5 Ways to Challenge Your Single Leg Stance and Improve Your Balance

Improve balance portland physical therapy

The ability to maintain our balance is linked to multiple processes in our body including muscles and joints, vision, and our inner ear. As we get older, there are changes in all of these systems that result in a loss of steadiness and an increased risk of falling. Fortunately, falling is not inevitable and with training, our balance can improve! Training your balance now is also effective in improving your athletic performance by making better use of the strength that you already have.

Whether from a physical therapist, a personal trainer, or part of the warm up routine of your sports team, balance is very often overlooked in any training program. Maybe it sounds a bit dull but there are ways you can make it fun! Balance training can so easily be incorporated into your exercise routine and the results can help to preserve your ability to balance as you get older, warding off injuries and keeping your body strong.

Gauge your own balance with the single leg stance. Stand next to something sturdy, like a chair or table, and raise one leg off of the floor with your hips bent to 45 degrees and your knee to 90 degrees. Begin by trying to balance for 5-10 seconds and then work your way up. To challenge yourself even more, try these single leg stance modifications:

Relax Your Toes

Most people, when they stand on one foot, automatically tend to “grip the floor for dear life” with their toes as a way of searching for any type of stability. Relaxing the toes increases the surface area of your foot and allows some of those deep intrinsic foot muscles that are just in the arch of our foot, to activate.

Practice Balancing Barefoot

Taking the shoes and socks off allows you to receive sensory feedback from the floor, letting your natural foot do what it wants on the floor. You’re also not forced into the position of your shoes (aka foot coffins). Runners who need to have really strong foot muscles will do a lot of training while barefoot. This gives these muscles a better chance of activating without that stability.

Look Up!

We’re so reliant on our visual system for balance and movement in general, we’ll always correct our posture so that our gaze is horizontal. When you look down at the ground, everything else follows—your neck is flexed, your shoulders are rounded, your butt may be sticking out a little bit to counter the weight—posturally you’re put in a really bad position. Looking up straightens everything out and makes it much more challenging.

Close Your Eyes

At first this may be difficult, but over time it will make you less reliant on your visual system. Closing your eyes will make your proprioceptor system work a little bit harder, helping to train and strengthen those muscles and ligaments.


Balance training doesn’t always have to be “stand on one leg and hold for as long as you can”. Practicing balance while frozen (not talking, not blinking, not moving) is not quite realistic to maintaining proper balance in everyday life. Shake things up by catching a ball while you’re balancing on one leg, having a conversation, thinking about something else, moving your arms, cooking, washing dishes, etc. Challenge your brain to focus on more than just your balance so that it becomes an automatic response.

Make balance training a part of your workout routine by practicing your single leg stance daily. You’ll notice improvements in no time!

10 Misconceptions about Physical Therapy

Misconception #1: All physical therapists are the same

Physical therapists all come from different backgrounds including training, continued education, and personal experiences. These varying characteristics can lead to different philosophies of treatment. Although PTs graduate with similar fundamental knowledge and “tools”, the education and career path each PT takes after their schooling may add more tools and will dictate what tools they use and when. While all PTs should have the same goal—getting you back to a pain-free lifestyle as soon as possible—not all PTs are created equal.

One negative experience with physical therapy doesn’t mean that you should write off the potentially life-changing care of a PT entirely.

But how do you go about finding a physical therapist who is right for you?

When seeking out a PT, it’s important to shop around and find one that you like. Where to start? Search different terms online to narrow down what you’re looking for (ex: knee pain specialist, back pain, etc.). Ask friends and family for recommendations or go to your doctor for a referral. Additionally, try cold-calling clinics and asking questions like “Do you offer one-on-one treatments?” and “How long will my sessions be?” Gather as much information as you can to find the right match for your condition. Try to find someone that you “jive” with personally as you’ll be spending some quality time together.

During your course of treatment ask yourself, “Does my PT understand my goals?” You should feel like you’re working towards those goals during each session. Finding a PT that you connect with and relate to could actually lead to a situation where you look forward to coming in for treatment!

Misconception #2: Physical therapy is going to hurt

That old adage of “no pain, no gain” is FALSE. Somewhere along the way, physical therapy picked up a reputation that treatment hurts, or that it’s supposed to hurt. Some patients even delay coming in to PT because they think they should wait until their pain subsides so they don’t make anything worse. Why wait when they can help you now?! If you’re in pain, there is rarely a reason to wait to come to PT.

