By Dr. Shara Labelson, DPT, CEAS
2020 has certainly had its challenges. My year began with a death in the family, leading to a diagnosis of “acute thyroiditis.” Just as I was getting my energy back, NYC got devastated by COVID-19 and a global pandemic. With New York shut down, and my move to all telehealth, I found more time to spend on my trusty friend, my bicycle. Why not make the best of an otherwise unfortunate circumstance?
Typically, in March, my bike racing season starts. That means, from January on, a program of very structured training including 4am wake ups to get on the bike for leg and lung busting workouts before work. I had no idea how I was going to be in shape to race after my thyroiditis, but as all racing got canceled, and cycling stayed an essential activity, I began to increase my miles and focus on my overall health and not just race shape.
The first thing I wanted to focus on was proper sleep. During sleep is when our body recovers and repairs to be ready for the next day. It is important for cognition, concentration, problem solving, reaction time, and overall performance (mentally and physically). On the flip side, poor sleep has been found to be correlated with an increased risk of type 2 diabetes, heart disease, depression and stroke.
The next item on my list was diet. With time to regularly go grocery shopping and cook proper meals at home, I wanted to make sure that I was eating a proper balance of fruits, vegetables, whole grains, healthy fats and lean protein. I had to make sure my body had the proper fuel for my daily rides. You cannot run your car on an empty gas tank. (It seems you also can’t take away my nightly ice cream fix though)
As a physical therapist, I always try to practice what I preach. I educate patients on the importance of stretching and strengthening in order to prevent injury. The most common injuries from cycling are tendinitis of the hamstring, quadriceps, and Achilles tendons and neck and low back pains. Some of these issues can be resolved with a proper bike fit. A saddle being even a few millimeters too high, low, forward, back, can lead to pain after miles of pedaling.
If the bike is not the issue, we must look at imbalances within ourselves. I began to pull out my yoga mat in the living room daily to foam roll and stretch my quads, hamstrings, calves and especially my tight hip rotators. With an increase in sitting during COVID, keeping the pliability of these muscles has become even more paramount. I also concentrated on trying to even out the strength imbalance between my right and left legs. Exercises for this included single leg bridging, clamshells and reverse clamshells, Bulgarian split squats and single leg calf raises.
To stave off back and neck pain from the increased miles being bent over on my bike and sitting in front of the computer, I challenged my friends to a plank challenge and added on other posture exercises including wall angels, shoulder external rotation with bands, and prone scapular stabilizations exercises.
Heading into fall, I was feeling like I was in the best shape of my life! I took a trip to the Catskills (not quite the Dolomites that I was planning for this summer to celebrate my birthday) to conquer a few mountain passes with some riding comrades who prefer the hills WAY more than I do. As a racer that usually competes in flat, sprint type races, this was quite the accomplishment. I did not have my companions waiting too long for me even at the top of the last over 4-mile climb with an elevation of 1,624 feet and gradients over 20% as we neared the summit.
Now you ask, the title of this is “Advice from an injured bike racer,” so what happened? And after all of this if she is injured why should we listen to her? There is one BIG variable that you cannot account for in cycling. What happens when you do not, as we say, stay rubber side down? Two weeks ago today, I was out riding and enjoying the sun on my face and wind through my helmet vents, when, as I crossed an intersection an 18 year old driver decided that he was going to make a right turn, cutting me off and knocking me off of my bike. Of all the possible outcomes in this scenario, I am happy to be writing this with left arm in a sling after only suffering a separated acromioclavicular joint and slightly sprained wrist.
So I guess the moral of the story is stay as healthy as you can to prevent injury, but sometimes stuff happens and when it does, being otherwise in good shape, will help you return to sport as fast as possible. I will end up with a bump on my shoulder that will slow me down for a few weeks, but I’ll be back!
In case this topic is of personal interest to you or someone you know, H&D is pleased to share that we are hosting a free webinar titled: Biomechanics of Cycling; How to stay pain-free on your bicycle.
