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MANHATTAN PT NEWS

4TH QUARTER 2009

Lower Manhattan Physical Therapy 40 Exchange Place, Ste. 1414 New York, NY 10005 212 425 1060 www.lowermanhattanpt.com

Yorkville Physical Therapy 210 East 86th Street Ste. 203 New York, NY 10028 212 249 0904 www.yorkvillept.com

Lewisboro Physical Therapy 890 Route 35, PO Box 104 Cross River, NY 10518 914 763 5941 www.lewisborophysicaltherapy.com

LOWER MANHATTAN PHYSICAL THERAPY is proud to announce the launch of our quarterly newsletter, Manhattan PT News. This complementary newsletter is designed to enhance our relationship with our patients, our referring physicians, and our New York community by providing you with: • Tools and resources to help you communicate with your patients about the benefits of physical therapy • Simple techniques to help your patients protect their strength, mobility and overall physical health • Information regarding recent developments in the fields of physical therapy, athletic training and personal training, massage therapy and strength and conditioning • Discussion about items that appear in media outlets. What is true, what is not; what is known, what is unknown, and what you and your patients can take away from the latest fad or magazine article • Information about our facilities and physical therapy staff to help you make informed decisions about including us as part of your patient care plan We hope that you find Manhattan PT News to be a valuable resource for your practice. If there are any topics you would like us to discuss in future issues please write to us at jim@yorkvillept.com. James Cavin PT, PES, CSCS Sean Waters PT


MANHATTAN PT NEWS

4TH QUARTER 2009

Lower Manhattan Physical Therapy 40 Exchange Place, Ste. 1414 New York, NY 10005 212 425 1060 www.lowermanhattanpt.com

Yorkville Physical Therapy 210 East 86th Street Ste. 203 New York, NY 10028 212 249 0904 www.yorkvillept.com

Lewisboro Physical Therapy 890 Route 35, PO Box 104 Cross River, NY 10518 914 763 5941 www.lewisborophysicaltherapy.com

WHY NEW YORK PHYSICIANS ARE CHOOSING LOWER MANHATTAN, YORKVILLE, AND LEWISBORO PHYSICAL THERAPY Our therapists have phenomenal backgrounds and emphasize individualized patient care. Our Physical Therapy staff are licensed in New York and undergo extensive continuing education to keep abreast of advancements in physical therapy techniques and research, in addition to new surgical technologies for orthopedic patients. We have developed strong relationships which are enhanced through well trained, caring employees with integrity and proactive approaches. We offer a variety of services to meet the needs of patients and referring physicians. We continually invest in our facilities to ensure that they remain among the most advanced in the New York area. To ensure that each service we provide stands on its own as a pillar of excellence, we have selected each staff member from among the very best in the state. We are confident you will discover that every member of our team possesses considerable education, experience and talent, as well as a pleasant and personal approach to working with patients. As a company, our vision is to make our clients into a mirror we view ourselves in. We created this vision with one goal in mind, customer satisfaction.

THERAPIST SPOTLIGHT: KAYLENE MEYER We are pleased to welcome Kaylene Meyer to our Yorkville Physical Therapy office. Kaylene came to New York City two years ago as a traveling therapist, and recently became a permanent employee. She originally hails from Billings, Montana, and she received her Bachelor’s degree in 2001 while a cross-country runner for the University of Montana. She also worked as an Athletic Trainer for the University’s NCAA Division I-AA football team, which won two National Championships during her time at UM before receiving her Doctor of Physical Therapy in 2005.


MANHATTAN PT NEWS

4TH QUARTER 2009

Lower Manhattan Physical Therapy 40 Exchange Place, Ste. 1414 New York, NY 10005 212 425 1060 www.lowermanhattanpt.com

Yorkville Physical Therapy 210 East 86th Street Ste. 203 New York, NY 10028 212 249 0904 www.yorkvillept.com

Lewisboro Physical Therapy 890 Route 35, PO Box 104 Cross River, NY 10518 914 763 5941 www.lewisborophysicaltherapy.com

Kaylene’s therapy interests lie primarily in outpatient orthopedics, with specialization in both geriatrics and women’s sports medicine. She remains an avid runner and enjoys cycling, swimming, cross-country skiing, the theater and pottery.

CORE MYTHS? Recently, the New York Times entered a discussion which has been ongoing in the physical therapy field for about fifteen years, namely, the role of a deep abdominal muscle called the transverse abdominus in protecting the spine. The transverse abdominus (TA) originates on the cartilage of the lower ribs, a broad, flat tissue in the low back called the thoracolumbar fascia, and part of the pelvis. It inserts on the vertical line the middle of your ‘six pack’, the linea alba. In the 1990’s a pair of Australian physiotherapists (the commonwealth’s equivalent of an American Physical Therapist) at Queensland University found that during repetitive arm motion the TA was activated, despite having no anatomical connection to the arm, and therefore no way to actually create motion at that joint. Another finding was noted: in people with low back pain, this muscle activation at the TA was delayed. The authors suggested that LBP might possibly be caused in part by the failure of the TA to stabilize the spine. As the Times article states, this idea spread like wildfire until many personal trainers, pilates instructors, athletic trainers and a number of other fitness enthusiasts were advocating the contraction of the TA—by “drawing in at the navel” or “hollowing the abdomen”—during all manners of activities. Eventually, this concept suffered the inevitable backlash


MANHATTAN PT NEWS

4TH QUARTER 2009

Lower Manhattan Physical Therapy 40 Exchange Place, Ste. 1414 New York, NY 10005 212 425 1060 www.lowermanhattanpt.com

