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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. 


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. 
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.  
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

A Beginners Guide to Pilates

“With body, mind and spirit functioning perfectly as a coordinated whole, what else could reasonably be expected other than an active, alert, disciplined person?” 
-      Joseph H. Pilates 
May 4 is Pilates Day, the perfect time to celebrate this popular exercise form designed to stretch, strengthen and balance the body. If you’re new to Pilates, here’s a guide to what it is, what the benefits are and why so many people are doing it. 
What is Pilates? 
Pilates is a form of exercise that involves a series of movements with names like The One Hundred, Criss-Cross, Scissor Kick, Elephant, and the Swan that are done in a specific order, either on a mat or on a piece of equipment called a Reformer. 
The History of Pilates 
According to the Pilates Method Alliance, Pilates was created in the 1920’s by Joseph H. Pilates. As a German national placed under forced internment while living in England during the outbreak of WWI, he created a series of original exercises done on the floor, known as “matwork,” which he taught to fellow camp members. The concepts and exercises he developed were based on more than 20 years of self-study and apprenticeship in yoga, Zen and ancient Greek and Roman physical regimens. In later years, he began devising equipment to create spring resistance to help rehabilitate injured internees who were struck with wartime disease and physical injury. 
The Main Benefits of a Regular Pilates Practice 
Michael Fritzke and Ton Voogt are internationally recognized Pilates presenters and certified Pilates Teacher Trainers who each have more than 25 years of experience in the fitness industry. Together, they co-founded ZENIRGY, a company created to promote health through innovative workouts, products and educational programs. They are also the creators of the TRIADBALL, a product that’s ideal to help build core strength during Pilates practice. 
Fritzke and Voogt describe Pilates as a “very complete and versatile form of exercise that can be used in conjunction with physical therapy or a stand-alone full-body workout, or as general conditioning and alignment for professional athletes and performers.” Because it’s a form of general exercise and conditioning it allows you to “mold it” to be exactly what you want it to be. They list the top benefits of Pilates as:  
·     Increased strength
·     Increased mobility and flexibility 
·     Improved posture 
·     Improved body awareness and control 
Common Misconceptions About Pilates 
Read below to find out how Fritzke and Voogt debunk common misconceptions about Pilates. 
      Myth: Pilates is like yoga on equipment
      Fact: Pilates and Yoga are two different modalities that complement each other but are not the same.  
      Myth: Pilates is for women only
      Fact: Pilates was created by a man, for men who were in the military. It provides a great workout for both men and women. 
      Myth: Pilates is a form of physical therapy
      Fact: Although it can be modified to help people with any physical injury or limitation, it isn’t physical therapy. 
      Myth: Pilates is for dancers only
      Fact: Although the movement form can be extremely helpful for dancers, it’s for everyone from professional athletes (including NFL and MLB players), to people with severe limitations – and everyone in between. 
How to Get Started 
Although private or semi-private Pilates lessons are more expensive, Fritzke and Voogt say that it will pay off and they encourage anyone looking to get started to find a local Pilates studio in their area. If you’re not ready for private lessons just yet, check out Pilates books and equipment that can help you get started on your own, or visit Pilates Method Alliance to learn more. 

READ MORE Amy Bowman, OPTP Staff Writer - May 3, 2019

Lauren Roxburgh at Goop Summit 2019

In Goop Health: 2019 Summit
In case you didn’t already know, actress Gwyneth Paltrow has transformed the meaning of the word “goop” from something you want to avoid running your sleeve through—to health, wellness and personal growth. In 2008, Paltrow started a healthy living newsletter called goop, which has grown into a company that sells beauty and wellness products and a high-end clothing line called G. Label. In addition, goop provides inspiration and information about the latest trends in fashion, beauty, food, style, travel, wellness and work via goop.com. These topics and more will be covered at the company’s annual summit, In Goop Health, to be held May 17-19 in Los Angeles.
Mind-Body-Soul Reset
The summit, which goop.com calls a “Mind-Body-Soul Reset” will be hosted by Paltrow and her chief content officer, Elise. According to the goop website, the two will “host panels and chats with cutting-edge doctors and scientists, thought leaders, and some of the women (and men) who inspire us the most. There’ll be restorative workshops and classes—for the spirit, for the body, for the mind, and for beauty—plus our signature retail hall, food, and drinks.” Studios holding smaller group workshops will cover the following categories:
  • Body
  • Intuition
  • Energy
  • Mind
  • Food
  • Beauty
Featured Attendees
One of the featured attendees at the event will be Lauren Roxburgh, the fascia and alignment expert who uses mind-body techniques, including foam rolling, to help her clients look and feel their best. Roxburgh is the author of the bestselling book Taller, Slimmer, Younger: 21 Days to a Foam Roller Physique and an internationally renowned wellness educator who is often referred to as the “Body Whisperer.” As the creator of the LoRox line of products, Roxburgh provides hours of workout videos for members of her Aligned Life Studio.
Other featured attendees at the goop summit will include:
  • Olivia Wilde: Director of Booksmart
  • Elizabeth Gilbert: Author
  • Jessica Alba: Founder of the Honest Company and Honest Beauty
  • Busy Philipps: Actress, author and host of Busy Tonight
  • Lisa Taddeo: Writer
  • Robynne Chutkan, MD: Gastroenterologist
  • Julianne Hough: Dancer, actress, and singer
  • John Amaral, DC: Chiropractor and educator
  • Erica Chidi Cohen: Doula, educator and author
Attend the Summit  
If you’re interested in attending the Goop Health 2019 Summit, you’ll want to act fast—in past years the event has sold out. Tickets are available from goop and can be purchased for one-day only, or as a full weekend pass.
To learn more about Lauren Roxburgh, click here.

