Not As Easy To Move As It Used To Be? Think About Structural Integration

I moved to Guilford, Connecticut from Brooklyn in the fall of 2013 to get closer to air, light and water. And a less expensive, more spacious apartment was a big plus. I especially like being near the ocean. Every morning I check out the tide chart that’s posted on the refrigerator and note when high tide will hit Guilford Harbor so I can run down to Jacobs Beach for a quick swim. I’ve enjoyed learning about the tides and like the feeling of moving through my day with a little deeper connection to natural rhythms than in my Brooklyn days. Walking back from a high tide swim recently I met Bob Mahoney, an old fellow I’d often seen walking slowly across the town green. Bob shared with me that he would be going sky-diving next week to celebrate his 80th birthday. I started to suspect that he was full of the Irish blarney when he told me he had finished the New York marathon when he was 76, then four years into his battle with Parkinson’s. Later I did an Internet search for Bob and sure enough, there he was, featured in the Shoreline Times edition of June 30, 2012. Yikes, and here I am, still patting myself on the back for completing my first 5K race in April and this old guy, a number of years my senior, has done the NY marathon while facing a serious neurological condition.

And more: From a recent NY Times article detailing research on athletes competing in the Senior Games I read, “…the results were impressive. While the athletes’ average chronological age was 68, their average fitness age was 43, a remarkable 25 years less…” One of the principal researchers comments, “A majority of the athletes didn’t begin serious training until quite late in life, middle aged or older…so you can start anytime. It’s never too late.”

I don’t think I’m going to start training for the Senior Olympics (I would qualify based on age) but I’m very aware that the more I move, the better I feel and the more I’m inclined to move some more. And I’ve learned that a couple of the most pervasive causes of the stiffness and tightness we associate with aging are gravity and lack of movement. We can’t do much about gravity but we can learn how to move more easily and efficiently in it’s field. A central aspect to my practice of KMI structural integration (a first cousin to rolfing) is to help my clients find and release those stuck spots (that we might not even be conscious of) that we move around, not through. Perhaps we’re compensating for an old injury or poor postural habits or whatever accumulation of traumas that bind tissues together in search of stability. It’s a natural bandaging process that in the short run serves to relieve pain but in the longer run can fix the body in less than healthy movement patterns that may ultimately cycle into chronic pain.

The KMI series is designed to systematically make conscious those impediments to movement and unwind deep holding patterns, always inviting length and breadth and balance. Most clients will experience a sense of “feeling taller” (sometimes they actually are!) and moving more easily. Normally experienced over 12 sessions, it is “project” oriented with each session focusing on a specific goal. Such as mobilizing a stuck ribcage that restricts free breathing patterns, realigning the feet and pelvis for better support, decreasing tension in the neck and back---all in service to gaining a better relationship to gravity and posture.

So if you’re experiencing stiffness or tightness and you like the idea of “a full body tune up” give me a call at 203-809-0036 to schedule a free consultation. I am in the Duffy and Bracken office on Fridays and occasional Thursday afternoons.

RD Hunting, CMT, CST

How to get the most out of physical therapy

This may surprise you, but lately I’ve had patients that come for therapy and seem like they are just fulfilling a requirement. They have minimal questions, one word answers and frequently ask how much longer until they are better.  Maybe they have had bad experiences in the past, or have lost hope of getting better.  But with everything in life, whether its work, fitness, or relationships, we get the most out of things we put time and effort into. Physical therapy is the same.

I thought it might be helpful to give a physical therapist’s honest perspective on how you as a patient can be sure to get the most out of your physical therapy sessions. First, it’s important to want to get better, and to prepare mentally for the likelihood that it will take time and patience to get there. You should be ready to put in the time needed for appointments and a home program. Also, part of wanting to get better is being flexible and open to limiting or changing current workout regime if needed.

Secondly, ask questions! Ask why you are doing specific exercises or why your therapist is using a specific manual technique on you. This is a great way to be involved and learn about your body. After all, this is YOUR body and you only have one! You can also do your own research on the web and ask us questions about what you find.

Lastly, be honest from the start. If you can only make 3 sessions or there is no way your life can go on if you have to quit running then tell us. Open communication is a key part of a patient-therapist relationship. We can be flexible too. If you can only make 3 sessions instead of 10 sessions, there is a big difference in what your therapist might spend their time doing during your sessions.

