Healthy Pastimes

The world is a staircase. Some go up, and some come down. We must ascend. From Accordion Crimes by Annie Proulx

Let me tell you one of my favorite pastimes:

On one of my strolls through a bookstore I found the book: "Stair Walks in San Francisco", by Adah Bakalinsky. She describes 27 stair walks around our beautiful city. I started to walk them, and already discovered many places I have never seen, San Francisco's back roads. I come across astonishing views of this beautiful city, hidden places, and learned the history of small neighborhoods. I highly recommend this book and the walks. Even though the walks can be challenging, you can take shortcuts if you are a beginner to exercise.

My favorite walk so far includes the magic stairway. It is a mind-blowing mosaic style stairway at Moraga and 16th Avenue. If you haven't seen it yet, it is a MUST. The author says: "people are entranced by the colorful mosaic tile stairway that tells a story of sky and water and birds and fish and flowers and frogs." And I was too. Come and see it. It is truly astounding!

If you'd like to tell us about some wonderful walking paths, stairs, or destinations around the city, feel free to email us at info@risingsunphysicaltherapy.com.

Prehabilitation

Prehabilitation--add a Physical Therapist to your multidisciplinary team for cancer treatment!

“Prehabilitation is the process of enhancing functional capacity of the individual to enable him or her to withstand the stressor of inactivity associated with a surgical procedure” — Wikipedia

What a concept! Not new, but just in recent years getting more attention. I have been advocating prehabilitation since the beginning of my career.

"I use the analogy that people wouldn't run a marathon without training for it," says Tony Brosky, PT, DHS, SCS, a professor of physical therapy and assistant dean of the Lansing School of Nursing and Health Sciences at Bellarmine University in Louisville, Kentucky. “…knowing the patient's range of motion, strength, and function preoperatively, through clinical examination and direct observation, allows the patient and PT to more accurately set realistic postoperative goals."

This makes total sense to me. Many patients are seeking pre-surgical Physical Therapy intervention from us, many are cancer patients, concerned about a side-effects like lymphedema and/or quality of life issues on long term, and returning to the current function and activities as soon as possible after treatment.

How smart to get pre-measurements, to understand status quo of function, range of motion, strength and volume of limb pre-surgery. Base line measurements are key to early detection of problems, reduce anxiety and will improve outcomes. Physical Therapy should be part of the multidisciplinary team to improve quality of life before, during and after cancer treatment.

But we are still far from being included automatically in a multidisciplinary team of treating cancer. San Francisco General Hospital however has been progressive and adding Physical Therapists into the multidisciplinary team in the breast cancer clinic. See article.

Tell your doctor that you want to have a Physical Therapist included to your team of experts in your cancer treatment as early as prior to your surgery, if time allows. Share the article with your doctors.

I am also teaching a informational class hot to reduce risks for lymphedema at CPMC every third Wednesday of the month at 6PM. Please share this information with anybody who has or had cancer treatment or going to have cancer treatment. We are here to help, This class is at no cost, and will give you lots of information.

Read on the newsletter of SFGH in 2011:

If you want to read more about some research of prehabilitation, please check out this link: https://integrativeoncology-essentials.com/wp-content/uploads/2013/08/Cancer-Prehabilitation-paper.pdf

Healthy Habits

As you may know, there are lots of busy things happening at Rising Sun Physical Therapy and in all our personal lives. But many might ask, how can you stay healthy being so busy and still enjoy some free-time to yourself?

The answer is simple: treat yourself well, stay in tune with your body and your limits, and rest!

Here are 4 secrets to staying healthy, energized and stress-free:

Secret #1: "Healthy Eating & Drinking"

You've probably heard the old saying, "you are what you eat", which is absolutely true!

This is why I eat lots of green leafy vegetables, healthy proteins, and drink lots of water. A gentle summer cleanse is in the air to energize for the long nights. A simple 10 days of staying clean and healthy. (Psst… don’t tell the secret: We will soon introduce you to our brand-new and improved fall cleansing program for all of you people who want to rid your body of those unnecessary toxins. Stay tuned)

Secret #2. "Keep it simple"

You probably know by now that I like to create simplicity while staying active. To do this, try incorporating physical activities and exercises into your daily routine such as biking or walking to and from work, taking the stairs instead of the elevator, and walking your dog. The summer brings lots of activities around the city that can add healthy movement to your life.

Secret #3: "De-clutter your life"

De-clutter your mind, computer, home and work.