READ MORE Amy Bowman, OPTP Staff Writer - April 24, 2019

5 simple foam rolling exercises to relieve lower body muscle tightness

It’s April and that means one thing; runners everywhere are hitting the trails, paths and pavement for an endorphin-driven mood boost. Whether you’re enjoying a leisurely short run or intensifying your marathon training, you may experience some lower body stiffness and muscle tenderness after your workout.

View this short video to learn 5 simple foam rolling exercises to help relieve tightness in the:

  • Hamstrings
  • Calves
  • Glutes
  • IT Bands
  • Quadriceps

READ MORE Tara Sowka, CPT - April 16, 2019

Rapid Identification Guide for Sacroiliac Joint Dysfunction

Identifying the cause of pain is vital in providing proper patient treatment. This guide from physical therapist Valerie Phelps, PT, ScD, of the International Academy of Orthopedic Medicine, can be used to help identify one of the most common musculoskeletal problems in the lower back and buttock region – sacroiliac joint dysfunction.

Patient background information

Always begin with an established system to gain information including patient history. This allows you to:

  • Easily recognize common pathologies
  • Identify new patterns of pain or clinical findings that can lead to detection of other specific disorders
  • Educate and reassure your client on the possible problem
  • Assist in selecting further consulting professionals

Patient history

The patient history should be an established system of seeking information and would include:

  • Age of the patient
  • A pain drawing used to help identify the pain
  • Identifying what provokes or improves symptoms

Clinical testing

The clinical testing would include a mechanical provocation test that helps answer the following questions:

  • Is it painful?
  • What provokes/improves symptoms?
  • Where is it painful?
  • Is this pain familiar (pain that has been bothering you for a period of time) vs. discomfort caused by the clinical test itself?

Battery of tests to determine areas of pain

  • Trunk motions
    • Forward flexion
    • Forward flexion with the addition of a chin-tuck
    • Extension
    • Side-bending to each side
  • Straight-leg raise performed supine on a table
  • Slump test (a dural test performed while sitting)
  • Sacroiliac joint provocation
    • Dorsolateral provocation
    • Ventromedial provocation
    • Asymmetrical in side lying

Pathologies for sacroiliac joint dysfunction

  • Arthropathy
    • Synovitis
    • Hyper/hypomobility
  • Pubic Symphysis
  • Pelvic Ring Dysfunction

Common contributors to sacroiliac joint pathology

  • Age (generally 18-35 years)
  • Pregnancy
  • Participation in sports that require strong unilateral movements, such as soccer

Common identifiers of sacroiliac joint pathology

  • Painful with asymmetrical movements, like standing on one leg, or taking stairs two at a time
  • Generally, shows localized region of pain at about the area of the PSIS
  • About 40% of the time the patient will show some referral pain pattern to the greater trochanter
  • If complaining of pain in lumbar region or down the leg, it’s rarely associated with SI joint pathology

Clinical test results that help identify sacroiliac joint dysfunction

  • Trunk and hip motions will potentially be painful at the end range where the joint gets a torque or tension to it
    • End range flexion
    • End range extension
  • Straight-leg raise test and slump testing will be negative
  • Painful provocation tests
    • Pain reduced/relieved when a stabilizing belt is applied, and the test is repeated

Additional tests when the patient also complains of midline or groin pain

  • Resisted adduction in 45°
    • This test is classically painful with a pubic symphysis problem
    • Pain resolves when repeated adduction is performed with a pelvic ring stabilizing belt