Research shows that the sooner you begin treatment, the better chance you’ll have of recovering quickly and efficiently (saving you and the healthcare system time and money).

As long as you can get to the clinic safely, even if someone else has to drive you, PTs can likely do something to make you feel better. Lastly, your PT should rarely do anything that makes your pain worse and if they do, perhaps they’re not the right fit for you. Know that your treatment may be a little uncomfortable at times depending on what you’re being seen for, but a good PT is going to be constantly checking in with you to gauge your comfort level throughout treatment. If something is bothering you, they’re going to adjust the plan of care accordingly.

you have to see a doctor before a physical therapist

Misconception #3: You have to see a doctor before you can go to a PT

This mindset dates back decades to when people began seeing their primary care doctor as “the gatekeeper” to all other healthcare professionals.

Truthfully, if you’re in pain or you have a musculoskeletal issue, a PT can likely help and you can save time and money by going straight to them.

Think for a second about a chiropractor. An average person experiencing back pain would probably think, “I should see a chiropractor”. They likely wouldn’t go to their doctor to ask permission, they would just go see a chiropractor directly. Physical therapy is no different! Physical therapists are the experts in musculoskeletal injuries and prevention. If you have pain anywhere, you should automatically be thinking physical therapy. If for some reason your condition is out of the scope of a PT’s practice, they are well-equipped to refer you to the appropriate practitioner. A good physical therapist asks all of the right questions to rule out anything that’s not musculoskeletal.

physical therapist education misconception

Misconception #4: To be a physical therapist, I just need a certification

Surprisingly, many people are unaware that to become a physical therapist you need about seven years of schooling, not to mention a ton of hands-on, clinical experience and education that continues even after you begin practicing.

PTs nowadays receive a clinical doctorate degree; that’s what the DPT after a PTs name stands for – Doctor of Physical Therapy.

They then take a national board exam to earn a license to treat patients, yet some people still can’t tell you the difference between a physical therapist and a personal trainer. By the way, personal trainers are awesome! However, when you’re in pain, your rehab becomes out of their scope of practice.

physical therapists fix people misconception

Misconception #5: Physical therapists “fix” people

A physical therapist’s job is to enable you and be active in your recovery but there is no “cure-all” button that they push to get rid of all your pain instantly. Physical therapy is a team effort. In other words, it is unlikely that you will get positive and lasting results from having all of your treatment done TO you (passive approach). As a patient, you should go in expecting to do a little bit of work.

A great PT will not fix you; they will help you learn how to fix yourself.

This may seem daunting at first but it’s actually quite encouraging as YOU are the one in control of your recovery. Your PT is there to guide you and provide some hands-on treatment early on while also teaching you the tools necessary to move and function long-term and on your own. As great as it is to see your PT regularly each week, you don’t want to do that for the rest of your life!

The work that you put in with your PT during each session is important but what is more important is what you do when you’re not with your PT. Your posture, your daily activities, what you’re doing at work, and even how you’re sleeping ALL affect your pain. There is only so much your PT can do during the time the two of you are together each week. Your physical therapist should give you the necessary guidance to function properly so you can continue an active, pain-free lifestyle on your own.

misconceptions clamshells no matter what

Misconception #6: You’ll be given clamshells no matter what

Look, there’s a time and a place for a clamshell or any other basic theraband exercise but doing clamshells for the rest of your life is not going to get you better. Your PT should give you custom exercises based on your unique body and specific condition (this may or may not include clamshells, but don’t be deterred!).

Your exercises shouldn’t stop at a clamshell; they should simulate the demands of the activities you are hoping to return to without pain.

On that note…

physical therapy is just exercise based

Misconception #7: Physical therapy is just exercise-based

Research shows that the combination of exercise AND manual therapy AND patient education is often the most effective treatment plan for a variety of musculoskeletal injuries. Although there may be some benefit to seeing a PT once and learning safe exercises you can do on your own (versus not going at all), this is not ideal nor should one expect a full recovery with this approach.

Some people may be hesitant to start PT because they’ve been told it’s going to be strictly exercise-based, yet they’ve never exercised before.

Know that your PT is there to be your coach and they’re not going to push you beyond your limits.