Go through your closet and let go of all the clothes you have not worn for the past 6 months, organize your inbox, your desktop, and lighten up your house and overcome your own barriers to an organizational bliss. Let me congratulate you if you are planning to start this process. Don't forget to create space in your house for meditation, to take time out, quiet your mind, breath and just be with yourself. Gas up here with fuel from the NOW, and de-stress your mind. Stimulating your vagus nerve will reduce your stress level and reduce inflammation in your body. OM

Secret #4: "Socialize"

Have a healthy social life with family and friends. Take time to meet with your friends every week, or at least once a month at your house for a fun game evening, or go to events. Are your ready for YOUR new practices and potentially a NEW YOU? What's your upcoming health goals for the summer? I'd love to support you in accomplishing your goals, so stay tuned for new ways to learn how you can stay healthy.

Why Physical Therapists Use Pilates as a Tool

If you ever go to the gym or fitness studio, you may be familiar with Pilates. It is a fitness system that is used to strengthen the core through a controlled workout. Pilates has become a popular choice in exercise and a vital tool in physical therapy. I use Pilates in my clinic because it helps strengthen weak muscles and improves movement practices, which help lower the risk of recurring injuries.

What is Pilates: In Pilates we focus on mind-body techniques in order to stabilize and engage the central core. Developing a strong core aids in controlled movement and teaches us to utilize our breathing patterns in order to power our energy systems. The two types of Pilates (mat-work and machine-based work) target core muscles and stabilization through strengthening, mobilizing, and stretching.

Why I use Pilates in Physical Therapy: Before I go into the reasons why I use Pilates as a physical therapist, it is important to understand the causes for recurring injuries: 9 times out of 10, a recurring injury is caused by poor movement practices. These are the seemingly minuscule habits that frequently take a toll on our physical function.

Our poor movement practices are often comprised of stronger muscles overcompensating for weak ones. Why do we do this? It is completely normal for us to use our strongest muscles because our bodies are programmed to do what feels the easiest. However, the easy way out does not always mean the right way. When we primary use our strongest muscles and neglect to strength weak muscles, our body will begin to suffer from imbalance. Imbalance results in injuries.

The reason why I decided to become a certified mat Pilates instructor, and use the technique in my physical therapy, is because I realized the benefit of rehab Pilates to help my patients realign, correct, and re-educate their muscles in order to prevent injuries from recurring. We find that the Pilates method works because it addresses the smaller muscles that are often overlooked during recovery. It helps us focus on balancing the body’s muscular system, and through that balance, many other body systems as well.

All in all, I use Pilates in treatment and as a rehabilitation tool because it helps my patients be mindful of the muscles they are targeting. Pilates helps adjust the body in alignment and eliminates bad habits so that injuries do not recur.

Let’s talk about: Muscle Tightness

Do you ever think you need to stretch more because your muscles feel tight? Or, have you ever wanted to increase your flexibility even though you could easily touch the floor leaning forward? Have you ever felt that it is suddenly hard to reach your feet to do your nails, but otherwise your muscles feel normal as you move through life? Well, for all of these cases, the knee jerk reaction is just to stretch because it must be tight muscles. However, there's a good chance that much more is going on here!

First, let me tell you a little bit more about the relationship between muscles and movement: Muscles are connected to bones by ligaments. When these muscles contract, they move the bones within the joint to a new position, such as when you kick your leg out. You're able to kick a ball because the bone of your upper leg can move in your hip socket. And, as you know, some people can kick higher than others. The height of your kick is part of the range of motion (ROM) within that hip joint.

So what effects movement within your joints? Our daily habits are a huge part of our ROM, joint health, and what might feel like tightness, but is much more. How many of you sit at a desk all day? We sit and lean forward to work at our computers. Then perhaps we ride our bikes home, sitting on the bike in the exact same position. And, finally, we relax on the couch in much the same position. Though, we might also get in a good walk or run on the treadmill as well, often in that same fiercely forward tilted posture of the upper body. Do we ever get out of this forward bend? It's just like a tree tilted by the wind all year round until it has grown into a constant leaning position; when our bodies spend most of our days in the same position, we get fixed in this position and the muscles that are supposed to move our bones within the hip socket get very tight. Alternately, the muscles that are supposed to move us out of that position get very weak.