Sacroiliac joint and pubic symphysis often create pelvic ring dysfunction

  • May or may not be associated with pain
  • Patient may complain of vague discomfort in the “panty area”
  • A straight leg raise test can be done to test strength of each side

Ways to manage sacroiliac joint dysfunction

  • Education
  • Manipulation to restore the position of the SI joint, as needed
  • Injections
    • SI joint
    • Pubic symphysis
  • Stabilization training
    • Diaphram
    • Abdominals
    • Gluteals
    • Latissimus Dorsi
  • SI-LOC Support Belt application
    • Often 24/7 for up to 2 years to allow for connective tissue to turn over, resulting in “tighter” ligamentous support
    • Can be worn less often, (during the pain producing activity, for instance) in less severe cases

The SI-LOC Support Belt is effective for treating SI joint dysfunction. Its lightweight, breathable fabric can be worn against the skin and conceals easily under clothes.

Learn more about the SI-LOC Support Belt

For more information about SI joint dysfunction and other physical therapy topics, visit IAOM-us.com

Valerie Phelps, PT, ScD, is a physical therapist and the founder and director of Advanced Physical Therapy. She is also the founder of the U.S. branch of the International Academy of Orthopedic Medicine (IAOM) where she serves as education director.

READ MORE Amy Bowman, OPTP Staff Writer - April 9, 2019

Back pain? It could be your SI joint

Sacroiliac (SI) joint dysfunction is a common contributor to low back pain. In this interview with physical therapist Valerie Phelps, PT, ScD, she explains what sacroiliac joint dysfunction is, how to identify it and what to do about it.

Q. Where is the sacroiliac joint?

A. The sacroiliac (SI) joint is located in the pelvis. It links the iliac bone (pelvis) to the sacrum (the lowest part of the spine, just above the tailbone).

Q. What is sacroiliac joint dysfunction?

A. The SI joint is designed to take on load and transfer it from the spine to the legs and reverse. It is what we call a “mobile stabilizer.” When the loads through the SI joint are too great, or the ligaments that hold it together become lax (such as in pregnancy), the joint becomes “too mobile.” This can lead to pain in the pelvic ring, and sometimes even in the low back or legs. It leads to an “unstable” foundation for the spine and legs, altering movement patterns and often causing a sense of weakness.

Q. What is the difference between muscle pain in the low back and low back pain caused by SI joint dysfunction?

A. Very often there is little difference in the sense of pain because these regions are so interrelated. One could say that pain above the iliac crest/sacrum “belongs” to the low back, where pain below the iliac crest or along the sides of the sacrum are related to the SI joints.

Q. How would a person know if their pain is due to muscle pain or if it’s caused by SI joint dysfunction?

A. In general, muscle pain due to a strain should only last a few days, such as after a long walk or a good workout. Heat often makes it feel better. In instances of a recent SI irritation (from too much motion, or sometimes a “locked” joint) the muscles will respond in a “splinting” type fashion; in this case they are trying to support the joint, and painful spasm of the muscles can be experienced. In longstanding SI joint pain, muscle pain can actually become part of the problem. They have been in a protective “splinting” for so long they develop trigger points and fibrous bands that will respond well to dry needling or manual therapy press and stretch techniques. In both recent and longstanding cases, the underlying problem still needs to be addressed, which is where the SI-LOC can be helpful.

Q. How long should someone wear the SI-LOC if they’re experiencing pain due to SI joint dysfunction?

A. People experiencing pain due to SI joint dysfunction can wear the SI-LOC Support Belt 24 hours a day, 7 days a week for 300 to 500 days (the length of time it takes the ligaments to “turn over” and shorten). The SI-LOC is meant to be what we call an “external stabilizer,” which people need when they can’t internally stabilize. It very simply holds the wedge-shaped joint at the lower aspect of the joint, much like an ice cream cone holds a scoop of ice cream.

Q. What sets the SI-LOC belt apart from other support belts?

A. It is simple, it can be worn next to the skin, and it’s invisible under the clothes.

Learn more about the SI-LOC Support Belt

Valerie Phelps, PT, ScD, is a physical therapist and the founder and director of Advanced Physical Therapy. She is also the founder of the U.S. branch of the International Academy of Orthopedic Medicine (IAOM) where she serves as education director.