During the pandemic, New York City saw over a 60% increase in bicycle ridership. Bike shops were deemed an essential service as the city shut down. However, as riders biked more miles than ever before, there was an increase in cycling-related repetitive strain injuries. Join Dr. Mark Klion, MD, orthopedic surgeon, Medical Director of the NYC triathlon and multiple time Ironman, and Doctor of Physical Therapy, Shara Labelson, DPT, CEAS, for an informative webinar to learn more about a sport they are both passionate about. They will discuss the biomechanics of cycling, the importance of proper bike fit, common cycling injuries (how to avoid them!) and what to do if you are experiencing pain.
This webinar will be hosted on Tuesday, September 15th, from 5pm – 6pm — space is limited. Please Register by Clicking HERE.
~By Michelle Troiano, PT, DPT
Physical Therapy through Zoom may not seem like it would be helpful to figure out how to fix those aches and pains, but it has proven to be as effective as going to a clinic. Multiple studies have analyzed the benefits of teletherapy for patients with musculoskeletal pain, including post-op, chronic back pain, and arthritis, and found real-time telerehabilitation to be comparable to standard practice with high satisfaction rates.
When you schedule an initial evaluation with a licensed therapist, you can expect a thorough examination starting with a history of your problem areas and visual examination. This can include assessing for range of motion, strength, balance, and form with functional movements. After identifying your individual needs and determining a proper diagnosis, you will be taken through a series of self-treatment techniques and prescriptive exercises tailored specifically for you with the guidance of your therapist at every step of the way. Through video, the therapist can modify your movement patterns, answer questions, and provide proper instruction without even having to leave the house. No equipment necessary, just the creativity of using household items to assist in your rehabilitation.
Want to see the research, no problem, click HERE, HERE, and HERE!
If you are interested in scheduling an appointment for telehealth, please click on the button below.
~ H&D Physical Therapy presents ~
Alternatives to Surgery;
Regenerative Medicine in 2020
Elective surgeries have re-emerged under the current COVID-19 landscape. However, many patients are turning towards non-operative procedures to alleviate their pain. New research in the field of regenerative medicine using prolotherapy, platelet rich plasma (PRP), and stem-cell injections has revealed very promising outcomes. Join Dr. Gregory Lutz, MD and Dr. Mairin Jerome, MD, of Regenerative SportsCare Institute (RSI) as they explore the growing field of Regenerative Orthopedic Medicine. Topics will include an overview of the approach to patient care at RSI, as well as treatments for specific cases related to the spine, hip and pelvic pain.
Tuesday, August 4th
5pm – 6pm
Dr. Gregory Lutz, MD
Hospital for Special Surgery
Dr. Mairin Jerome, MD
Live Webinar limited to the first 100 attendees. Reserve your spot today!
We are pleased to share our updated library on YouTube, filled with patient experiences, testimonials, walkthroughs, helpful health tips, wellness advice, workouts, and fitness tips. Today, we’re sharing this playlist featuring all of our exercise oriented videos.
Please remember, if you’re attempting to try any of these as an address to your health — the right pairing of motion to syndrome should cause fairly quick resolution. If you’re not getting the anticipated results, you just might need one of our provider’s to take a look and hear out your story on how you got here in the first place.
First & foremost, we would like to extend our most sincere wishes to you, your families and loved ones that you are safe and healthy, and are making it through this crisis without too much hardship. Fortunately, the staff at H & D Physical & Occupational Therapy are healthy at this time. Since the onset of “shelter in place”, we have been offering significantly reduced office hours supplemented by Home Visits and our New TeleHealth and TeleWellness services. Given that NY State Department of Health considers PT’s and OT’s to be an essential service and more of us are ready to return to work, we will be gradually expanding our office hours and reopening all of our offices. This will be for patients who require our services in person and are comfortable coming to and returning to the offices.
We are reopening our Midtown office and expanding staffing and hours at our 88th St and Yorkville offices on Monday May 18, 2020. We would like to make you aware of the following precautionary procedures that have been instituted to ensure everyone’s safety. Given the ever changing nature of this situation, certain aspects of these protocols may change over time.
In accordance with New York State Department of Health laws, everyone who enters the office will be required to wear a face mask. Our entire staff will also be donning face masks.
We will provide hand sanitizer to everyone who enters the office, and will require each individual to thoroughly wash and/or sanitize hands upon entry.
We will take the temperature of every individual entering the office utilizing a no-touch infrared thermometer. If an individual is found to have a temperature above 99.6 F, s/he will be asked to reschedule their appointment for another time and be instructed to contact their primary care physician (PCP).
