5 Daily Hip Exercises to Reduce Your Pain [BONUS Low Back Tips]

Your guide to reducing hip pain, improving hip mobility, and preventing falls.

Bold Statement #1: If you have hip pain then you probably sit to much. Although ‘taking it easy’ may seem like the best (and easiest) thing to do, this is usually counter productive and making your joint pain worse.

Bold Statement #2: Even if you have hip pain then your hip joint may not actually be the problem. Your hips, although not indestructible, are actually designed to withstand a great deal of wear and tear. It is at least as likely that the source of your pain is your low back, even if you do not feel any pain in your back.

Table of Contents
Statistics
Causes of Lower Back Pain
Current Treatment Options
The 6 Acupressure Points for Lower Back Pain Relief
Additional Acupressure Tips
Summary
References

The first important thing is to understand the nature of your pain so you can make an educated effort towards fixing it. Some questions to ask yourself are:

  • Are your hips just tight? If so, then simply increasing your activity and applying some light stretching and hip mobility may improve your range of motion.
  • Does one of them grind when you step on it? Oftentimes grinding is a structural malady. You should think arthritis or possibly a damaged labrum.
  • Does your hip pop when you walk/ stand up/ turn around? There is likely some instability or a compromised labrum. Some strength training to particular muscle groups are a good idea.
  • Does it only hurt when you step on that leg? This tells us that compression of the joint is irritating something. It could be as simple as arthritis pain, or it could be something more complicated.
  • Does it hurt when you are lifting the leg off of the ground to move it? Lifting the leg activates a combination of muscles that creates joint compression for the sake of stability. That compressive force could be irritating arthritis, straining a muscle, or flaring up a stress fracture.
  • What word would I use to describe the pain? Sharp? Achy? Dull? Throbbing? Sharp and sever pain is generally a sign that you should see a doctor and/or get an x-ray.
  • What can I do to relieve the pain? (Rest, Anti-Inflammatory Meds, Heat, Ice) How the pain responds tells you a lot about its nature. If anti-inflammatory meds work, then something is causing irritation. If they do not help but Tylenol does, you know that the pain is manageable but not necessarily due to inflammation. Heat generally helps strained muscles and decreased blood flow issues.
    • Note: These issues are not comprehensive but I aim to convince you that your success in pain relief depends on you being able to differentiate symptoms.

The Hip Joint:

Anatomy:

The hip joint is a ball and socket joint that allows a great range of motion in the hip area. It consists of the head of the femur (upper leg bone) and the acetabulum of the pelvis (deep socket). The acetabulum is ringed by a shallow cup of cartilage called the labrum which further deepens the socket and helps to keep the head of the femur from slipping out. There labrum has help in the form of four major ligaments that keep the hip secure during daily activities. Additional stability is provided by the hip muscles.

Insight:

You probably should not blindly stretch your hip when you have hip pain. Hip hypermobility (loose hips) are just as common as tight hips. If you stretch the wrong target muscles then you may be doing more harm than good.

The Lower Back And Lumbar Spine:

Anatomy:

There are 33 spinal bones called vertebrae that are divided into 5 regions. The lower back region is called the lumbar region. These lumbar vertebrae are the largest and specialize in supporting the weight of the upper body.

The articulating surface on top and bottom of each vertebrae is covered with cartilage and connected to the intervertebral disc. There are 5 ligaments at each articulation that help keep the disc in place as well as keep the vertebrae stable yet functional. Most notable for this article, there are foramen on the side of each articulation through which the lumbar spinal nerves exit the spinal column and travel downwards towards and through your legs.

Insight:

Nerves are responsible for all sensation and for controlling the firing of all muscles. Even if you have a single point of localized pain directly in the hip and no other symptoms, it is still very possible that the cause of the issue is your lumbar spine.

Look At This Like A Physical Therapist Would:

Possible Hip movements are flexion, extension, abduction, adduction, and internal/external rotation.
Compliments of Quizlet.com

The hip is a very complicated joint with multiple degrees of freedom and multiple structures that contribute to its mobility and stability. Additionally it is a passthrough for the major nerves that govern the lower legs.

A good physical therapist will realize that your hip pain is not to be viewed in isolation but considered along with the integrity of your lower back, abdominal muscles, spinal curvature, upper leg and lower leg orientation, knee and ankle mechanics. You are a complete person and not just a painful hip to be exercised.

This is how you should view your hip injuries so that you can perform the right corrective actions.

Oftentimes it is much more important to enhance your functional mobility than it is your flexibility. There is a subtle difference. Physical therapy exercises can help to achieve this in young athletes and older adults with the right strategy. This is why a physical therapy consult can be invaluable when dealing with arthritic hip pain, chronic hip pain, hip replacement surgery, or plain old sore hips.