READ MORE Amy Bowman, OPTP Staff Writer - April 9, 2019

The Top 10 Holiday Gifts

Happy Holidays from OPTP®. To make your holiday shopping just a bit easier, we’ve compiled this list of our Top 10 Holiday Gifts. Avoid the chaos of the malls and make your holiday shopping simple and enjoyable. Visit OPTP.com for gifts for the yoga or Pilates participant, the exercise enthusiast, the dance devotee, those in need of a little TLC, and anyone else on your holiday shopping list.

For the Yoga or Pilates Participant
PRO-ROLLER® Pilates Challenge Book $11.95
Ready to roll up to the next level of Pilates for a joyful, strong and healthy body? The book PRO-ROLLER® Pilates Challenge encourages exploration of movement through 40 intermediate-to-advanced Pilates exercises on the PRO-ROLLER such as Oblique Can-Cans, Windmill, Mermaid Series, Bicycle, Push Up Combo and Leg Circles.
OPTP® PRO-ROLLER® Soft $23.65 – $37.80
Wondering what all the foam roller hype is about? Get a foam roller for yourself, and someone special on your holiday list. The OPTP® PRO-ROLLER® soft is gentle enough for those who are more sensitive or who have never used a foam roller before. These high-quality foam rollers offer a variety of uses and benefits from massage and myofascial release, to physical therapy, Pilates, yoga exercise, and more.
For the Exercise Enthusiast
Performance Wedges  $37.95
Ideal for yoga, Pilates, physical therapy, and fitness training, Performance Wedges™ serve as an assistant for alignment and form during squats, planks, pushups, and balance-related movements.
Gymnic Exercise Ball  $21.40 – $60.45
Available in six sizes, this exercise ball is ideal for workouts in the gym, clinic or at home. It’s an extremely versatile tool for physical therapy, Pilates, fitness and general exercise.
Foam Roller with Massage Book Gift Set $34.95 (Holiday sale price until December 31, 2018)
The OPTP PRO-ROLLER® Standard foam roller offers a medium density that is ideal for both self-massage and exercise. Roll out stiff, sore muscles and relieve stress to improve posture and flexibility. This gift set includes Angela Kneale’s exercise book showing proper foam roller massage techniques for over 30 moves that target tight areas throughout the body.
Stretch Out Strap®  $17.95
With multiple loops for deep, gradual stretching, the Stretch Out Strap allows you to stretch major muscle groups with greater safety, control and effectiveness than is possible unaided.  
For the Dance Devotee
Book: Conditioning for Dance: Training for Peak Performance in All Dance Forms  $28.95
Improve dance technique and performance with over 160 dance-specific exercises designed to maximize mind-body conditioning. Achieve higher jumps, tighter turns and more tension-free lift by strengthening your core, increasing balance and improving alignment.  
Happy Feet Book and Franklin Textured Ball™ Gift Set $29.50 (Holiday sale price until December 31, 2018)
In the book Happy Feet, mind-body guru Eric Franklin takes his teachings of body design and imagery and focuses on where posture begins – the feet. Perform the movements as described and pictured in the book, using the Franklin Textured Balls which feature a unique surface that stimulates the muscles’ relaxation reflexes. Great for dancers and anyone interested in using imagery to work directly with the nervous system and change the way they use their body.
For Those Seeking a Little TLC
Massage Ball Gift Set $15.95 (Holiday sale price until December 31, 2018)
This collection of massage balls soothes muscles and relieves tension across the body. The tools are especially ideal for self-massage of the hands and feet, and for targeted relief of trigger points in smaller areas. Set includes one Super Pinky Ball, two Half Balls, two Mini Balls and one Franklin Fascia Massager™ Oval.
Thera Cane® Massager  $44.95
With six strategically placed massage ball points, the Thera Cane® allows you to apply deep trigger point therapy with concentrated self-massage pressure to the lower back, middle back, and upper back, as well as the neck, shoulders, triceps, biceps, forearms, thighs, hamstrings and calves.
We hope that our Top 10 Holiday Gift List helps make your holiday shopping easier, making you – and your loved ones, healthier and happier. 

READ MORE December 5, 2018

Hip, Knee and Shoulder Surgery: Understand Your Body to Regain Your Activity (Neuroscience Education)

Maybe it’s due to aging of the joint. Or maybe a previous injury. Whatever the reason, you find yourself no longer able to tolerate the pain and stiffness associated with your hip, knee or shoulder. The time has come for surgery.

The decision to go ahead with surgery is a big commitment. And certainly, it’s not something you’d choose to do if you didn’t feel it was absolutely necessary. But there is reason to be hopeful.