We will observe recommendations for physical distancing by spacing out appointments to avoid having more than 1 or 2 patients in the waiting area at any time (depending on which office you go to). Following initial screening, you will be escorted to a private room or the gym depending on individualized treatment and/or therapist.
We will observe all recommendations for infection control regarding the cleaning procedures of all surfaces that patients and therapists come in contact with.
We request that you attend your visits alone. We recognize that there may be situations when this is not possible. If that is the case, we request that you inform us at the time you are scheduling your appointment. We will address each circumstance on an individual basis. The assessment will be done by our clinical policy and procedure team which has been set up in advance to address these type of issues.
In summary, our COVID-19 safety protocols are as follows:
- Prioritizing Cleanliness: All rooms and high touch areas will be disinfected frequently. Disinfectants, hand sanitizer, and related supplies will be available to staff and patients at all times. Staff will open doors for all patients, and wash hands between each patient interaction.
- No ‘waiting rooms’: Patients will be asked to arrive when it is time for their appointment to avoid waiting.
- Staggered Appointments: We will be staggering the appointments to ensure adequate time to wipe down spaces in order to maintain a safe and clean environment.
- Screenings: We will be screening patients over the phone and at the time of their appointment to ensure they are healthy.
- Reduced & Healthy Staff: Any of our staff who can work virtually will be working outside of the office, and all staff will be screened daily to ensure they are healthy.
- Protective Equipment: Our staff and patients with appointments will wear a mask and gloves at all times. We ask that all patients come to their appointment with a mask!
If you have any questions concerning the information contained in this correspondence, please feel free to contact us at anytime. Thank you for your cooperation in these matters. We really have missed and look forward to seeing you when you feel safe in returning!
Entire Staff of H & D Physical & Occupational Therapy
Dizziness, imbalance, and falls are a significant problem for older adults and one of the most common reasons for hospitalizations or visits to the doctor. Here are some statistics:
- Every 20 minutes, an older adult dies from a fall
- 1 in 4 older adults report falls with 24% of those requiring medical treatment
- Less than half of older adults who fall talk to their physician about it with men being less likely to report falls than women
Despite these harrowing statistics, falling is thankfully not just a symptom of getting older. Dizziness, imbalance, and falls are not considered to be a normal part of aging, and in fact, usually indicate there may be problems affecting the balance systems. Your balance relies on three senses: vision (eyes), proprioception (sensors in the feet and legs), and the vestibular system (inner ear). The brain interprets this information and sends messages to your eyes, feet, and other parts of your body to maintain balance and focus. Dizziness, imbalance, and falls may signal these systems are not working correctly.
Falls may be directly linked to malfunctioning of one or more of these balance systems. Risk factors for falls include vestibular disorders, home hazards, vision impairment, foot/ankle disorders, vitamin D deficiency, certain medications, and orthostatic hypotension (a type of low blood pressure which occurs after standing up from sitting or lying down). Fall prevention strategies are usually aimed at addressing one or more of these risk factors.
Exercise is an extremely useful tool to help prevent falls, however, not all exercise is considered the same. An exercise routine should focus on training strength, endurance, flexibility, and balance in order to reap the full benefits of exercise relating to fall risk reduction. Tai Chi, originally conceived as a martial art, is another exercise which has been shown to reduce falls and fall risk. It combines breathing exercises, deliberate movements, controlled weight shifting, and meditation.
It is recommended to see a physical therapist if you feel like you are having problems with balance. A physical therapist will perform a comprehensive assessment of your balance and risk for experiencing a fall while providing balance training and prescribe exercises specifically tailored to your deficits. A vestibular physical therapist specializes in evaluating and treating patients with balance and dizziness disorders and may provide additional resources.
Imbalance, falling, and dizziness are not considered a regular part of getting older and usually indicate there may be problems with your balance systems. It is recommended to take action if you are experiencing these symptoms: talk to your doctor or physical therapist and exercise! H&D Physical Therapy provides physical therapy, vestibular rehabilitation, and wellness services aimed at improving balance and reducing risk for falls.
Bradley, S. M. (2011). Falls in older adults. Mount Sinai Journal of Medicine, 78, 590-595.
