Building a Successful Therapeutic Relationship!

The patient-therapist relationship is vital to the success of the patients' plan of care. Although that theory may seem obvious, the value of a functional relationship between a PT and their patient is sometimes neglected whether consciously or unconsciously. Good service is invaluable!

So how do we develop this relationship?

Open Dialogue: From the initial evaluation all the way to discharge, therapists and their respective patients should be continuously discussing the progression of their therapeutic program. Therapists should be assessing what's giving positive results, no results, or negative results.

Education: Therapists should be consistently keeping their patients aware and engaged by educating them on what may be causing any symptoms, the plan to treat it, why they're doing what they're doing, and what to expect from it all. Being that a therapeutic program has time limitations, it's also quite essential and beneficial for the patient to be given lasting information to take from their care in order to be responsible for their health in the forthcoming days after they have been discharged.

Accountability: On the other hand, therapists are not the only takers to responsibility. Patients MUST be willing to trust in the therapist's creative plan, follow the therapist's guidance, and take the initiative to perform their Home Exercise Program (HEP) regularly. Patients should be open enough to tell therapists how they feel about their current treatment program. I ask my patients how they feel about their treatment at almost every subsequent appointment.

When there's a good communicative relationship between the two parties, it creates a larger potential for a successful therapeutic experience even if physical therapy is determined to not be the cure to their specific disorder. As a Physical Therapist, I think I can speak for a grand number of other therapists when I say we find gratification in gratifying. Personally, it serves as a humbling reward for a patient to express gratitude for how they were treated throughout the patients' tailored program. It is the fuel that keeps my wheels turning (or my hands mobilizing to keep things in perspective).

 

Clifford Civil, PT, DPT, ACSM-HFS

clifford@duffyandbracken.com

Ski Season: A Guide to Preparing for the Slopes!!

I am so excited for ski season this year but before I hit the slopes I want to give some friendly advice to all of our patients on how to avoid an injury!

Here are some very scary statistics for you type 'A' personalities:

Half of all ski injuries involve the lower extremity (hip/knees/calf/ankle/foot) and about 1/3 are upper extremity (shoulder/elbow/hand/wrist) - the rest are back/trunk injuries and head injuries. Head injuries are almost twice as common as back injuries so wear your helmet!

With snowboarding, 2/3 of all injuries are upper extremity. Usually from falling on our stretched hands – wrist guards can significantly decreases the chance of a wrist fracture. Also if you plan on doing tricks, snowboarders are 3x more likely to be injured while jumping than skiers.

Now that everyone is properly scared here are some tips to prevent you from becoming one of the above statistics:

• Stay active! It takes a lot of endurance to ski down a hill and once you are at the top there are only two ways down – ski/snowboard or being sled down by ski patrol (yes I have had to do this – meniscus re-injury!) Start small – if you can keep a conversation while you perform your cardiovascular exercises then you are working at a good level.
• Stay flexible! While you do not need to be like Gumby, snow sports take a lot of movement.

1. Quadriceps – hold your ankle to your hip and push your pelvis forward
2. Hamstrings – sitting in a chair, put your leg straight out in front of you, heel on the ground, and lean toward your toes 
3. Iliotibial band – cross one leg in front of the other and push your hip out to one side
4. Hip rotators/low back – Lie on your back with your knees bent. Let your knees fall to one side. Hold for 30 seconds and repeat on the other side 

• Stay strong! I don’t want to hear any whining about being sore after skiing! 

1. Quadriceps – Squats 3 sets of 10. To add more strength, I add 5 seconds holds when my patients are ¼ their normal depth. This is to reproduce the stance posture you have when skiing or snowboarding. This can also be done on a BOSU ball (black platform side up) to make it harder and to insure that both legs are working equally 
2. Hamstrings and glutes – Lunges 3 sets of 10 to make things harder use a BOSU ball to lunge onto the blue dome side 
3. Core – Planks, hold 1 minute, repeat 3 times. On your toes and hands, push your body up. Do not let your back/hips dip down toward the floor.

• Improve your balance! It is always helpful to be upright while you ski! Stand on one leg (near something you can hold on to) for 30 seconds at a time - repeat 4x on each side. To make it harder you can stand on a pillow/BOSU ball or even close your eyes. 
• Be able to jump (a lot)! You will need to be able to jump and land at times on the slopes to turn or to impress your friends in the “trick park”. 45 degree stair jump – Start on the bottom of the stairs with your feet at a 45 degree angle from the stair then jump up one stair and land with your feet at the opposite 45 degree angle. 

Remember to warm up before you start on those black diamonds and no, this does not mean drinking cups of hot chocolate at the lodge. Now if you feel that you have been a couch potato since last season, may I suggest one of our Gravity Training System (GTS) classes. Each class has a three person maximum with a trained, experienced, wonderful instructor. A couple of classes before ski season will insure that you look fabulous on the slopes!

Let it Snow!!

Julie Garner, PT, DPT, COMT, CCI

julie@duffyandbracken.com

D & B NYC Marathon Champions

Congratulations to all the Duffy & Bracken patients who participated in the 2013 ING NYC Marathon. 

We are proud of all of your hard work and dedication. 

Thanks for allowing us to help you get ready for the race!