Whether you have are having a full joint replacement or other type of surgery, the good news is that these procedures have come a long way and are generally quite successful.1-3 The doctors will help repair the wear and tear of the joint and reduce the inflammation. The rest of the recovery process, however, will be largely up to you.

You have aspirations and specific things you want to achieve following the surgery. These can be anything from simply regaining function of the joint to performing daily life tasks to returning to activities you enjoy such as golf or gardening. So, what strategies will you employ on your path to recovery?

Education is Therapy
After surgery, you will most likely undergo physical therapy. This will help you improve your range of motion and gradually regain your strength. But in addition to exercise, education can also aid you in your recovery. In fact, scientific research has shown that understanding how pain works in the body can help you hurt less, exercise more and return to regular activities more quickly.4-6

Author, researcher and talented educator Adriaan Louw, PT, PhD has been spreading this positive message for several years now. He speaks on the value of this relatively new approach, known as pain neuroscience education, around the world to both clinicians and patients. As he likes to say, “Education is therapy” and “Know pain, know gain.”

The premise of neuroscience education is based on the principle that all pain is determined by the brain, which processes messages it receives from the nerves. By understanding how our body and brain work together in this way, it allows us to utilize that knowledge to lessen our pain and improve mobility.

Louw’s Neuroscience Books
Adriaan’s gift for making the science of pain accessible to everyone is evident in his presentations and books. He has a way of talking about pain that makes it less intimidating, and this is especially evident in his pain neuroscience education books. As the exclusive publisher of these books, OPTP carries the full series, which is now comprised of 11 titles.

Several of the books specifically address hip, knee and shoulder surgeries, revealing what to expect from the procedures before, during and after surgery. All titles feature memorable concepts that are explained through approachable language with metaphors, examples and illustrations. Most importantly, they are designed to help you harness the power of your brain to take control of your nerves and lessen pain, increase movement and return to regular activities as quickly as possible.

Recovery Ready
If you’re in the process of scheduling hip, knee or shoulder surgery and looking to get a head start on your recovery, consider learning more about pain neuroscience education. Not only is it a fascinating field, but you’ll discover knowledge that will guide you in your return to activity and success of your goals.

  1. Jolles BM, Bogoch ER. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. The Cochrane Database of Systematic Reviews. Jul 19 2006(3):CD003828.
  2. Chaudhury S, Gwilym SE, Moser J, Carr AJ. “Surgical options for patients with shoulder pain.” Nature Reviews Rheumatology. Apr 2010; 6(4):217-226.
  3. Coghlan JA, Buchbinder R, Green S, Johnston RV, Bell SN. “Surgery for rotator cuff disease.” The Cochrane Database of Systematic Reviews. Jan 23 2008(1):CD005619.
  4. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of physical medicine and rehabilitation. Dec 2011;92(12):2041-2056.
  5. Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: A case report. Physiotherapy Theory and Practice. Jul 3, 2011.
  6. Moseley GL, Hodges PW, Nicholas MK. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clinical Journal of Pain. 2004; 20: 324-330.

READ MORE Adriaan Louw, PT, PhD - June 13, 2018

How to Choose a Foam Roller: 3 Features to Consider

So you’re going to get a foam roller? Seems like an easy enough decision to make. I mean, it’s a simple piece of foam, it can’t be that hard to figure out. But then you start looking at all the options out there, seeing the many different varieties. Pretty soon, it can become overwhelming.

Trying to decide which foam roller is best for you isn’t as easy as you might think, but it’s important. Choosing the right roller will help ensure effectiveness, usability and compliance. After all, if it doesn’t feel right you won’t be motivated to use it…and a roller that goes unused doesn’t provide much benefit!

In this article, we’ll look at three keys to consider when picking a roller, helping you break down the options. As follows, we’ve identified what we feel are the three most important factors; density, size/shape and construction.

  1. Density
Arguably the most important choice to make regarding your new foam roller is the density. You might also hear this referred to as the compression, firmness, cushion or “give,” which all mean the same thing. Generally, rollers can be broken down into three density categories; soft, medium or firm.

Soft density rollers have more “give” or cushion to them. They’re designed for those who are looking for more comfort as opposed to the deeper massage of firm and standard rollers. The soft density produces a massage that is gentler on the muscles, making it ideal for users with sensitive muscles or those who simply prefer a less intensive massage.
These rollers have a medium firmness. Their universal quality makes them ideal for both self-massage and exercise. They provide just enough firmness for deep massage while still having moderate cushion. Their medium density also serves nicely as stable props for use in core strengthening exercises such as those performed in Pilates and yoga.

