Toilet Ergonomics: Posture Matters In Places Other Than The Office

Squatty Potty

 

Written by Dr. Emily Melzer, DPT

For centuries, humans have squatted to defecate, but due to 19th century advancements of the sewer system and sanitation, the porcelain throne we sit on today was born. However, in that moment of history, society was unaware of the dysfunction they were setting us all up for.

Real Potty Talk

The dysfunctions I am alluding to are hemorrhoids, constipation and diverticulitis. Not to mention increasing our risk of syncope (fainting), deep vein thrombosis and stroke. You may wonder why simply sitting to defecate would put you at risk for these complications. As you hear quite regularly in regards to the office, there is a certain posture to help you work most efficiently, that is commonly referred to as ergonomics. Ergonomics are important in places other than the office, for instance in your bathroom. Research has sought out and proved the most efficient, effective and proper way to defecate.

And that position is, drum roll…SQUATTING.

The reason squatting is effective when defecating is due to the function of the puborectalis muscle. The puborectalis is responsible for keeping your rectum closed off, increasing the angle between the colon and rectum. Research demonstrates that the angle decreases when obtaining a full squat to defecate, easing the release of contents. This body mechanism reduces the need to strain, in turn eliminating the risk of hemorrhoids, syncope and stroke. It also better allows the release of all content, decreasing the risk of constipation.

Improve Your Toilet Ergonomics

Eliminating the toilet all together seems like a drastic, and let’s face it, unrealistic goal for the United States, but simply adding a small stool underneath our toilet, is a feasible change you can make today. One research study looked at defection while seated, seated with knees raised 60 degrees and a full active squat to 60 degrees. While the full active squat demonstrated the least angle and the quickest time for release of content, the passive squat achieved by placing a stool under the feet was a close second.

I personally have a Squatty Potty in my home, and I can provide consumer feedback of the improvement in efficiency, effectiveness and overall improved bowel health with the addition of this product into my life. I will never be without a squatty potty under the porcelain throne in my home. I may even consider purchasing the travel version (that’s right, there is an inflatable squatty potty!).

Give us a call today and we would love to help you with your mobility and strength to help in this everyday daily activity!

1. Dov S. Comparison of Straining During Defecation in Three Positions – Results and Implications for Human Health. Digestive Diseases and Sciences. 2003; 48: 1201-1205.
2. Sakakibara R, Tsunoyama K, Hosoi H, et al. Influence of Body Position on Defecation in Humans. LUTS, 2010; 2: 16-21.

Why Do Joints Hurt More In The Winter?

WHY DO JOINTS HURT MORE IN THE WINTER?

Young man having a knee injury while jogging outside in sunny winter mountains

MOM’S ARTHRTIC KNEES FORECAST RAIN

Young woman having knee pain

You have probably heard it before: those with arthritis claim they can predict the weather, especially if it is going to rain. I am sure everyone has a self-proclaimed meteorologist in his or her family. Researchers have looked into this phenomenon over the years to determine if weather is to blame for some of the surges in pain in people with arthritis during the winter. While some studies are inconclusive, several suggest a definite relationship between pain and both the change in barometric pressure and ambient temperature.

UNDER PRESSURE (cue Queen)

Barometric pressure is the amount of pressure our atmosphere exerts on us at a given point in time. It is constantly changing and has a big effect on the weather we experience. A drop in pressure is associated with rainfall and colder weather. There is a lot of info and several blogs on the internet that say the decrease in external pressure to our bodies allows the internal pressure to rise and this results in swelling and pain. It seems to make sense but the research doesn’t consistently support this. Some studies find that the increase in barometric pressure results in increased pain. They acknowledge the flaws in their own study but seem to find more flaws in the studies that suggest the opposite. The common denominator is that the change in pressure seems to affect what we feel in our joints that exhibit osteoarthritis.

THE PROOF IS IN THE PUDDING….OR PHYSIOLOGY. 

Cadaver studies1 have found that the hip joint gets a healthy dose of stability from the atmospheric pressure. The change in atmospheric pressure affected the hip joints in the study such that there was a slight loss of joint stability, which caused a very mild (8mm) shift of the joint and could potentially be a reason for pain. Pressure changes external to our bodies have also demonstrated, in the lab, alterations in cellular processing of little pain signaling proteins.

