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3 Self-massage Techniques to Decrease Pain, Depression and Anxiety

August is National Wellness Month. Make wellness a priority with self-massage techniques using a foam roller. For centuries, massage has been helping people feel good, and medical research confirms the health benefits of massage to enhance function, assist healing, and promote relaxation and wellbeing.
 
According to Angela Kneale OTD, MA, OTR/L, in her book PRO-ROLLER Massage Essentials, “One single massage decreases your stress hormones. Twice-weekly moderate pressure massages improve range of motion, decrease pain, reduce depression and anxiety, and enhance immune function.” These three foam roller techniques can help you experience the benefits of self-massage during National Wellness Month and beyond.
 
 
Forearm Massage
Release tightness in forearms while improving forearm and wrist mobility.
 
1.     Kneel on the floor with your hips flexed and place your forearms on the roller.
Foam Roller Forearm Massage 1
2.     Moving your body from your hip joints, gently press your forearms into the roller to move it away from you and draw it back. Roll with palms in, and then rotate palms up to roll outer forearms, and down to roll inner forearms.
Foam Roller Forearm Massage 2Foam Roller Forearm Massage 3
 
Low Back Massage
Release tension in the low back while increasing comfort and flexibility and improving posture.
 
1.     Place the roller crosswise beneath one side of your pelvis. Keep your knees bent and feet flat on the floor in front of you, with your forearm on the floor behind the roller to support your upper body.
Foam Roller Low Back Exercise 1
2.     Reach your other arm to your knee, slightly rotating your torso. Gently roll the roller up and down next to your spine at your lower back. Repeat on the other side.
Foam Roller Low Back Exercise 2
Hamstrings Massage
Release leg tension while improving leg and lower back movement and comfort.
 
1.     Place the roller beneath the back of your thighs, with your hands on the floor behind you.
Foam Roller Hamstring Exercise
2.     Slowly roll down and up the back of your thighs, from your hips to your knees.
Foam Roller Hamstring Exercise 2
 
Find these and more self-massage foam roller exercises in PRO-ROLLER® Massage Essentials.
 

READ MORE Amy Bowman, OPTP Staff Writer - August 12, 2020


PROfiles: Deborah Riczo | Physical Therapy and Women’s Health

Empowerment Through Education

In 2016, Deborah Riczo retired from MetroHealth Medical Center, where she worked for 30 years, serving as a physical therapist, providing program development, and helping with administration duties. Yet, when she talks about her schedule it’s clear that she’s anything but retired. “I worked yesterday, I’m working today, and I’m getting materials ready for a one-day course on sacroiliac pain and pelvic girdle pain that’s being hosted by the Academy of Pelvic Health Physical Therapy,” she says.

The work Deborah does is through Riczo Health Education, the organization she founded in 2011. In addition to speaking engagements, writing and continuing education courses, she serves as a volunteer physical therapist for Womankind—a Cleveland non-profit that provides medical care and social support to pregnant women who don’t have health insurance. She also sits on the board of directors for several organizations.

Deborah has dedicated her physical therapy career to empowering women through education, and it all started by empowering herself through education.

Brian Mulligan in the 1980s

Deborah Riczo in 2020.

Following her passion

Deborah’s career started in marketing, working full-time to put her husband through law school. When she was offered a sales position (a role the company rarely offered to women at that time), Deborah turned it down knowing it wasn’t her passion and that she wanted to complete her undergraduate degree and do something related to science and healthcare. “I went to the library and researched different careers,” says Deborah. “Physical therapy is what spoke to me—the more I looked into it, the more I realized that that's what I wanted to do.”

When her husband John secured a job in law, Deborah was able to go back to school. She needed to take an entire year of prerequisites before she could even apply to the physical therapy program. After a year of taking the required classes, she was accepted into Cleveland State University, where she graduated with her physical therapy license in 1980.

Empowering women through prenatal and postpartum education

Deborah’s first job out of physical therapy school was at MetroHealth Medical Center in Cleveland, Ohio. A therapist at the hospital took Deborah under her wing, asking if she and another therapist wanted to be involved with the postpartum program; Deborah said yes, and the three eventually launched a business called Contemporary Physical Therapy Services. With contracts at three area hospitals, Deborah and her colleagues led classes that included prenatal and postpartum exercises and education, including the importance of relaxation and deep breathing—putting conscious relaxation into practice.

“That’s where it all started,” says Deborah—with prenatal and postpartum education. Ever since then, women’s health has been what I’ve focused my entire career on.” For Deborah, that has meant being a source of knowledge and support for women during an extremely important time in their lives—while they’re dealing with the emotional and physical changes that happen during pregnancy and postpartum.

She and her colleagues successfully ran Contemporary Physical Therapy Services from 1983-1993. During that time, Deborah returned to Cleveland State University, where she earned a Master’s Degree in Education and had two children of her own; a daughter named Alexa, and a son named Christopher. When one of her colleagues decided to move out of state in 1993, the women closed the business and Deborah ramped up her hours at the hospital.

Brian Mulligan in the 1980s

Deborah presenting to a community exercise class in Cleveland in 2003.

More than 30 years of serving as an advocate for women’s health

Deborah worked at MetroHealth Medical Center for more than 30 years. As an advocate for women’s health, she helped shape a rehabilitation program for women recovering from breast cancer and worked with women struggling to recover after childbirth. “Many women have their direction in life change after they have a child because they may have problems with their lower back and their pelvic girdle—and that affects how they’re functioning, their self-esteem, and their body image,” says Deborah. “They may struggle to get their weight down, have abdominals that are weak, and it can affect their relationship with their husband, or even with their children, if they aren’t able to be as active as they used to. So, I feel like if I can intervene with some simple education and techniques it can be extremely beneficial.”

Brian Mulligan in the 1980s

Deborah working as a clinician and coordinator of the Industrial Rehabilitation Program at MetroHealth Medical Center in 2013.

Using a patient-centered approach

Deborah says her focus has always been to help her patients meet their goals using a patient-centered approach. “If a patient comes in I instruct them on how to get changes in their body themselves. Sometimes I would do hands-on therapy, but then I would show them how to do that for themselves at home.”

Her passion for women’s health and the reputation she had gained as an expert on women’s health issues provided Deborah with the opportunity to present at national conferences, including the APTA National Conference for the Section on Women’s Health, which has recently been renamed the Academy of Pelvic Health. When she returned to school once again, working on her doctorate in physical therapy at Marymount University in 2007, her capstone project focused on an exercise approach she was using successfully at the clinic, which she later named the Pelvic Girdle Musculoskeletal Method, or PGM Method.

Brian Mulligan in the 1980s

Deborah presenting a 2-day lecture/lab course to physical therapists at Ohio State University for the Women’s Health Section in 2016.

Expanding her reach through Riczo Health Education

Deborah graduated with her doctorate in 2009 and founded Riczo Health Education in 2011. Her goals with the company are to provide consumer health education on sacroiliac pain, pregnancy and postpartum, breast cancer, and health and wellness. She also provides continuing education courses to health professionals, presentations to consumer groups, and consulting services to healthcare organizations.

Brian Mulligan in the 1980s

Deborah presenting a morning lecture as part of the Women’s Leadership Conversation Series at Cleveland State Alumni Association in 2018.

Reaching a wider audience through books

Deborah published her first book in 2018, Sacroiliac Pain: Understanding the Pelvic Girdle Musculoskeletal Method, and her second book in 2020, Back & Pelvic Girdle Pain in Pregnancy & Postpartum. Her desire to continue educating women and to reach the most people with a non-pharmaceutical, non-surgical approach was the inspiration for the books because, as she says, and as her long and successful career proves, “I’m a true believer in the power of education and empowering the individual to take back control of his/her health, to make healthy choices and lead a healthy lifestyle.”

READ MORE Amy Bowman, OPTP Staff Writer - July 22, 2020


PROfiles: Brian Mulligan | Manual Therapy

A prepared mind leads to a life filled with chance discoveries

“Chance only favors the prepared mind.” These words were spoken by Louis Pasteur, the French biologist known for his scientific discoveries. It’s not surprising that the quote is a favorite of Brian Mulligan, a legend in the physiotherapy world who has made his own important discoveries—including manual therapy techniques that have made a profound impact on the field.
 
Brian says the Pasteur quote applies to almost every aspect of his life, including his introduction to the field of physiotherapy and his achievements throughout his career that’s spanned more than 60 years. He attributes it all to chance and a prepared mind.
 

A prepared mind and a false start


Growing up in New Zealand during World War II, Brian’s greatest aspiration was to join the army; he took all the subjects necessary to be accepted into officer training and was devastated when he failed the eyesight test. His dreams dashed, Brian joined a large chemical company where he was encouraged to take classes toward a commerce degree. Working at a desk all day, while studying subjects like bookkeeping and company law at night, Brian says he was an “unhappy chap.”  
 

A prepared mind leads to the discovery of a new career


A chance work-related phone call changed Brian’s life. The brief conversation was with an employee at another company who happened to live nearby and was leaving his job at the end of the day to attend school for physiotherapy. It was a field Brian had never heard of. If he wanted to learn more about this new and exciting career, the young man on the phone suggested that Brian visit Oliver Olson—a physiotherapist with a practice in Wellington.
 
“I went to see this guy, and I saw his practice,” says Brian. “He had all this fascinating equipment and was very successful and confident. He was treating all these different patients and I thought, gosh, this is far more exciting than sitting at a desk all day!” Brian applied and was accepted into the New Zealand School of Physiotherapy, where he began classes the following year. “That chance discovery was just wonderful,” he says.
 