I enjoy being a physical therapist because of the relationships I build with my patients and the opportunity it gives me to help and motivate patients. These things work so much better when patients are ready and willing to be active participants in the rehabilitation process.

Candice Amat, PT, DPT
candice@duffyandbracken.com

Is Your Internal GPS Working Properly?

The importance of our balance system cannot be overstated in life. We all know that we need good balance to stand on one leg or walk a tightrope. But did you know that your balance system works 24/7 ? Running, walking, standing, sitting and even sleeping! Without proper functioning your brain is like a little boy lost in the woods and your body is on a constant merry-go-round. So let's discuss what contributes to the balance system.

Our balance system is three pillar strong:

1. Eyes
2. Inner Ear (VESTIBULAR SYSTEM)
3. Proprioceptive (sensory) systems of the body (such as the skin, muscles, and joints)

Information about our surroundings is gathered by our eyes, vestibular system and sensory organs which is relayed to the brain. It is then processed and we get the awareness of our body position.

THE VESTIBULAR SYSTEM

The vestibular organ consists of a complex network of sacs, canals and receptors present in your inner ear (DEEP inside the ear). It contains millions of tiny little cells that move/vibrate when you move your head/body. This movement from BOTH vestibular organs is then sent to the brain by your ear nerves.

The vestibular system helps answer two basic life questions: Which way is up? Where am I going? In essence, the vestibular system is like a PRECISE INTERNAL GPS, used for maintaining the orientation of head and body in time and space.

So what happens when our Internal GPS doesn't work properly?

VESTIBULAR SYSTEM DYSFUNCTION

The vestibular system can fall prey to three "I"s like many other organs in the body: Injury, Infection and Inflammation. Without a constant input of body position and sense from your vestibular organs to your brain, internal confusion sets in. Most times your brain is struggling to figure out if you are standing, sitting, moving etc.

SYSTOMS FROM VESTIBULAR DEFICIT:

• Spinning or whirling sensation; an illusion of movement of self or the world (vertigo)
• Lightheaded, floating, or rocking sensation (dizziness)
• Sensation of being heavily weighted or pulled in one direction
• Imbalance, stumbling, difficulty walking straight or turning a corner
• Clumsiness or difficulty with coordination

And since one of the three pillars of balance (Eyes, Vestibular and Proprioception) is not doing its job, the other two work OVERTIME. And no wonder, they don't like it.

SYMPTOMS FROM EYES/VISUAL SYSTEM OVERLOAD

• Headaches, blurred vision, double vision
• Trouble focusing or tracking objects with the eyes; objects or words on a page seem to jump, bounce, float, or blur or may appear doubled
• Discomfort from busy visual environments such as traffic, crowds, stores, and patterns
• Sensitivity to certain types of computer monitors and digital televisions
• Increased night blindness; difficulty walking in the dark
• Poor depth perception

 SYMPTOMS FROM PROPRIOCEPTION (Muscle/Joint/Skin) OVERLOAD

• Sensitivity to changes in walking surfaces or footwear
• Muscle and joint pain (due to struggling with balance)
• Difficulty finding stability in crowds or in large open spaces
• Fatigue

If you think or have been told you have a vestibular condition, you should see a trained Vestibular Physcial Therapist. Contact Duffy & Bracken and ask for an appointment with me. The longer you system stays "uncompensated", the harder it is for it to revert back. Knowing about your condition can help ease anxiety and you can learn skills to cope with the symptoms. Exercises and balance training can bring your confidence back and put you on the road to recovery.

    Nidhi Sharma, MPT, MCMT

    Vestibular Specialist 

    Nidhi@duffyandbracken.com

Gravity: Is it taking a toll on you?

There is no escaping gravity, in fact it is the one constant thing that never changes on this earth! It doesn't matter if you sit, stand, walk, run, play sport or are sedentary .... It is a constant 9.8m/s2 and it does not have favorites. In the world of gravity we are all equal to its pulling effects. If it weren't for gravity we wouldn't be grounded -- we would be free floating heavenly bodies--- no we are not fallen angels!!

Dr. Carolyn Richardson from Queensland Australia is one of the pioneers in research of gravity and the muscular system. She and her team have been well published as her research is scientific and sound. She has coined the term GRMC or Gravity Related Medical Conditions.... You can read more in her book at www.gravityfit.com. I've been a fan of her research for over 15 years and it has served as a keystone in my clinical practice in NYC. As you know I am in the business of pain and gravity keeps me very busy! 