Another reason our less than perfect joints feel more pain around this time of year could be the effect that the cold temperature has on blood vessel dilation/constriction and changing the flow of inflammatory cell production and transport and the overall healing processes.

Also, research2 suggests increases in pain with the colder temperature could be related to a change in viscosity of the joint fluid, which lubricates many of the body’s joints much like oil lubricates a car’s engine. A car takes longer to “warm up” when driven in the Pacific Northwest in January vs Southern California in August.

It is helpful to know that there are reasons for increased pain we may be feeling with the change in climate but it is even more helpful to know what to do about it! As physical therapists, your gurus in movement efficiency and functional wellness, we can work with you physically and provide education that can help ease your pain this winter. Give us a call or schedule an appointment online with us at your convenience.

1 Wingstrand H, Wingstrand A, Krantz P. Intracapsular and atmospheric pressure in the dynamics and stability of the hip: A biomechanical study. Acta Orthop Scand. 1990;61(3):231–5. doi: 10.3109/17453679008993506.

2 Laborde JM, Dando WA, Powers MJ. Influence of weather on osteoarthritis. Soc Sci Med. 1986; 23(6):549-554.

Are you contracted with my insurance company?

health insurance policy and piggy bank

 

Are you contracted with my insurance company?

This is a question we get all too often.  It is often thought that if a physical therapy clinic you want to go to is not in-network with your insurance, you cannot use your insurance to receive care there. In actuality, most insurance plans have out-of-network reimbursement. While the details of deductible and coinsurance may be different, you can still come to our clinic and receive the therapy you deserve.

The most important point is that you can still come see us!

Why go out-of-network?

To be in-network, it means the physical therapy clinic has a signed contract with a health insurance company. The downfall of this contract is that it allows the insurance company to dictate the kind of therapy you receive. And the truth is, not all therapy is created equal. At Therapydia, we customize your treatment, we individualize programs, we work one-on-one with you. At Therapydia our therapists keep up to date with the latest techniques and strategies to deliver the most effective treatments, techniques and strategies. 

Our 45-60 minute one-on-one treatments with a doctor of physical therapy will often expedite your treatment as it allows us to address multiple components of your body mechanics and movement. We do not follow standard guidelines; we use our solid platform of education, clinical experience and learned skills from continuing education to provide therapy appropriate for you and you specifically.

Receive the care you deserve

Man stretching a woman's arm in a room

Receiving therapy using out-of-network coverage at Therapydia Portland will get you a higher quality of care as we dictate how your treatment is given, not your insurance company.  We will form a caring relationship and will be available to encourage you and offer support through your recovery. Your PT will be available to you via PT Anywhere, our exclusive online patient portal, to answer any questions and/or concerns in order to keep your rehabilitation on track.

While out-of-network benefits vary, we have discovered that out-of-network reimbursement is often comparable to in-network coverage. Please feel free to contact us so we can help you learn more about your physical therapy benefits; we will gladly call your insurance to verify your coverage and provide you with the information we receive.  We look forward to helping you on your path to recovery!

 

Cool Down For What?

young business man use fans to cool down

Cool Down For What? 
Don’t leave your exercise routine hangin’!

Cooling Down – the most underrated and ill performed part of a work out. Most don’t consider it a necessity let alone even part of a work out. In reality, it is equally as crucial as the warm up and main event. A patient at Therapydia Portland had a revelation when we were wrapping up our session last week and felt armed with new knowledge of what a real cool down entailed. He inspired this blog.

For those that include a cool down in their exercise or sport repertoire, congratulations, but you’re not off the hook yet. I’ll bet the majority take the last 5 minutes of their run, for example, and slow it down a bit and call it a cool down. This should be considered maybe a start to the cool down process but let us dissect the pieces of a proper cool down and then package it up in a savory morsel for you to enjoy, reflect upon, and crave.

Step One: Ramping Down Your Heart Rate for Homeostasis.