Finish time 3:39:00

Mile 18 and still smiling

Finish time 5:22:45

D & B therapist C. Shante Cofield, DPT finished in 3:55:51

 

 

 

Great Expectations: How To Pick A Physical Therapist

As a physical therapist, all too often I have new patients come in who tell me that they’ve tried physical therapy in the past for six, seven, eight plus months, with basically nothing to show for it. The two questions I always ask these patients are: “What did they do with you?” and “Did you think that what they were doing was helping?” While I don’t expect patients to remember every detail of their PT regimens, they should be able to say with confidence whether or not they felt that PT helped them. For those of you reading this who can align yourselves with the plights of those poorly-served PT patients, I’d like to offer you these few pointers to help ensure that your next PT encounter doesn’t leave you feeling like all you’ve managed to accomplish is throwing a few dollars at that high insurance copay or deductible.

Your physical therapist should be:

1. Present – Your physical therapist should BE PRESENT. If your therapist is spending 5 minutes with you then passing you on to an aide or trainer never to be seen again, it’s time to look for a new physical therapist.

2. Hands-on – While physical therapy does emphasize exercise and therapeutic activities, the manual techniques employed by your therapist can greatly help accelerate your healing process or correct dysfunction that could lead to injury down the road. If the physical therapy that you’re used to centers around ultrasound, heat packs, and stim, (electrical stimulation) with the therapist basically spending three minutes giving you a bad massage, it’s time to look for a new physical therapist.

3. Approachable and Informative – Too scared to ask your therapist why they have given you a specific exercise or why they are using a specific manual technique? You shouldn’t be. While the busy schedule of a physical therapist does not afford them the opportunity to spend hours upon hours with each patient, a therapist should be both willing and able to answer any relevant questions asked (and not asked) by the patient, within the allotted time.

4. Creative – Don’t expect a poetry reading when you go to physical therapy, however, your physical therapist should be able to provide you some variety with your exercises and treatments. If you’re doing the same exact thing at every session, for weeks on end, with no progression and no improvement in your symptoms, it’s time to look for a new physical therapist.

5. Competent – It goes without saying that your therapist should know what they’re doing, however, it is important that you feel confident in their competency. I’m not advocating that you base your physical therapist selection on their pedigree or how many letters they have after their name, but the manner in which they explain things to you, the exercises they prescribe, and the manual techniques they perform should all instill confidence in you that they can help you achieve your goals and improve your symptoms.

Here at Duffy & Bracken each of the physical therapists on staff bring with them all of these characteristics, and many more. However, my intent is not to tout how much better our practice is than others out there. Let this blog simply serve as an informative piece for anyone who has been to PT, is currently attending PT, or is looking for a physical therapist and wants to ensure the quality of services being offered. 

It’s your body. It’s your health. Choose wisely!

   

C. Shante Cofield, PT, DPT, CSCS

Duffy & Bracken Physical Therapy and Wellness

Carmen@duffyandbracken.com

HELP I CAN'T PEE!!!

Here's a testimony from one of our Pelvic Floor patients that was too good to keep to ourselves. 

MY ROAD BACK TO A LIFE

I didn't have a life. That is, not much of one.  Sadly, I'd lost the ability to do many of the things that I enjoyed and that helped make life fun and meaningful. And THAT was because I'd lost the ability to do one of life's most basic tasks...I couldn't pee.

I assume, if you are still reading this, then something similar has happened or is happening, to you.I was in my office when I first realized I couldn't pee. Quite a shock. Quite uncomfortable. Quite a trip to go to the ER and have a catheter installed. That lead to medication to deal with my enlarged prostate that was, apparently, blocking the flow of urine down my urethra. It worked well for many months...until it stopped working well and I was back in the ER. This time my urologist recommended TURP surgery, a laser procedure to reduce the size of the prostate and open things up. Till it could be scheduled I had to wear the catheter. That meant no running, no sports, no working out, difficulty sleeping, occasional discomfort, and walking slowly.

Then I had the surgery and all was well...for about 2 months. And then the same problem returned. My urologist kept saying he didn't understand, the prostate was no longer squeezing on my urethra, it must be that I was doing something wrong, I must be getting too anxious and tightening my sphincter and preventing the urine flow.

So, apparently, it was all my fault for being too anxious. So we tried a few different anti-anxiety medications. I took them and he took the catheter off. And a few days later I couldn't pee and it was back to the ER. After some tests they could find nothing amiss, my urologist recommended redoing the TURP. We did. Nothing got better. By now I was getting recognized on my return visits to the ER.

Life had become nightmarish. I decided to try something different.

I went to another urologist who specialized in difficult cases. He recommended that I learn to self cath when needed. That way I could avoid ER trips and not have to wear a catheter. It was the scariest thing I ever heard of. No way I'd EVER do something like that! But what was the alternative? So I learned it and it was painless and no big deal.

And I told him I wanted to try physical therapy. He agreed and gave me a few names. I called around and that's how I ended up at Duffy and Bracken. Lucky for me!