Then why do I hurt and others don't  --- if you are thinking this then you must  read on to get an inside view on pain. I say these two things to every patient of mine "If YOU don't have a good relationship with gravity your body will breakdown" and "Better the relationship, the better the quality of life".

Let me explain!

Gravity has a pulling effect on you and if your muscles don't respond to that pull you will fall flat to the ground. To avoid that, your muscles offer gravity a counter pull via core muscles and anti-gravity muscles to keep you upright.

Balance of reaction forces between gravity and muscles = all well. 

Imbalance = all hell

It's that simple Really.

Our "jungle life" allowed us to closely interact with gravity as we climbed, rolled, stood, walked, and jumped --- all things that tone activate rejuvenate the core and anti-gravity system. It uses our sensory tactile system to send messages to our body to perform and thrive. Our "urban life" causes us to sit and the static predictable nature of a computer screen desensitized our sensory system to movement. Yes we don't move for over eight hours a day and counting.

In the same way we recharge our cell phones every night for using it during the day..... prolonged sitting posture discharges sensory awareness when sitting at a computer. Yes sitting reduces tone in the core and anti-gravity muscles --- making your body use phasic muscles to do the job which leads to breakdown and eventually pain.

We were meant to move; not sit for prolonged periods of time. If we don't move often or are not aware of how we sit --- breakdown happens within the gravity relationship causing pain.

To avoid GRMCs finding a balance between all the static postures and constant movement is optimal and important. It can be taught and learnt just like any other skill be it a language, cooking or art.

I can do that! Come to Duffy & Bracken and let me reacquaint you with Gravity!

Renuka Pinto, MPT, PGDR, CSCS, CES
Duffy & Bracken Physical Therapy Director
renuka@duffyandbracken.com

The Power of Manual Therapy

Physical Therapists (PTs) use a number of different strategies to help restore an ailing client’s functionality. The three most popular restorative propellers are: manual techniques, modalities, and exercises. These three treatment resources are commonly combined into some fashion that aide in physical rehabilitation. As a passionate physical therapist, certain distinct things being practiced often bother me. For starters, it BLOWS my mind when a new client comes into my office for an evaluation with me, and tells me that they were treated in a previous PT facility that did little to no manual therapy. It also BLOWS my mind when referring medical doctors (MD’s) have prior conversations with patients strongly advocating the use of modalities as a major component in restoring functionality. Great… Thanks to that and their status on the hierarchy of the medical system, a nescient patient is now brain-washed into believing a passive, non-cerebral object is going to bring him/her to fame. Furthermore, I now have the pleasurable responsibility to try to convince otherwise; which, is more often than not, an impossible task. Concisely, manual therapy (hands-on treatment) is the driving force behind healing in physical rehabilitation. Simple.

Before I indulge in discussion about the preeminence of manual techniques, let’s define the term. Manual therapy can be defined as all the hands-on techniques that help reduce pain, increase mobility, increase muscle firing, increase strength, facilitate movement, increase function, decrease edema and/or reset or re-align anatomical segments. These techniques are provided by healthcare professionals in rehab such as: physical therapists, occupational therapists, chiropractors, osteopaths and the like. Manual therapy techniques include: joint mobilizations, soft tissue manipulations, deep tissue massages, rolfing, passive muscle stretching, muscle energy techniques, and proprioceptive neuromuscular facilitation to name a few. There are multiple reasons for the administration of manual treatment; moreover, the importance of manual work with injured patients is extensive.

For starters, it allows for an objective feel of the soft or bony tissue by the treating clinician. Clinicians can get an overall assessment of the static quality of the palpated tissues, as well as, the dynamic quantity and quality of movement. Moreover, certain manual techniques can deliver soothing sensations, which help patients feel better and puts them at ease. Most importantly, manual therapy can shorten the injured party’s convalescence by directly targeting the problematic source. Manual techniques can help a client move better, move faster, and restore proper movement mechanics by increasing a patient’s range of motion in a specific joint.

