What can physical therapy help with?

What Can Physical Therapy Help With?

Physical therapists can provide supplementary treatment to a wide variety of medical conditions, depending on their specialty.

Physical therapists treat musculoskeletal conditions and work to optimize recovery or educate a person on how to optimize their movement patterns.

Some conditions that our physical therapists specializein include:

• Post- op Rehab, including total knee replacements, labrum repairs, menisectomy, spinal fusion.

• Conditions that affect the hand, such as carpal tunnel syndrome, and trigger finger.

• Musculoskeletal dysfunction, including back pain, rotator cuss tears, and knee pain.

• Sports-related injuries, such as tennis elbow, achilles tendonitis, ACL tears.

• Chronic pain.

• Hypermobility, leading to joint instability and pain.

How Long Should We Stretch?

How Long Should We Stretch?

When stretching our muscles, the general consensus is that we should stretch up to 60 seconds per muscle. Whether it is 20 seconds 3 times or 30 seconds 2 times as long as the muscle is stretched for 60 seconds.

There are others however who advocate a different stretch duration and repetition. Thirty years ago a man by the name of Aaron Mattes developed the 2 seconds, 10 times stretch. The premise of this technique is holding a stretch for only 2 seconds inhibits the protective stretch reflex (myotatic reflex).

The stretch reflex inhibits the muscle from lengthening for the stretch after 2 seconds. If the target muscles is indeed being inhibited then true lengthening without soreness will not occur.

The stretch is performed using Active Isolated Stretching. Using the muscle opposite in action to the target muscle to be stretched and only holding for 2 seconds, performing up to 10 repetitions with progressive increase in range of motion will allow progressive lengthening and eliminate overloading the stretched muscle which could cause potential microtears. An example would be contracting your quadriceps muscle to stretch the hamstring. By activating the quadriceps the brain then tells the hamstring to relax thus allowing the stretch.

So does it work? I put AIS to the test with myself and several patients. The muscle to be stretched was the left Middle Scalene which bends the neck to the side and is often a source of neck pain and tightness. I did not experience any rebound tightness later in the day or the following day. The increased ROM persisted for several days. One of my patients did not feel any difference between the 2 second x 10 reps stretch and the traditional 30 seconds x 2 reps stretch. The remaining 3 patients felt less soreness and improved ROM with AIS.

I then tried stretching my painful L Iliopsoas muscle. I had been doing 30 seconds x 2 reps with temporary relief (a few hours). The next day I tried the 2 seconds x 10 reps. I noticed a slight ache post stretch which resolved quickly. The pain and tightness remained improved for at least 2 days. Next, I tried stretching my non painful Hamstrings. I did not notice much of a difference between traditional stretching and AIS for reduction in tightness and duration.

My study is small and limited but it is possible the 2 second stretch works well for a painful muscle which is not responding to traditional stretching and other patient populations which have to be careful with stretching.

So which stretch to use? Check with your physical therapist if you are in rehab or other wellness provider who may be aware of both techniques. Most importantly, stretching should not make you feel worse than when you started and NEVER stretch a cold muscle.

To your health and wellness!

Joann Tippett, PT, MSPT, CKTP, CCI

30 minute stretching routine (advanced)

Level 3: Advanced Stretches

Before you begin any level of stretching, follow these tips for best results:

• Warm up for a few minutes first so your muscles stretch more easily (walk briskly, march in place, or do another physical activity).

• Stretch at least two to three times on each side, taking turns.

• Keep good form and posture.

• Breathe throughout each stretch — never hold your breath.

• You should feel slight discomfort and a pulling sensation, but not pain, with each stretch.

• Never bounce while stretching — hold steady till you feel the stretch and try to relax while holding.
  
  

Advanced Hamstring Stretch

1. Stand facing a chair or counter and put your heel on top of it. Choose a chair if you are less flexible or a counter if you are more flexible.

2. Keep your hips directly facing the chair and place both hands on the outside of your thigh.

3. Lean forward, leading with your chest. Keep your head up as you slide your hands down the outside of your thigh. Do not allow your back to round or bring your chin down.