Depending on the intensity of the exercise, this could take a few to several minutes. You can use the latest technology to monitor your heart rate or the good old-fashioned two-finger pulse check on the carotid artery along the side of the neck (press gently). Reduce the intensity of movement or exercise and monitor your pulse for baseline rate. Normal baseline heart rate will fall between 60 and 100 beats per minute. Practice taking your heart rate often when at rest to determine your average resting rate and aim for this at cool down.

Step Two: Soft Tissue Restoration.

After exercise, your muscles and fascia (connective tissue, see previous blog on Graston Technique® for loads of info on fascia) have taken a toll and need some attention in order to restore flexibility and proper length tension relationships to be ready to perform for you again in exercise or general daily life tasks. All the contraction-relaxation of muscle during exercise builds tension in the muscle and its surrounding fascia (excellent! this is part of what nourishes muscle). If muscle and fascia are allowed to remain constricted, they will not be able to perform at 100% capacity for you in other tasks, which reduces your performance potential. This cyclic malpractice can also amount to injury in a short period of time. Bad news!

The soft tissue restoration routine should include self-massage and stretching. I am a huge advocate for the foam roller! It is a beautiful piece of equipment – cheap and effective – and it should be in every person’s house. My green dude is a staple in my living room and he keeps the side of my couch company when I’m away. If shoulder injury or stability is an issue and you cannot perform self-massage by supporting yourself over a foam roller, you can easily convert this method to handheld roller and apply the same principles. Rolling your body over the foam roller (most of the body is accessible for this technique) in multiple angles will, in a sense, “iron” out the “wrinkles” in the fascia and muscle. Points of significant restriction will be very tender and you want to be sure not to hold your breath or tense up over these spots. If too painful, work adjacent to these areas first and use limbs not currently being massaged to support yourself to take a little more weight of your body off of the foam roller.

Stretching is last and this is a great time to perform static stretching; whereas dynamic stretching (stretching through movement) is awesome for a warm up to prep the tissue to accept increased loads. Static stretching is holding a stretch posture for an increased length of time. The traditional hamstring stretch and runner’s calf stretch are examples.

Simply put, the recipe for a cool down is 1 part heart rate resolve, 1 part foam rolling, 1 part static stretching. We at Therapydia Portland want to be your go-to resource for specific routines that complement your fitness style. We know there are many ways to stretch and foam roll, which can be daunting to sift through all the information on the web. Schedule an appointment with us at your convenience and let us guide you to keep you healthy and injury free.

Breaking Down The Graston Technique®

GrastonTechnique of the Shoulder-2Breaking Down The Graston Technique®

Summer is officially here and outdoor activities are calling. However for anyone who is suffering from an injury, the longer daylight hours means you’re missing out on even more fun. If resting and icing hasn’t helped you heal as quickly and effectively as you would like, you may want to consider the Graston Technique to help you find relief and get you back out there.

The Graston Technique® is an evidence-based form of instrument-assisted soft tissue mobilization (IASTM) that enables clinicians to effectively assess and treat restrictions of scar tissue, muscle, and fascia that contribute to dysfunctional movement of the kinetic chain.   The technique involves the use of hand held stainless steel instruments applied to the body’s soft tissue in various sophisticated strokes to release or unlock areas of pain and poor function. No treatment is complete without being coupled with an appropriately designed therapeutic exercise program to restore the normal functional movement of the treated tissue.

Set Your Fascia Free

Luke, I am your fascia…. Star Wars puns aside, fascia is a very important part of the human body that I think doesn’t get a lot of credit and definitely not a lot of attention. Shameful! This beautiful tissue, also referred to as connective tissue, exists all over the body! Think of it like an internal webbing that provides dynamic internal structure by supporting and connecting all your moving parts. It is 3-D in nature and thus is not always addressed adequately by your weekly or monthly massages when lying on the table passively. Within the fascia live important cells called fibroblasts that are precursors of collagen production, super important for injury healing or recovery from regular daily abuse that results in normal break down. When there is any restriction of this fascial tissue, from injury or daily wear and tear, the fibroblasts can be left unable to do their jobs, especially if they can’t get their nutrition and hydration as a result of what can be considered a tissue traffic jam (thoughts of Oregon 217 South at 5pm, shudder!).