Muscle weakness is a very common problem in our immobile society! When muscles are weak, they will have a hard time stabilizing the joint, which can lead to injury. In the example above, we saw extremely tight muscles from a repetitive movement and body position, with the alternating muscles being very weak from lack of use. Now say you stretched the muscles that were tight without also strengthening the weak muscles. You will then have loose muscles on one side and weak muscles on the other. Do you think that the bones of that hip joint will be well stabilized by those loose and weak muscles? Probably not. Will it then be easier to injured in that joint? You betcha!

Another issue we often see is hyper-mobility within a joint, which is very similar to those stretched and weak muscles we've been talking about. However, hyper-mobility can often be a genetic trait, such as being double jointed or being able to over-extend, or push past straight, in the at the knee joints or elbows. Hyper-mobility can also be from extreme stretching--something we see often in dancers, gymnasts and athletes. The ligaments, bones and connective tissue can be pushed past their natural limit, and if the muscles around that joint aren't strong enough to control the looseness of that joint, it can often lead to injury.

What about when you feel like a muscle is tight but it isn't? Or you are having a hard time with one particular movement? In these cases the problem could actually be with the nerves that are feeding information to and from the muscles. You could have a misalignment within the spine that is impeding a nerve's ability to communicate with your muscles. The problem could be postural and not at all to do with simply a tight muscle. In all of these cases, the most important step to correcting the problem is identifying it.

This is where Physical Therapists come in! Your Physical Therapist can examine and identify the underlying issue that is causing or contributing to that feeling of tightness, or that recent injury. In discovering the weakness, hyper-mobility, postural issue, or bad habit, you and your PT can start working on the strengthening and good habits that contribute to healthy joints and movement. It is vital to take care of your joints with a careful understanding of your natural range of motion, limitations, muscle weaknesses and areas to improve. But, the first step is to ask; we are here to help!

Dance of Chaos

“We dance to reclaim our brilliant ability to disappear in something bigger, something safe, a space without a critic or a judge or an analyst.” Gabrielle Roth

Chaos. The very word triggers a flinch. Something that every individual has experienced and sometimes negatively resulting in bad stress. Unfortunately, this can then infringe on our health and happiness. This weekend at a 5rhythms dance workshop, I came to the realization that we can also use chaos to help us let go. The best example of which I accomplished while dancing: a chaos like no other.

The definition of chaos is complete disorder, unpredictability. So it should not be a surprise that when you express your movements to a simple beating drum or a recorded song, you are living chaotically in the moment. Letting your body surrender, going with the flow of the song.

What this really means is that it helps us live in the moment. Mindful of the energy coursing through our bodies. A mindfulness that represents not the past (which can sometime depress us), not the future (which can sometimes make us anxious), but the present moment we are in.

In fact, many people unwind differently. The point of it all is the same. To find a release by being mindful of the present and somehow creating a calm center — a grounded self. By practicing this in the things we enjoy on the weekends, we can also apply this to everyday life. Remind yourself, when a chaotic week comes to an end, to focus on the present of what you are doing. There is nothing more you can do then what you are doing at this very moment.

What is CranioSacral Therapy

If you are familiar with Rising Sun Physical Therapy and our therapists you have most likely heard the words CranioSacral Therapy used in a consultation or during the course of your rehabilitation. Furthermore I, or your Rising Sun physical therapist, have probably even used this technique as a tool during your recovery.

CranioSacral Therapy is a method of therapy that I have gained a deeper understanding of over the years. In fact, when I first started learning the technique I was taught by the very developer of CST, Dr. John E. Upledger, at the Upledger Institude. Then, after learning CranioSacral Therapy, I started to bring the holistic approach into my own work with patients.

Although it can get a bit complex when learning about the intricacies of CranioSacral Therapy, it is in the most basic sense a therapeutic practice that uses the healer's hands to feel the natural rhythm of the central nervous system in order to stimulate healing. Using CST is to listen to the inner workings of the craniosacral system - the system comprised of membranes and cerebrospinal fluid surrounding both the brain and spinal cord (notably the most important).

This all leads to why we, as practitioners, use this form of therapy. The biggest reason for me is because it is on the holistic side of medicine. As a therapist who is positively attracted to noninvasive medical approaches, it has been my complete pleasure to successfully heal people with the use of CranioSacral Therapy (to give one example, ridding them of chronic head or neck pain).

Although I use a number of different techniques and approaches in my private practice, I have never felt so connected to the healing arts as I do when using CranioSacral Therapy. It teaches therapists to listen to their patients' internal processes and has been a successful tool for many health professionals.