A prepared mind leads to a new way to treat patients


After qualifying to practice in 1954, Brian began making connections with other young, enthusiastic physiotherapists, including Stanley Paris and Robin McKenzie (who had also been a childhood schoolmate). The three connected with Freddy Kaltenborn, a physiotherapist who was learning manual therapy techniques and teaching them to other up-and-coming therapists in Europe and, later, on trips to New Zealand.
 
This led Brian to Helsinki, Finland, in 1970, where he attended Freddy’s classes—later returning to New Zealand to teach everything he had learned to his eager colleagues. “I had never taught anything in my life and that was my introduction to teaching,” says Brian.
 
Manual therapy became Brian’s area of expertise, and to this day, he credits the late Freddy Kaltenborn for his excellent handling skills. “To bring about change using my hands was really special to me and Freddy was an excellent teacher—he certainly made an impact on me. He gave me all my handling skills and I would never be where I am today if it wasn’t for my ability to deal with joints as Freddy taught me,” says Brian.
 

A prepared mind leads to a new technique


Brian Mulligan in the 1980s 
Brian in the 1980s. 
These hands-on treatments led to another chance discovery that was made while treating a young basketball player who came to Brian sometime in the mid 80s with a grossly swollen, injured finger that she couldn’t bend. After treating it with ultrasonics, Brian tried a manual technique to see if he could get it to move. “I tractioned and I did anterior and posterior translations and I was getting nowhere,” says Brian. “Then I remember grabbing her finger and just translating the distal surface medially, which she said was painful. When I translated the surface laterally she said it did not hurt. While sustaining this, I asked if she could bend her finger. I was amazed! Her finger started to bend straight away.”  
 
Brian went home and thought about how the technique had worked—even dreaming about it that night. “When the techniques I was initially using didn’t work and then something did work—I certainly had a prepared mind,” says Brian. “I thought, good heavens, why did that happen? I’ve got to find out why… and I found out why.”
 
When he was able to make sense of it, he began treating other injuries using this method. With a prepared mind, he started to reposition joint surfaces in pain-free directions and sustain the repositioning to see if he could get results. He says the results were amazing. Almost every day he would do something that he had never done before, and after some months was able to try this new approach right through the entire body.  
 

A prepared mind leads to more new treatment techniques  


Brian teaching one of his mobilisation techniques
Brian teaching one of his mobilisation techniques.

Chance and a prepared mind had led to a new way to apply manual therapy techniques: Mobilization with Movements (MWMs). “There is no other manual therapy approach being taught in the field of musculoskeletal medicine, that when indicated gives an instant pain-free result,” says Brian. In the ensuing years, this approach helped Brian make more discoveries, including the Pain Release Phenomenon (PRP), the Squeeze technique and a special hip muscle technique.
 
Already teaching conventional manual therapy, Brian felt strongly that any new technique that could help patients be active, functional, and pain free should be taught and made available to the public. This led to the formation of the Mulligan Concept Teachers Association (MCTA) in 1995. The organization helped meet the huge demand from therapists wanting to learn his techniques, while ensuring high teaching standards. Currently, there are MCTA colleagues teaching in over 30 countries and last year there were over 5,000 course participants in Europe and the UK alone.
 

A prepared mind, an exciting career, and a happy retirement


Brian accepting the Geoffrey Maitland Award in 2016
Brian accepting the Geoffrey Maitland Award in 2016. 

After more than 60 years in the field of physiotherapy, Brian says he’s most proud of receiving the Geoffrey Maitland Award, which he was honored with in 2016. He’s also extremely proud of his teachers who are teaching all over the world in 30 different languages. “They’ve found things that I haven’t found, and they’ve improved my concepts,” says Brian.
 
Last year Brian traveled to Africa, Spain, Mexico and Taiwan to teach, but after turning 87 he decided to stop and let his teachers carry on his work. Although he still has his license to practice and sees patients every now and again, Brian says he’s mostly retired. His time is spent golfing, gardening, reading, playing the piano every day, and spending time with his wife and family, including great-grandchildren.
 
“It’s been a privileged life,” says Brian. “I have doctor friends who had to give up medicine when they were in their 60s. And here’s this old so-and-so still traveling the world, teaching and enjoying life. Looking back, I could not have had a more exciting career.”
 
Brian has developed a variety of mobilisation tools for use in physical therapy. He is also the author of several books including The Mulligan Concept of Manual Therapy and NAGS, SNAGS, MWMS, etc. 
 

READ MORE Amy Bowman, OPTP Staff Writer - June 26, 2020


Benefits of using a stretching strap

There are so many great benefits of partner-assisted stretching, but what do you do if you don’t have a partner to stretch with, or you don’t want to pay the expense of visiting a stretching studio? That’s where a stretching strap comes in. Stretching straps are made of durable nylon and have multiple loops that permit deep, gradual stretching of major muscle groups, providing the benefits of partner-assisted stretching, without the partner.

Benefits of using a stretching strap include:

  • More control – The strap features various loops to hold onto; the tension in the strap allows for controlled movement of your limbs.
  • Go deeper into the stretch – The additional length provided by the strap allows you to move gradually into a deeper, more effective stretch.
  • Better posture while stretching – Reach into poses without tensing or rounding your upper body.
  • More stretching options – The control provided by the stretching strap allows you to reach into poses you otherwise would not be able to.
  • Perform contract-relax stretching – Tense the muscle group you want to stretch while pressing into the strap, relax for a moment, and then slowly and gradually stretch. This type of stretching has been shown to improve both flexibility and strength.

Here are 3 simple stretches you can do with a stretching strap:

Hamstring Stretch

Hamstring Stretch

Start: Place the center of the Stretch Out Strap beneath your left foot and reach the left leg straight out. Sit tall with neutral spine and bend the right leg to place your right foot against your left inner thigh. Hold loops of the Stretch Out Strap with both hands. With neutral spine, hinge forward from your hips.

Stretch Out: Press the back of your left leg into the floor, tensing the hamstrings. Relax for a moment, and then lean your upper body further forward. Continue contracting, relaxing, and stretching your hamstrings 2 to 3 times, and then hold the stretch for at least 10 seconds.

Quadripceps Stretch

Quadripceps Stretch

Start: Hook one Stretch Out Strap end loop around the middle of each foot. Lie face down, bend both knees and hold the center of the Stretch Out Strap behind your head.

Stretch Out: Try to straighten both knees, tensing quadriceps muscles, while resisting with the Stretch Out Strap. Relax for a moment, and then bend your knees further, as if reaching your feet toward the middle of your back. Continue contracting, relaxing, and stretching your quadriceps 2 to 3 times, and then hold the stretch for at least 10 seconds.

Chest & Biceps Stretch



Chest and Biceps Stretch

Start: Stand tall with the Stretch Out Strap behind your back. Each hand holds the first or second loop from the center, with palms facing forward. With your arms straight, reach back as far as comfortable.

Stretch Out: Tense the chest and biceps muscles as if pressing the Stretch Out Strap forward, without moving the strap. Relax for a moment, and then reach your arms further back behind you. Continue contracting, relaxing, and stretching your chest and biceps muscles 2 to 3 times, and then hold the stretch for at least 10 seconds.

Find these stretches and more in a free stretching guide that comes with the purchase of The Original Stretch Out Strap from OPTP.

READ MORE Amy Bowman, OPTP Staff Writer - June 10, 2020


3 Foam Rolling Exercises for Relaxation & Resilience

The simplest actions often make the greatest positive differences. Playfully rolling on a foam roller can help your body feel more relaxed, aligned and resilient as you release soft tissue and encourage tight areas to soften and lengthen. Read on for three foam roller exercises to help release stress and tension, recommended by Occupational Therapist and Certified Pilates Instructor Angela Kneale.
 
Middle Back Massage
Release tension between your shoulder blades while improving posture and flexibility.
 
1.     Sit on the floor with the roller behind you, and lean back onto the roller at the lower edge of your shoulder blades. Hands behind your head for support, reach your elbows toward the ceiling.

2.     Lift your pelvis, and slowly roll up and down your middle back from the top of the shoulder blades toward the bottom of your ribcage. Experience the support of your core muscles during movements.

 
 
Hip Rotator Massage
Release hip tension, increase hip mobility and improve posture.
 
1.     Sit on the roller crosswise, knees bent, and arm supporting on the floor behind the roller. Lean to one side and place that ankle on the opposite knee, rotate your hip outward as much as is comfortable and angle your knee down toward the floor.

 
2.     Slowly roll from top of your pelvis down toward the top of your thigh, relaxing and releasing deep hip rotator muscles. Repeat on the other side.

 
 
 
 
 
Low Back Release
Release lower back tension and promote segmental spinal mobility while improving posture.
 
1.     Stand tall and place the roller crosswise behind your low back. Hold the roller with your arms, palms facing forward.

 
2.     Gently press your arms forward and arch your back over the roller, adjusting roller placement for comfort. Maintain position for a few slow, deep breaths.

 
Find these and more relaxation exercises in PRO-ROLLER® Massage Essentials by Angela Kneale, OTD, MA, OTR/L, NBC-HWC.
 

