4. CHRONIC PAIN SUBSIDES Dartmouth Professor Describes His First PT Experience
6. THE STANDING DESK
7. NATURAL PAIN RELIEF with TURMERIC
Fad or Fundamental?
From the Spice Rack to the Medicine Cabinet
CIOFFREDI & ASSOCIATES THE INSTITUTE FOR HEALTH & HUMAN PERFORMANCE
3 “FLY GIRL” USA
TARA GERAGHTY-MOATS SOARS AGAIN AFTER INJURY
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CHRONIC PAIN SUBSIDES by Dr. Duane Compton
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SUCCESS STORIES Clients Share Their Cioffredi & Associates Stories
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WORKPLACE WELLBEING What & Why?
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DESK FITNESS
Avoid Stiffness with Easy Stretches and Exercises
CONCUSSIONPROOF
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USE YOUR HEAD Helmet Safety How-To’s and TBI Awareness
MOVEMENT
FOR LIFE
NEW YEAR’S RESOLUTION CHALLENGES New Year’s resolutions: most of us make them, and many fade by the first few months or even weeks. In our work, throughout the year, our purpose is to help people achieve their goals. We track every client, and our percentages are pretty high on helping people hit their target. This kind of goal-setting practice has reached beyond my professional life, and while I don’t profess to have great wisdom on the topic, I can tell you what has worked for me personally. It’s pretty simple, and involves three steps.
BILLY CIOFFREDI, PT FOUNDER
1. Make your ‘resolution’ a specific goal that you can achieve. It’s something you can complete and is done. If your resolution is to exercise three times a week, that’s something you do— not an end result. What is your purpose with the exercise? For example, if you’d like to be able to spend a week exploring the coast with your grandkids in August or bike the Prouty in July, now you’ve created a purpose for exercising three times a week. When people come to us for help and we ask them what they want to accomplish with our treatment, oftentimes their response is something like, “reduce my pain and feel stronger.” While these kinds of responses are understandable, one of our first tasks is often to help the person identify the real purposes behind their goals (lifting their child without pain, carrying groceries, stacking firewood?). How will you know when you’ve achieved your goal? 2. Decide that you’re going to accomplish your goal. The keyword, decide, means commitment. If the goal is just to exercise three times each week, something may easily come up that interrupts this plan. Deciding that you’re going to walk that piece of coastline with your grandkids is different. Can you see? The more decisive you are, the more likely it is that you’ll be able to engage and handle the challenges that surely come up along the way. 3. Make a picture of the goal. I don’t mean a concept, I mean a real ‘photograph’ in your head (or maybe even on your fridge) where you see yourself completing this goal. The picture is concrete, and you can look at it anytime you need or want—weekly, daily, or more often. You can map it out into a series of short-term goals, but I haven’t found success without doing number 2 and number 3 emphatically. Editorial continues on page 2.
112 Etna Road • Lebanon, NH • 603-643-7788
EDITORIAL, Continued. I see two keys to this basic process. One, challenges will come up and you will have to persist. It may even throw off your timeframe to fully accomplish the goal. The second sounds contradictive, but is essential: You have to be able to take a loss. It’s what allows us freedom from compulsively having to achieve. You can’t be very decisive if every time something doesn’t go as planned you walk away carrying accumulated failure with you.
do the Traverse around the summer solstice to have enough daylight to complete it. I kept going, but one of my test hikes on the Franconia Ridge left me sore (and slow) enough that I knew it was unlikely I would hit my goal, and the attempt would carry a lot more risk. It’s a narrow window of time, and it was going to pass. So, I made a game out of completing the Traverse after I turned 60 (last
And if it doesn’t happen . . . just get going on the next thing. October), which would give me a year to prepare instead of a few months. I found other ways to exercise that allowed my hip pain to resolve, and I’m Make a serious effort, but don’t take yourself too seriously. This past year, I decided I would hike the Presidential Traverse in one day. That’s about a 20-mile hike with about 8,500 feet of elevation change in New Hampshire’s White Mountains. I set the goal and started training in April, using the Dartmouth stadium to sprint and walk the stairs. While I improved over six weeks, I also irritated my hip to the point that I had to stop training for a while. This was a real problem, because you need to
Thank You, Valley News Readers!
in better shape now than ever. There is this great picture in my head at the end of the trail, and there’s still plenty of time before the summer solstice. Best wishes for a happy, healthy New Year. Sincerely, Billy
Speaker Series Recap PHOTOS FROM OUR FALL EVENT We would like to thank everyone who attended the Institute’s Fall Speaker Series to hear “Carrying Sports Through Life.” We also extend our thanks to Daniel O’Rourke, MD, MS, MEd for sharing his time and expertise with the community. Dr. O’Rourke, a cardiologist and longtime Hanover Varsity Girls Basketball coach, teamed up with our own Billy Cioffredi, PT, to explore coaching for life lessons, ethics, and safety in youth sports.