4. You should feel a stretch behind your thigh and knee.

5. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   
   

Advanced Groin Stretch

1. Sit on the floor with your back against the wall. Keeping your knees straight, spread your legs apart as far as you can.

2. Leading with your chest, place your hands together out in front of you, and lean forward. Do not allow your back to curl or bend.

3. You should feel a stretch in your groin.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   
   
   

Advanced Quad/Hip Flexor Stretch

1. Kneel on a pillow or folded towel and place one leg out in front of you (Photo A).

2. Leading with your waistline and keeping your chest upright, lunge forward (Photo B).

3. You should feel a stretch in the front of your hip. For further challenge, increase the stretch by grasping your back foot and try to bring your heel to your buttocks (Photo C).

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   

Advanced Calf Stretch

1. Stand on a stair with your heel over the edge.

2. Slowly lower your heel so it falls below the stair and you feel a stretch in the back of your calf (Photo A).

3. First, do this exercise with the back knee straight. Then try it with a slight bend of your knee for added stretch.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   

Advanced Overhead Reach

1. Stand tall with your toes at the front edge of a doorway. Place the outside of both hands (little finger side) on the doorframe as high as possible (Photo A).

2. Do NOT lean through the door. SLOWLY step through the doorway, keeping an upright posture (Photo B).

3. Slowly step back to your starting position.

4. You can do this stretch with your arms in various positions of elevation.

5. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   

Advanced Spine Flexion and Extension

Flexion

1. Sit on the front edge of a chair with your feet flat on the floor and your knees spread out as wide as possible (Photo A).

2. Tuck your chin to your chest (Photo B) and slowly "roll down" from your head (curling down like a wave), allowing your arms and shoulders to go between your legs (Photo C).

3. You should feel a stretch in your spine and low back.

4. Hold this position for five to 10 seconds.

5. To come back up, "unroll" from your waist back up to an upright sitting position. Repeat two to three times or more, as you feel matches your fitness level.
   

Extension

Caution: If this position is too uncomfortable for you based on age or history of spine pain, do not do this exercise.

1. Lie on your stomach with your upper arms straight out at shoulder height, elbows bent to 90 degrees, and palms down.

2. "Press up" and straighten out your arms keeping your waist on the floor, then slowly return to the starting position.

3. Repeat this five to six times, slowly.

4. Repeat another one to two times, locking your elbows and allowing your back to sag and "relax" in this position for five to 10 seconds, keeping your waist on the floor, then return to your starting position.

5. Repeat two to three times or more, as you feel matches your fitness level.

30 minute stretching routine (moderate)

Level 2: Moderate Stretches

Moderate Hamstring Stretch

1. Stand facing a yoga block or footstool that doesn't slide. Use a stool or block height that is lower if you are less flexible. Increase the height of the item as you become more flexible.

2. Place one heel on the center of the stool, keeping your hips square/facing the stool and place both hands on the outside of your thigh (Photo A).

3. Lean forward, leading with your chest and keep your head up as you slide your hands down the outside of your thigh. Do not allow your back to round or bring your chin down (Photo B).

4. Do not round your back or lower your chin. Keep looking straight ahead.

5. You should feel a stretch behind your thigh and knee.

6. Hold this position for 15 seconds. Repeat two to three times or more as you feel matches your fitness level.
   
   
   

Moderate Groin Stretch

1. Sit on the floor with your back against the wall. Put the soles of your feet together.

2. Pull your heels toward your body. You should feel a stretch in your groin.

3. For more stretch, push down on your knees.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   
   
   

Moderate Quad/Hip Flexor Stretch

1. Lie on your stomach.

2. Bring the leg you will stretch slightly out to the side, bend your knee, and loop a belt or a strap around your ankle.

3. Bring your knees back together. Gently pull on the strap so that your heel comes as close to your buttocks as possible.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   

For more challenge:

1. Lie on your stomach.

2. Bring the leg you will stretch slightly out to the side, bend your knee and grasp your ankle, pulling your heel to your buttocks.

3. Bring your knees back together, keeping your heel as close to your buttocks as possible.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   

Moderate Calf Stretch

1. Stand upright with your palms flat against a wall and the leg you want to stretch behind you (Photo A).

2. Turn your toes in and your heel out on your back foot (Photo B).

3. Leading with your waist and allowing your arms and front knee to bend, lean toward the wall, and keep the heel of your back leg on the floor.