READ MORE Amy Bowman, OPTP Staff Writer - May 11, 2020


PROfiles: Emilio Puentedura | Manual Therapy and Pain Science

Following Fate

 
Emilio Puentedura (who is fondly known as “Louie”) was first introduced to physiotherapy through his older sister Vicky who had contracted polio at the age of 18 months. Seeking better healthcare for her, Louie’s family uprooted from Madrid, Spain, and moved to Melbourne, Australia, in the early 1960s. Unable to sit up on her own, Vicky was enrolled in a school for children with disabilities at the age of seven and began working with a physiotherapist who provided in-home hydrotherapy treatments in extremely hot water. Louie, who was only five years old at the time, remembers wanting to get into the hot water: “I would say ‘I want to go in! I want to go in!’ and the physio kept telling me that I couldn’t. And then I’d put my feet in—and they would fly right out, and I’d yell, ‘it’s too hot!’” remembers Louie.
 
He also remembers the wood and steel brace his sister was required to sleep in. “When she didn’t sleep in it, it was leaning up against the wall—in the dark it looked like a scary monster,” said Louie. “I remember crying a lot because I was scared of that damn thing,” he added. Although they seemed scary at the time, these events helped shape Louie’s future professional life.

Louie at 10 years of age.
Louie at 10 years of age.
 

Physiotherapy: a life changing experience

Within several months of treatment, Louie’s sister was walking with the help of a walker and continued to become stronger over the years—eventually securing a full-time job, getting married and having three daughters. Vicky’s physiotherapy experience was life changing for her, and made a profound impact on Louie, too. “I think subliminally I must have realized there were some cool things being done for my sister and ultimately, I think that experience inspired me to go into medicine,” he said.
 
Being only one point shy of getting into medical school, Louie enrolled in a core program in physiotherapy and liked it so much he decided to stick with it. Transferring into the full-time physiotherapy program required an interview with the head of the school, which seemed to bring Louie’s path full circle. During the interview, the head of the school had a big smile on her face and asked Louie if he remembered her—he didn’t. “The last time I saw you, you were five or six years old,” she told him. “I recognized your name, and you look just like the little boy I remember.” That’s when Louie realized he was meeting with the physiotherapist who had helped his sister walk for the first time so many years before.
 

Manual therapy as a systematic way to evaluate and treat people

Louie’s transition from school into his professional life included a job at a school for children with disabilities, followed by a job working with geriatric patients. Eventually he settled on orthopedics, and in 1983 he completed a graduate diploma in manual therapy—which is one of his areas of specialty. “Manual therapy was covered very little in my undergrad program because there was a belief that it could hurt people or wasn’t really effective,” said Louie. “But when I learned more about it and started using it, I realized how effective it really can be. It’s a systematic way of evaluating and treating people—and it’s not dangerous if you use it with common sense and sound clinical reasoning,” he added.
 
Although a proponent of manual therapy treatments, Louie began to come across patients who suffered from such severe chronic pain that they couldn’t be touched due to their heightened sensitivity. This led Louie to pain science—and the work of Geoff Maitland, Louis Gifford, Lorimer Moseley and David Butler. It also led him to Adriaan Louw, who became a good friend and a co-worker when Louie signed on to teach at Midwest Spine Therapists—a seminar company Adriaan and his wife, Colleen, were running. Around 2006 the organization became the International Spine and Pain Institute and some of Louie’s courses, including Thrust Joint Manipulation, have since been incorporated.

Louie in Australia where he worked as a physiotherapist, 1981.
Louie in Australia where he worked as a physiotherapist, 1981.
 

Marrying into a family dynasty of physical therapists

Fate seemed to step in once again when Louie was working in Ballarat, Victoria, where he met and eventually started working for Peter Rice, a physical therapist who was very skilled at manual therapy and spinal manipulation. Louie was introduced to Peter’s daughter, Danielle, and was so fond of her that he proposed four years later. “I married into an incredible family dynasty of physical therapists,” said Louie. “Both my father-in-law and mother-in-law were physical therapists and my wife’s grandparents and great-grandparents way back at the turn of the century—the 1890s—were physical therapists in Australia,” he said.  
 
An opportunity to work at an outpatient clinic in Yuma, Arizona, brought Louie and his wife Danielle and their three children Ben, Georgina, and Alexander to the U.S in 1995. He completed a post-professional Doctorate in Physical Therapy at Northern Arizona University in 2005 and after receiving a job offer to teach, he decided he needed to further his education. He received his PhD in Physical Therapy at Nova Southeastern University in 2011 and served as a faculty member at the University of Nevada Las Vegas for 10 years, as Assistant and then Associate Professor of the Doctor of Physical Therapy Program. 
 

Shaping careers and changing lives through teaching

Now a Professor at Baylor University in the accelerated hybrid-model Doctor of Physical Therapy Program, Louie is inspired to help young PTs with a passion for learning to become the best they can be by helping them learn clinical reasoning skills, along with manual handling skills. In this role, he is helping shape the course of many students’ careers and providing them the opportunity to go out and make a positive difference for people who are struggling with pain and physical challenges; Call it a profession. Call it a mission. Call it fate. Whatever you choose to call it, it certainly seems like it was meant to be.
 
Emilio is a Professor at Baylor University in the accelerated hybrid-model Doctor of Physical Therapy Program. He is the co-author of a variety of books including Thrust Joint Manipulation Skills for the Spine, Pain Neuroscience Education and Integrating Manual Therapy and Pain Neuroscience.

READ MORE Amy Bowman, OPTP Staff Writer - April 20, 2020


PROfiles: Valerie Phelps | Physical Therapy

Valerie Phelps is a physical therapist whose career path has come full circle. From the time she was a young girl she wanted to be a brain surgeon—now she’s providing physical therapy care in a neurosurgery clinic two days a week. “I grew up knowing I wanted to take care of people,” Phelps says. “But when I looked into becoming a brain surgeon I got really discouraged because everything about it seemed overwhelming. Then I began volunteering at a hospital and realized that I got sick at the sight of blood,” she adds. At the urging of her mom, she began investigating physical therapy as a potential career field.
 

Finding a calling, not just a career

“What really called me to the physical therapy profession is the fact that you’re always working for the betterment of somebody, you’re always helping somebody improve their life—and that’s on both a physical and mental plane,” she says.
 
But the thing that made Phelps realize she wanted to be a physical therapist is the opportunity to establish a relationship with each patient, which isn’t necessarily the case with other occupations in healthcare. “Talking to your patient and getting to know them as an individual and as a person, not just a patient, is such an important part of the healing process,” Phelps says.  
 

Searching for a better way to treat patients

After graduating from the University of Minnesota in 1981 with a B.S. in physical therapy, Phelps says she floated around for almost seven years searching for the type of treatment that would work best with her patients. “I was an enthusiastic young clinician and I took every course I could and researched every concept out there. I went through periods of treating with a Maitland approach—then Barnes, then McKenzie, then Kaltenborn—and the list goes on,” she says.
 
Things fell into place on an unlikely trip to Aruba where Phelps attended an International Academy of Orthopedic Medicine (IAOM) conference. “I thought I already knew everything there was to know about the shoulder, so I went to this conference thinking I might learn a few things, but mainly I’d have a good time. Instead I was introduced to a whole new way of practicing and I was like—oh, wow, this is a philosophy of treatment based on anatomy that involves looking for patterns in the clinical setting and then matching treatment to the specific patient. Up until then, what I had studied involved using the same technique on every single patient,” she says.

 
Valerie consults with Physical Therapist Phillip Sizer in the late 90’s.

Discovering a treatment philosophy that fits

Phelps describes the IAOM approach as a concept that isn’t a one-person based program but a solid, multi-planar, anatomical approach that looks at movement, the biomechanics of the joint, the structures that cover the joint, the muscles and the myofascial structures that move the joint, and then other influences on the joint. “It’s just a really great system that looks at the whole kinetic chain,” Phelps says.
 
When she started studying with IAOM, Phelps says it became clear that if she knew what she was treating, she could select techniques from any of the specific areas of manual therapy she had studied. “Suddenly, I had hundreds of tools to utilize based on the patient,” she says. “IAOM’s treatment philosophy is that ‘it all fits,’ and the expertise comes from knowing when to use a particular technique, and with which patient.”  
 
Phelps was so impressed with the philosophy and the results she was seeing in the clinic that she trained to be an international instructor for IAOM in 1994. Eventually, she founded the U.S. branch of IAOM, where she serves as education director, delivering courses and lectures throughout the U.S. and Europe.


Valerie presenting at an IAOM conference.
 

Providing patient-centered care in the clinic and beyond

Another way that Phelps puts her patient-centered care into action is at Advanced Physical Therapy—an employee-owned practice that she founded and where she serves as practice director. With five locations throughout Alaska, the practice is made up of physical therapists, occupational therapists and massage therapists who customize treatments and provide education for patients with physical problems ranging from simple to complex, or as Phelps describes, “We treat everything from the big toe to the head.”
 
Her quest to help people experiencing pain doesn’t stop in the treatment room. Phelps helped develop the SI-LOC® support belt after years of working with patients experiencing sacroiliac joint pathology and not having an effective support to offer them. At the time, the only support option was a brace with a large triangular pad over the sacrum, which she says didn’t make biomedical sense. This inspired her to create a more effective support belt.
 
“Imagine holding a cone in your hand,” explains Phelps. “When we hold an ice cream cone, we don’t have to squeeze it very hard. If we create a little ring with our hand it just snuggly fits in that ring. That’s where we came up with the idea for the SI-LOC. It’s a simple but effective ring for the wedge of the SI joint to snuggly fit into and it only needs about 20 pounds of force to stabilize the joint. The SI-LOC works beautifully as a temporary assist for external stabilization while you’re working on internal stability, which can take a few months to several years,” she says.


Valerie presents with Phillip Sizer, PT, PhD, at a conference.
 