Every plan of care is different and will be tailored to your unique needs. Most importantly, don’t be afraid! If you are, be honest with your PT and let them know. Chances are they’ll make you feel at ease in no time.

misconceptions PTs will tell you to stop

Misconception #8: Your PT will tell you to stop doing what you love

Your physical therapist’s number one goal is to get you back to doing what you love as soon as possible! To delay treatment and ignore your pain because you want to keep running or keep training is only going to hurt you in the long run. In many cases, the longer you hold off treatment, the longer your recovery will take. Ideally, your physical therapist will not tell you to stop participating in your favorite activities unless it is necessary for health and/of safety reasons. Instead, they can incorporate these activities into your treatment plan.

Sometimes reducing or eliminating the aggravating activities is necessary to make progress, but this may just include modifying the amount of any particular activity, not stopping it entirely.

They want to focus on what you CAN do, not what you CAN’T do.

Another reminder that the goal of your PT is for you to get back to your favorite activities, fully healthy and as soon as possible.

you have to be in pain to go to physical therapy

Misconception #9: You have to be in pain to go to physical therapy

Frequently, people only think of PT when they’re seriously injured such as after a bad car accident or while recovering from surgery. Physical therapists do a lot more than address pain after an injury. A lot of their expertise lends itself to injury prevention and improving performance. Diagnosing problems in movement and function before those issues turn into serious or debilitating conditions can save you time, money, and frustration down the road. You don’t need to be in pain to come see a PT.

Believe it or not, it’s actually quite likely that you’re moving in a way that is dysfunctional – putting you at risk for future injury – even if you have no pain at all!

Addressing the issue now can pay off in the future.

once you're discharged you're done

Misconception #10: Once you’re discharged, you’re done

This misconception goes back to one we’ve already discussed: Physical therapists “fix” people. Your PT should give you the tools necessary to live a pain-free life but the ball is in your court to use those tools correctly and to ensure that your daily activities are not compromising the work that you’ve already put in.

YOU are in control of your recovery and you and your PT have hopefully worked together to help you adopt new healthy habits for lifetime wellness!

9 Yoga Poses For Runners

With spring finally trying to break through the Portland grey skies, a lot of people are moving their exercise routines outdoors. From biking to jogging to dog walking, people are excited to stretch their legs and get some fresh air. With all this moving and shaking we need to also be aware of what a long cold winter could do to our joints. Sitting by a cozy fire or curling up on the couch with a good book can cause tightness in our joints, but we might not notice these restrictions until we go for our first spring run. Yoga is an amazing way to get stability and flexibility around all of our joints, and especially for our weight bearing joints such as hips, knees, and ankles. Below are a few quick yoga poses that are very beneficial for stretching hip flexors, quadriceps, hip rotators, and the low back.

Anjaneyasana (low lunge)

Horizon lunge with quad stretch

Horizon lunge with quad stretch (with props)

Revolved Figure 4 Stretch

Supine Twist

supine twist

Supta Baddha Konasana (Restorative pose)

supta bhadda konasana

3 Poses For Glutes and Hip Stability

Running in is a great way to get outside, explore your surroundings, and get a good cardiovascular workout! Yoga is the perfect compliment to running in that it stretches muscle groups that can get tight or strained. Runners are prone to overuse injuries due to tight muscles, particularly the hip flexors. Weakness in certain muscle groups, such as the glutes and abdominals, can also contribute to run-related injuries. To improve glute strength and hip stability give these poses a try:

• Warrior III – Virabhadrasana III (veer-ah-bah-DRAHS-anna)
• 1/2 moon – Ardha Chandrasana (are-dah chan-DRAHS-anna)
• Tree pose – Vrkasana (vrik-SHAHS-anna)

The balance of strength and flexibility is one we should always strive for. For more information regarding running or yoga benefits please contact Therapydia Lake Oswego!

Health Benefits of Squatting

squat physical therapy

There are few exercises that exist that are more beneficial than the squat. Contrary to popular belief, when properly coached and progressed, squats are an excellent training tool for improving leg and hip strength, load tolerance in the knee, and core strength. While it is true that squats produce compressive loads within the knee joint and tensile loads of the ligaments and tendons of the knee, current research has shown that those loads are still below the maximum tolerable loads of those connective tissues. In fact, evidence also points to a higher levels of tensile strength and cross-sectional area (CSA) of the quad, patellar, and achilles tendons in athletes who have participated in weightlifting vs non-weightlifting sports. Strengthening exercises for the quads that allow for progressive loading, such as squats, can in fact reduce the long-term risk of injury.