Living within the superficial fascia are the majority of your sensory nerve endings that transmit messages of pain. Treating this fascia and increasing regular functionality of this tissue can help mitigate pain. Bye bye pesky pain!

What Does Graston Technique® Feel Like?

Well, have you ever had a massage that in some places it feels good and others it is uncomfortable as it is happening but afterward there is this sense of “hey! I’m able to move better! And that original pain is gone!” It is much like that. Sometimes there is reddening of the skin that lingers for a day or two; this is the result of scar tissue or adhesion break down and allows for new healthy blood vessels to regenerate and allow increased healing potential.

You might be thinking that if Graston Technique® is like massage, then what is the difference? During a typical treatment, a patient should expect to be positioned in various postures, particularly the posture that is dysfunctional. The tissue is 3-dimensional and thus is treated in this manner including through movement. If adequately applied, this technique should allow the patient to see a difference in his or her movement and capability straight away!

So one or more of these six stainless steel Graston instruments can be used to restore adequate mobility of this tissue network under the skin and result in faster recovery time, reduced overall treatment time, result in less need for anti-inflammatory medication, and resolve chronic conditions not adequately addressed by other treatments. As an adjunct to a physical therapy regimen, Graston Technique® should be considered! Schedule your appointment at Therapydia Portland and try out Graston with our certified provider.GT_Provider_Logo_RGB-2

Postpartum Incontinence Case Study

Woman Suffering From Stomach Ache

Patients come to physical therapy for a variety of treatments from post-surgery rehabilitation to balance improvements. We at Therapydia Portland are happy to share a patient’s experience with postpartum incontinence on her behalf to educate our community on what this means and to eliminate any taboos around this issue.

First, what is incontinence? Here is a link that defines the basics about incontinence.

Understanding Postpartum Incontinence Treatment Methods

LK drove by our clinic one day and came in to inquire if we provided postpartum incontinence physical therapy. This category of physical therapy incorporates a lot of different solutions for healing and depending on the patients needs. Some patients just need proper hands-on interventions and exercises to improve their functional limitations while others need internal biofeedback and other internal techniques performed by pelvic floor specialists. For LK, she wanted to see if she could be treated without a non-invasive approach first and if required, we would refer her to the appropriate specialist to continue her care.

Living Accident-Free

Within two physical therapy sessions, LK’s associated low back pain and complaints of incontinence had decreased significantly.  Being able to lift her two sons without experiencing accidents was a big improvement in just the first two sessions.  LK was seeing improvements and was closer to reaching her ultimate goal of becoming physically active again and to play with her kids and being able to jog without incontinence accidents. We continued to see LK 1x/week for the next few weeks each time seeing marked improvements with pelvic floor control, decreased accidents and improved flexibility and strength. Within 1 month LK was able to squat, lunge, perform some agility drills and was able to jog on a treadmill up to 5 minutes without any accidents!

active mother jogging

LK reports 80% return to her prior level of function and even states that she feels stronger than before having her two children. LK plans to come in for 1-2 more sessions to progress her functional mobility and strength and we will emphasize a proper home exercise program for her to keep moving towards 100%.

Thanks LK for letting us share your story! If you or someone you know is experiencing postpartum incontinence problems give us a call and let us help you get these issues back to normal.

For more information on what physical therapy can do for incontinence here is a great link defining the role of physical therapists in regards to incontinence.

 

Supporting local Community

Attention local community members! Keep an eye out for our new ad in the local Laurelhurst newsletters… we are excited to provide quality care to the community and we have been receiving great feedback about our services.  Check out our testimonials on our site or see what people are saying on our Google plus page!Portland Physical Therapy: Laurelhurst, Kerns

Is Crossing Your Legs Bad For You?

crossing legs harm crossed legs bad for you

Crossing your legs seems like a natural sitting position but can it actually be bad for you?

Aside from claims that it raises your blood pressure or that it can cause varicose veins, regularly sitting with your legs crossed may result in a stooped posture, lower back pain, neck pain, and/or hip discomfort. This seemingly harmless sitting position could be contributing to aches and pains and actually increasing your chance of further injury.