How To Tell If Your Hip Pain Is True Hip Pain:

LocationSymptomsTiming
True hip pathology is usually found at the side or front of your thigh and hip.
Pain during movement or weight bearing.

Stiffness.

Tenderness to touch.
During or after movement.
Oftentimes in the inner thigh and anterior crease at the top of your leg.Reduced flexibility.

Possible swelling.

Possible grinding or grating with movement.		Stiffness is usually greatest after periods of inactivity or when waking up.

How To Tell If Your Hip Pain Is Actually A Back Issue:

LocationSymptomsTiming
Posterior aspect of your hip and in your butt muscle. It may feel like it is directly in your ‘hip bone.’ Sciatic Nerve Pain that starts in your lower back and travels down your right and/or left leg.

Possible numbness or weakness in the hip and leg muscles. 		Back issues typically are worst with prolonged postures (either sitting or standing) and while laying down.
It is exceedingly rare that pain in the back of your hip originates from the hip.Potential bladder control issues and incontinence.

Potentially reduced anal tone leading to more flatulence and bowel issues.		Laying flat on your back is a big problem due to the compression this position places on the spine.

The following exercises will provide are great examples of exercises that will address common issues at that cause hip pain. Remember that consulting with a physical therapist is a great way to jump start your recovery and skip some of the guess work.

Note: If any of these move increases or causes severe pain, you should consult your physician or physical therapist. It could be as simple as improper performance of the exercise or it could be a sign that you need medical management.

5 Daily Hip Exercises: (Perform 2-4 repetitions of each stretch and 10-20 repetitions of each exercise)

1. Kneeling Hip Flexor Stretch:

Hip Flexors are notoriously tight due to the excessive sitting that we all do.

The kneeling hip flexor stretch is a simple way to stretch a commonly tight muscle.
  1. Starting position: Kneel on the ground with your right hip and right knee bent and your right foot flat on the ground. Your left knee should be directly under your left hip and your left foot behind you.
    • You may already feel a stretch in the tight muscles on the front of your left thigh.
  2. If tolerable, engage your core, tuck your pelvis, and press your left hip forward while keeping your torso upright.
    • Aim for a significant BUT NOT PAINFUL stretch.
    • Your goal is to hold the gentle stretch for 15-30 seconds.
      • Research suggests this is the greatest change occurs at 15-30 seconds.1,2
      • No further benefit is had after 2-4 repetitions.3
  3. Repeat on your right leg.

Modification: If you can not knee without sore hip, knees, or back, you can perform this stretch in the modified Thomas Position pictured below:

Performing the hip flexor stretch in this modified thomas position in another option.
The Band/Strap is optional for a deeper stretch.

2. Piriformis and Abductor Stretch:

The piriformis was found to be excessively tight in almost 80% of the population.4

This seated piriformis stretch can be useful to an estimated 80% of the population.
  1. Sit on the floor and extend your left leg directly in front of you, then cross your right foot over your left thigh, placing your right foot flat on the floor to the left of your left thigh.
  2. Rotate your torso to the right.
  3. Next, reach back place your right hand on the floor behind your right hip and reach your left elbow to press on the outside of your right thigh, increasing the stretch to the outside of your right hip.
    • Take deep breaths while you count up to 15-30 seconds.
    • After you have had a good stretch, switch legs.

Modification: If you have trouble getting onto the floor or if twisting causes too much pain, then you can perform the Seated Piriformis stretch pictured below:

An easy way to modify the piriformis stretch if you lack flexibility.

3. Donkey Kick into Fire Hydrant:

Most people have strength and mobility deficits in all directions except straight ahead. This move will remedy that problem.

Oxygenmag.com
  1. Start on your hands and knees
    • Your left and right wrist directly under your left and right shoulders, respectively. Your bent knees should be directly under your hips.
    • Engage your core by imagining squeezing your belly button down to into your pelvis.
  2. Use your gluteal muscles to slowly kick back and extend your leg in a straight line with your body.
  3. Return to starting position and immediately lift your bent knee to the side, mimicking a dog peeing on a fire hydrant.
    • Again return to starting position and repeat with opposite leg.

4. Squat: The King of All Exercises (maybe)

When done correctly this simple exercise works your gluteus muscles ( gluteus medius and maximus), the quadriceps muscles on front of your thigh, the hamstrings on back of your thigh, and everything else down to the soles of your feet.

The squat is a multi-joint movement.
All Hail the King of Exercises.
  1. In the standing position, start with your feet shoulder width apart.
  2. Bend knees and hips to move as if you were beginning to sit back into a chair.
    • Maintain good form by keeping your knees above your feet and not letting them drift forward past your toes.
    • Lower to your tolerance, with the goal being a 90-degree angle.
  3. From this semi sitting position, use your legs to push back into stance and squeeze your glutes together at the very top.