I began seeing Ann Duffy twice a week. In the evaluation she used a biofeedback mechanism to measure the strength of my Pelvic Floor Muscles. I didn't know I had a Pelvic Floor nor did I know that there were muscles there. Turned out they were extremely weak. She could also measure their ability to relax. Turned out they were not very good at that either. My pelvic floor muscles were under strength and over tense. "You have pelvic floor dysfunction," Ann told me, and traced it back to surgeries I'd had in the area some years ago. She explained that, because the muscles are weak, they had to work extra hard to keep me from being incontinent. As a result they were in a constant state of tension. And that is what lead the muscles to over tighten at the wrong times and prevent me from being able to pee.

We had a theory on what was wrong that went beyond telling me to relax or giving me anti anxiety medications! And that lead to a theory of what would help: Strengthen the pelvic floor muscles and supplement that with relaxation techniques.

So that's what we did. I learned Kegle exercises (though probably not how to spell them correctly) that I did both with Ann and on my own as well as other exercises I could do at home. Using biofeedback we could measure the muscles' strengthening and also see what relaxation techniques worked best for me. We found deep belly breathing did the trick.

Things did not immediately get better. I had to self cath a number of times. Sometimes I felt pretty discouraged and anxious. Ann was encouraging but also action oriented. "What good does getting anxious serve?" she asked once. We got back to the Kegels.

Then things improved significantly! I had a long stretch of feeling fine. When I had a rough few days, Ann quickly figured out the problem...I'd hurt my lower back lifting some boxes I shouldn't have. The muscles there tightened and that caused surrounding muscles to also tighten...including those pelvic floor muscles. So Ann gave me stretches to do and then strengthening exercises for the area. Things have gotten better again.

I think the best thing I can say about my work with Ann at Duffy and Bracken is that it is individually oriented and self empowering. That is, what she did is figure out what was going on with ME and then devise exercises, stretches and relaxation techniques that enable me to vastly improve and, hopefully, remedy the problem. NOT oriented at all (at least in my case) to medications and that is something I think is a very good thing. They almost always have side effects.

Duffy and Bracken is a business and I'm sure Ann is a good business woman. But everyone knows that physical therapy can take a while and that can be expensive and cause people to shy away. But what I found with Ann is that she'll do her best to work with you, to use your insurance, to come up with something fair should the insurance stop helping or be unavailable for whatever reason.

I'm very happy with what I've accomplished with Ann's help. I'm back to my active life. I'm pretty confident that you will improve things, probably greatly, if you work hard and consistently with the folks there.

I'd be happy to talk to you about all this if you think it could be helpful.

Regards, 

Michael Leiman

TAKE YOUR "BACK" TO SCHOOL!

With the school year beginning next week...after a restful summer…..we will be back to a more structured routine!! The trains will be busy with school kids being part of the rush hour commute.

Every year for the past decade, I have observed school kids carrying heavy loads...totally unaware of their posture. As a Spine Specialist, I naturally notice poor posture in others and I must say adults are just as unaware of their posture.

Our sitting world places undue stress on the spine if we are not aware of “ WHERE OUR BODIES ARE IN SPACE”.  Leading unsurprisingly to all sorts of aches, pains, and complaints of back stiffness.

I have coined 3 words to describe the spinal positions:

•   Hammock Spine: this is when we slouch curving our spine to its limit ---that it resembles the shape of a hammock. All structures are being pulled and stretched up to their end point resulting in weakness and loss of stability. E.g. slouched on the couch sound familiar!!!

•  Swagger Spine: this is when the spine sways laterally and does all the work while the rest of the body comes along for the ride. E.g. Walking with packages and doodling sideways

•   Pencil Spine: this is when the spine is so straight and rigid that any movement seems impossible.  E.g. Turning and twisting to look behind is a total body effort

 I’m sure you can identify where you fall in this spectrum. 

If we are all busy doing yoga, pilates, cross fit and gym workouts --- why then does our super strong core still cause low back pain?  The answer is in our individual lack of postural awareness; and this is where the expertise of a skilled PT with a keen sense of observation is invaluable.

Static and dynamic posture determine spinal health…so why not put your “ BACK TO SCHOOL”. Let us teach you how to enhance spinal mobility, spinal strength and spinal wellness.

Duffy and Bracken has partnered with Intelliskin (a performance apparel company) to help build the bridge for patients who struggle with back pain due to years of poor posture. Our postural assessments consist of a total spine evaluation and assessment, corrective exercises and clothing advice to help maintain good spinal posture. 

Contact us today for more information. Isn’t it time that we adults took our BACK to School ---to improve our quality of life!

Renuka Pinto, MPT, PGDR, CSCS, CES

Renuka@duffyandbracken.com

D & B IS NOW IN-NETWORK WITH CIGNA!!

Duffy & Bracken Physical Therapy is pleased to announce that we are now a participating provider with Cigna Healthcare.

We participate in most major insurance plans, in-network as well as out-of-network. If needed, we offer payment plans to our patients and work with them to make treatment possible at a reasonable cost. With many of today's insurance plans, the out-of-network coinsurance can cost the patient the same (or even less) as the in-network co-payment.

We know that understanding your benefits and/or coverage can get tricky. Our experienced billing staff is committed to working with you and addressing all of your insurance concerns. 

Below is a list of the most popular HMO, PPO, POS insurance plans that we work with, both in- and out-of-network. If your insurance is not listed, do not hesitate to contact us. We will do everything possible to work with your plan.