2 | www.cioffredi.com
Movement for Life
TARA GERAGHTY-MOATS COMING BACK STRONG FOR TEAM USA
A broken ski binding caused a summer training accident in 2016 that grounded Ski Jumping National Champion and Team USA member Tara Geraghty-Moats with an elbow fracture. Back home in the Upper Valley, she trusted Cioffredi & Associates Physical Therapist Kate Leiser to help her get back into competition for a 2018 Olympic bid. Arms are critical for balance in ski jumping, and pain of any kind can cause an elite athlete like Tara to lose focus. In a sport where everything depends on a ten-second performance, focus is key. IN TARA’S WORDS... I was originally referred to Cioffredi & Associates in 2010 by my doctor, and at that time my doctor didn’t think ski jumping again was a possibility for me. Through a lot of hard work, paired with time, Kate helped me return first to biathlon and then to ski jumping. The relationship with a therapist is an extremely important factor for me. This fall I didn’t have time to waste getting to know someone and building trust with a new PT, regardless of how good they might be. I trusted that Kate would set reasonable limits and help me get back to action as soon as safely possible. I have an international career and a chance at the Olympic Team riding on my results this winter, so a speedy and quality recovery was essential. It’s such an honor to represent my country. I’ve had so much support from people; I hope I can make them proud, and enjoy the ride.
Hopefully by defying the rule of gravity I can inspire others to do things that they perceive as impossible too.
Tara worked with Kate Leiser, PT, DPT, OCS this fall to recover from a fracture and prepare for Olympic qualifying events in Park City. The two had worked together previously at Cioffredi & Associates in 2014 and 2015.
Did You Know? TARA GERAGHTY MOATS B. 1993, Lebanon, NH Hometown: West Fairlee, VT Longest Jump: 125 m. (410 ft.)—Park City, Utah
WOMEN’S SKI JUMPING While ski jumping has been an Olympic event since 1924 for men, and women have been ski jumping for 100 years, the 2014 Winter Games in Sochi, Russia marked the first time women would compete in Olympic Ski Jumping. The 2018 PyeongChang Winter Games will feature one jumping event for women (Normal Hill Competition), and three events for men. The games open on February 9, 2018.
Cioffredi.com/tara-soars 112 Etna Road • Lebanon, NH • 603-643-7788 | 3
My First Experience with Physical Therapy by Dr. Duane Compton Professor of Biochemistry and Cell Biology; Dean, Dartmouth Geisel School of Medicine My primary care physician referred me to Cioffredi & Associates for treatment of chronic pain and loss of motion and strength in my shoulder joints, and I’m very grateful that she did. This was the first time that I’ve experienced this type of joint problem. Thus, it was my first experience with physical therapy as a treatment program. Overall, my experience was outstanding and the results are quite impressive. Through a series of expertly guided and progressive stretching and strengthening exercises, I have full mobility in my shoulders and can now move without pain and no longer wake every night due to that pain.