Squats Can Actually Help Your Spine

When looking at the impact of squatting on the lumbar spine researchers have found no adverse effects on disc height in the long-term. In other words, the idea that barbel squats cause degeneration in the lumbar spine is based more on fear than science. In fact, the increase in demand on core musculature would indicate that loaded squatting improves the stability of the spine rather than the opposite.

As mentioned earlier, learning to squat can provide a whole host of benefits that outweigh the risks. Those benefits include:
1. Increased overall leg strength for daily activities.
2. Increased core strength for spine health.
3. Increased hip and ankle mobility with progressive loading.
4. Increased metabolic rate due to the increased muscle growth.
5. Improved movement patterns to minimize injury risk with other sports and activities.

If you are experiencing pain with squatting, consider meeting with a physical therapist to assess what the possible causes might be. Not everyone needs to squat the same and a good therapist will help identify what your limitations are and how to properly progress your program to continue to reap the benefits of squatting without increasing pain.

Do You Need an Ankle X-Ray?

ankle sprain xray

Rain is no stranger to the colder months here in the Pacific Northwest. This winter has not only seen a fair share of rain but also a higher than normal amount of snowfall. With those falls typically comes a trip to the emergency room and a subsequent series of xrays to rule out a fracture of some kind. However, more often than not those xrays show up to be negative and instead result in a larger medical bill, radiation exposure, and time loss. Luckily there is a checklist that exists called the Ottawa Ankle Rules to help patients identify whether an xray is necessary.

xray for ankle fractures

If there is pain in the malleolar zone (the malleoli are the bony bumps on inside and outside of the level of the ankle) then an xray is indicated if you also have just one of the following symptoms.
1. Tenderness along the tip or backside of the medial malleolus (inside ankle bump).
2. Tenderness along the tip or backside of the lateral malleolus (outside ankle bump).
3. Inability to bear weight for four steps. (note: inability does not mean that it is painful to bear weight. Pain is to be expected!)

If there is pain in the midfoot zone (region of the arch is, or the middle 1/3 of the foot) then an xray is indicated if you also have just one of the following symptoms.
1. Tenderness at the base of the fifth metatarsal (usually directly in the middle of the outer edge of the foot).
2. Tenderness at the navicular bone (the bone just above the arch of the foot).
3. Inability to bear weight for four steps.

If your symptoms qualify you for a xray, you may still have a negative radiograph result. However, if you do NOT qualify under these guidelines then you can be pretty positive that you do not have a foot or ankle fracture. Regardless of the outcome of these guidelines, your best bet for a proper recovery and reduced risk of re-injury is to find a physical therapist that will ensure your mobility and strength return to normal quickly and appropriately.

Core Training For Expecting Moms: Diastasis Recti Exercises

pregnancy exercises

Pregnancy is an exciting time for a woman, as well as, a time of many physical musculoskeletal changes as the body prepares for birth. Both during and after pregnancy the abdominals will actually separate at the midline; this is called diastasis recti and it’s absolutely normal and occurs to some degree by the third trimester in every pregnancy.1 There are exercises that you can do both during and following pregnancy to lessen the width of abdominal separation, as well as restore balance to your core and reduce incidence of urinary frequency and pelvic pain.


Any effective core stabilization program should always start with breathing exercises. Focusing on deep, intentional breathing has been shown to reduce stress, promote muscle relaxation, lower heart rate, and even reduce nausea during scenarios that normally induce motion sickness2. On top of all of these benefits, deep breathing helps to normalize intra-abdominal pressure and the relationship between the respiratory diaphragm and the pelvic floor musculature. The breathing diaphragm is closely related to the pelvic floor muscles in that they form the ceiling and floor diaphragms for the abdominal organs. As you take air into the lungs and the diaphragm lowers the pelvic floor relaxes to allow space for organs. When there is dysfunction in either the diaphragm or the pelvic floor there is increased pressure and sometimes pain on the pelvic organs. Try this diaphragmatic breathing exercise to get you started with finding your own deep breath:

  • Lie on your back on a comfortable surface with your knees bent and your feet planted flat.
  • Use pillows or blankets to cushion your head and neck so you can truly relax.
  • Gently place your left palm on your lower left rib cage just below your heart and your right palm on your right lower belly just to the right of your navel. Close your eyes.
  • Breathing through your nose, take a deep breath in and feel your ribs expand as your lungs fill with air.
  • Pause for just a moment, then exhale completely and feel your abdominals engage as your ribs relax and your lungs empty.
  • Continue to inhale and exhale at a slow pace and focus on relaxing any other tension in your body as you breath – relax your face, your jaw, your shoulders and your clenched glutes.
  • If you’re feeling dizzy, which can sometimes happen, just lessen how deep of a breath you’re taking but still feel the ribs and abdominals engage.

Aerobics class practising deep breathing for relaxation lying on their backs on their mats on the floor with focus to a young African American woman in the foreground

TA Bracing In Hooklying With Movement

Next we’ll activate the transverse abdominus (TA) muscle with abdominal bracing.  The TA is a deep abdominal muscle that wraps horizontally around the abdomen to the posterior spine. Because of this horizontal muscle fiber orientation the TA is often referred to as the body’s natural corset. Strength in the TA supports the spine to reduce low back pain, as well as provides support to the other core muscles and organs.

  • Lying on your back with your knees bent and your feet planted on the floor.
  • Move your right and left palms to your low abdominals to the right and left and inferior to your naval.
  • Take a deep inhale through your nose and as you exhale through your mouth feel your abdominals tighten and engage under your palms to “corset” your trunk.  
  • Maintain this muscle activation as you take another inhale, and exhale.
  • Repeat this pattern for 5 rounds of breath while holding your TA abdominal contraction.

A simple movement that you can add to this exercise to further challenge your TA muscle contraction is the bent knee fall out (BKFO). As you inhale slowly lower your bent right leg to the right. Keep your trunk stable to avoid rocking and control the leg movement so it’s smooth. Perform 5 repetitions with the right leg, then 5 repetitions on the left.

ADL and Sport Specific TA Strengthening

Now that you’re proficient with deep breathing and transverse abdominus activation, it’s time to progress to sport and ADL (activity of daily living) specific training. A physical therapist can design a home exercise program specific to your needs and goals. Whether it’s competitive cycling, weight lifting, casual running, or Pilates, our PTs at Therapydia are experts at getting your body in top shape to perform. We’d love to help you be your best.

  1. Fernandes da Mota PG, Pascoal AG, Carita AI, Bo K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbopelvic pain. Man Ther. 2015 Feb;20(1):200-205.

2. Russel MEB, Hoffman B, Stromberg S, Carlson C. Use of controlled diaphragmatic breathing for the management of motion sickness in a virtual reality environment. Appl Psychophysiol Biofeedback. 2014; 39: 269-277

Ride On: 10 tips for a safe winter bike commute

winter cycling safety

Posted by: Jen Craft PT, DPT

Though the weather outside is frightful, there’s no reason to place your bike in storage for the winter and give up on your commute. With a little bit of prep work and extra considerations for safety you can absolutely stay on two wheels this winter. Below are 10 tips to help you have a successful bike ride this winter season:

  1. Bundle up. Wind chill has a sneaky way of making it feel a whole lot colder than it is outside. For example, the thermometer might read 32 degrees but a cold front of wind can make the air feel 10 degrees colder. It’s best to dress in layers and be overdressed rather than underprepared (and frosty!).
  2. Pack an extra set of dry clothes. Dry socks, underwear and pants will mean the difference between being cold and soggy or dry and comfy all day.
  3. Cover your eyes. If you wear glasses you already know how annoying it can be when raindrops cover your lenses and blur your vision. A brimmed running or cycling cap under your helmet can keep the flurries out of your eyes so you can focus on the road. To prevent your glasses from fogging apply a layer of anit-fog or make your own with toothpaste or dish soap (the internet has a plethora of DIY suggestions).img_0330
  4. Gloves are a must. Two pairs of gloves are even better. Heavy, warm ski gloves are great for keeping your knuckles warm while you ride but warmth usually also comes bulk. If you need to change a tire or make any other adjustments to your bike during your ride you’ll be thankful for packing a thinner spare pair of gloves for fine tuning.
  5. Consider your tires. Riding with mountain bike or studded tires will provide you with more traction on slick roads. There are even tire chains that you can purchase for your bike, much like the ones you put on your car tires. Another option is to slightly under inflate your tires to increase the surface area contact with the road. Be careful not to lower the pressure so much that you’re at risk of a pinch flat.
  6. Shine on. Remember that it gets dark much earlier this time of year. In July it’s easy to enjoy the daylight into the early evening hours but in the winter it starts getting dark after 4pm. Don’t forget both your front and rear lights so you can safely be seen!
  7. Fenders are your friends. Fenders over your tires will prevent the icky street slush from splashing up onto you as you ride and are well worth the investment. cycling safety sign
  8. Mind the rails. Snow and slush on the roads can make streetcar and train tracks less visible after a storm. As always, approach the tracks at an angle but also be mindful that the metal of the rails can be slippery. Try keeping your bike as upright (vs angled) as possible when crossing the tracks to avoid wiping out.
  9. Stay hydrated. Just because you’re cold doesn’t mean that you’re not thirsty. Remember to rehydrate after your ride just as you would any other season.
  10. Be aware and enjoy yourself. Confidence and awareness of your surroundings go a long way towards keeping you safe on the road. Enjoy the fresh air and rush of adrenaline that a bike ride can give you and don’t let the weather get you down!

Crash Course: Physical Therapy after a Motor Vehicle Accident


Statistically speaking, every person traveling in a motorized vehicle will be in an accident at one point in their lifetime. On average, there are more than 6 million car accidents on the roads annually (1). According to the 2015 census, there are approximately 2.4 million people in the Portland region (2). That is a lot of impending injury! Post-accident care for non-fatal crash injuries can range from a same day ER visit to a primary care physician visit a week later with medications, Xrays or MRIs frequently prescribed. This initial medical care to rule out red flags is important especially considering advanced age, high speed collision, paresthesias or numbness/tingling, and if mobility is extensively limited. Though, this is often the end point of treatment for most individuals and they are left to guide their own care. Typically, massage and chiropractic treatment is the duo of care accessed, yet more and more people are realizing that there is something missing in their recovery and that is the restoration and rehabilitation of functional strength that was lost after the accident. Without functional strength retraining under the guidance and expertise of a physical therapist, healing can be severely delayed and result in, among other issues, loss of job attendance and revenue. In 2010, motor vehicle crashes in the United States equated to almost $1 trillion in productivity loss (3). Yet, a lot of physicians do not prescribe physical therapy, especially for the “minor injuries” with little to no pain at all.

depositphotos_36839587_originalSay what?

You might be surprised to have just read that I suggested physical therapy for “no pain at all” after a motor vehicle accident. Pain is a peculiar thing. Initial pain from an injury can be present or not depending on inflammatory processes ignited, pain processing per individual, and sometimes severity of injury. I am eluding to the idea that the absence of pain does not equate to non-injury. There is research that demonstrates decline in muscle activity post MVA resulting in diminished muscle bulk over time and this almost always leads to significant dysfunction and pain down the road with additional loss of productivity at work, participation in recreational activities, and altered daily lifestyle. In the neck, for example, post MVA MRI assessments of injury to the cervical spine in relatively “injury-free” individuals revealed swelling in the major deep cervical flexor muscle (4). Swelling within a muscle renders it dysfunctional and muscles so close to the spine have basically ZERO leverage to be able to just “come back on their own” with daily movement and typical exercise approach. The longus colli muscle is responsible for supporting the neck the way the abdominal core supports the trunk. It provides crucial stability for the cervical spine to disallow shearing forces with the day to day insults, let alone more aggressive endeavors in recreation like running, soccer, crossfit, and yoga, to name a few.


086-cartoon-businessman-shoulder-debt-boxBaby Bye, Bye, Bye.