United Health Care
Empire Blue Cross Blue Shield
Oxford Health Plan
Cigna
Empire Plan (MPN)
Medicare
Workers Compensation
No Fault
Federal Employee PPO
Mt. Sinai- NYU H.S.M.C.M.N.
Anthem
1199
Horizon NY & NJ

Sex & Your Pelvic Floor!

Did you know that physical therapy can help your sex life??

Duffy & Bracken, PT has a unique specialty called Pelvic Floor Physical Therapy that can benefit both men and women. There are very few physical therapy clinics that specialize in this and Duffy & Bracken was one of the first to do so. Not to mention, we now have 20 years experience in this area. 

Painful sex is NOT normal!! Many people experience ongoing pain during sex, and the longer they let this go on, the more chronic and stubborn it may become. We all know that a woman’s first sexual experience is often painful because the hymen, which is very sensitive may still be intact. Anything from tampons to GYN exams (with a speculum) or physical activity before intercourse may have widened the hymen. However, some women are unable to use tampons or have sex due to extreme sensitivity, pelvic muscle spasm or nerve pain-neuralgia. Fear-avoidance also adds to this problem since fear acts like cement to pain and makes it difficult to overcome. Understandably, everyone is afraid of pain but understanding where the pain is and why it’s there, in addition to learning techniques to decrease it; can slowly stretch the vaginal opening allowing you to have pain free intercourse. This process can be quite quick if you do your homework, and usually resolved in 6 to 12 visits or sometimes even less! Even chronic cases sometimes resolve quickly especially if you work at it with your therapist.  

Pelvic Floor conditions do not only affect women. Men who have pain with ejaculation may have painful or trigger points in their pelvic floor muscle (PFM) that can be treated with retraining and massaging of the muscle. Additionally, getting education that explains 'pain' can aid in reducing the fear and hopelessness that sometimes accompanies pelvic pain.

Pelvic pain and dysfunction may also cause urinary and bowel problems or vice versa since the pelvic floor controls voiding. Poor posture and muscular skeletal problems involving the back, pelvis, sacrum, coccyx (tailbone) and hips, can also be a cause or a result of pelvic dysfunction - or as we like to say the 'culprit or the victim.' 

Likewise, women may experience pelvic pain during or after menopause as we lose estrogen and the pelvic floor muscle thins and atrophies (muscle gets smaller). Men lose testosterone around age 60 and sexual dysfunction may accompany this. Strengthening the pelvic floor muscle can help keep and sustain erection plus improve orgasm for both men and women.

There are many reasons to keep the pelvic floor muscle healthy including: pain free sex, better orgasm, and improved sexual stamina. Not to mention, a healthy pelvic floor also prevents: prolapse (the bladder and cervix can fall out of the vagina), incontinence (leaking of urine or feces), and flatulence (gas). It also improves posture and results in a flatter stomach, as the pelvic floor muscle works together with the transverse abdominis (which holds the belly flat).   

Medical terms used to describe these problems include: pelvic floor dysfunction, dyspareunia, levator ani spasm, vulvodynia, vulvar vestibulitis, vaginismus, and erectile dysfunction. These conditions may accompany: coccydynia, low back, sacroiliac or hip diagnosis, urinary or bowel frequency, constipation or irritable bowel or bladder disorder, interstitial cystitis, and post-partum scars from tearing during childbirth.

Let us help you with these very personal problems today. So get a move on receiving help or recommending anyone you know to a specialized PT. We will make you feel comfortable in more ways than one!

Ann Duffy, M.A., P.T.

Owner & Pelvic Floor Expert

Ready, Set, Go The Distance Injury Free!

 

Are you preparing for a marathon, half marathon, 10k or 5k? Let the experts at Duffy & Bracken help you get ready for your race with our Marathon Training Program. We have put together a dynamic team of therapists to help our patients prepare for their race as well as prevent injuries.

Here at Duffy & Bracken our therapists want to see you perform at your best, so they have arranged an incredible package to get you ready for your chosen race. Since every individual has special needs and are at different fitness levels, we give you the option of choosing three out of the four available sessions. You have the power to decide what sessions you would benefit the most from based on your areas of strength and weakness.

Marathon Package Session 1:  “The Rub Down”
This 50-minute massage will utilize both deep tissue and medical massage techniques to restore your optimal performance. Physical Therapist Johann Howard helps to reduce pain, facilitate increased range of motion and improve tissue quality.

Marathon Package Session 2: “Body Fuel”
This 20-minute session will include tips on performance eating, proper hydration as well as suggestions on the finest supplements such as; gels, chews and recovery drinks. You will receive nutritional advice from physical therapist and avid runner, C. Shante Cofield. Since Shante is always training for her next race, she knows where you’re coming from. She’ll provide support, motivation and recommendations on informational reading about running.

Marathon Package Session 3: “It’s a Marathon Not a Sprint”
This 30-minute session will start by assessing your current training program. It will include a gait analysis, running stride and lower extremity mechanics evaluation. For optimal running the session will include core training and lower extremity strength training. Internationally trained therapist, Renuka Pinto, has been working with professional athletes for over a decade, so she won’t have a problem whipping you into shape. She’s our foot expert, so she will also make shoe and socks recommendations based on your individual foot type and running style.