For those seeking a deeper, more intense massage, firm density foam rollers are the answer. Athletes and highly active individuals often have tight muscles that can benefit from the penetrating nature of these rollers. Firm rollers are great at breaking up even the most constricted fascia (the interconnected web surrounding the muscles), a process known as myofascial release.  

  1. Size and Shape
There are also many different sizes of foam rollers on the market. While the majority are the traditional full-size round cylinders, many other sizes and even different shapes exist. Let’s take a look at some of the more common sizes to see how each lends itself to certain uses.

Standard Full-size
When most people think of a foam roller, this is usually what comes to mind. The typical full-size roller measures approximately 36” length x 6” diameter. This size is versatile for a variety of uses, including massage (ideally larger muscles groups like hamstrings, quads and the back), physical therapy and general exercise. Due to their three-foot length, these rollers are perfect for any type of exercise where you lie on the roller with it positioned vertically along the spine, such as Pilates or related core strength and balance movements.
Shorter Length
If you’re looking for a more portable roller, perhaps one that is travel size and you can take with you to the gym, physical therapy clinic or Pilates studio, consider a shorter length. Most shorter rollers have the same diameter as a traditional full-size (6” or thereabouts) but feature a shorter length; typically either 18” or 12”. In addition to the benefit of portability, they also make it easier to target certain muscle groups. The shorter rollers are ideal for targeting more precise areas such as calves, IT Bands or glutes.

Smaller Diameter
A smaller diameter roller — typically 4” — means that it will be lower to the floor and more stable. This is often important for physical therapy patients, aging users or those with a compromised sense of balance. Being lower to the floor means that it provides a safer, more stable feeling. It’s also easier to control while using for massage.
Ridges or Bumps
Need a little something extra? Some uniquely designed foam rollers offer protrusions for those that like a more invigorating massage or simply want the ability to target precise areas. Rollers with ridges, bumps or points can provide a deeper penetrating massage that breaks up fascia in even the most tight, compact areas.
Flat Half-size
There are a variety of foam rollers that lend themselves nicely to balance and core strength exercise. Although they come in a range of shapes, a typical size is a 36” length x 3” height that is cut in half the long way, making it rounded on one side and flat on the other. This shape is useful for physical therapy, Pilates, yoga, Feldenkrais® and general core strength exercise.

  1. Construction
Not all foam is created equal. Believe it or not, there is a fair amount of engineering that goes into the development of a foam roller. The way it is constructed helps determine its longevity — and primary location of use — important considerations to make before purchase.

Rollers built with an open-cell construction, while suitable for massage and exercise, tend to break down much faster than closed-cell rollers. You’ll typically find open-cell rollers at your local big-box store and, while inexpensive, there are higher-quality closed-cell options available at affordable prices. Closed-cell foam rollers offer the durability you expect from a foam roller and are available in two types of foam; EPP and EVA.

EPP Foam
Rollers made from EPP foam beads are high quality but still relatively inexpensive. They’re versatile and suited for users of all levels. Because they offer a nice combination of durability and affordability, they make a great starting point for the average person while still being effective for the more advanced user. EPP rollers are designed to last much longer than open-cell rollers, though they do not offer the supreme durability of EVA foam.

EVA Foam
Rollers made from EVA foam deliver unmatched durability. These “professional strength” foam rollers are built to withstand the type of heavy, repeated use often found in gyms, clinics or Pilates studios where many people are using them throughout the day. The at-home user can also benefit from the longevity of these rollers, having confidence in knowing they will hold up for a longer time than any of the other foam types.

As you can see, there’s a bit of thought required before making your foam roller purchase. But put the time in up front and you’ll be rewarded with a roller that suits your comfort level and intended usage, motivating you to use it with consistency. Start with the big three features — density, size/shape and construction — and you’re well on your way to making the perfect selection.

Ready to browse all the options? View OPTP’s extensive selection of foam rollers, including the densities, sizes and foam types mentioned in this article.

READ MORE Josh Crane, OPTP Staff Writer - June 12, 2018

Care that Counts: Home Exercise Programs

For nearly 40 years, we’ve been manufacturing and supplying the highest quality manual and physical therapy equipment for your clinical use. During this time, we’ve also seen a growing demand for therapy and fitness tools for in-home exercise programs, and we acknowledge the importance your referrals have had with the increasing use of our self-care products by your clients and patients.   
Whether you’re a personal trainer, physical therapist, Pilates instructor or a chiropractor, we’re grateful for these referrals. When your patients and clients walk into our showroom or order products over the phone, they often mention you by name, providing praise for your services.
By recommending self-care strategies or prescribing home exercise to your clients, it shows that you’re genuinely concerned about their health and wellness. Ultimately, our products supplement the critical work that you do in the clinic or studio, and we’re proud to be your trusted resource for these solutions.  