CranioSacral Therapy in Big Sur

"It is said when the Eagle and the Condor share the same sky the world will come more into balance," Daniel Bianchetta

Last week I had the pleasure of assistant teaching at a CranioSacral Seminar with the Upledger Institute at Esalen in Big Sur. And I must say, Esalen, the Center for Theory and Research, is a really wonderful spot. When we were not delving into the intricacies of CranioSacral techniques, we had the pleasure of enjoying all the various activities the site had to offer.

I spent my evenings soaking in the hotsprings, enjoying the farm and garden, visiting the art center, and feeling the soothing waft of the ocean breeze. Between discovering the place, the waters, and the land, it felt less like work and more like a rejuvenating vacation.

My favorite part of the seminar was getting to share what was given to me when I began studying CranioSacral Therapy 23 years ago. The gift I gained from working closely under Dr. John E. Upledger, the developer of CranioSacral therapy, was the insight to listen with the touch of my hands. Even after his passing in 2012, his teachings remind me to constantly keep an open mind about the validity of non-traditional medicine, to stay on my path no matter the obstacle, and to make a positive impact on people's lives.

I am so grateful for the knowledge I have gained training with Dr. Upledger. Not only has he given me the tools to succeed in my field, he has also inspired me to learn more and teach this wisdom to other holistic healers and CranioSacral practitioners.

Last week at such a magical site I was surrounded by healers and intellectuals. This week, I can't help but feeling energized. So with this energy I hope to pass on the appreciation for life. Take a moment to ask yourself who has given you wisdom and shaped you into the person you are today. Finish out your week with positivity and have a great weekend!

Ergonomics

Here's a fundamental truth - the way you sit, stand, and move at work and at home has a huge influence on the muscular skeletal system.

We all fall victim to bad posture, and especially at work. Neck pain, back pain, headaches, eye strains, we've all experienced it. But not very many people take an effort to change their ways or finally prevent these issues from happening. If you experience or have experienced this before, then it's time to revisit the term "ergonomics".

What are Ergonomics?

This is a big word for a simple idea. Ergonomics, in it's most basic sense, asks the question "how efficient am I in a static environment?" Often times the collective strain on your body over a long period of time can lead to muscle fatigue resulting in various musculoskeletal disorders (like carpal tunnel syndrome, or tendinitis). The point of ergonomics is to lessen the most possible amount of strain by adjusting your work station and posture.

A Simple Solution:

Adjusting your work equipment in ways where your keyboard and computer help create good posture is now the first trick in the book to great ergonomics. Make sure the top of the monitor is squarely fit in front of you and just below eye level (never above!). Secondly, make sure your elbows are bent to where they create a 90° angle when using the keyboard.

Good posture is of utmost importance, but even sitting in the same position for hours can decrease circulation in your muscles and joints. As a precautionary step, make sure you're taking adequate breaks from the desk, getting up to stretch or doing simple exercises to lessen the load.

Kinesio Tape is Therapy Magic!

Have you ever wondered what the tape is your physical therapist uses to tape the surface of your injury? The one that comes in many different colors and is either applied as a thick band or as octopus legs spread out over the problem area? Well, that tape is called Kinesio Tape and it is a holistic form of therapy when it comes to stimulating the lymphatic system and healing sports injuries. In fact, physical therapists all-over attest to the many benefits of it during recovery!

So what exactly is it? Kinesio Tape is an elastic tape used in therapy; the technique of which provides support to the joints and muscles without limiting the movement of them. The real magic behind it though is that it lifts the skin at a microscopic level which increases circulation and causes lymphatic drainage. In other words, Kinesio Tape is known to decrease the inflammation of an injury and influences faster healing.

Your physical therapist will likely let you know if taping is the best method to recovery, but never be afraid to ask! Not only is it an efficient way to leave any PT clinic, it is also fun - kind of like you just got a temporary tattoo! And since there are dozens of ways to tape an injury, it never ceases to please. On another note, learning to tape your own injuries when they occur is a great skill and easily taught. Of course it won't replace a physical therapist, but it will definitely help ease the pain until you see one.

Known for benefiting injury rehab and lymph drainage therapy, Kinesio Tape has made a grand appearance on the bodies of professional athletes (especially during the Olympics in the early 2000s that seemingly popularized the practice). Surprisingly, it has even shown up in Versace's Milan fashion week in 2014! But regardless of whether it's a Versace getup you're wearing, you will always look great with a taped-up injury. Pick the colors you like best, at Rising Sun Physical Therapy we have bright blue, pink, and a classic black.