medical visits per year in the US are for stress-related disorders. Many conditions we treat clients for have a stress-related component. So how can you get those tense muscles in your neck, back or pelvis to relax?
Often in physical therapy treatment, we recommend a course of progressive relaxation on a daily basis for a minimum of 8 weeks, which is the length of time studies have shown to have long-term effects. It makes sense to treat the nervous system which may be out of balance due to chronic pain or stress, both of which trigger the autonomic nervous system’s sympathetic fight or flight response. The body responds in predictable ways under these conditions. To name a few: breathing becomes shallow and more rapid, heart rate and blood pressure increases, digestion slows and becomes more acidic, and concentration and memory are decreased. Plus, prolonged stress inhibits the immune system from fully functioning.
The good news is that the autonomic nervous system also has what is called a relaxation response (controlled by the parasympathetic division). This is not just the absence of the flight or flight response but an actual process that the system “does”.
After regular daily practice of progressive relaxation or other techniques such as meditation, yoga or breathing exercises, one can expect to experience a more natural calm, increased ability to concentrate and solve problems and increased resilience to stressful conditions. Studies show that a long list of medical conditions can be improved with these practices. While other interventions may be important or beneficial to address sources of stress, progressive relaxation can be a helpful adjunct to any of those interventions.
I usually recommend using a recording (the one our practice uses is 25 minutes long) as one falls asleep at night since it may be the only time you lie down to relax without doing anything else, and also to improve sleep quality, since during deeper stages of sleep we replenish neurotransmitters needed for coping with stress or pain. I’ve also found it enjoyable to listen to the recording while commuting on the subway or even walking -- why not learn to relax while you are in motion?
If at times during practice of progressive relaxation you experience challenges in your ability to maintain focus, letting go of tension or discover tension that results in you feeling less relaxed, realize that with intention and practice you will improve these skills.  Also the nervous system takes time to adapt so results may take minutes or repeated practice, and “more relaxation” versus “perfect relaxation” constitutes success.
Overall this healthful practice is fairly simple to implement and has a wide range of health benefits. Once you’ve discovered whether it works for you, it’s a practice you can return to throughout your life. 
Sara Chan, PT, CFMT
Duffy & Bracken Physical Therapy

Monday, August 13, 2012

Is Your Home Exercise Program Really Necessary?

 I asked my Dentist years ago if I really had to floss my teeth regularly. His reply simply was, “only the ones you want to keep.” Ever since I’m a flosser! When a physical therapist gives you an exercise, activity or stretch it’s a lot like flossing… It’s in your best interest to do them and to do them every day unless your PT states otherwise. Your home exercise program (HEP) and your postural corrections are as important to the success of your therapy as is the massage, ultrasound or joint mobilization. The HEP is not only designed to correct muscle imbalances but in the long run, and sometimes short-run, helps reduce your pain and keep it from coming back. 

     I used to be a massage therapist and I would get a lot of  “PT drop-outs.”  My clients/patients would say things like, “PT didn’t help me at all. I still have pain, that’s why I’m here to see you.”  I would ask if they did their HEP. Often I would hear, “No, was that really so important? It was so boring and I didn’t have time.” I think from the patients’ point of view it’s easy to feel that way. Your PT gives you these exercises and some of them may indeed feel really boring and inconvenient to do. However, what is more inconvenient, the pain that can keep you up at night or the exercises?

     It is important to remember that a therapy program is usually not an overnight process. Typically patients come to us with groups of muscles that are weak or dysfunctional (Even athletes! Especially athletes!), and in order to help stop the pain, we need to improve the strength/performance of those muscles. Improving strength typically takes 4-6 weeks when the exercises are done regularly. So, we ask you to please hang in there and be patient with your exercises. The results are not over-night.  This is true particularly when we are trying to break poor postural habits and inspire new ones.

     On the other hand, we need to know if the HEP is increasing your pain as you perform it and if so how much. It should not increase your pain significantly so if the next day you wake-up after your exercises and the pain has shot up a lot, you need to tell us. As it relates to your HEP and your symptoms, it’s good to ask yourself: “When does the pain come on? …… When I’m sitting, laying down, running, washing my hair or right after my HEP.” Being clear about what aggravates your symptoms really helps us identify the culprit. 

     Lastly, look at the exercises this way, you will not only be proud of yourself when you stick to it, but you’ll look better and feel stronger. Also some of you ask if you’ll have to do these exercises for the rest of your life. The answer is not necessarily, but you should want to keep strong for the rest of your life anyway; look at the exercises like a tool that’s helping you keep healthy and away from pain. It’s a win, win situation!

John Howard (Johann), DPT, LMT
Duffy & Bracken Physical Therapy