On the other-hand, modalities are therapeutic agents, or machines mostly powered by electricity, that are designed to contribute to healing. These modalities include: electrical stimulation, moist heat, ice packs, ultrasound and the like. The inherent problem is that there is currently little to no scientific evidence in medical literature that advocate the rehabilitative efficacy of these said modalities.

Hands on techniques help develop a successful therapeutic relationship, which I’ll blog about on my next post. In my everyday practice, I employ hands-on techniques, and have developed great bonds with my clients. The fact of the matter is that the patient/client has to first trust you to allow you to touch them. It drives down insecurities and helps not only the physical rehabilitation process, but the never negligible mental rehabilitation process as well. Injury takes a toll on people’s body and psyche often equally. The warmness of your heart can be felt through your hands.


Bottom line: Passive modalities do NOT suffice. I know we are in the information age, and the trend is to believe that nearly all machines nowadays can take the place of humans, but this is not true for physical rehabilitation. For all patients and physical rehab clinicians out there, please know that the best way to tackle the issues head-on is hands-on.

 Clifford Civil, PT, DPT, ACSM-HFS

Six Reasons to See a Pelvic Floor Physical Therapist Postpartum

Having a baby is a joyful and fulfilling experience but also can take a heavy toll on your body. Growing and carrying a baby for nine months followed by delivery might cause new aches and pains that a Pelvic Floor Physical Therapist can help you address. 

Here are six reasons you may need to see a Pelvic Floor Physical Therapist postpartum

1.      Musculoskeletal pain

-          Growing and carrying a baby for 9 months really can take a toll on our musculoskeletal system. Some common postpartum issues include: tight hip flexors, poorly activating abdominal muscles, low back pain and instability through the pelvis.

2.      Weak Pelvic Floor Muscles (PFM)

-          Pelvic floor weakness can lead to symptoms such as poor or weak orgasm, urine leakage and/or a feeling of “falling out” vaginally.

3.      Prolapse

-          “falling down” or “downward displacement” of the bladder, uterus and/or rectum

-          This can happen in varying degrees and symptoms can include “falling out” feeling vaginally or even vaginal tissue extending externally.

4.      Diastasis Recti

-          The separation of rectus abdominis muscle which can happen during pregnancy.

-          You might notice you have this if you attempt to do a crunch and see a half football shaped bulge vertically on your stomach.

5.      Incontinence

-          Urine leakage, a common compliant post-partum, is another reason to see us!

-          Prolapse, weak PFM and poor neuromuscular control of PFM can all cause this annoying symptom.

6.      Scar sensitivity

-          A sensitive scar can be the cause of painful intercourse, can limit your ability to perform a kegel and/or can cause tension in pelvic floor muscles leaving you with pain.

We, at Duffy &Bracken PT, have the skill set and tools to help you feel like yourself again. We use biofeedback equipment to measure pelvic floor muscle strength, manual skills to treat pain and our skill and experience to teach and encourage you along the way. Let’s not forget what our bodies went through over the last nine months! We need to take care of ourselves and be proactive about our health and wellness; after all we are now responsible for a little one. See you soon!



Candice Amat, PT, DPT

Battle Your Hormonal Shifts By Simply Breathing!

My mother was a wise woman who passed down self-help techniques to me, as her mother did to her. She was born in 1923 and her mother in 1903, in times with very little preventative care or self-help books available. One of the things I didn't quite understand was her advice during my menstrual cycle. She said things like don’t drink or touch plants while I had my menses because it wasn't good for the plants?? I'm not a horticulturist and I don't know if there is any validity to the plant thing but she was basically saying your body composition is different when you have your period. The plants know it and they don't like it. The drinking thing -- well that’s the last thing you need with everything going on.

It's incredible what women have to put up with. Think about it, we menstruate every month! That's 2,400 days over 40 years and that’s if it were only 5 days a month but this process seems to affect us all the time, in one way or another. When I asked my mother why, she told me the story of Adam and Eve. So, is it all Eve's fault? Well I thought I would explain a little more of what’s really going on in your body while you go through hormonal shifts and the lining of your uterus sheds.

In the first 14 days, estrogen levels are higher and there is a rise in carbon dioxide (CO2). Global warming is going on inside your body for 2 weeks a month! During the second 14 days, progesterone levels are higher and there is a decrease in CO2. So we're more oxygenated during this time and this can really turn on the gas and our super human powers. A quote from Ginger Rogers comes to mind, "I did everything that Fred Astaire did but backwards and with heels on." Give yourself a pat on the back and a break when you're not at your peak and power it on when you are!