Falls are a major threat for your patients (fact sheet). STEADI. Centers for Disease Control and Prevention. https://www.cdc.gov/steadi/pdf/STEADI-FactSheet-MajorThreat-508.pdf
Horak, F. Role of the vestibular system in postural control. Vestibular Rehabilitation. Herdman, S. 3rd Edition. F.A. Davis Company, 2007, Philadelphia: 32-53.
Take steps to prevent older adult falls (fact sheet). STEADI. Centers for Disease Control and Prevention. https://www.cdc.gov/steadi/pdf/STEADI_ClinicianFactSheet-a.pdf
Meditation: You have probably read or heard that modern science continues to confirm the substantial benefits of meditation.
Harvard has confirmed what has been taught for thousands of years:
Meditation reduces stress
Fosters clear thinking
Increases our capacity for empathy and compassion
On a physical level, meditation:
Lowers high blood pressure
Lowers the levels of blood lactate, reducing anxiety attacks
Decreases tension-related pain, such as, tension headaches, ulcers, insomnia, muscle and joint problems
Increases serotonin production that improves mood and behavior
Improves the immune system
Increases the energy level, as you gain an inner source of energy
With regular practice of meditation:
Emotional stability improves
Clarity and peace of mind is gained
Problems become smaller
Meditation sharpens the mind by increasing focus and expands through relaxation.
A sharp mind without expansion causes tension, anger and frustration
An expanded consciousness without sharpness can lead to lack of action/progress
The balance of a sharp mind and an expanded consciousness brings perfection
You can try this simple technique to begin enjoying the benefits of meditation yourself:
Find a comfortable position with your back easy and straight.
Support your back with pillows if you need to.
Your hands should rest easily.
Place a comfortable smile on your face and breathe in filling your belly first for 4 seconds, hold your breath 5 seconds and exhale for 6 seconds.
Start with anywhere from 5 to 10 to 15 minutes, choose an amount of time that you will do, just get started!
Other meditation options:
Meditation Vexations and Advice
Monkey Mind? It is completely natural for your mind to wiggle and wander, (meditation/focus is a skill like any exercise. Your mind will likely try to fill the silence/recovery you are creating). It will probably bounce around, – like a monkey. Don’t be upset or discouraged, just notice and let it go, without urgency or judgement, return to your orienting activity.
Start with an easily “doable” time, 10 mins? Any amount of time is better than none!!
If you don’t feel anything profound, if you feel you didn’t do well, it’s still good! Suspend judgement!
Environment: It is easiest to be in a quiet space as you introduce yourself to practicing meditation
Food: Generally we are encouraged to do this when your stomach is not full
Power of 1+, meditating with another person or a group, however small increases the ambient feeling of peace, sometimes by and exponential amount
One writer said his practice was to do this in the morning: Drink a cup of coffee, meditate for 20 minutes. During that time the system is still able to relax, then physiologically, the caffeine kicks in and you are ready to go.
Keep your spine upright and neutral
Put a small smile only your face as the Buddha did. Physiological research backs this up, -endorphins!
You are doing something VERY positive for yourself!
Take notice of any positive, “salubrious” effects, mood, relaxation, mental alertness, creative ideas, or just rest and relaxation. With the investment of time and practice you will very likely begin to notice subtle changes in your response to stressful situations. This response will be amplified the more you practice and you will begin to notice the benefits listed above.
May the smile you practice become a smile of your relaxed and responsive body and soul.
*H&D offers Tai Chi classes which is “moving meditation”
There is a famous literary quote ascribed above the gates of Dante’s Inferno that reads as follows, “Abandon all hope, ye who enter here.” For those suffering under the imprisonment of chronic disability, whether it be of physical, mental, emotional, or social constraint, the burden of an unfulfilled life can feel at times to be just short of a living Hell. And all people, whether rich or poor, or famous or forgotten, will at some time in the marathon of life come across insurmountable hurdles that trip, bruise, and injure with a sense of ambivalent disconnect that seems as if the world itself is cruel and merciless. But the sun shines equally on the good and the bad alike, and not everyone hates a rainy day… so to some degree our imprisonment is partly due to our perspective. Right?