Marathon Package Session 4: “The Finish Line”
This 20-minute post-marathon session will evaluate you after the race. It will include both corrective exercises for common running injuries as well as preventative exercises to avoid future injuries. Our therapists will be here to patch you back up and get you into a treatment plan if needed.

For just $250 we help prepare you for your most successful race yet. Whether it’s your very first race or you’re a veteran, we can help you cross the finish line injury free.

Call the office to reserve your sessions today!

Kieffer Pearce
Director of PR & Marketing
212-402-5430

Help Us End The Unfair Practice of "Specialty Copays"

A Bill (S.2319/A.1666) put forth by The New York Physical Therapy Association (NYPTA) is on the current NY State Assembly agenda and we need your help to get it passed. The unfair practice of so-called "specialty" copays is costing patients in dollars and forgone treatment, leaving New York State with a more costly and less effective health care system. 

Managed care companies continue to restrict access to physical therapy services by imposing "specialty" copayments of $40-$50. As the patient you maybe paying $50, while your insurance company is paying the physical therapist $5 or $10. Managed care health insurers have designated physical therapists as specialists for copayment purposes, allowing health plans to charge patients more per visit while maintaining reimbursement levels to physical therapists at 1980's levels, shifting more of the cost burden onto the backs of consumers and pushing PT's near bankruptcy.

These specialty copayments add up for New Yorkers, since physical therapy frequently requires multiple visits over an extended period of time as the practice of physical therapy works in conjunction with the healing process. In 10 visits the patient may pay ($50 X 10) $500 while the insurer pays ($5 X 10) $50. You have a COPAY and they have a Nopay.                                       
The bottom line is this: HIGH COPAYS HURT PATIENTS

The bill is currently in committee and we need your help to move it along. Please call your NYS Legislator and tell them to stop high copays for physical therapy care and to support S.2319/A.1666. This will help end the imposition of additional copays on New Yorkers for physical therapy services.
Sincerely,
Ann Duffy, MA., P.T.
Owner, Duffy and Bracken Physical Therapy


 Ways You Can Help!  

Talking Points for High Co-Pay Legislation - S.2319/A.166

Find your NYS Legislator

ELIMINATE WORKPLACE ACHES & PAINS!

Please allow me to introduce myself, my name is Julie and I recently joined Duffy and Bracken, PT. I practiced as a physical therapist for 7 years in Seattle Washington before moving to Downtown NYC. One of my specialties in Seattle was workplace modification and 5-hour return to work testing. These included activities such as touring a sawmill to adjust a workstation to accommodate an injured shoulder patient to modifying the internal organization of a police car to accommodate a low back patient. While the average New Yorker I currently treat is not in an industrial occupation, workspace modification is no less important. You spend 8-10+ hours a day at your desk and the more efficiently you set it up, the less stress you will experience on your neck, back and arms.

Here is a little test – can you sit with your back straight and feet flat on the floor for 5 minutes without fidgeting or adjusting and without an increase in pain? If you cannot then your core musculature does not possess the endurance for an 8 hour day in a chair.

Ergonomics strives to keep your joints in a neutral position to minimize the stresses on the muscles and ligaments. People come in different sizes so no two desks should look alike. Here are some suggestions for easy adjustments to your desk:

Adjustable Chair

When you are sitting your knees should be bent at a 90-degree angle with your feet resting on the floor. If you are petite and can lower your desk this is ideal but most desks do not have modifiable heights. If your feet do not touch the floor, bring the floor up to your feet with a footrest or even a small box.

The end of your seat should reach to four finger lengths to the back of your knee. Any farther forward can pinch nerves in your leg and make it uncomfortable to sit. Legroom under your desk should be at least 60 cm to allow for easy foot movement.

The backrest should be adjusted so that there is a convex surface supporting your low back. (If your chair does not have this I would suggest an adjustable lumbar support, which we stock here at Duffy and Bracken).

The arm rests should be positioned so that your elbows are slightly forward and bent at near a 90-degree angle.

With Foot Rest

 I am asked a lot about therapy balls as chairs. While I think this is good for watching TV, spending 8 hours a day on a therapy ball requires a lot of core endurance. If you would like to sit on a ball at work I recommend keeping a chair nearby for when your back becomes fatigued.

Keyboard

When you are typing your wrist should be supported and your elbows should be at a 90-degree angle. Because your arm rests should also support you at a 90-degree elbow angle it sometimes comes in direct conflict with your keyboard. I would suggest table length arm rests (they are shorter and allow you to push your chair up to the desk) on your chair or none at all if you are mostly on the computer or writing while at your desk.

Mouse

A traditional mouse used to control your cursor can add increased stress on your arm and shoulder because you have to elevate your arm for long periods of time. I recommend a trackball mouse. Your hand rests on the mouse and your thumb moves a roller ball that controls the cursor. They are inexpensive and your neck and shoulder will thank you.

Computer Screen

When you sit upright at your desk your eyes should be level with the top line of your screen. It is much easier for your eyes to track inferiorly without affecting your neck posture than it is for your eyes to track superiorly. If your computer screen is too high we tend to push our head forward and angle our head upwards, which tightens the back upper neck musculature. This is a good time to walk around your office and see your co-worker’s computer posture.

If you have a laptop it is harder to modify. I suggest putting it on a pedestal to raise the screen up and buying a wireless keyboard. 