Coming full circle

After almost 40 years of practicing, Phelps says she loves physical therapy as much today as she did the day she graduated. “I probably love it more now because I know how much I don’t know. When you get out of school, you think you have all the tools you need and that you’re going to get everybody better, and that it’s completely dependent on you,” Phelps says. “But it’s a process and we’re always learning. I taught a course this past weekend and some colleagues I’ve known for at least 20 years flew in from across the country. It was really nice to sit down and share what we’re doing and to continue to learn from each other.
 
This is a profession that gives us the opportunity to learn more every year and as we discover more we understand more, allowing us to help improve patients’ lives—and that’s what I set out to do from the beginning.” 

Valerie is the founder and practice director of the employee-owned clinic Advanced Physical Therapy, with locations in Anchorage, Fairbanks, the Mat-Su Valley, and the Kenai Peninsula. She also helped develop the SI-LOC® Support Belt. Learn more about the SI-LOC here


READ MORE Amy Bowman, OPTP Staff Writer - February 3, 2020


PROfiles: Sarah Haag | Pelvic Health

Conversations about bowel, bladder and sexual function are all in a day’s work for Physical Therapist Sarah Haag. Because her job as a pelvic health specialist involves talking about deeply personal problems, her role has a bit of a therapist quality to it, “But you certainly would not want to come to me for help with relationship or life issues,” she says, laughing. 
 
Sarah helps patients who are experiencing problems with basic, everyday bodily functions. “When those basic functions aren’t working well, it can really affect your life,” says Sarah.  “Plus, there aren’t many places to talk about these topics. People come to me with problems they find embarrassing and they don’t want to tell their doctor—or they did tell their doctor, who said, ‘Well, that’s no big deal.’ Or, ‘That just means you’re old.’ I let patients know that it’s okay to talk about it and that they can get better,” she adds. 
 

Discovering a way to help people

The ability to help people get better is what drew Sarah to the physical therapy field in the first place. As the daughter of parents who both work in the medical field, she had exposure to what nurses and doctors do, but it was a volunteering opportunity at a local hospital during high school, and encouragement from her grandmother, that solidified Sarah’s interest in physical therapy. “I was volunteering and observing the physical therapists, and I thought—this sounds great because literally my job gets to be helping people do things they want to do and helping them feel better,” she says.  
 
Knowing that physical therapy was her ultimate goal, Sarah enrolled in a direct admit program at Marquette University, first completing her sociology degree, followed by a Master’s degree in Physical Therapy, which she completed in 2002. After completing a stint at the Texas Back Institute directly out of college, Sarah accepted a position at the Rehabilitation Institute of Chicago, where they were just starting a Women’s Health team that they asked Sarah to join. “I said, ‘Absolutely!’ And it was amazing because it was just a perfect fit,” says Sarah. “I was really inspired and excited to help people experiencing problems with these basic, everyday bodily functions. It's just an absolutely amazing part of the profession to be involved in,” she adds.  
 
Sarah feels that her success helping pelvic health patients is partly due to her ability to talk about difficult topics, which she says is a result of her upbringing and her background in sociology. “Studying sociology made me aware that the relationships people have with those around them impacts their lives and that we're all different,” she says. “So, for example, if you grew up in a place where women don't exercise, that’s important for me to know. If I have a better understanding of that culture, that upbringing, or that value system, it can really be useful when I’m trying to help you figure out a way that’s okay to start exercising. It’s not just looking at people as bones and joints and muscles, but rather looking at them as people who are trying to figure out how to change their bones and joints and muscles in order to feel better.”
  Sarah Haag teaching fellow clinicians.
Sarah Haag teaching fellow clinicians.

High volume clinics with lower quality care

Getting to know her patients in order to provide better care was difficult when working in high volume clinics in the early years of Sarah’s career. “The hardest part was helping people navigate and better understand the healthcare system,” she says. “Sometimes there’s a disconnect between what good health care is, what health insurance will pay for, and what a healthcare provider is actually able to do,” she explains. 
 
Because there are so many moving parts, Sarah says providing quality patient care can be tricky and that a lot of high volume clinics don’t do a great job because many clinics expect the PT to see four or five people at a time, patients can’t get an appointment as frequently as they should, and treatment isn’t individualized because the PT doesn’t have time to sit down and listen to them. “When I was in that environment I realized that I was working in a system that wasn’t working for me anymore. I wasn’t able to give the care that I thought was best,” she added. 
 
These frustrations led to a series of conversations with Sarah’s friend and fellow physical therapist, Sandy Hilton. The two shared their thoughts on treatment approaches and principles, and the challenges that are present in the healthcare system, which, ultimately, resulted in the decision to open a clinic together. “We wanted to provide health care in a way that is more efficient and effective,” says Sarah. In 2012, they opened the doors at Entropy Physiotherapy in Chicago, Ill. 
Sarah Haag presenting at the Third World Congress of Sports Physical Therapy.
Sarah Haag presenting at the Third World Congress of Sports Physical Therapy.

Helping people feel less like patients, more like people 

“People come in and say it doesn't feel like a clinic,” says Sarah. “We have normal living room chairs and exposed brick and exposed beams. The whole idea was to have people feel less like patients and more like people who are just trying to work out some physical problems, because another thing we tend to do in the system is medicalize people. And although some problems are ongoing, we shouldn't have people stay patients forever,” she adds.
 
Helping people get better and get back to their lives as usual involves taking the time to really get to know them, which Sarah has the time to do at the new clinic. “Really understanding why a patient is having trouble doing their home program, really understanding why it's hard for them to make that change, and then working with them to figure it out—that's where we actually have the biggest impact,” says Sarah. 
 

Doing what she set out to do—help people

For Sarah, the process of helping people feel better starts with humanizing the medical system. Here’s an example she shared: ”I just had a patient this morning who told me, ‘I don’t know why I always cry when I’m around you,’ which sounded really terrible. And then she said, ‘No, I just feel really safe and comfortable here.’ I think that’s beneficial—and I think that comes down to my ability, especially in the setting I work in now, to shut up and listen and let patients know it’s okay.”

 
In addition to treating patients at Entropy Physiotherapy, Sarah enjoys educating people about pelvic health topics which inspired her to write her first book, Understanding and Treating Incontinence. Learn more here.

READ MORE Amy Bowman, OPTP Staff Writer - October 21, 2019


PROfiles: Adriaan Louw | Pain Neuroscience

Introducing PROfiles, a series highlighting health and wellness professionals who are making a difference.

Adriaan Louw is a self-described introvert, but you wouldn’t know it by talking to him. That’s because the South Africa native speaks a mile a minute and has made it his life’s work to spread the message about Pain Neuroscience Education (PNE), which he speaks about often and enthusiastically. 

 

Physiotherapy: An Accidental Profession

Dr. Louw’s introduction to his area of specialty was almost as accidental as his introduction to physiotherapy. As an undergraduate student at the University of Stellenbosch in Cape Town, he had a strong interest in medicine and sports but struggled with some of the chemistry classes required for med school. After a school counselor suggested physiotherapy, which Dr. Louw didn’t even know about at the time, he enrolled in a physio class and was immediately hooked by the idea of gaining the skills and knowledge to help people in pain. He completed both his bachelor’s and master’s degrees in physiotherapy before beginning his career in a hospital outpatient department in Cape Town. 
 
After practicing traditional physiotherapy for many years, Dr. Louw was introduced to PNE when his manual therapy skills didn’t seem to do enough for some of his patients. “Manual therapy is nice because you can often see the result immediately, but the reason I got interested in pain neuroscience is because manual therapy is limited when it comes to treating people with chronic pain,” he says. “I had been practicing for a long time, so people started sending me the more difficult patients and I got to a point where I felt like, ‘I don’t know what to do with them anymore.’ I needed a new paradigm, I needed a new way of helping people,” he says. 
 
This roadblock led him to other notable physiotherapists and leaders in the pain science movement: Dr. David Butler and Dr. Lorimer Moseley. “These guys were super nice to me,” says Dr. Louw. “And I worked with them for many, many years on the whole pain science movement before we started doing more of our own work individually.” In addition to becoming a mentor and friend, Dr. Butler encouraged him to enroll in a PhD program in therapeutic neuroscience education and spinal disorders, which Dr. Louw completed in 2014. 

 

Pain Neuroscience Education—A New Way of Thinking 

The PhD program at the University of Stellenbosch solidified Dr. Louw’s belief in the PNE movement which is contrary to the common way of thinking about pain. “The old-school thought was we always tied injury to pain. If you have an injury, you’re going to hurt. I mean, if you hurt you must have an injury,” says Dr. Louw.  “And we now know that 30% of people experience pain with no injury. There are emotional times in our lives when our nervous system will protect us by producing pain, for example. So, we've taken on the concept that we separate the health of our tissues from the experience of pain.”
 
“It’s just the concept that we’re treating human beings, we’re not treating a joint or a muscle,” Dr. Louw added. “You know we always say, ‘Every joint has a brain. Every joint has a family.’ In the past I treated the joint—all I cared about was this joint in front of me. But we forget that that joint has a person attached to it—that there’s a human being we’re treating and we’re so into the joint or the muscle, we forget about the person. And what pain science has done for me, is it’s humanized the pain experience. It’s a human being here that we have to help,” says Dr. Louw. 