Modification: If you have difficulty balancing while keeping this alignment, perform in front of the kitchen sink with hands holding onto the counter and a chair placed behind you for guidance.

5. Side Lunge:

This is one of the best exercises to stretch your hips, train your balance, and build strength from the standing position.

  1. Stand with your feet wide apart, approximately twice the width of your shoulders.
  2. Begin the movement like a squat but keep your left leg straight as you allow your right to bend and accept your weight.
    • Allow your upper body to drift over to align above your bent right knee.
    • If you have knee pain, simply do not lower down as far.
  3. Use the strength in your right leg to push back up to the starting position.

5 Daily Back Exercises: (Perform 10-20 repetitions of each exercise)

The key to low back health is appropriate mobility at the spine combined with synchronistic activation of the core. This includes pelvic floor activation, appropriate length of hip flexors and consistent gluteal tone to maintain pelvic alignment, optimal performance of the transverse abdominus and the multifidus to support the spine and allow force production, and full functional range of motion at the diaphragm.

The good part is that you do not have to understand all of that to achieve the desired affect, simply follow these strength exercises:

1. Bridge Exercise:

The first exercise is the basic back bridge from the supine position.

  1. Lay on your back with your knees bent and feet flat on the floor.
  2. Push down through your heels and lift your hips into the air.
  3. Hold for 2+ seconds, lower to the starting position, and then repeat.

2. Pelvic Tilt

A great way to optimize pelvic and low back mobility.

  1. Lay on back with knees bent and feet flat on floor, place your hands on the bony front of your hips to guide movement.
  2. Rock your pelvis forward and backward through full range of motion.
    • Flattening and hollowing your low back.
  3. Perform10-20 and move to the next motion.
    • Side-to-side, circles, riding a bike motion.

3. Abdominal Hollowing / Vacuum Pose

The most direct way to work your transverse abdominus, aka your ‘inner girdle’.

  1. Lay on your back with knees bent and feet flat on the floor.
  2. Suck your belly button in and down towards your spine as if trying to make your waist as small as possible.
  3. Hold for 5+ seconds, relax, repeat.
    • You can make this exercise more challenging by performing in different positions:
      • Sitting
      • Laying face down
      • Standing
      • While performing other activities and/or exercises.

4. Multifidus Walk Out:

You will need a resistance band for this one, but it is well worth the small investment.

  1. Attach one end of the resistance band to a solid and immovable object such as a door. Grasp the other end with both hands and hold at arms length directly in front of you.
  2. Side step away from the anchor point without letting the resistance rotate your body.
  3. Return to starting position without letting resistance pull you off balance or move you too quickly.
    • Repeat.

5. Kegel Squeeze:

This is a strength exercise that is

a.] simple,

b.] overlooked,

c.] critical for spinal stability and urinary health

  1. Squeeze your pubococcygeal muscles in the exact same way as if trying to stop the flow of urine.
    • Variations:
      • Hold for different lengths of time.
      • Gain control by varying the strength of your contractions (25% power, 50%, 75%, 100%)
      • Perform in different positions.
      • Perform throughout the day while doing your daily activities.

BONUS: Diaphragm Breathing

The above exercises address all of the critical components of your core except for the diaphragm.

The Diaphragm is the cone-shaped muscle directly beneath your lungs that flattens out when it contracts and is directly responsible for you taking a breath.

A healthy diaphragm muscle is the last piece of the puzzle that is your healthy core and spine support.

  • Tissue Box Breathing:
    1. Lay on your back with a box of tissues (or other light object) on your belly.
    2. Breath in deeply while allowing your belly to rise and lift the tissue box as high as you can.
      • Perform these breaths for 30-60 seconds in a natural rhythm.
  • Tissue Breathing
    1. Hold a Tissue 3-4 inches from your face.
    2. Take a deep breath in through your nose (while allowing your belly to push out as above).
    3. Blow out through pursed lips causing the tissue to flutter (but hold onto it). Try to keep the tissue ‘in the wind’ for as long as you can, completely emptying your lungs.
      • Perform 5-10 breaths like this.

A Personal Word from Dan / Lead Therapist and Owner at Rehab Revolution:

The moral of this story is that you ARE NOT powerless against hip pain (or back pain for that matter). There is someone very close to me that often says ‘I’m just getting old’ or ‘this is just the way it is’ or ‘I know I need to ___, I will get to it.’

On one hand I am grateful that this person is at peace and not tormented by the failings of the body. On the other hand I am very concerned that although this person is not very old, they are missing out on mobility, pain relief, and happiness that is still available to them.

I have been doing this for well over a decade and I know that almost everyone can help themselves with just a modicum of effort. Whether that is performing low-impact cardio, identifying bad habits, or simply not settling for ‘the way it is.”