When you cross one leg over the other, muscle imbalances are created in the lower back and the hips which can contribute to pelvic and sacral dysfunction as your body naturally shifts to one side. The pelvic imbalance eventually makes the hip flexor and inner thigh muscles shorter and the outer thigh muscle longer, putting your joints at risk for stiffness and dysfunction. Your pelvis also rolls backward and “unstacks” the spine, putting pressure on the lower back and forcing you into a leaning position favoring the side that the leg is crossed over. You end up with tight muscles on one side and on the other side, muscles that are weakened and overstretched. No good!

Sitting with your legs crossed slightly twists the spine which may lead to back pain, neck pain, and disc problems. For PT patients who experience back pain, it is recommended that they work on breaking the habit of crossing their legs as it may lead to compensation and stiffness, making their symptoms worse. Sitting this way after treatment can even undo physical therapy work that has already been done. It becomes a constant battle of reactivating muscles and restabilizing the pelvis and sacrum. Finding a neutral position is key to begin stabilizing better. When your pelvis is in a neutral position, the rest of the spine can also find a more neutral position

crossing your legs is bad for your health physical therapy

So I can’t cross my legs…how am I supposed to sit?

If you’re used to crossing your legs while sitting, it can be a particularly difficult habit to break as many of us do it without even thinking. It may take some time to get used to but practicing crossing your legs down at the ankles with your feet on the floor allows your pelvis to sit in a neutral position so that the rest of your spine can also be in a neutral position. Your stabilizing muscles can activate best in this position as there’s no negative tension on the ligaments, joints, and discs.

To find that neutral posture, your weight should be just slightly in front of the sit bones. To find this while seated, roll back and forth so you can feel your sit bones. Make sure both feet are flat on the floor with your knees and hips as close to 90 degrees as possible.

Telemedicine: Case Study

With the advancement of technology coupled with the limitations that physical therapy health care providers are encountering via insurance limitations telemedicine allows patients immediate access, near and far, to get specific health care advice, prescriptions of movement and consultations which could prevent unnecessary diagnostic tests and measures.

As our health care world continues to change I am excited to be part of the telemedicine movement.

In the past month we had a patient encounter that we felt we important to share for a couple reasons:

  • This case specifically highlights the difficulties that normal people go through when dealing with our current medical model and all the practitioners one may encounter.
  • It also highlights how when patient cases are dealt with properly someone can get more effective treatment regardless of whether someone is local or thousands of miles away.
  • With proper resources and communication people can receive physical therapy via telemedicine and it can be very effective

To protect the patient’s confidentiality names have been omitted, substituted with initials.  DW has agreed for me to post this case and she hopes that it will provide some insight to our Telemedicine process and how it has helped her.

A few weeks ago I received a Facebook message from an old college friend asking if I knew anything about a “rare” diagnosis named “idiopathic lumbosacral radiculoplexus neuropathy”.  Turns out his mother, who lives on the other side of the country, had been diagnosed with this over a year ago and was frustrated with her progressive worsening.  I told him that I had seen thousands of patients with idiopathic back pain that also had some sort of radicular symptoms down the extremities.  In layman terms idiopathic means unknown cause, lumbosacral defines the lower back and pelvic tailbone region, radiculoplexus neuropathy basically is an irritation or inflammation of the nerve bundles that exit from the spine.  It is important to note my friend’s mother, until acquiring this diagnosis was a normal active nurse and after dealing with this diagnosis she had now lost the ability to walk independently or perform many of her prior activities of daily living. I received multiple emails from the son and daughter of the patient, which gave me some insight on the patient’s medical history and timeline of diagnostic tests.  Now through these emails I had found out that over the past year DW had been to multiple doctors, multiple specialists, undergone 7 MRIs, 2 X-rays, formal physical therapy and various prescription medications to help her symptoms without any definitive plan or answers to why she had acquired this “idiopathic diagnosis” or more importantly what to do from today moving forward.