 

Sharing his Knowledge Through Books 

Dr. Louw’s research resulted in his first book, Your Nerves are Having Back Surgery, which he wrote as a pre-operative pain program for individuals preparing for spinal surgery. The publication of that book resulted in letters from people requesting a book for those who weren’t preparing for surgery, which led to the publication of the book Why Do I Hurt?. This resulted in requests for more books that addressed other types of pain. Dr. Louw feels the success of the series—which now includes twelve patient books, as well as a clinical text and teaching system—is because the books are short, inexpensive, and provide a quick route to understanding and treating pain. “I think we also found a nice voice for clinicians who were looking for the right words to use with patients in the clinic,” he says. 
 
In addition to writing books and research papers, Dr. Louw travels all over the world teaching classes and speaking at conferences. He’s also building post-graduate programs in pain science and working with a lot of students. He and his wife, Colleen Louw, who is also a physical therapist, own the Ortho Spine and Pain Clinic in Story City, Iowa, where they provide PT services to members of the community.
Adriaan Louw teaches a class about pain neuroscience.

Adriaan Louw teaches a class about pain neuroscience.


A Movement with a Message 

Dr. Louw’s goal as a physical therapist is to make the world a better place by teaching people who are in pain about their pain. “When I work in the clinic, I may see 15 patients; I can impact 15 people that day,” he says. “But through my teaching, writing and speaking in front of thousands of people—maybe I can be part of a movement that can mobilize to take this message out to more people. That’s probably the biggest thing we’re doing: can we get the next generation trained to train the next generation about PNE, and help more people who are hurting?”  
 
“Therapists and healthcare providers can get down really quickly,” Dr. Louw says.  “You know, there’s the opioid epidemic, and people are struggling—the doctors are getting frustrated—there’s a lot of negative out there. But when I do commencement speeches, I tell students all the time, ‘The future looks bright. There’s a lot of good happening in this world. I know we’re faced with some serious challenges right now, but there’s so much good happening and we’ve got an incredible opportunity to make this world a better place, including for people in pain.’” 
 
Fortunately, this self-described introvert who discovered physiotherapy by accident has found his voice and is willing to use it, because the pain epidemic is a global challenge and his message could help some of the millions of people who are affected by it. 
 
Adriaan Louw is the author of 12 patient books, a clinical text and a teaching system for patients. Learn more about his books and resources here.
 
 

READ MORE Amy Bowman, OPTP Staff Writer - October 7, 2019


Top Picks for National Read a Book Day

“If you want to change your body, start by changing your mind.” 
-      Eric Franklin, Grow Younger Daily
 
Today is National Read a Book Day. Why not read something that will not only open your mind but can help improve your health and wellness, too?

Read these books to find out how you can keep your body feeling and looking young; help decrease pain by understanding the causes of it; find out how you can feel more relaxed, aligned and resilient through foam rolling; learn ways to treat or even prevent incontinence; and find out the key component to overall physical, emotional and spiritual health with our top picks for health and wellness reads. 
 

GROW YOUNGER DAILY:

THE POWER OF IMAGERY FOR HEALTHY CELLS AND TIMELESS BEAUTY, SECOND EDITION 

By Eric Franklin 
The Franklin Method, developed by author Eric Franklin, combines movement and Dynamic Neurocognitive Imagery (DNI)™ to harness the transforming power of the mind to move efficiently and keep the physical body young and energized. With the power to change the body from the inside out, imagery can influence and rejuvenate everything from individual cells to the immune system and organs, showing that remaining young is largely a question of attitude. 
This updated, second version of Grow Younger Daily features new imagery and additional exercises for strengthening and lengthening muscles and keeping your body feeling and looking young. 
 

MAKING SENSE OF PAIN: STORIES AND ANALOGIES THAT HELP DEFINE PAIN 

By Jim Heafner PT, DPT, OCS and Jarod Hall PT, DPT, OCS 
For the millions of people who suffer from acute or chronic pain, this book explains in simple terms what causes pain, the reasons why we feel pain, and what motivates people to get better. The book then guides readers through stories and analogies that make it easier to visualize and talk about pain. By educating readers on how pain works, this book can help people on their journey toward healing. 
 

PRO-ROLLER® MASSAGE ESSENTIALS, THIRD EDITION 

By Angela Kneale OTD, MA, OTR/L 
The simplest actions often make the greatest positive differences. Spending just a few minutes lying or sitting and playfully rolling on a cylinder-shaped piece of foam can help your body feel more relaxed, aligned, and resilient. This revised third edition provides recent research about the benefits of foam roller self-massage and comprehensively guides more than 40 exercises, and numerous modifications for rolling and releasing sore or tight muscles, fascia and connective tissues. 

 
UNDERSTANDING AND TREATING INCONTINENCE:
WHAT CAUSES URINARY INCONTINENCE AND HOW TO REGAIN BLADDER CONTROL 

By Sarah Haag PT, DPT 
Urinary incontinence is a health problem that impacts millions of men and women worldwide, costs billions of dollars, and can have a negative effect on quality of life for those experiencing it. The good news is that there is help and there is hope. This new book, by physical therapist and pelvic health specialist Sarah Haag, explains what’s happening, why it’s happening, and what you can do about it. 
 

THE POWER SOURCE:
THE HIDDEN KEY TO IGNITE YOUR CORE, EMPOWER YOUR BODY, RELEASE STRESS, AND RE-ALIGN YOUR LIFE 

By Lauren Roxburgh 
Located at the root, all energy and strength flow up from the pelvic floor, and it impacts everything from our daily body mechanics to our nervous system. Without addressing the health of our pelvic floor, we are missing out on a powerful key component of our overall physical, emotional, and spiritual health. In The Power Source, celebrity trainer and body alignment expert Lauren Roxburgh introduces her program, which uses pelvic floor strength to release stress, strengthen the body, and treat the physical and mental origins of tension. 
 
Happy National Read a Book Day, and happy reading! 

READ MORE Amy Bowman, OPTP Staff Writer - September 6, 2019


7 Ways to Interpret a Positive Straight Leg Raise Test

Welcome to Orthopaedic Medicine Tips and Tricks for Physical Therapists, a series of blog posts highlighting clinical and practical issues that PTs involved in musculoskeletal medicine are frequently confronted with. Today’s topic: 7 ways to interpret a positive Straight Leg Raise test. 
 
The SLR test is a popular test often used for back patients. Common questions to ask during an SLR test include: 
  • Is there always a nerve root involvement in the case of a positive SLR?  
  • Does a positive SLR only cause leg pain?  
  • What about back pain on testing?
A careful interpretation and definition of a positive SLR is imperative to reach a useful diagnosis and define part of your treatment strategy. Let’s have a look at some key elements:


Test first on the pain-free side

Firstly, we have to find out which range of movement is normal for this particular patient. Secondly, the patient needs to distinguish between a “normal” (painful) stretching of muscles and his actual symptoms. So, always perform the SLR bilaterally.
 

Don’t miss a painful arc

Since a painful arc at SLR is not uncommon, we should not abandon the test as soon as pain is provoked. The moment we provoke pain, ask for the localization of the pain and then continue with the passive movement, possibly provoking a painful arc. A painful arc is typical for a small and easy reducible internal derangement. 
 

Add accessory neck flexion on testing

First, go to the end of the movement, interpret pain and range of motion, then add accessory active neck flexion. If the added neck flexion affects the pain, then this is a clear dural test: we exclude the sacroiliac joint, the facet joints or the hamstrings as the cause of pain, and we firstly think of a lumbar internal derangement. We can expect three possible reactions :
  • No influence on the pain
  • More pain (in the back, gluteal area or leg)
  • Less pain
The SLR is not only a root test but also a dural test. Just like neck flexion stretches the dura upwards, SLR stretches it downwards. Actually, we can state that any considerable limitation of dural mobility results in a limited or painful SLR.
 
The limitation is mostly bilateral if the pain in the back is central/bilateral, e.g. in an acute lumbago, a large central protrusion compresses the dura mater resulting in clear dural signs.
 
A unilateral internal derangement can cause a unilateral limitation of SLR, or a limitation which is more prominent on one side. When the compression of the dura ceases, the range of movement becomes normal again.
 
The SLR is a very useful criterion during a treatment session by e.g. manipulation. We can easily follow the gradual reduction of the disc protrusion/internal derangement by means of the evolution of the SLR.
 

Example 1: a patient with backache and 30° limitation of SLR 

We start manipulation using  SLR as a control test criterion in-between the maneuvers. After a first manipulation, the test shows about 10° limitation. After the next manipulation, SLR becomes negative, although there is no full reduction yet. Some movements in standing may still be painful. We continue our manipulative strategy, but from now on the positive movements in standing become our new control test criterion.  
 

Example 2: a three week old sciatica with 30° limitation of SLR 

The treatment is e.g. daily mechanical traction; every day, the SLR is tested before traction begins.  At the end of the first week, only 10° limitation remains. During the weekend, the patient takes an excursion with his family; he sits in his car for hours, and when he comes back on Monday he has again 30° limitation of SLR.  
 
We see that the situation is worse again, but we do not know yet how much worse. So, we do the complete examination, and if we do not find any neurological deficit, we go on with traction.  
If, however, we find neurological deficit, we know that the protrusion has become too large and therefore irreducible and we have to consider other treatment options.
 