 

Divide Your Desk Into Angles

Items that you use constantly should be within a radius of 50 cm – which means you do not have to reach far or rotate your body to grab them.  Items you use less can be a short reach away. 

Standing Desks

If you do a lot of reading you can make yourself a standing station at your desk. The optimal reading angle is with a 45-degree slanted desk and if you are writing the optimal angle for your elbows is with a 15-degree slanted desk. 

Unslanted Desk

 

Breaks

Most importantly you need to get up and walk around to give your body breaks from being in one position. Most people become so engrossed in what they are doing that they forget so I propose setting your cell phone to go off every 1-2 hours. A 5-minute walk around your office will help clear your head and give your muscles a chance to relax.

If you have any further questions about how to modify your workstation or you want a professional to assess your sitting ability, please do not hesitate to see me here at Duffy and Bracken, PT.

                                                                                                                                  

Julie Garner, DPT, COMT, CCI

julie@duffyandbracken.com

Strengthening Your Weak Link!

Kinesiology is the study of movement. It is what physical therapists are experts at. In kinesiology, a leg or an arm is often referred to as a "chain." The reason being is that a leg or an arm is comprised of parts with links, those links being joints. Muscles originate on a bone, cross a joint and anchor on another bone so it can stabilize and move a joint. So when we hear the expression, "a chain is only as strong as its weakest link," we could easily apply that idea to a human chain. That's a very important concept especially if you are an athlete. 

Aside from being a Physical Therapist, I have been an avid martial artist for a good 20 years. In that time I have suffered a nice bouquet of injuries; everything from a broken bone, to torn muscles in my mid back. After a four year hiatus, I recently joined a new martial arts school. I wanted to see how well prepared I was physically to go back into this very demanding activity so I had myself evaluated by Renuka Pinto (the supervising PT here at D and B) using the Functional Movement System (FMS). The FMS system, is a movement screen that is often used to assess an athletes' quality of movement by studying each kinetic chain. It can also be used on a non-athlete to evaluate how well they are functioning in their body in terms of movement. The individual scores are added together to create an overall final score. The FMS helps to identify not only the athletes limitations or weakness but also the compensations that cover up those weaknesses. The test takes about 20-30 minutes. It is broken up into subsections that look at very specific movement patterns. What's great about the FMS, is that not only does it identify these weaknesses, with each section, it will also give specific exercises to help improve the areas the athlete is weak in making it a very clear systematic approach.

By the end of the test, I had a good idea of where my weak links were. Renuka and her student (Karen), gave me exercises to improve my weakness and  enlightened me on my compensations. So not only will the FMS help refine whatever game you compete in, but more importantly, will help identify what injuries you are predisposed to. Whether you are a golfer that wants to improve that vital finite control in your swing, or you are an Ironman competitor that is looking to improve your endurance, the FMS will help you improve your practice and prevent injury so you can keep doing the game you love to do... So for all of you athletes out there that are preparing for an event or want to maximize your chances of preventing injuries I would highly recommend the FMS here at Duffy and Bracken. It is one of the many programs we offer to try to maximize how we can help you. If you are interested, ask anyone of us and we'd be happy to answer any questions. 

 

Happy Training!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Johann Howard, DPT, LMT

DIARY OF A PREGNANT THERAPIST!

For my last blog before going on maternity leave for the first time, I felt inspired to share some reflections related to my experience during pregnancy which has enhanced my insight as a physical therapist. This may peak the curiosity of others interested in the topic of pregnancy or even on the topic of creating new physical experiences.

As I have undergone childbirth preparation classes and read material on natural childbirth in hope of promoting a birth experience as normal/natural and, believe it or not, enjoyable as possible, it has been repeatedly pointed out that the prevalent portrayal of childbirth as a painful and dangerous experience has created a fear of this experience and belief that this description is inherently true. Thankfully, there is a widespread body of resources that helps to transform these beliefs into confidence in a woman's innate ability to birth. This makes a very simple point that fear of the birth process creates resistance to and intolerance of the physical experience of labor, and that by both understanding the physiology of normal uncomplicated labor and trusting the natural ability of mother and baby to safely complete the process, this fear can be eliminated, allowing an entirely different birth experience to unfold.

So though one of the hottest topics during pregnancy is the birth itself, there is a lot of "story" about what "happens to" a woman's body during pregnancy as well. A conversation develops about the potential dangers of childbirth as well as the potential for injury due to pregnancy. This includes not only impact on the mother's body during birth but during pregnancy and in life after pregnancy. What I found novel is that while it is well established that these unfortunate perceptions of childbirth are prevalent in modern civilized societies, so might our perceptions of the experience of carrying a child before and after birth be influenced by cultural expectations. What became tangible for me was that much like I wanted to undo my learned cultural beliefs about childbirth, I could change my perception of what my body was experiencing as pregnancy progressed. Though I felt that I possessed helpful knowledge that would enable me to care for myself and "prevent injury", I still needed to believe in nature's design just a little more.

To build upon this conversation, I would like to also point out that so far the conversation is talking about the mother as a pregnant individual, not a mother and child living, moving, birthing, and continuing to live together with ease, harmony and comfort, and actually establishing a relationship (though perhaps not with a lack of new sensation and experience for both parties).