Credibility & Safety

Over the years, we’ve been privileged to form solid relationships with numerous health professionals who are world-renowned experts. Many of our therapy and fitness tools are the result of these exclusive partnerships, which include prominent names like Robin McKenzie, Adriaan Louw, Eric Franklin, Lauren Roxburgh and many others.
What does this mean for you? By working with those who are leaders in their field, we are able to bring you innovative and dependable products you can trust. Their passion, like ours, is to create solutions that play an essential role in achieving the goals you set for your clients.

In addition, you can be assured that our products are designed with the highest safety standards. Items are manufactured with considerations for latex, flammability and other concerns. And many also come with information on operation instructions, safety precautions, contraindications and product care.

Proven Effectiveness

Evidence-based outcomes continue to suggest that self-care plays an important role in regaining healthy musculoskeletal function. For example, one study on osteoarthritis of the knee evaluated the effectiveness of clinically-applied treatment that included exercise and manual therapy versus a home-based exercise program.

The results indicated that, in addition to a reasonable schedule of clinical visits for the application of manual therapy and supervised exercise, a home exercise program provides important benefits such as an increase in the average distance of a six-minute walk.1 In addition, a home-based component for patients with ankle sprains has been found to increase attendance at clinic appointments and intervention completion rates.2

Whether you are recommending a Knee Glide® for knee replacement rehabilitation, Robin McKenzie’s Treat Your Own Back™ book for back pain, Handii™ Healthy Hands for hand therapy or any of our foam rollers for myofascial release and mobility, conservative care products increase patient adherence and improve the effectiveness of your practice.

Bringing it Home

The next time you have an opportunity to prescribe home exercise, consider our wide selection of self-care solutions. With categories like movement therapy, balance, posture, stretching, Pilates and many more, we offer tools that patients can easily use at home, helping them to develop consistent use, take pride in their care and establish positive long-term habits. We’re here to make your job easier and improve the health of your patients and clients.

Find solutions for your next home exercise program by checking out all of our tools, including more than 25 new products, in our latest professional catalog.

  1. Deyle, G.D., Allison, S.C., Matekel, R.L., Ryder, M.G., Stang, J.M., Gohdes, D.D., Hutton, J.P., Henderson, N.E., & Garber, M.B. (2005). Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program. Physical Therapy, 85(12), 1301-1317.

  2. Bassett, S.F., & Prapavessis, H. (2007). Home-Based Physical Therapy Intervention with Adherence-Enhancing Strategies Versus Clinic-Based Management for Patients with Ankle Sprains. Physical Therapy, 87(9), 1132-1143.

READ MORE Josh Crane, OPTP Staff Writer - June 5, 2018

The Squat: How to Improve Depth, Increase Muscle Activation and Protect the Low Back and Knees

The standard squat. It’s one of the most commonly performed exercises, yet it’s often feared. It’s the topic of many internet queries and qualms (try searching the web for “proper squat form”) and it’s simultaneously loved and hated for both its simplicity and challenging nature.    
Assuming the classic move is done correctly, it holds great potential beyond just stronger glutes and quadriceps. Its many benefits also include greater core strength and stability and improved hip mobility to name a few. It’s no wonder the squat is a trusted favorite among fitness experts, athletic trainers, physical therapists and movement specialists.
Development of a Training Tool
As someone with an affinity for rehabilitative exercise and fitness performance, I’ve made it my mission to understand as much as I can about squat mechanics. It’s become a passion of mine to try and make the squat safer and more effective for people of all abilities.
To help accomplish this, I set out to create an exercise tool that would aid those having difficulty accomplishing the squat movement. Nearly 35 years of professional development in the clinic and rigorous personal training and rehab in the gym led to a product that we now call the Performance Wedges™. And while this pair of foam wedges is a versatile companion for planks, pushups or balance-related moves, they’re especially valuable for assisting with the almighty squat.  
Throughout my research and training observations, I’ve found that using the Performance Wedges with my clients can result in the following three benefits.
1. Improved Depth
The ankles are an area that can often have limited flexibility, which is usually due to tightness of the gastrocnemius or calf musculature. This limited ankle range of motion can restrict the ability to achieve proper squat depth. But tightness in the calves and lower leg can easily be addressed with stretching.
To do this, we start by positioning the Performance Wedges in the incline position. The heels are placed at the low end of the Wedges and the toes near the grooves. Standing in this position, lean forward slightly to stretch the calves, holding for 45 seconds and repeating for three sets. Reducing calf (and lateral lower leg) tightness in this way will encourage improved ankle mobility that will help with squat depth.