I would recommend Cioffredi & Associates to anyone needing physical therapy for the following reasons. The staff were all very friendly and courteous. The front desk staff always greeted me cheerfully by name each time I arrived and there was never a long wait time to begin treatment at each appointment. The facilities are up to date and clean and tidy. They have a large array of apparatus for strength and stretching of any joint/muscle, and were always conscientious to ask me politely if I preferred a private room or would be comfortable
in the open gym (my first appointment was in a private room, but subsequently I chose the open gym). Scheduling my appointments was not difficult and they were accommodating of my schedule. I worked with three different therapists during the course of my appointments, and I found all three to be highly skilled and informed about the nature of my condition and the overall strategy needed for recovery. I also found no lapse in the continuity of my treatments from one appointment to the next on the occasions where a different therapist worked with me. The computer notes ensure that each therapist was well informed with where I was in the progression of treatment. The therapists were all courteous, polite, professional and skilled. I was carefully examined and evaluated at my first visit and informed that it would take approximately 8-10 weeks to resolve the condition. Being a novice at physical therapy treatment, I admit to being incredulous when this assertion was made. In retrospect, I now realize that these therapists are highly trained and can provide well-informed estimates for the time to recovery. I remained a bit skeptical until I started to feel real improvement and the chronic pain began to subside. Having completed treatments over
ten weeks, I have renewed sense of strength and stability in my shoulders and a regained sense of confidence in these joints. The therapists provided a combination of massage, stretching and strength building to areas of my back and shoulder. They carefully escalated the regime and added different elements each week as my strength improved. They clearly explained how to perform the exercises so that I could continue them at home. Moreover, they were flexible in their approach and were always willing to discuss modifications to exercises if I expressed some sense of discomfort or concern as we tested them out during an appointment. They pushed me to progress in a controlled manner and never extended me beyond my limits. Overall, I am very satisfied with my treatment experience at Cioffredi & Associates, and I am pleased with my outcome. I would not hesitate to return to them if I ever needed physical therapy treatment again in the future and I would not hesitate to recommend them to someone else in need of physical therapy.
MEDICALLY BASED PERSONAL TRAINING “Adam is helping me gain stability in my low back so I can get back to activities I love.” - Jen Rybeck-Houde
More Client Success Stories
Cioffredi.com/Success 4 | www.cioffredi.com
Client Success Stories
IN THEIR OWN WORDS
“Coming to PT/OT allowed me to understand what was happening with my symptoms, and how to prevent them by exercises and positioning. I had to unlearn poor positioning and will now be able to continue playing music without symptoms.” - E. M.
HOLISTIC APPROACH TO INJURY REHAB “I came into Cioffredi’s with a foot injury that just approach that I think that sets Cioffredi’s apart. wasn’t resolving on its own. I met with Anna and I feel as if I have been set up for success better instead of just treating the immediate symptoms, than I would if they just focused on fixing the she highlighted important imbalances and injury. Even when I would experience moments of inflexibilities that were contributing to the lingering uncertainty or discouragement, Anna was quick pain. She focused on both healing the injury and to reassure that I was still on the right path and improving my mobility. As we progressed with my would emphasize working on my concern for treatments and I began to improve, Anna shifted that appointment. Even though I am happy that our focus to making sure my form was correct my injury is resolved, I will be sad to leave the while I was performing my athletic activities, great staff and atmosphere at Cioffredi’s!” so my pain would not come back and I could be less prone to additional injury. It is that holistic
- Emmaline Berg, Dartmouth ’14 Assistant Coach, UVM Track & Field
“Came in unable to walk, with considerable pain, using a cane. Two months later, functional with virtually no pain or restrictions. Big believer in the benefits of PT.” - Bill Samuels
PHYSICAL THERAPY & MASSAGE “I’ve regained most of the range of motion after two fractures in my upper arm and intensely knotted muscles all over the shoulder area. My physical therapist was very good at keeping me thinking positive and knew just when to push me to the next stage of exercises. The therapeutic massage provided synergistic help and sped up my recovery. I appreciated that the physical therapist and massage therapist coordinated closely with each other and always were on top of my case.” - Dr. Anne Kapuscinski Professor of Environmental Studies, Dartmouth College 112 Etna Road • Lebanon, NH • 603-643-7788 | 5
The Standing Desk FAD OR FUNDAMENTAL? by Anna Hinman, PT, DPT Certified Ergonomic Assessment Specialist
The ups and downs of this new office furniture (making its rise all over the Upper Valley).
Here are some of the benefits of a using standing desk: 1. Burn calories. Standing for an afternoon has been found to burn over 170 calories more than sitting. That’s almost 1000 calories a week!
Our bodies like to be in comfortable and relaxed positions, however those positions are not always the best for us. The real key is to move often so that your body isn’t stuck in 2. It may lower your blood sugar levels after a meal. A study of office workers showed that a harmful posture for too long. There is a great Anna demonstrates the Varidesk. standing for 180 minutes after a meal reduced deal of hype around standing desks, and it’s blood sugar levels by 43%. true that you can have just as many issues Adjustable height desks are available in many with standing for long periods as you do with 3. It may lower your risk of heart disease. It is styles and price points. There are a few options for thought that sitting for prolonged periods of sit-to-stand desks that can be very affordable for sitting. A sit-stand desk is what we recommend, because it allows you to vary your movement throughout the day, to keep your body from harmfully adapting to any single position.
time could increase your risk of heart disease by 147% compared to standing.