Let me illustrate what these changes in perception boil down to for me. There were times I was distressed because of pain while walking. However, as the baby grew it dawned on me that I was already the mother of this baby.Then a bigger picture emerged illustrating that just walking down the street pregnant was at this stage already an activity in our parent-child relationship. I began to realize that it made sense that I could move in a natural way (though perhaps slower) with her (yes, it's a girl!), and not only feel less pain but feel happy in my new relationship. Sensations that I felt as physical stresses (abdominal muscle strain, pubic bone pressure when I walked or sacroiliac pressure with changing positions) began to be perceived differently- as evidence that my baby was resting on certain body parts of mine or guides for me to move with more mindfulness. Feeling “out of breath” and extra work in my legs going up stairs changed into “taking in more air” for the two of us.

Now am I saying that pain is all in the mind? No. Have I enjoyed the benefits of physical therapy to prevent, prepare and manage? Absolutely! Though attention to physical wellness continues to play an important role, what has also contributed to me feeling better and better while walking and moving are perceiving things in the following ways:

1. RELAXING and trusting that my body can "carry" my baby without additional effort or injury if I let it. In the early stages I noticed that as I walked there were times I tensed muscles around my waistline and in my hips, exerting effort to “carry the baby”.  When I realized I could relax all those muscles and move in a way that was harmonious with her, I soon saw that my body did not feel added stress. 

2. Building on the point about relaxing, being sure to BREATHE PROPERLY. Though the growing uterus takes up space near the diaphragm and ribcage, the diaphragm can still do its job. A breathing pattern which primarily originates in the diaphragm and is not restricted by tension in the shoulders, ribcage, abdomen or pelvis is an essential component of efficient posture. Being able to maintain efficient breathing is a good sign that you are feeling good!

3. TAKING TIME to move, whether it’s getting up, moving in bed, walking or squatting, not just because of being heavier or that it’s “harder”, but because “moving for two” may take that extra bit of mindfulness to negotiate how to move in a way that is kind to my body. I’m not saying that you couldn’t still run in the Olympics if you wanted to, but as for me, no more running for the bus!

As a PT, I have learned important lessons from experiences as the caretaker of my own human body which enhance how I help others help themselves. Whether you are carrying a baby in your womb, a child in your arms or even bags of things in a city schlep, I invite you to create a new language for what it is you are doing. Is there some way you could create more ease for your body, create more harmony between you and the person or things you are carrying, or learn to trust your body more? Time and time again it is a relief to find out that breathing easier and relaxing more creates more efficiency, comfort and pleasure in the body. If you are unsure of how to create ease in your body - pregnant or not - schedule an appointment with a physical therapist...we can help!

Sara Chan, PT, CFMT

Sugar Uncovered: Don't Make These Mistakes!

In the last few weeks there has been a lot of buzz around sugar because of the law that Mayor Bloomberg is trying to pass limiting the sale of large sized sugary drinks. As a health coach, I have had many people ask me about sugar and its effect on the body. The short answer is frequent consumption of sugar leads to weight gain, lethargy, and mood swings. Prolonged overconsumption can lead to obesity, diabetes and heart disease! How could such delicious treats cause so much harm?

The challenging part is that sugar has become part of our cultural DNA, which makes it almost impossible to avoid completely. Every holiday has its special sweet. When we mark significant life milestones - birthdays, graduations, weddings - cake takes center stage. Children do well on a test; we reward them with ice cream. When I walk around the streets of NYC, there are frozen yogurt shops and cupcake cafes popping up on every corner. We are surrounded by it!

But aforementioned sweets are not the only sugar culprits. The obvious treats are easy to spot and we can try to avoid them. But what happens when we THINK we are making a healthy decision BUT we are actually ingesting large amounts of sugar and don't even know it!

Don't be duped by these seemingly healthy but sugary favorites:

• Sauces/Glazes - Many times to get that perfect complement to your savory dish, chefs will add a sauce or a glaze. But beware, many glazes have added sugars. So that soy glazed salmon dish you love may look like the healthier choice but could have over20g of sugar...more than 1 chocolate glazed doughnut!
• Yogurt - This delicious snack can be very healthy but beware of yogurt with added fruit. Yoplait strawberry yogurt has 26g of sugar...as much as a Snicker's bar! If you are going to eat yogurt, eat the plain and add your own fruit for the touch of sweetness.
• Granola - Eaten by hippies for years...it must be healthy right? As it turns out, Kellogg's Original Granola has 17g of sugar...as much as 3 chocolate chip cookies!! If you are going to have granola, either make your own or be sure to check the labels for lower sugar options.
• Coffee/Iced Tea -I was floored when looking into coffee drinks and iced teas. I never thought twice about these, as they were obviously the healthier choice to the dreaded soda. Wrong!  A Starbucks Grande Cafe Mocha has 33g of sugar, which doesn't include any flavor shots, or sugar people add after they get it. If you are going to drink coffee or iced tea it's best to have it black/unsweetened.

Knowing a few of these sugary pitfalls will hopefully help you to make healthier, informed decisions. At 1 Healthy Life we know that it's easy to get off the healthy track and sometimes difficult to find your way back. That is why we work with people to help them take small steps(like cutting out sugary drinks) now that lead to BIG changes in your health later.