The six SLR stages:

  • SLR is negative: a minor disc protrusion/internal derangement is still possible.
  • SLR is painful, not limited: the protrusion cannot be large.
  • Painful arc on SLR: again, this must be a small easily reducible internal derangement.
  • Painful, limited, without neurological deficit: a somewhat larger protrusion, interfering with mobility, not with conduction.
  • Painful, limited, with neurological deficit: severe compression, not only of the dural sleeve about the nerve root, but also of the parenchyma. Both    mobility and conduction are disturbed.
  • Negative (no limitation, no pain) but with neurological deficit. The patient has had a sciatica for some time. Now thepain gets even worse for minutes or hours or even days, after which rather suddenly the pain disappears completely and SLR becomes negative again. This is an ischaemic root atrophy: the protrusion is maximal, the compression is so severe that the nerve root has become ischaemic. Stretching it causes no protective reflex anymore and SLR ceases to hurt. There is motor and sensory deficit, possibly with loss of knee or ankle jerk. The patient has become symptomatically better but anatomically worse.
“Adherent root” is also an interesting interpretation:
Rarely, the SLR is slightly limited with end range pain: if repetitive testing doesn’t affect the symptoms, this might suggest root adhesions. This is a typical “Dysfunction syndrome”, which has its own particular clinical image and treatment strategy.
 
I hope this provided you with some inspiration…there’s more to come in the next blog post. See below for a companion video.


Questions? Feedback? 

Email Steven De Coninck, chair ETGOM at info@cyriax.eu.
 

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READ MORE Steven De Coninck, MSc, PT - August 28, 2019


5 Ways to Avoid Neck and Back Pain

Neck and back pain can make the most simple, everyday movement feel like a major feat. Turning to check traffic before making a lane change can cause sharp pain that stops you in your tracks. The best way to deal with neck and back pain? Avoid it altogether, if you can. 
 
Dr. Greg DeNunzio, chiropractor and Clinic Chief of Staff of the Biomechanics Division at Northwestern Health Sciences University provided the top 5 ways to avoid neck and back pain. 


Sleep on your back 



 

“One of the main things I would talk with my patients about is their sleep posture because it’s so important,” says Dr. DeNunzio. “You’re in bed for around eight hours a night or more, so outside of ergonomics, sleeping in a healthy position is the best way to avoid neck and back pain.” 

According to DeNunzio, the best sleep position is lying on your back because you have the support of the spine and your body weight is more equally distributed. You want to sleep on a flat pillow, so you don't reverse the curve in your neck. You can also purchase a cervical pillow that can be placed inside your pillowcase to support the neck. 


Sleep on your side 



“If you have a pillow between your knees, you definitely can sleep on your side,” says Dr. DeNunzio. The pillow keeps you from twisting at the hip or rolling over. So, for instance, if you’re on your left side and have no pillow between your knees, your right leg could fall over the top and you kind of roll to that left side causing your hips to twist. The pillow keeps your spine and hips in line. 
 
According to Dr. DeNunzio, having a pillow between your ear and the bed keeps your neck in line with your spine. Just be sure it’s the correct size pillow that doesn’t angle the neck towards one shoulder or the other. In addition, Dr. DeNunzio says it’s important to sleep toward the back of the shoulder, closer to the shoulder blade, instead of having your shoulder perpendicular to the bed which causes too much force directly on the shoulder joint. 
 
It’s also important to make an effort to switch sides – either during the night or every other night. 


Avoid sleeping on your stomach 




Lying on your stomach is the worst position to sleep in for two reasons, according to Dr. DeNunzio. First, there’s no support of the spine, so you tend to really arch your low back and you can jam the vertebra together by doing that.
 
Plus, you have to turn your head to one side or the other in order to breathe. “When you do this, you’re stretching the musculature on one side and shortening musculature on the opposite side of the neck, which sets up an imbalance,” says Dr. DeNunzio. This can cause tension in the muscles that attach at the base of the skull, which can lead to neck pain, headaches, and upper back pain.  


Have your workstation ergonomics checked 




If you sit at a desk, Dr. DeNunzio advises that you check to make sure that the top of your computer screen is at eye level and that your keyboard is on an adjustable tray, so you always keep your wrists as straight as possible. The same with the mouse – it should be on the keyboard tray so you’re not reaching up for it. 
 
“Adjust your chair so your knees are slightly below your hips, which allows you to keep good posture through your low back into your upper back and neck,” says Dr. DeNunzio. If your knees are above your hips you start to round out your low back which puts a lot of stress on the low back, so you really want to avoid that. 


Stretch 




In addition to taking breaks from sitting every 30 minutes or so, Dr. DeNunzio tells people to do what he calls scapular retraction exercises. Put your thumbs under your armpits and pull your elbows back. Pulse and squeeze the shoulder blades together while keeping your elbows behind you. 
 
Lastly, focus on holding your head straight up and try to be conscious of where your chin is. You want to keep your chin from jutting out in front of you, causing your head to protrude forward. Basically, you want your head to stay in line with your spine.  


Bonus Tip 

Following these simple tips can help you avoid neck and back pain. Should you find yourself in pain, Dr. DeNunzio says that the sooner you get in to see a practitioner the better – whether it’s a chiropractor, physical therapist, acupuncturist, or massage therapist. If you get in right away it’s easier to get back to feeling well more quickly because you haven’t given the muscles the time to start to change length in a more permanent way. 
 

Greg DeNunzio, DC, BSME

Dr. Greg DeNunzio has a Bachelor of Science in Mechanical Engineering and is a licensed Doctor of Chiropractic. He is currently completing his Master’s in Exercise Science. He has 25 years of experience working as a chiropractor in a multidisciplinary clinic and is the Clinic Chief of Staff of the Biomechanics Division at Northwestern Health Sciences University. 
 

READ MORE Amy Bowman, OPTP Staff Writer - August 16, 2019


5 Fixes to Common Pre-Workout Mistakes

Most gym-goers aim for the same goals and share the same inspiration. However, not many walk out of the gym doors with a sense of accomplishment. Many fail to achieve their goals due to misinformation on how one should really be working out.
 
Pre-workout mistakes don’t happen at the start of a warm-up – or the lack thereof. These mistakes happen before you even get to the gym. We compiled a list of 5 common pre-workout mistakes you might be making as well as the solutions to them:
 

1.     You don’t think warming up is necessary.

 
Warming up isn’t the most enjoyable part of going to the gym. Nobody will hold it against you if you admit to hating it. We often ignore the advice as we don’t think it’s necessary, but warming up does play a huge role in your overall performance.
 
The purpose of warming up is to elevate your heartbeat in order to allow the blood to circulate better. Warming up is important to the muscles as they perform better when they receive an adequate amount of blood supply. These routines also improve your muscles’ ability to absorb impact and handle more weight – reducing the risk of injury.
 

2.     You think warming up only involves stretching.

 
There’s no denying that a little warm-up is always better than not warming up at all. However, warming up is a dynamic process that involves more than just left-over-right stretches.
 
As the purpose of warming up is to improve your overall performance during your actual workout, adding some cardiovascular exercises would be better. Stretching aids in flexibility, while cardiovascular exercises greatly benefit the heart.
 
On average, your pre-workout exercises should take at least 5-10 minutes each. A proper warm-up should reduce muscle soreness that usually happens from a previous workout.
 

3.     You eat too much or too little.

 
If there’s one thing we can all agree on, it is that working out takes a lot of energy. While it’s tempting to eat a lot before a workout, it’s not something you should do. And there’s so much more to it than just overloading yourself with macronutrients.
 
Eating too much pre-workout prevents you from maximizing your time at the gym. It can lead to bloating, cramping, and overall poor performance. The same goes for eating too little. It is crucial to eat the right amount of food and maintain a proper diet to supply the body with the oxygen that aids in utilizing fats better.
 

4.     You rely on health supplements.

 
There has been a growing demand for health supplements over recent years. Some experts are strongly against using them, but others believe that the additional nutrients can benefit the body.

Even before the health supplement industry took the world by storm, many people had already managed to achieve their fitness goals without the use of them. The body is designed to store nutrients. It also understands when to use them. Thus, relying on supplements to boost your performance at the gym isn’t really necessary; after all, they’re only called supplements.
 

5.     You think it’s fine to hit the gym after a sleepless night.

 
Though it is admirable to see someone sticking to their fitness routine, exercising when tired or sleep-deprived can have dangerous consequences. Memory is impaired when sleep is compromised, and it affects your performance in the process. Additionally, sleep-deprivation makes you more sensitive to pain – you need to put in more effort to accomplish your usual routine.
 
Skipping the gym and taking the day off after a sleepless night is always better than having your body fight off a potential infection. Your stress hormones will greatly benefit from it too.
 
As everyone’s physiology is different from each other, the type of diet and warm-up needed to achieve peak performance may vary from one person to another. Also, before engaging in any physically-demanding activity, make sure that your physician rules out any underlying diseases or conditions you might have.


 
The Center for Athletic Performance & Physical Therapy offers five locations throughout Arizona and provides physical therapy and sports training services including orthopedic therapy, hand therapy, dry needling, massage therapy and more.

READ MORE Tom Bratcher - August 1, 2019


Breathing for Peak Performance: A Book Review

In his new book, Breathing for Peak Performance: Functional Exercises for Dance, Yoga, and Pilates, movement educator and mind-body expert Eric Franklin explains the anatomy of breathing and tells how you can do it better in order to be more alert, have more energy, and improve performance. 
 
“People take about 20,000 breaths a day. Therefore, improving your breathing brings noticeable benefits to every aspect of your daily life. Generally better breathing makes your life more comfortable. It makes you more alert and energetic, and it improves exercise and sport performance,” says Franklin, who has tested his ideas and exercises during more than 30 years of teaching. His principles have been used by dancers, yoga practitioners, Pilates instructors, actors, vocal coaches, singing coaches, and many others. 
 
The book begins by breaking down the evolution of breathing to better understand why we breathe the way we do, before going into detail about the function of each of the major muscles and organs involved in breathing, including the diaphragm, rib cage, lungs and more. Franklin provides exercises to help you visualize the breathing process in order to fully understand how it happens. “If you cannot see the design and movement of … any part of the body, improving it is difficult,” Franklin says. “Positive change begins with awareness.” 
 