I have always admired the emotional stability of cats. Living in suburbia I frequently come across the curious happenings of the neighborhood alley cats. They are typically tough by nature, as can be expected, typical to the stereotype. They harbor all sorts of scars and scratches from earlier battles but still limp up to the stoop for a quick warm meal, bearing absolutely no trace of self pity for their maladies whatsoever. In fact, for those who own cats (or more appropriately – share a house with them) the lack of any observable distress or pain response in these animals can be an emotionally challenging experience for their owners. Cats will famously hop around on a broken leg and still fight for their right to lie on the spot they want to lie.
But cats are cats, and people are people. And cats are also mysteriously strange creatures…
For those inclined to the musings of philosophy and metaphysics to find “questions to their answers… to their questions,” there has always been a debate on suffering and the value of life. Is suffering inherent to growth in life, or does it detract from experiencing life more fully? There’s also the classically ambiguous question of self worth, ascribing value to what I can do for others versus who I am inside for me. An obvious cycle of never ending questions and answers can no more guide us toward our escape from disability, than distract us from the finality of the predicament we’re living.
Is life a forced predicament? Does a fish not swim in circles in a bowl without ever showing signs of withdrawal, or depression, or boredom? Please, I will not attempt to insult you with a reasonable comparison from a fish to a human being! But… how do you “reasonably” search for hope within a sealed room?
Houdini was made famous for escaping from the inside of a hermetically sealed metal vault. He was also known as a child to sleep very little and stare at space incessantly thinking. The point is that the escape was done, and can be done, realistically and without magic or delusion. Houdini was known for proudly debunking mystics and charlatans, claiming his tricks were simply the extreme end ranges of human ingenuity and incessant training. The key attribute here being “incessant,” that is never giving up and going on continually. Just imagine how long he would practice inside those vaults, running his fingers along the cracks and seams of the door, feeling the intricacies of the spindle-lock-mechanism, struggling to get some movement from it… some freedom from just a crack. Even his celebrated live escape could take up to an hour to finally experience!
Of course, very little is spoken of the locks Houdini could not pick, or of the one time he broke into a swearing rant from frustration and simply walked away.
Most everyone would agree that frustration, itself, is perhaps one of the worst, most disabling imprisonments of all, simply because we impose it on ourselves. There is nothing worse than scratching along the impenetrable surface of a brick wall that we put up in front of us. Even worse is the one sided brick wall, with no boundaries or corners to trap us in a corner. Sometimes we need to step back, evaluate ourselves and simply look at the big picture to find a solution. I personally have found in most, if not all cases, I need to reach out to someone “outside my head,” who can walk me around the wall from his or her unique perspective. The ultimate path to freedom was so natural and simple, but I could not see it standing from my solitary angle.
In the end, all types of people deal with their suffering in diverse and different ways. I just hope for your sake that it is not alone. And although it may sound cliche, remember that tomorrow is another day! And that where there is the sun and there is life, there is always hope!
The goal of attaining a “solid six pack,” “toned abdominals,” or “strong core” is incessantly peddled through the mass marketing engine of society’s fitness ideals. Billboards, TV commercials, online promotional products, and novelty gyms have all standardized the image of the perfect midsection, located just below the chest and at (or slightly above) the waistline of a glamorized human body. Even worse, the pseudo-medical term “core” is applied so casually to most every mainstream strengthening program that most people who believe they’re “working it” don’t even know what, in fact, they are actually working. Patients frequently ask me, “Where, or what, exactly is my core?”
The simple answer found on the bottom of a workout poster in the gym would read, “the muscles comprising the abdominal and lumbar regions, including the rectus and transverse abdominus, obliques, quadratus lumborum, paraspinals, etc, etc…” First of all, the phrase “strengthening the stomach” is, anatomically, a total misnomer. Our actual stomach is located just below the heart at the lowest border of the ribcage – thus the term “heartburn” for acid reflux is appropriately derived. What people actually mean by strengthening their “stomach” would more correctly apply to the region holding together the “sack” of roughly 25 feet of intertwined intestines and bowels, resting above the pelvic basin.
Relaxing the definition of “core” as beyond a distinct anatomical boundary, it is much easier to begin to understand a “center of structure,” or “framework of strength” when looking outside the typical exercise-type scenario. Take for example the explosive, tightly coiled posture of a rattlesnake ready to strike death in the fraction of a second…
Who could doubt the existence of the snake’s strength? Impossible! But where is the existence of its core? Certainly it is in there somewhere. Perhaps it’s in the abdomen (wherever that is), or maybe it’s in the alignment of its extra-elongated spine. Could the “true” core be in the abstract projection the animal’s body assumes and not in the physical bones at all?