In addition to stretching, the Performance Wedges can be used for depth assistance during the squat itself. To achieve this, we place the Wedges in the decline position with the heels at the top of the Wedge in the grooves and the toes toward the floor. Performing your squats with this setup places the low back in a more vertical position and allows for increased flexion at the hip and knees1. This not only aids in squat depth performance but also decreases stress in the low back area and potentially makes the movement more comfortable at the knees, allowing the fuller range of motion to be accomplished with more comfort and ease.
Decline Squat 
2. Greater Muscle Activation
Like most other exercises, the squat can provide great results when performed properly. This includes increases in strength and muscle activation; both of which should be goals regardless if you’re an athlete aiming for hypertrophy or a patient rehabilitating from injury.

To achieve these benefits though, depth is key. Generally, taking your squat depth below parallel is going to provide greater muscle activation for the glutes, hamstrings, adductors and quads.

As illustrated previously, we can use the Performance Wedges in the decline position (heels placed at the top, toes toward the floor) during the squat to place the low back in a more vertical position. This can make the movement more comfortable at the knees and allow for that deeper range of motion that produces greater muscle activation.3
3. Protection for the Low Back and Knees
Of course, no exercise is valuable if it results in harm. Preventing injury or pain in the low back area has always been a primary concern of mine, and it’s one of the main reasons why I developed the Performance Wedges.

Using the Wedges in the decline position helps prevent medial collapse of the knees (which can cause ACL injury) and allows for increased flexion at the hip and knees3. This increased knee and hip range of motion helps prevent rounding of the low back, in turn decreasing stress on this area.

But it’s not just the back that benefits. With the increased hip range of motion, it becomes easier to keep the knees from migrating too far past the toes. This, along with the cushioned nature of the foam Wedges themselves, helps support the knee joints and increase comfort during exercise. (While it is important to note that studies do show an increased force on the knees when the spine is in a more vertical position, it is negligible and safer compared to the stress of having the knees travel too far out over the toes.)

Additionally, the increased range of motion aided by the Performance Wedges may also help prevent hyperextension of the knee and valgus (collapsing of the knee inward), actions that can lead to knee pain4,5.

I’ve had the privilege of seeing many unique exercise products throughout my career. But I can say, thanks to a lot of effort that went into the design of the Performance Wedges, that I feel especially confident recommending this product to anyone looking to enhance strength and functionality throughout the body. The simplicity of its design — just like the simplicity of the squat itself — has reminded me that sometimes in life, the simple things provide the most value.

  1. Kim, S.-H., Kwon, O.-Y., Park, K.-N., Jeon, I.-C., & Weon, J.-H. (2015). “Lower Extremity Strength and the Range of Motion in Relation to Squat Depth.” Journal of Human Kinetics; 45, 59–69. http://doi.org/10.1515/hukin-2015-0007.

  2. Soma, M., Murata, S., Kai, Y., Nakae, H., Satou, Y., Murata, J., & Miyazaki, J. (2015). “Kinematic analysis during toe-gripping strength exertion: angular changes in the ankle joint and leg muscle activities.” Journal of Physical Therapy Science; 27(6), 1957–1960. http://doi.org/10.1589/jpts.27.1957.

  3. Hayley S. Legg, Mark Glaister, Daniel J. Cleather & Jon E. Goodwin (2016). “The effect of weightlifting shoes on the kinetics and kinematics of the back squat.” Journal of Sports Sciences; 35:5, 508-515, DOI: 10.1080/02640414.2016.1175652.

  4. Ota, S. et al., “Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait.” The Knee; Volume 21, Issue 3, 669 – 675.

  5. P. Tabrizi, W. M. J. McIntyre, M. B. Quesnel, A. W. Howard. “Limited dorsiflexion predisposes to injuries of the ankle in children.” The Journal of Bone and Joint Surgery [Br] 2000;82-B:1103-6. Received 21 April 1999; Accepted after revision 4 May 2000.

 * Always consult with your healthcare provider before starting any new exercise program.
The Performance Wedges, available exclusively from OPTP, were invented by Dr. Greg DeNunzio and personal trainer Luis Leonardo. They’re sold as a pair and can be used singly or together for squats, pushups, planks and a wide variety of other exercises in fitness, physical therapy, Pilates or yoga.

READ MORE Dr. Greg DeNunzio, DC, BSME - May 15, 2018

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