The book includes 35 breathing exercises with step-by-step instructions, as well as color photos and illustrations. At the end of the book, Franklin presents a recommended daily practice, which is ideal for individuals, professionals, coaches, practitioners, and students of dance, yoga, and Pilates. 
 
Breathing for Peak Performance is extremely concise and includes the information necessary to help achieve the goals for improved breathing, including: 
·     Embodying optimal breathing function 
·     Improving posture 
·     Reducing gripping and unnecessary tension 
·     Improving mobility and coordination of the rib cage and thoracic spine 
·     Increasing flexibility and strength in the muscles of breathing 
·     Optimizing breathing patterns for individual situations 
·     Evening movement distribution between breathing regions 
·     Improving coordination in the powerhouse of breathing, the diaphragm 
·     Improving your state of mind 
 
Whether you are an athlete, a coach, or simply someone who wants to experience the many benefits of breathing more efficiently, then this book is for you. 

Eric Franklin 
Eric is the founder and director of the Franklin Method, which he created over 25 years ago and has taught all over the world. He earned his B.S. from the University of Zurich and his B.F.A. at New York University’s Tisch School of the Arts. Eric presents at numerous conferences internationally and teaches at universities and schools including the Julliard School in New York, Rutgers University and the University of Vienna. Eric’s series of more than 20 books and Franklin Method products were created to help people learn to harness the transforming power of the mind to make positive changes in the way they move for a more youthful and energized body.  

READ MORE Amy Bowman, OPTP Staff Writer - July 25, 2019


SMARTROLLER: The Yin and Yang Approach to Foam Rollers

The original “foam” rollers were created by Moshé Feldenkrais in the 1920’s and were made from the middle roll of thick cardboard that was used to wrap carpets in Israel. Now made of foam, most rollers mimic the original roller, with a cylindrical shape that comes in a variety of sizes and densities. Then there’s the SMARTROLLER® -- a uniquely designed foam roller that provides more opportunities to move more freely, with less pain and more flexibility. 
 
A durable “two-in-one” foam roller, the SMARTROLLER features a flat side that can provide more stability when sat on or stood on for balance-related movements, and a rounder side, which provides a more challenging, dynamic workout. The dual sides provide a yin and yang approach to foam rolling, while its lower height makes it an easy roller to mount and dismount for people of all ages. 
 
Designed by physical therapist Stacy Barrows, the SMARTROLLER is ideal for rehabilitation and balance training and can be used as an exercise prop for a variety of disciplines, including Yoga, Pilates and Feldenkrais. “I designed the SMARTROLLER to help people improve their sensory-motor awareness and to help facilitate higher learning,” says Barrows.  “My goal was to create a roller that anybody could use, no matter their level of fitness, while still providing the option to create more challenge for those who want it.” 
 
When the roller is used lengthwise with the rounder side in contact with the floor, most people find that the flatter side feels more comfortable along the spine. That’s because the less aggressive curve more closely approximates the convex shape of the torso — a shape that also eliminates overstretching of the ribs. And, because it rests closer to the floor than traditional foam rollers, you can lie on it to support the right tension in your body which will allow you to move more easily. Flipped over, with the rounder side up and the flatter side in contact with the floor, the SMARTROLLER has more of an arc. This provides added stability, which creates even more possibilities for movement and balance play.


Use the SMARTROLLER with the rounder side down for a less aggressive curve along the spine or feet. 


Use the SMARTROLLER with the flatter side down for added stability. 

To continue learning about the SMARTROLLER, and about how you can use it to help you move more freely, with less pain and more flexibility, check out Stacy Barrow’s book SMARTROLLER® Guide to Optimal Movement
 
Stacy Barrows, PT, DPT, GCFP, PMA®-CPT 
Stacy is a physical therapist, a registered Guild Certified Feldenkrais® practitioner, and a PMA certified Pilates teacher. She has more than 25 years of experience working as a physical therapist and is the owner of Smart Somatic Solutions, Physical Therapy, Inc. 
 
 

READ MORE Amy Bowman, OPTP Staff Writer - July 17, 2019


Experience More Vitality and Happiness with the Feldenkrais Method

“What I’m after isn’t flexible bodies, but flexible brains… actually what I’m after is to restore people to their human dignity.” 
       - Moshé Feldenkrais 

The annual Feldenkrais Method® conference is taking place June 26-30 in Boulder, CO. Learn more about the Feldenkrais Method and its benefits in this interview with Feldenkrais Method Trainer Candidate Anastasi Siotas. 
 
Q. What is the Feldenkrais Method®? 

A. In simple terms, the Feldenkrais Method provides a way for people to learn how to perform everyday activities differently, helping them avoid injury and experience more vitality and happiness in their lives. It’s not a therapeutic method per se – it’s more of an educational methodology that can provide therapeutic benefits. 
 
The Feldenkrais Method® helps you sense and understand, through movement and the experience of moving, how you might do things more efficiently. That could mean sitting in a more organized way, because even though sitting isn’t an ideal activity to do for a long time, you can learn through exploring movement how to do it more optimally. It’s a way of mindfully being present to your body and paying attention to how you’re performing daily activities. 
 
Q. What is the purpose of the Feldenkrais Method? 

A. Feldenkrais is a ground-breaking modality that helps address how we can learn to live pain-free and conserve our energy so we can live comfortably for as long as possible. There are so many things in our modern convenience driven way of life that draw us away from our evolutionary endowment. Since the industrial and internet revolutions we’ve changed our activities of daily life very rapidly – especially in the last 100 years – away from the kind of physical tasks that our bodies evolved to be able to do to keep us healthy, like hunt for food or escape predators on a daily basis. 
 
 Feldenkrais work taps into a holistic and organic understanding of human development and our maturation process from childhood to adulthood. What we learn in this process includes the acquiring of habits, some good and some not so useful. By exploring our innate developmental movement patterns and those from our evolutionary biological history – we can upgrade our habits and by re-exploring movement, we come to understand ourselves better. We become more efficient in how we move while learning to divest ourselves from painful physical habits, thought habits, or emotional habits that leave us in a less than optimal state.
 
Q. What are the main benefits of the method? 

A. Awareness through Movement® Feldenkrais lessons offer ways to discover how you do what you do so that you might choose to shift the way you perform any action by having explored new options that weren’t on your radar. In this way, you discover new options that offer greater freedom. I also believe it can help you live longer because if you’re more efficient in the way you use your energy, then you have more energy left for the things you want to do – you’re not wasting effort doing things that are counterproductive. 
 
Q. What are some unhealthy habits that the Feldenkrais Method can help people break? 

A. To be healthy, we have to have good use of every part of ourselves, nothing should be left out. Our entire musculature and skeletal system shapes and remodels itself around the activities that we most often do. As we live ever more sedentary lifestyles, spending many hours each day looking at devices that bring our heads forward – our body is adapting to that and a forward head is less than optimal. Compare this to the hunter-gatherers who held their head high, as they ran around chasing down their food as opposed to going to the supermarket or a restaurant. 
 
Many of us do things to counteract our sedentary lifestyle – we go to the gym, we run, we take part in a variety of activities, but there’s still such a large percentage of our day that most urban people spend being sedentary. This lifestyle contributes to upper-body flexion because our head is held forward to engage with our virtual world. Our skeleton and muscles will adapt to keep us up and keep us going but we’re running into a lot of trouble with our forward head posture. More and more people are experiencing chronic neck pain, shoulder pain, lower back pain – it’s really a global problem for first world countries. This is because we’re not using our bodies for any long period of time in accord with what evolution has dictated. Our biped structure has been shaped by the way we evolved to move over hundreds of thousands of years. Our convenient modern city-based lifestyle is putting us ever more rapidly out of step with nature. 
 
Q. Who can benefit from the Feldenkrais Method? 

A. I have a huge variety of clients. I work with children, seniors, people in the performing arts – actors, dancers, musicians. I work with athletes as well as people with neurological impairments – Stroke, Parkinson’s, Traumatic Brain Injury. The variety is endless because everybody moves. And I believe if you move, you can improve. 
 
People are not coming to me to be fixed. They’re coming to me to learn about what’s going on with them. It’s an educational process that we engage in together. Since it’s primarily a learning process I help them find ideas and practical tools to go away with and work on so they can continue to improve. 
 
Q. What is your goal in teaching this method? 

A. The Feldenkrais Method has helped me live a better life, a more comfortable life and I want to help others do the same. My goal is pretty high. We only have this one body we live in and we have this one life to live. We might as well use our clever brains to help us make the most of it. 

Anastasi Siotas is a Feldenkrais Method Trainer Candidate based in New York City. His background as a researcher in marine cell biology and as a professional modern dancer, choreographer, and director provided a unique blend of art and science that lent themselves well to a career in the Feldenkrais Method of somatic education. He has taught the Feldenkrais Method for more than 25 years and maintains a private practice for individuals and groups in downtown Manhattan. 

READ MORE Amy Bowman, OPTP Staff Writer - June 25, 2019


10 Tips to Stay Active and Healthy at the Office

According to the American Heart Association, sedentary jobs have increased 83% since 1950 and physically active jobs now make up only about 25% of the U.S. workforce. This means that the majority of working Americans are spending quite a few hours sitting every day, which we all know can have some serious negative consequences. Take control with these 10 tips to help you stay active and healthy during the workday, even at your desk job.  
 