Yorkville Physical Therapy 210 East 86th Street Ste. 203 New York, NY 10028 212 249 0904 www.yorkvillept.com

Lewisboro Physical Therapy 890 Route 35, PO Box 104 Cross River, NY 10518 914 763 5941 www.lewisborophysicaltherapy.com

from Medical Doctors, Physical Therapists and Biomechanists, who (correctly) insist that the TA is not the whole picture when it comes to lumbar stabilization. The most outspoken critic of this overemphasis TA is Stuart McGill, a Professor of Biomechanics at the University of Waterloo in Canada, who was quoted in this and other New York Times articles on this subject, and advocates a more traditional approach to lumbar stabilization by concentrating on the global trunk muscles. In the article, he suggests the following: The Rectus Abdominus (what people traditionally think of as their “abs” or your “six-pack”) and the obliques he advocates training with a crunch with the hands placed below the lower back to maintain lordosis and limit disc-endangering flexion. For the Spinal Erectors (the muscles running alongside the spine) he recommends the “bird dog” performed in quadruped with hip extension and alternate shoulder flexion. For the quadratus lumborum and the obliques, he recommends a side-plank. This is what can be considered to be a safe and balanced “core” program, albeit one which is relatively plain and non-functional and will eventually require modification for most participants to avoid staleness and to maximize the enjoyment and the physical benefits associated with exercise. There are however a few things that should be realized about such a program and the article in which it was presented. The first and most important is that it is NOT meant as a rehabilitation program. The vast majority of people with acute or chronic low back pain will not benefit from such


MANHATTAN PT NEWS

4TH QUARTER 2009

Lower Manhattan Physical Therapy 40 Exchange Place, Ste. 1414 New York, NY 10005 212 425 1060 www.lowermanhattanpt.com

Yorkville Physical Therapy 210 East 86th Street Ste. 203 New York, NY 10028 212 249 0904 www.yorkvillept.com

Lewisboro Physical Therapy 890 Route 35, PO Box 104 Cross River, NY 10518 914 763 5941 www.lewisborophysicaltherapy.com

a program because it is not targeted towards addressing an injury; rather it is just a means for general strengthening and prophylaxis. People with significant or persistent low back pain should seek an evaluation from their MD. Second, while targeting the muscles that support the spine, this is not a terribly functional program. The reason for this is that generally, most human motion does not occur lying flat on the floor. Rather, it occurs when standing, bending, sitting, twisting or during combinations of these motions. Lastly, this article may give the impression that it is unnecessary or even dangerous to train the TA. This is not true. The transverse abdominus still contributes greatly to lumbar stability, something that Dr. McGill points out in his text “Low Back Disorders.” While the action of drawing-in may not be advisable during lifting or day to day activities due to a potential decrease in the stability-producing capabilities of the other muscles, Drawing-In, as part of a controlled exercise program, either in isolation or as part of another core exercise remains a good way to train this muscle to maximize the muscular ‘armor’ of the fragile lower back.

DECREASING YOUR INJURY RISK WHILE PARTICIPATING IN SPORTS While participating in sports, recreation and exercise (SRE) activities is one of the best ways for your patients to maintain a healthy lifestyle, create work-life or school-life balance, and forge valuable social relationships, such activities can often come at a cost. Each year, an estimated 30 million American children and adolescents and 150 million adults participate in some kind of nonwork-related physical activity. More than 10,000 Americans receive treatment each day in emergency departments for injuries sustained during SRE activities, and one in five emergency department visits for an injury result


MANHATTAN PT NEWS

4TH QUARTER 2009

Lower Manhattan Physical Therapy 40 Exchange Place, Ste. 1414 New York, NY 10005 212 425 1060 www.lowermanhattanpt.com

Yorkville Physical Therapy 210 East 86th Street Ste. 203 New York, NY 10028 212 249 0904 www.yorkvillept.com

Lewisboro Physical Therapy 890 Route 35, PO Box 104 Cross River, NY 10518 914 763 5941 www.lewisborophysicaltherapy.com

from participation in sports or recreation. That is over 4 million SRE-related injuries annually. In addition, such injuries are, ironically, a leading reason people stop participating in potentially beneficial physical activity. While many SRE-related injuries occur during physical contact, slips and falls, and the like, a great number of preventable injuries are caused by repetitive microtrauma, called overuse injuries, in a specific muscle over a period of time that results in local tissue breakdown. This may lead to inflammation characterized by pain and dysfunction. Whether star athletes or weekend warriors, your patients can mitigate the risk of SRE-related injuries by following some simple tips: • Train in cycles. You cannot always be at your peak. Rest for a few days in between sports and increase your training levels gradually. If a muscle is sore, rest and try cross-training in another activity to help maintain fitness while your sore muscle heals. • Flexibility is key. Even if you work out every day, flexibility is key to avoiding injuries. Be sure to include a stretching warm-up and cool-down during your conditioning to avoid potential muscular problems. If you are unsure which stretching activities are best for you, talk with a qualified physical therapist, family physician or sports medicine physician. • When your body talks, listen. If you feel pain at any point during your activity, stop. Continue only when you are free of pain and have complete range of motion in the affected area. You will not increase endurance, or performance, by continuing the activity when you are in pain. Be sure to pay special attention to any recurrent injuries or chronic problems may develop. • Use the right equipment. Whether it is shoes, racquets or helmets, your gear should always fit you properly and should be designed for the specific sport. For example, running shoes are not ideal for playing volleyball. Always replace worn out shoes and equipment to avoid insufficient support that can result in an injury.


4th Quarter (2009)