So how does carbon dioxide affect us? CO2 determines the acidity in our body. All metabolic function is reliant on acid base balance. Increased CO2 affects the excitability of our nervous system. Our muscles are hyper-irritable, pupils dilate, extremities are cold and there is an increase in sweat. CO2 is regulated by breathing… so breathe! The loss of CO2 during hyperventilation and shallow breathing affects blood flow to the brain, hands and feet. Hyperventilation can also affect memory, digestion, absorption of food, coordination and ambulation .

So it’s no wonder you've been feeling like Dr. Jekyll and Mr. Hyde. Breathing can produce amazing results by relaxing us. It relaxes muscles and helps with pain particularly back pain. I have even breathed out Migraines and heard testimony from others who have done the same. It makes sense to practice this all the time especially during your menses. So now we know the importance of carbon dioxide and breathing, let’s learn how to breathe more effectively. Here are some breathing tips to help you relax.

You need to breath with your diaphragm. Imagine the rib cage being a barrel. The ribs are the sides and the diaphragm is the bottom. You can feel your diaphragm by pressing your fingers up into the bottom of the drum. As you breathe in, your diaphragm will lower and your belly will balloon and expand out. You should feel your breath expanding the sides of the drum all around- out your back, sides and front as your diaphragm drops and your abdomen expands. Your abdomen should be soft and relaxed so it can relax and expand as you breathe. Your pelvic floor muscle moves down with your diaphragm. Diaphragmatic breathing stimulates the parasympathetic portion of the nervous which will help calm down your muscles, nerves and you. Practice your breathing exercises every hour or anytime you need to calm your body or mind. 

Physical Therapists can teach you techniques to help you learn how to help yourself. Women are very powerful beings and we can heal ourselves if we give ourselves the right environment to do so. I encourage you to learn how and let a physical therapist help.

Ann Duffy, Owner & Women's Health PT

Duffy & Bracken, PT

ann@duffyandbrackne.com

Health Insurance 101

It never fails to amaze me when I hear a patient talking about how much they hate their current insurance policy. “They are horrible” “They pay nothing” “It’s such a waste of money” “It’s so expensive each month”. These are just a few of the things I hear almost on a daily basis. At the end of the day it is your money that goes into your healthcare so why not take charge when it comes time for you to choose your healthcare policy.

For many people health insurance is something that is only utilized when they become sick. So what do people do? They go the inexpensive route. I will admit I too would look at the cheapest offer first. But what exactly are you getting out of it? Cheap is not always better and when it comes to your health, it shouldn’t be.

In this entry I hope to offer you some advice on deciding which policy to switch to.

What kind of policy do you need? When looking for a policy there is a variety of things that you want within the plan. Keep in mind who it is for; yourself, your spouse, your children. What specialties do you visit often? Are emergency room visits a priority?

Education. HMO, PPO, POS. They aren’t just letters associated with health insurances; they mean something. Take the time to learn what they mean because when deciding on your future policy they can either help or hinder you.

Research companies. Take initiative and read about the different kinds of insurances that are out there. There are a huge variety of them with both pros and cons. All insurance companies are not the same and do not offer the same benefits. If they did, there wouldn’t be so many to choose from. Read, call, and question everything you do not understand. Educating yourself will help you gain knowledge.

Network Status. There is nothing worse than coming for years to your favorite primary care doctor or specialist, only to find that your new insurance plan is no longer in network. Be proactive and find out what insurance your favorite medical providers accept to help you decide on a policy.

Get familiar with your out-of-pocket expense. So many times a patient is shocked to hear their co-payment amounts or how high their deductible is. When you are looking at your policy options you can also learn beforehand what these amounts will be. Often times an individual sees that they may have a high deductible then covered at 100% at a small monthly fee. Although you are saving money the downside of this is you are walking into your medical appointment and being told that you are paying your deductible and this amount is $100 per visit. Trust me, this has happened before and it won’t happen to you if you know what you’re looking for and educate yourself.

​The whole insurance ordeal can be tricky but taking charge can put you in the right place so that you won’t get trapped in a low allowable visit amount or high deductible policy.

Von Petteway
Duffy & Bracken Verification Specialist
vonceia@duffyandbracken.com