4. Reduces back and neck pain. A CDC study found a reduction in neck and back pain of 54% in 4 weeks with a sit-to-stand desk 5. Improvement in mood and energy level. Studies show less stress, less fatigue, and up to an 87% increase in vigor and energy. 6. Boost productivity. Having less fatigue and less pain, you are able to get more done throughout the day. 7. Could standing more throughout your day even make you live longer? Studies show that reducing sitting by three hours per day may extend your life two years (on average).
you or your employer. The Varidesk costs around $400. It is very easy to move from sitting to standing and back to sitting, however it is not very adjustable to a person’s specific measurements.
A more economical option is a Stand Steady desk which runs around $150. It is more adjustable to the employee’s height requirements but not as easy to move up and down from the standing to sitting positions. Along with changing positions throughout the day, small exercises to focus on posture like squeezing your shoulder blades together, stretching your chest in the doorway, tilting your head to the side, or lightly bending backwards or forwards in the chair or standing can all help to remind your muscles to do their job.
Learn More: www.Cioffredi.com/Workplace-Wellbeing
Workplace Wellbeing? A WIN-WIN FOR WORKERS AND EMPLOYERS Employees spend a considerable portion of their waking hours in the workplace. Worker health shouldn’t just be an off-duty concern. SIMPLE FACT: HEALTHY WORKERS ARE MORE PRODUCTIVE Along with fewer absences, a healthy workforce benefits an employer through improved morale, reduction in turnover, and lower healthcare costs. We consider that positive workplace wellbeing. Many of the chronic diseases and conditions that drive up individual and group health costs are largely preventable, such as heart disease, stroke, obesity, type 2 diabetes, arthritis, and even some forms of cancer. Encouraging employees to make healthier choices about diet and exercise through education, motivation, and support is a win-win for workers and employers alike. Employers can also maximize employee productivity and safety with prevention measures around workplace ergonomics. Ensuring that each worker is physically prepared for the work they’re responsible for doing, and providing a safe and appropriate environment in which to do it is key to preventing injury and containing associated healthcare and lost time costs. Everyone feels better about a healthy workplace. 6 | www.cioffredi.com
WORKPLACE WELLBEING
Top 5
• Health promotion education programming. • Wellness program activities and incentives. • Healthy food options available in the workplace. • Ergonomically sound workstations and processes. • Worker and facility safety policies and monitoring.
Natural Pain Relief with Turmeric FROM THE SPICE RACK TO THE MEDICINE CABINET: TURMERIC HAS POWERFUL ANTIOXIDANT AND ANTI-INFLAMMATORY PROPERTIES Turmeric has demonstrated anti-inflammatory and anticancer activities in lab studies, and research is ongoing to explore its potential to prevent and slow the spread of certain cancers. (Sources: Memorial Sloan Kettering Cancer Center, Mayo Clinic, National Institutes of Health) Turmeric is derived from the underground stems (rhizomes) of the Curcuma plant, a member of the ginger family. A well-known golden spice in Indian cuisine, it is responsible for the yellow color of curry dishes and also of American mustard. This knobby root is warming and slightly bitter, and its most active constituent, curcumin, has powerful antioxidant and anti-inflammatory properties. Many of us in the holistic wellness and whole health food professions have known for several years what many cultures have known for centuries of the numerous therapeutic benefits Turmeric yields, and now, this spice is steadily gaining popularity among those who want to benefit from its powerful properties, especially as an alternative to over-the-counter NSAIDs. Studies have discovered many conditions curcumin may help; below are just five.
Learn more at: www.Cioffredi.com/turmeric
GOLDEN MILK (Turmeric Tea)
TOP 5 HEALTH BENEFITS • Anti-Inflammatory (internal & joint/muscle & acute injury) • Help in Reducing Pain • Anti-Cancer Properties • Gut Health – from aiding with digestion to helping repair damage and calm inflammatory conditions like IBD and colitis. • Skin – can speed up wound healing, reduce psoriasis flares, calm pores, and decrease acne.
WAYS TO GET THE BENEFITS • Cook with it! No need to limit to curry dishes; add to soups, vegetables, and spice rubs for meat. • Add it to smoothies, or make turmeric tea (see sidebar for Golden Milk recipe). • Best Way? Take it via tincture or supplement capsules as directed.