After reviewing the medical notes I set up our first Telemedicine appointment, which was just like any normal evaluation we perform here in our clinic.  Per the patient’s request DW had her daughter present on the video conference as to be an assistant just in case DW would need help with any mobility testing and/or we had technologic difficulties. Normal subjective examination was performed, objective testing, and special tests in order to determine an action plan.  In the hour appointment we spoke of DW’s diagnosis, and I came up with a physical therapy assessment of her orthopedic limitations and her functional impairments.  In addition I gave her some mobility exercises to start on that day that she could perform independently and some exercises that her daughter would assist with.

It is important to note here that in just this first appointment DW and her daughter mentioned that they received more from me in the initial evaluation that they had in the past 6 months. How does this happen?! How can one person see that many doctors, specialists and participate in formal physical therapy without some sort of education, evaluation and proper action plan to address this patient’s needs and goals.

Our next appointment was 1 week later however I told DW and her daughter that we were always available via phone, email, or Facebook messenger if they needed to contact us prior to our next appointment.

The next appointment we learned and witnessed some pretty amazing things. She had gained more mobility in her leg than she had in previous months.  She also mentioned feeling more sensation in her leg something that had been absent for quite some time.  Her mobility was starting to return but her strength and endurance for maintaining these new positions was very poor.  At this appointment she was given a progression from her day one exercises and we planned on meeting in another week.  The next goal would be to stand and be able to shift her weight from one leg to the other.

Next appointment was two weeks later and once again more good news. DW was bearing more weight through her legs with less assistance with her arms on the assistive walker she had been using to stand.  Even better news was that DW felt her muscles in her legs working, something she hadn’t felt in months.  Her ability to transfer from chair to wheelchair, wheelchair to bed, bed to sitting and sitting to standing all improved.  Her strength and endurance were slowly improving but more importantly DW had new hope.  She was seeing progress herself.

Now DW and her daughter were given more exercises to perform daily and DW was instructed that returning to a local physical therapist was the next recommended intervention.  Going to a local physical therapist that understood DW’s needs, goals and progression was crucial to her continued recovery.  In order to assure DW’s transition our office called local physical therapists near to DW, explained to the therapists what we had accomplished in just a few visits & recommended our physical therapy assessment and plan of action and collaborated with DW what she would have to do moving forward from here on out.

I’m happy to say that DW had her first physical therapy appointment this week and I received some good feedback from her regarding her first visit.  I plan to follow up with a video conference in the beginning of next year to see how far she has come with her functional mobility and if she is closer to her goal of being able to walk again…

Tips to stay healthy during the holiday season…

Be active, happy and healthy

As the weather is changing and the end of the year quickly approaches there are many of us that are experiencing the holiday work parties, the friendsgiving gatherings, and the eventual holiday hustle to travel, eat, drink and be merry.

With all these increases in tasks and relative decreases in time to complete the parties, shopping and last minute meetings stress is bound to increase.  Statistically the last quarter of the year is when hospitals see a large increase in admissions.  This has been attributed to heart attacks, strokes, and car accidents mostly stress related.  Managing stress through proper planning can prevent these health issues and potential accidents.

Thankfully we only have a few weeks left of 2014 to get through this stressful quarter however here are some gems from the Center of Disease Control and Prevention to use while we close out this year.

Wash your hands to avoid getting a cold of flu

If you haven’t done so already, consider getting a flu shot

Balance your day with work, home, play and rest

Plan properly for those holiday travels

If you are more musically inclined here is The CDC Holiday song on the 12 ways to Health.

Another component to be mindful of is Vitamin D intake.  Living in Oregon most physicians recommend taking Vitamin D supplement due to the lack of Sunshine that the population receives.  In the past 10 years technologic advances have pushed people to spend more time indoors on computers, watching television or spending time on our tablets.  During the winter as temperatures drop and holiday season demands increase people spend less time outside, therefore Vitamin D intake is sparse. This leads to increased reports of depression possibly due to seasonal affect disorder and/or people who may not have friends or family to celebrate the holidays.  This article highlights some good information regarding Vitamin D, SAD and depression.

Lessons to be learned, plan ahead this holiday season, aim to properly balance work, home, play and rest, and get outside and enjoy being active!