1.  Get an exercise ball 
Sit on an exercise ball instead of your regular office chair for 30 minutes or more every day. Consider alternating between your chair and the exercise ball throughout the day. 
 
2.  Get moving 
Get up and walk for 5 minutes every hour. Do a lap around the building, take a trip to the water cooler to fill up your water bottle, say hello to a colleague who works in another part of the building, or step outside for a few minutes of fresh air. 
 
3.  Try a standing desk 
Find out if it’s an option to get a standing desk, a treadmill desk, or a sit-stand desk which will allow you to alternate between sitting and standing during the day. 
 
4.  Hold walking meetings 
Need to hold an informal meeting or brainstorm session? Take it out of the office for a walking meeting outside, bonus points if you can find a wooded trail or park to walk in. 
 
5.  Commute by bike  
If possible, ride your bike or walk to work instead of driving or taking the bus. If you normally take the bus and the distance is too far to bike or walk, consider getting off at an earlier stop and walking the rest of the way to work. 
 
6.  Check the ergonomics of your workspace 
Have the ergonomics of your workspace checked to ensure that your chair and computer are at the correct height and that your keyboard is at a comfortable distance and in a position that won’t cause additional strain on your hands and wrists. 
 
7.  Get a lumbar roll 
Need additional back support? Consider getting a lumbar roll to attach to your desk chair, which will provide lower back support and help you maintain a healthy posture. 
 
8.  Do strength exercises at your desk  
Keep small hand weights or resistance bands at your desk and do simple strength exercises like bicep curls, lateral raises, and overhead presses. 
 
9.  Try desk Pilates  
Desk Pilates is different from many other forms of exercise because it invites you to move mindfully, focus on your breathing, and strengthen your deep postural muscles. Learn simple Pilates movements you can do at your desk in the book Desk Pilates: Living Pilates Every Day, 2ndEdition
 
10.  Focus on your breathing 
Sounds pretty simple, but just a few minutes of focused breathing can help reduce stress, anxiety and negative feelings while improving your ability to concentrate. 
 
Don’t let your desk job negatively affect your health. Adopting just a few of these simple habits can help you improve your workday and your health. 

READ MORE Amy Bowman, OPTP Staff Writer - June 13, 2019


Four Ways to Relieve Stress

What were you doing the last time you felt calm, comfortable in your body, free of stress, and positive about life? Were you walking in the woods? Playing golf? Skiing? Spending time with a particular person or a particular group of people? Stacy Barrows is a Los Angeles-based physical therapist and Feldenkrais® Pilates instructor who wants you to start paying attention to those pleasant experiences, so you can develop more of them. 
 
“I see a lot of people with very complex pain problems, and I think what’s compounding it is the speed of information coming in. We’re very overstimulated right now and it’s causing stress,” Barrows says. “I want people to continue to do what makes them feel good so when they move, they enjoy the experience. When people are in that positive state it allows them to flow through the overstimulation and stress that is so common in our culture today,” she adds. 
 
Here are four things that Barrows recommends doing to relieve stress and calm your mind so you can enjoy more pleasant experiences. 
 
Breathe
Deep breathing is an excellent way to lower stress in the body. When you breathe deeply, and with little effort, it sends a message to your brain to calm down and relax. The brain then sends this message to your body. “I don’t tell people how to do the right kind of breathing,” Barrows says. “I help my clients observe how to regulate their breathing through a refined awareness so that it can be a guiding force for how to be in a place of calm,” she adds.  
 
Walk
Walking is one of the best exercises you can do. It strengthens the heart, boosts immune function, eases joint pain, and burns calories in addition to boosting energy and improving mood. “If you can walk comfortably, it’s the ideal form of movement to help decrease stress,” says Barrows. But the main point is to move your body. If another form of exercise is more enjoyable for you – do that. 
 
Explore nature 
“The benefits of nature can be accessed so simply,” says Barrows. There are so many amazing benefits that spending time outdoors has actually become a form of therapy, known as green therapy or nature therapy, prompting healthcare providers to give their patients “nature prescriptions” because of the regenerative powers of the outdoors, including improving mood, and easing anxiety, stress and depression. 
 
Listen to your body 
If a practitioner provides guidance about what they think is right for your body, take into consideration what you know about yourself. Listen to yourself and follow your intuition. “One of the worst things a practitioner can do is reduce your confidence in what your body is telling you,” Barrows says. “If a client has a gut reaction to something I’ll ask, ‘What do you think that means?’ This is one way I’m helping my client build intuition and a sense of self-care.”  

READ MORE Amy Bowman, OPTP Staff Writer - May 21, 2019


Training in the Flow: Rest and Recovery Between Hard Workouts

Personal trainer Luis Leonardo knows a thing or two about pushing his body to the limit. His background in endurance sports began when his love of running landed him on a sprint triathlon team at the age of 13, where he completed the 5k running portion of the event. By the age of 16, he completed his first full triathlon on his own and at 20 he completed his first Ironman race – an even more intense endeavor involving a 2.4-mile swim, a 112-mile bike ride, followed by a 26.2-mile run. 
 
The Importance of Recovery
As important as it was for Leonardo to learn how to push the boundaries of his limits, the key thing he learned was the importance of recovery. “I have over-trained many times in my life,” he says. “I have injured myself and it happened through not understanding the importance of recovery. There were times when I’d wake up on a given day and my legs were super tired from a hard workout the day before and then I’d go do another very hard workout without understanding that my body was asking me to recover right now.” 
 
Training in the Flow 
These experiences led Leonardo to his philosophy for personal training, which is to help people learn how to train in the “flow” in order to avoid injury. As the owner of Tres Sports, a fitness studio located in Edina, MN, Luis encourages his clients to push themselves and explore the boundaries of their capabilities, while respecting their bodies and their limits. Leonardo says the most common thing he sees as a trainer is people overdoing it while training. “They’re doing way too much,” he says. “I try to teach them how to make it a little more balanced and to be consistent over a longer period of time. That way they’re going to get a lot farther.” 
 
Training in the flow means that if you’re training at an exertion level between 1-100, you’re trying to stay within the 60’s and 70’s most of the time. Through time, as you continue to workout consistently –  for three months, six months, one year – that 70% is going to continue to grow, so before you know it your 70% is going to be what once was your 90%. “That way you’re less likely to get injured,” says Leonardo. “You’re more mindful of your own body, you’re having more fun, and things come a little slower, but the end result is much bigger.”  
 
Listening to Your Body
Training in the flow is counterintuitive to a lot of common messages regarding fitness because it’s not about following a strict plan. It’s about doing what’s right for your body on any given day. “That’s what has helped me become a better version of myself as a trainer is to not always have a strict plan,” says Leonardo. “When my client walks in the door I ask them how they’re doing. Based on that response the workout plan for the day unfolds. It’s based on how the client feels. I’m just a big believer in listening to your body one day at a time and trying to build consistency,” he adds. 
 
Building Consistency 
“With consistency and not trying to rush things, you start to develop that mental capacity, that mental awareness. And I think the more mature you get and the more comfortable you get with yourself you begin to understand, ‘Okay this is way too much for my body to handle right now.’ Because your body’s always going to tell you through pain or through an injury what it needs.” That sounds like good advice from someone who is all too familiar with going the distance.

These days Leonardo is testing his limits by doing his signature 30-minute high metabolic style training from tr3smethod.com, where he checks how much his mobility, strength and endurance are improving. His goal these days is to feel fit every day, to own his own body and not to abuse it, in order to achieve longevity. He is also providing personal training, individualized training plans, and group fitness classes at Tres Sports
 
 
 
 
 

READ MORE Amy Bowman, OPTP Staff Writer - May 15, 2019


Grow Younger Daily: A Book Review

“If you want to change your body, start by changing your mind” 
      -  Eric Franklin 
 
If you’ve ever heard the phrase, “if you can imagine it, you can become it,” then you’re familiar with the basic concept behind the Franklin Method. Founded in 1994 by dancer and movement educator Eric Franklin, the Franklin Method teaches how to use exercises, motivation strategies and dynamic imagery to change your body, by changing your mind. 
 
Athletes, dancers and fitness experts have long used sophisticated mental imagery to enhance performance and with the Franklin Method you can, too. In the newly published second edition of Eric Franklin’s book Grow Younger Daily, The Power of Imagery for Healthy Cells and Timeless Beauty, Franklin demonstrates the connection between imagery and physical and mental health and shows how you can use the Franklin Method to change your body from the inside out to help you look youthful and feel energized.
 
Many books have been written about mental imagery but Grow Younger Daily takes it to another level--to the basic building blocks of your being: the cells of your body. The book demonstrates how your thoughts and imagery affect your body at a cellular level, and then explains how different forms of imagery can be used to improve everything from the appearance of your skin, to the clarity of your vision. 
 
In the book, Franklin states“In the West, we often define ourselves according to the newest scientific research, but the changeable nature of our very structural being has long been proposed by Eastern philosophies. We very much become how we behave, and how we behave is based on the way we move, our posture, our emotions, our mental life, and the predominant imagery and self-talk circulating through our brains.” 
 
In addition to learning about self-talk, imagery, and some less-common forms of self-care, the book covers common strategies for looking and feeling your best by reducing stress, healthy eating, exercising, and surrounding yourself with a strong support system. Franklin says that the first step to change is acknowledging that you have the power to change. With that knowledge, read Grow Younger Daily with an open mind before putting his strategies into action. Learn more about the Franklin Method at franklinmethod.com
 
 
 

READ MORE Amy Bowman, OPTP Staff Writer - May 8, 2019


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