Without proper rehabilitation of these deep neck flexors and core musculature, they will remain inhibited and atrophy as a result. Say goodbye to these deep, small, essential muscles and prepare to welcome the beast that is pain. Or…. seek the care that you need. An orthopedic physical therapist is trained to screen for red flags that would prevent one from being able to participate in a rehab program at that current time and help get you the right care. They will examine the pathoanatomical causes of symptoms and are uniquely trained to tease out the impairments and dysfunctions from the crypt! The sooner one seeks treatment, the less underlying dysfunctions that set in and cultivate. This equates to less down time from life, less $USD spent on playing catch up in care, and happier, pain-free people in the long run. If you have or know someone who has had a motor vehicle accident, we at Therapydia would be happy to help with an assessment and treatment as needed. Give us a call or email us to get started.





  1. http://www.lawcore.com/car-accident/statistics.html
  2. http://www.oregonmetro.gov/news/portland-region-nears-24-million-residents-growing-41000-last-year
  1. http://www.rmiia.org/auto/traffic_safety/Cost_of_crashes.asp
  2. Deepak Takhtani, Eduardo Scortegagna, Oguz Cataltepe and Sathish Dundamadappa. MRI Findings of Injury to the Longus Colli Muscle in Patients With Neck Trauma. Neuroradiology/Head and Neck Imaging, August 2016, Volume 207, Number 2.

5 Lacrosse Ball Exercises For Trigger Point Relief

At Therapydia, we provide individualized, scrupulous assessment and effective treatment of musculoskeletal dysfunction utilizing precise manual therapy techniques among other modalities. Our goal is to restore proper length tension relationships of soft tissue and enhance normal joint mechanics for proper function. Our patients can replicate some release techniques at home with the use of a lacrosse ball applied to trigger points in tissue. Trigger points are areas of adhesions within soft tissue resulting from trauma or overuse and can lead to ineffective movement, weakness, and pain. Below are common applications of lacrosse ball trigger point therapy we teach our patients to overcome their functional obstacles:


The area between the upper scapula and spine can be addressed by self-massage with a lacrosse ball to help keep one mobile and also tame the upper traps that are often used in activity. The release technique here is more of a self mobilization and can be applied with short duration holds of pressure over a few locations left and right of the spine. The progression would be to add dynamic movement of the arm into flexion overhead and back down to the hip for several reps, encouraging more upper thoracic extension at end range shoulder flexion.


TFL (Tensor Fascia Latae)

Foam rolling is a great way in general to get soft tissue more pliable and flexible pre work out, but it can be an ineffective tool for the hip flexors due to their proximity to the center of mass and thus need more pressure to release. We advocate the use of a lacrosse ball with a static acupressure approach- finding key points to compress for a few seconds before moving to another area within the same tissue. Place the lacrosse ball just below the ASIS in the lateral hip flexor bulk for 30 seconds to 1 minute per side; staying away from the femoral triangle to avoid compressing the major nerve, artery, and vein.


Pectoralis Minor

Stretching the pecs is a very common exercise given by most physical therapists because as a species, we humans engage in movements that stress mostly the front of our bodies and tighten or shorten this soft tissue. But the stretches given often target the pec major and don’t address the pec minor. The pec minor responds well to acupressure using a lacrosse ball at the wall. A good starting point is to place the ball about 2 inches below the mid point of the clavicle and press your body into the ball on the wall. Static holds of a few seconds before moving the ball slightly to target a different part of the tissue is good practice and spending approximately 30 seconds total per side. Alternately; moving the arm dynamically in abduction for a few repetitions along the wall while maintaining pec-to-lacrosse ball pressure provides an active release.


Axillary Border

The axillary border is a great site for release techniques; targeting the lats, lateral body fascia, and teres major. Restricted soft tissue here will disallow full overhead movement of the arm and patients tend to move inefficiently through lumbar extension to compensate. We instruct placement of the lacrosse ball between the outer axillary soft tissue and the floor using the opposite hand to help guide and keep the ball stable in space as one gets situated. Rocking the body onto and off of the ball with little movements provides a dynamic functional release or static holds over trigger points is perfectly acceptable and spending up to 30 seconds total over several points.


Gluteal Musculature

Typically a foam roll will get the job done for most of the gluteal tissue. There are areas of the deep glutes that respond better to trigger point releasing with a lacrosse ball. Sitting on the floor, place the lacrosse ball toward the outer gluteal tissue near the greater trochanter. One will need to angle one’s body slightly to the same side of the ball to get better contact; the opposite knee will be bent with foot on the ground to help gain position. We have patients perform the release for 30 seconds each side with light rolling or short bouts of acupressure.