4. First, do this exercise with the back knee straight. Then bend your back knee slightly while keeping your heel on the floor for added stretch.

5. You should feel a stretch in the back of your calf.

6. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   

Moderate Overhead Reach

1. Stand tall at the front edge of a doorway.

2. Place the outside of your hands (little finger side) on both sides of the doorway (Photo A).

3. Slide your hands up the doorway (Photo B), then slowly lean or step toward — but not through — the door.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   
   

Moderate Spine Flexion and Extension

As we age, we often spend more time in a flexed posture due to prolonged sitting, poor posture, or sleeping in side-lying positions. This can cause loss of spine extension and make it difficult to stand upright and keep good posture. To combat this:

Flexion

1. Lie on your back and bring one knee and then the other toward your chest.

2. Grasp both knees with your hands and squeeze them toward your chest (Photo A).

3. You should feel a stretch across your back.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.

Extension

Caution: If this position is too uncomfortable for you based on age or history of spine pain, do not do this exercise.

1. Lie on your stomach and put your arms and elbows under your chest.

2. Prop up on your elbows as shown and relax your back. Do not look up. Pretend you are reading a book while lying on your stomach.

3. If comfortable enough, hold this position for 30 seconds, then come back to a flat position lying on your stomach. Repeat two to three times or more, as you feel matches your fitness level.
   
   

Moderate Trunk Rotation Stretch

1. Lie on your back with your hips and knees bent. Your hands and arms should be shoulder high and stretched out to the side (Photo A).

2. Your arms and shoulders should stay flat on the floor.

3. Keeping both knees together, allow your hips and pelvis to rotate to one side (Photo B).

4. Hold this position for 15 seconds. Return to your starting position and complete these steps on the other side. Repeat two to three times or more for each side, as you feel matches your fitness level.
   
   
   

Before you begin any level of stretching, follow these tips for best results:

• Warm up for a few minutes first so your muscles stretch more easily (walk briskly, march in place, or do another physical activity).

• Stretch at least two to three times on each side, taking turns.

• Keep good form and posture.

• Breathe throughout each stretch — never hold your breath.

• You should feel slight discomfort and a pulling sensation, but not pain, with each stretch.

• Never bounce while stretching — hold steady till you feel the stretch and try to relax while holding.

30 minute exercise routine (advanced level)

Level 3: Advanced Strengthening Exercises 

Advanced Standing Bridge for Hip Extensors

1. Stand upright with good posture (Photo A). You may stand near a wall for balance if needed.

2. Lean forward from the waist, keeping your back straight and one foot flat on the floor, while allowing the other leg to rise straight behind you and your arms to naturally hang in front of you. Use a count of 1-2. Try to get your trunk and back leg parallel with the floor (Photo B).

3. Hold this position for five seconds, then count 1-2-3-4 to slowly return to the starting position. It should take you longer to return to your starting position than to get to your bridge position. Control is important.

4. Repeat with your other leg. Repeat as many times as you feel matches your fitness level.

Note: To make this exercise more challenging, hold weights or small heavy objects in your hands.

Advanced Sidelying Leg Lift for Hip Abductors

1. Lie on your side with the bottom leg bent (Photo A). Roll your hips forward about 30 degrees.

2. Lift your upper leg slowly to the count of 1-2 (Photo B).

3. Then, slowly return your leg to the start position with a count of 1-2-3-4. Control is important.

4. Repeat as many times as you feel matches your fitness level.

Advanced Stair Dips for Quad Strength

1. Stand on your left leg on the bottom stair with your right leg over the edge of the stair. Use the handrail for balance as needed. Keeping an upright posture, flex your right foot so that your toes are up (Photo A).

2. Allow your left knee to bend and slowly lower your right heel to the count of 1-2-3-4 so that it gently touches the floor, without putting your weight on it. Pretend that your heel is touching an eggshell, so as not to break it (Photo B).

3. Straighten your left knee to return to your starting position using a count of 1-2. It should take you longer to step down than to step up.