MOST IMPORANT (AND MISSING) TIP
Gently heat: 1 – 1.5 cups plant-based milk such as coconut, almond, rice, or ‘Ripple’ (pea protein). We like to use a combination. 1 rounded teaspoon ground turmeric -or- 1 tablespoon peeled, grated fresh turmeric. 1 – 2 slices of fresh ginger. A couple cranks of freshly ground pepper (to flip the therapeutic switch!) Pinch of cayenne pepper (optional). Pinch of non-processed salt (Try Himalayan Pink Salt, for example). Raw, local honey to taste.
Add black pepper to flip the therapeutic switch. The compound piperine (Piper Nigrum L, trademark name “BioPerine”) in black pepper boosts the absorption of curcumin in turmeric by 2,000% and together is a powerhouse of anti-oxidant and anti-inflammatory properties. If you’re considering adding Turmeric in supplement form, be sure it includes piperine/BioPerine.
Strain before serving.
**NOTE** As always, check with a medical professional before adding a supplement, especially if you take regular prescription or over-the-counter medicines, supplements or herbs. Possible interactions include blood-thinning medications, acid reducers, and drugs for diabetes. Visit our website for a link to additional information about interactions.
DESK FITNESS STAY FIT WHILE YOU SIT: SIMPLE STRETCHES Our bodies weren’t designed to stay seated for long periods of time, and so it’s important to break up your seat time with movements that loosen and elongate your muscles and connective tissues. To prevent injury, don’t stay in the same position at your desk for more than 30 minutes without a movement break, and if you’re stuck in your seat try these PTapproved chair stretches. Breathe deeply while you do them, and drink lots of water throughout the day. If these movements are painful, take it slow and consider scheduling a consultation with one of our movement specialists.
Learn more: Cioffredi.com/Desk 112 Etna Road • Lebanon, NH • 603-643-7788 | 7
CONCUSSION IS BRAIN INJURY
While there is no concussion-proof helmet, wearing the right helmet can protect you from a serious brain or head injury. Helmets were originally designed as a shell, mainly to prevent skull fractures. Manufacturers and medical professionals have worked together in recent years to engineer lining systems within the shell that can help absorb and redirect the forces of impact in order to lessen risk of concussion. Ask your helmet retailer about these systems, and plan to invest in a good quality helmet. The Centers for Disease Control (CDC) publishes helmet guides for every sport, which you can access from cdc.gov or on our website:
Cioffredi.com/helmethead
A concussion is a mild form of traumatic brain injury that generally resolves quickly. It is caused by a blow or bump to the head or body. It’s important to note that it doesn’t always have to be a major collision for a concussion to occur, nor does it always come with a loss of consciousness. If you suspect a concussion, you should seek immediate medical attention. Rehab for concussion is managed in a very specific sequence, allowing time for the brain to fully recover. If not properly managed, you can experience post-concussive symptoms for months, limiting your ability to concentrate, read, or even watch TV.
RETURN TO ACTIVITY PROTOCOL Initial focus of rehab is on relieving symptoms of dizziness, headache, loss of balance and coordination. Once these symptoms are gone, a strict return to activity protocol is followed. If at any point in the protocol the person’s symptoms return, this is a sign that their brain is not ready, and the progression needs to be modified. NOTE: Both the State of New Hampshire and the State of Vermont require sign off by a qualified healthcare professional to return to sport, and this is something that we are able to provide after the rehab process is complete.
LEARN QIGONG
Saturday Mornings 9:00 to 10:30 a.m. with Peter Payne This ancient mind-body movement practice helps prevent injury, speed healing, and enhances endurance, coordination, and performance. The practice also helps you learn to release tension and balance emotions.
Cioffredi.com/Qigong • 603-643-7788 PHYSICAL & OCCUPATIONAL THERAPY | MASSAGE THERAPY | MEDICALLY BASED PERSONAL TRAINING HEALTH COACHING | NUTRITION COUNSELING
“When initially referred by my PCP for physical
P. O. BOX 727 | 112 ETNA ROAD | LEBANON, NH 03766-0727 603-643-7788 | CIOFFREDI.COM
MOVEMENT FOR LIFE www.cioffredi.com
therapy, I was truly skeptical and less than enthused about the time commitment involved. I am now a true “born again” believer in the entire process. [Physical Therapist] Emily Milbank has not only treated my physical problem but has also educated me on some of my lifelong problems and behaviors that have contributed to my physical breakdown. I now know enough about my posture, stretching and exercises to avoid future problems or head them off before they get worse. Thanks, Emily!!”