Working with a health coach will:

• Help you to truly identify realistic, attainable health goals
• Develop a customized plan that will step you toward your goal over a series of sessions
• Hold you accountable (in a loving way) to those goals week after week
• Identify if there are certain steps that are not working for you and help you to modify the plan so it works specifically for you. Not everyone is the same...therefore, no plan is going to be exactly the same

1 Healthy Life has partnered with Duffy & Bracken Physical Therapy to develop a program that is the one...two health punch combining wellness & exercise. In only 3 months you will have a Total Health Transformation! We will dive deep into eating right, reducing stress and improving your energy while Duffy & Bracken trainers will kick your butt on their Gravity Training System to improve your muscle tone, flexibility and overall physique.

You only get 1 life; why not make it your best life possible? And you can...with small steps and support along the way.

Schedule your 1 on 1 complimentary health breakthrough session today. What do you have to lose?

Mina Penna, Holistic Health Coach

Mina Penna is a Holistic Coach who works with clients to help them reduce stress, improve their energy, find more balance and lose weight. Mina was certified at the Institute of Integrative Nutrition and is a member of the American Association of Drugless Practitioners. Additionally, Mina is the Corporate Nutritionist for Sabra Dipping Co., LLC.

Cliffs Notes: Your Guide to Physical Therapy!

About a month ago, Duffy & Bracken owner, Ann Duffy wrote a passionate blog detailing both the role and the ability of physical therapists in providing preventative services and helping to curb ever-growing healthcare costs. A few weeks later, D & B director, Renuka Pinto, wrote an equally fervent blog highlighting how physical therapists can help individuals invest in their health with the same proactive, calculating approach they take to investing in their financial well-being. As luck would have it, these blogs were posted around the same time that a very poorly-informed segment aired on Dr. Oz, grossly misrepresenting what we as physical therapists actually know and do. (Disclaimer: if you are currently attending PT and receiving the type of care depicted in Dr. OZ's segment, please find a new physical therapist ASAP) To this end, I felt it only appropriate that I complete the D & B blog trifecta and devote this entry to summarizing the many skills that we as physical therapists possess, and reiterating how we can help you, the health care system, and the country as a whole .

Despite what Dr. Oz would have you believe, physical therapists are not merely the keepers of the machines, wielding ultrasound and electrical stimulation units against the dark forces of persistent low back pain, reinforced by our trusty sidekicks, the hot and cold packs; quite the contrary. Currently, to become a physical therapist, one must attend 3 years of graduate schooling, in addition to their undergraduate or post-baccalaureate. Pre-requisites for PT school are the same as those required for med school, generally with the addition of courses like exercise physiology and kinesiology in place of organic chemistry. Physical therapy graduate course work includes biomechanics, physiology, kinesiology, pharmacology, and radiology. PT students study pathology of not just the musculoskeletal system, but also pathologies of the neurological, cardiopulmonary, genitourinary, gastrointestinal, and integumentary systems. Following roughly 7 years of schooling, physical therapists currently graduate with their doctorate, and then enter the health care industry with an identity that is often time misunderstood, and a role that is severely underutilized by the general public.

Here are the cliffs notes as to what a physical therapist is, and what we actually do:

Physical Therapists are musculoskeletal specialists. With extensive coursework in anatomy and physiology, physical therapists possess the knowledge to both diagnose and treat nearly all musculoskeletal pathologies or refer patients to the appropriate practitioners if needed.

Physical Therapists are movement experts. With a strong foundation in biomechanics and kinesiology, physical therapists are trained to analyze everything from your gait to your golf swing. We can determine why your knee hurts when you go down the stairs, help you decrease your half marathon time, and tell you which shoes are best for your needs.

Physical Therapists take an active role in your recovery. Physical therapists use manual techniques such as joint and soft tissue mobilizations, taping in conjunction with therapeutic exercises to facilitate a return to full function. It is our hands, not the hot packs that will make you better.

Physical Therapists are easily accessible. Thanks to Direct Access, patients in New York can see a physical therapist (who has been practicing for at least 3 years) WITHOUT a referral from a physician. Patients are allowed to attend physical therapy for 10 sessions or 30 days before they are required to see their doctor and obtain a prescription.

Physical Therapists don't just cure pain, we can also prevent it. Physical therapists can predict your likelihood of injury by watching you perform simple functional movements. Additionally, patients are provided with home exercise programs and educational tools that allow them to prevent the reoccurrence of injuries and employ self-management strategies should symptoms return.

Physical Therapists help save you money. Although co-pays can be frustrating, attending physical therapy can help people get out of pain quicker, help people avoid invasive surgical procedures, and decrease the amount of medications that a patient needs to take. Six sessions with a $20-$35 co-pay and an adjustment to your workstation versus back surgery. I'll let you do the math.

If you're reading this blog, there's a good chance that you already know the benefits of attending physical therapy. However, I ask that you share this blog with your friends and family, and anyone who's complained to you about their stiff neck and their sore knee. For those of you who just had a mind-blowing experience, carry this knowledge with you and see a physical therapist the next time that ankle (or knee, shoulder, elbow, back, neck) starts acting up.

Carmen Shante Cofield, DPT, CSCS

Duffy & Bracken Physical Therapy