4. Repeat as many times as you feel matches your fitness level.

5. Repeat with the opposite leg.

Advanced Heel Raises for Calf Strength

1. Stand on the bottom stair on the front of one foot, so that your heel is off the edge of the stair and your other leg is hanging, not supporting you. Use the rail for balance if needed.

2. Slowly lower your heel below the level of the stairs to the count of 1-2-3-4 (Photo A). Control is important.

3. Then, rise onto your toes to the count of 1-2 so that your heel is up as high as possible (Photo B), your other foot still hanging, and not providing support.

4. Repeat as many times as you feel matches your fitness level.

5. Repeat with the other leg.

Advanced Abdominal Exercises

Back lying


Lie on your back with your hips and knees bent to 90 degrees and your feet off the floor. Pull your navel inward and down toward your spine, and flatten your lower back against the floor (Photo A).

1. Slowly extend your legs out until you feel your pelvis start to rock forward. When you feel this, bring your knees back toward you by about 1/8 to 1/4 inch (Photo B).

2. Hold this position for 15 seconds, making sure to count out loud, so you do not hold your breath.

3. To release this position, bring your knees toward the chest, then lower your feet to the floor.

4. Repeat as many times as you feel matches your fitness level.
   Note: To make this exercise more challenging, cross your arms across your chest.

Plank

1. Lie on your stomach supported by your elbows and with your toes dug into the floor.

2. Tighten your back and stomach muscles, and then lift your torso off the bed or floor so that you are supported by your toes and elbows (Photo C).

3. Hold this position for 30 seconds.

4. Repeat as many times as you feel matches your fitness level.

Advanced Push-ups for Pecs/Triceps

Knee ups

1. Lie on your stomach with your palms on the floor at shoulder level (Photo A).

2. Keep your knees on the floor and push up with your hands to the count of 1-2 to attain a modified push-up position (Photo B).

3. Return to your starting position to the count of 1-2-3-4. Repeat as many times as you feel matches your fitness level.

Note: If you have enough strength, you may do full push-ups.

Full push-ups

1. Lie on your stomach with your palms on the floor at shoulder level and dig your toes into the floor (Photo C).

2. Push up with your hands to the count of 1-2 to attain a full push-up position, making sure to keep your back straight (Photo D).

3. Return to your starting position to the count of 1-2-3-4. Repeat as many times as you feel matches your fitness level.

Advanced Shoulder I, T, Y, W Exercise for Rotator Cuff/Scapula

Note: This exercise requires a large exercise ball or an ottoman and light hand weights or 16- to 20-ounce bottles.

1. Kneel on the floor and put your chest on the exercise ball or ottoman (Photo A).

2. With a small weight in each hand, lift your arms to the count of 1-2 to form the letter "I" by raising them straight out in front of you (Photo I). Then, slowly lower your arms to the starting position counting 1-2-3-4.

3. Next, lift your arms to the count of 1-2 to form the letter "T" by raising them out to the side (Photo T). Then, slowly lower your arms to the starting position counting 1-2-3-4.

4. Next, lift your arms to the count of 1-2 to form the letter "Y" by raising them at an angle in front of you. Then, slowly lower your arms to the starting position counting 1-2-3-4.

5. Last, lift your arms to the count of 1-2 to form the letter "W" by raising them with elbows slightly bent and out to the sides (Photo W).

6. Do each of these slowly. Control is important.

7. Repeat as many times as you feel matches your fitness level.

Advanced Bicep Curl With Overhead Press

Note: This exercise requires the use of small hand weights (10-15 pounds) or other objects that you can easily grasp with your hands and lift overhead. If you do not have weights, then 16- or 20-ounce water bottles, canned goods, or quart-sized milk or juice containers will work. Add more repetitions to challenge your muscles if you cannot increase the weight.

1. Stand upright with good posture, holding your weights in each hand with your arms at your sides (Photo A).

2. Slowly bend your elbows and curl your weights up to a 1-2 count until your elbows are at 90 degrees (Photo B).

3. Then, slowly press your weights overhead to a 1-2 count (Photo C).

4. Slowly return to your starting position counting 1-2-3-4. Control is important.

5. Repeat as many times as you feel matches your fitness level.