Is Your Posture Causing Your TMD? Jaw Dropping Facts About TMD

tmj physical therapist

The temporomandibular joint is probably the most used joint in the body and, as such, it takes a serious beating. Temporomandibular joint dysfunction (or TMD/TMJ) prevalence in the USA is estimated at 3-12% and has been suggested that 25% of the population will experience some TMD related symptoms in their lifetime, more commonly affecting women than men with ratios as little as 1.5:1 and up to 4:1. The impact on quality of life is substantial and it may impact your work life; roughly 18% of people with TMD will have to miss work as a result of TMD. The numbers are hard to crunch given that TMD is a complex issue involving the jaw, face, teeth, head, neck, thoracic spine, and upper quadrant. There is no standard definition or test, but a conglomeration of functional measurements of the aforementioned body parts and concomitant symptoms reported by the patient along with history. Whew! That’s a mouthful… pun intended.

How Do I Know I Have TMD?

Common symptoms of TMD include pain in the jaw, face, neck and upper back, headache, joint sounds or clicking and popping when opening or closing the jaw, ringing in the ears, jaw locking or difficulty with opening or closing, sensitive teeth, and chewing difficulty. It is important to note that some of these pain symptoms are similar to other more concerning conditions such as heart attack. If your symptoms are accompanied by chest pain, shortness of breath or arm symptoms or concern due to history of high blood pressure or previous heart issues, it is important to see your medical doctor immediately.

Your Posture Can Affect Your Jaw

Causes of TMD include bruxism or clenching and grinding of the teeth, malalignment of one’s bite, trauma to the jaw or face, and poor posture. Forward head posture actually places the condyles of the jaw deeper into their sockets, which may be a source of pain. And guess what? That oh-so-common slouched sitting that all of us are guilty of at some point in our day; it’s not just bad for the lower back, but also the neck and jaw! Slouched sitting from the pelvis up results in forward head posture as a way for the body to counter balance itself. This posture also creates altered length-tension relationships of the muscles attached to the jaw and can trigger hypertonous (increased tone or contraction) activity of some of those muscles that compress the jaw. Imbalanced muscle forces around the jaw, including the suprahyoid muscles under the chin on the front side of the neck that open the jaw, are usually weaker compared to the masseter and temporalis, which close the jaw. The correction of this muscle imbalance to restore proper length tension relationships has a great effect on reducing pain, clicking, and deviation of jaw movement.

Quick Tests To See If You Have TMD

Don’t know if your jaw deviates? Stand in front of the mirror and keep neutral posture with your head neither tilted up nor down. Neutral head on neck posture can be self assessed by creating a shelf of 4 fingers on one hand under your chin with the pointer finger touching the Adam’s Apple or thyroid cartilage and then see where your chin falls on your hand. If your chin touches the pinky finger (wiggle it up and down to assess), your head is too far forward. Once in neutral head on neck posture, put the tip of your tongue on the roof of your mouth behind the two front teeth and open your mouth only as wide as you can keep your tongue in place without letting it come free. Watch the central line of your mouth or teeth and if dysfunctional movement occurs, you can see the jaw or mandible move out of midline for a moment and come back in, much like making a skewed S curve. This is deviation and it is dysfunctional. When you opened your mouth, did you tilt your head back to make it happen? Check again; this, too, is dysfunctional.

Improve Your TMD With Physical Therapy

Treatment should include a combination of dental and physical therapy intervention for best results. A dentist will examine for evidence of bruxism and mal-alignment and could make recommendations such as a night guard, maxillary splint, or orthodontics. A physical therapist will work with you to provide a thorough biomechanical analysis and treatment program such as postural training, motor control and strengthening exercises, manual therapy techniques like massage and joint mobilization, training in jaw relaxation including breathing exercises, and education in modifications to food types and ergonomics. For specific exercises and education, it is important to make an appointment with your physical therapist for an evaluation to determine your individual needs. Give us a call or email to get started. We also have great relationships with our local dentists and can refer as needed.

Orofacial pain prospective evaluation and risk assessment study–the OPPERA study. Maixner W, Diatchenko L, Dubner R, Fillingim RB, Greenspan JD, Knott C, Ohrbach R, Weir B, Slade GD. J Pain. 2011 Nov;12(11 Suppl):T4-11.e1-2.