Is shape alone evidence of structure? I won’t even tease upward levels of “core” abstraction with something like a jellyfish’s swirl! At least sticking with one species that we are most familiar with makes things a bit simpler. Take the woman pictured below in the ever famous, and always celebrated core-exercise pose… “the plank.”
A quick, yet obvious, examination of her poise will reveal she possesses at least adequate, if not excellent, core strength. The alignment of her shoulder joint is solid to the trunk of her body; the angles formed by her elbow and knees in relation to the ground are sharp and not sagging; even her eyes and face radiate a level of determination and “inner strength” that extend “deeper” than her six-pack sack of abdominal muscle two feet below. The “core” here is witnessed being far more than stomach anatomy, more than muscle itself — it is a frame of mind!
So what, where, how (or even when?) is the mysterious “core” actually defined?
Ironically, the purest, Latin definition of core as “that of the heart” lies closest to the truth. In Chinese medicine, the heart has two natures, physical and energetic. Aside from commanding the 5-6 liters of blood through every vessel of the body, it also shares an energetic relationship with the psyche, or the emotions of the soul. It is actually the center point or “core” of our character, the focus of our internal vision.
In the end, it is the “goal,” the “prize,” the “process” that we set ourselves upon, whether training in the gym or in life, that ultimately becomes our heart’s purest reveal… our truest core.
There is an unfortunate yet pervasive trend among some patients, and even practitioners, to speak of “fixing their problem,” versus “having themselves healed.” At first glance it doesn’t seem to be that important of a distinction; “fix” is more objective sounding, while “heal” is a bit more abstract, or mystic in contemporary jargon. One term typically applies to the recourse taken on a refrigerator or defunct transmission, the other to a human being. This semantic difference is, in almost all cases, an often innocent and benign mistake spoken out of desperation, convenience, or simply uncertainty. On rare occasion, however, it can be a more noxious indicator of a pernicious and highly difficult condition to treat… the case of “the patient that doesn’t want to help himself.”
In classical Chinese Medicine, physicians were esteemed not only by the potency of their medicines or the success of their treatments but by their ability to determine which patients were decidedly untreatable. One such legendary doctor, named Bian Que, lived almost 2,000 years ago and has been long revered for his ability to cure many difficult illnesses, and bring many hopeless cases back from the brink of death.
However, Dr. Que is also uniquely remembered for a case that he would not attempt to cure. His patient at the time was an arrogant, and robust king. The affluent man led an indulgent, selfish lifestyle, but also harbored a “hidden” illness that only the doctor could see. The king, reveling in his apparent good health and fortune, scoffed at Dr. Que and disregarded all opportunities to change his ways and undergo relatively simple treatment interventions. Finally, and all at once, the king became gravely and irreversibly ill. It was then, at this “untreatable” state, and in fear of the king’s delirious wrath, that Bian Que fled the royal palace and ran safely off into the woods.
Although many practitioners today would love to “run off into the woods” at the first sign of a troublesome patient, professional protocol and local State Law prevent such an amusing convenience. However, this true story does illustrate the importance of the patient’s “active” and working participation in the process of becoming better, that is… being healed.
Personally, I have learned through clinic experience that there is always hope in healing even the most difficult and “untreatable” conditions if the patient is of a positive and encouraged attitude. Likewise, how impossible it is to work with the opposite type of person, who condemns himself, or herself, at the onset of treatment, preferring instead unnecessary surgical approaches or other “passive” panaceas. Perhaps the inanimate, more lifeless term “fix” is here more appropriately resigned.
In contrast to our modern medical machine, the ancient system of patient and healer was without solicitation, salesmanship, or commercial bargaining on behalf of the doctor. These ancestral patients would “actively” seek out help for themselves by traveling far off the beaten path, and overcoming much hardship, to find and commit to a distinguished healer. Therefore, it is just as important for us today that we approach our own health and wellness with the same dedication and enthusiasm as those that have come before us.
So take charge of your body, reach out in the form of hope for active “healing,” surmount impossible obstacles and grasp upward with the desire to help yourself.