While the above exercises and stretches are not comprehensive and there is no one-size-fits-all program, they do offer a fantastic and easily accessible starting point. If you have any questions or need some insight, please reach out to me.

References:

  1. McHugh MPMagnusson SPGleim GWNicholas JA. Viscoelastic stress relaxation in human skeletal muscle. Med Sci Sports Exerc. Dec 1992;24(12):1375–1382
  2. Bandy WDIrion JM. The effect of time on static stretch on the flexibility of the hamstring muscles. Phys Ther. Sep 1994;74(9):845–850; discussion 850–842
  3. Taylor DCDalton JD, Jr.Seaber AVGarrett WE., Jr. Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching. Am J Sports Med. May-Jun 1990;18(3):300–309
  4. Mondal M, Sarkar B, Alam S et al. Prevalence of piriformis tightness in healthy sedentary individuals: a cross-sectional study. Int J Health Sci Res. 2017; 7(7):134-142.

The Daily Ship

Why is this section called ‘The Daily Ship’? It is my effort to ‘ship’ my work on a daily basis. I have a lot of insight to share and the best way to convey this (as well as get better at my craft) is to ship my work every day. Here is my effort to stay consistent and provide insight into Physical Therapy Delivery, Health and Longevity, and even Entrepreneurship.

Enjoy…

5.20.21 – The Transition Is The Audition.

When it comes to entrepreneurship, not many people realize that you will have to work much harder than you do at your regular job. When you work for Company X, all you have to do is show up, clock in, and perform your assigned task(s). You don’t have to worry about marketing (unless you are in the marketing department), customer acquisition (unless you are in the customer acquisition department), website design (unless… you get it) , financial management, or employee training.

The reality is that you have lots of extra time when working for someone else. You can clock out, return home, and start your side hustle. In between playing with the kids, making dinner, and watching TV, you can make your knick-knack and post it on Etsy. That thing will sell within a week (because you are awesome) and voila… a quick little profit.

If making knick-knacks isn’t your thing, maybe you spend 30 minutes on your blog, providing consulting service to your client, or walking the dogs on your block for extra money… all for a small time commitment and similarly small payout. The tricky part is when you decide to stop spending your time making money for Company X and start spending more time Hustling for your Last Name.

There is a magic tipping point where you are making almost as much money on your side hustle as your main job. It’s magic because then you can seriously consider quitting the 9-to-5 and focus solely on your Business, your Passion, your Company. Getting there is tough though, it requires extra time, extra effort, and a monumental sacrifice of most of your creature comforts: no more TV, a bit (or a lot) less sleep, no more going out on the weekends. You have to ‘Make It Happen’ and that is difficult.

It quickly becomes overwhelming, you are working twice as long and doubly as hard. Then you start to question if it is actually worth it? Or if you should give up and settle for the comfort of a job with set hours and a reliable but limited income.

Welcome to your Audition. If you can’t cut it now then you may need to reconsider because entrepreneurship requires blood, sweat, and tears for years before you get your glory… but the glory is worth it. Push through and embrace the struggle, embrace the grind and embrace the roller coaster of emotions. In the end, not only will you have built something on your own but you will see it grow and reward you far beyond what your 9-to-5 ever could.

Welcome to the Game.

5.13.21 – Balance 102.

In Balance 101 I detailed the three causes of impaired balance, here I’ll show you how you can improve your ‘inner sense of balance’ by training your vestibular function. The vestibular function is very intimately connected to the movement and tracking ability of your eyes. This is called the Vestibular Ocular Reflex or VOR.

The VOR serves to stabilize images on your retinas while your head is moving. The vestibular organ (inner ear) does this by sending signals to your eye muscles to make small adjustments in an effort to keep your view steady during head movement. Without it our vision would blur every time we moved our heads, impairing our sense of balance and leading to higher fall risk.

As mentioned in ‘101’ there are multiple reasons why this reflex gets impaired or slowed, not the least of which is normal aging. The good news is that we can train the reflex to keep it sharp.

Exercise #1:

  1. Sit at the edge of your chair with your back straight and hold your arm straight out in front of you, making a ‘thumbs up’.
  2. Slowly turn your head left and right while keeping your eyes locked on your upright thumb.
  3. Increase speed of your head turns until your vision starts to blur.
  4. If and when it begins to blur, slow down (but don’t stop) until you can see clearly.
  5. Increase speed again until your vision starts to blur.
  6. Repeat multiple trials until you can increase speed without blurred vision.
    • Repeat with vertical movements.

Exercise #2:

  1. Assume same position as before, with arm outstretched and thumb up.
  2. Without moving your head, switch your gaze from the top of your thumb to a mask on the wall approximately 10-20ft away.
  3. Return gaze to thumb.
  4. Repeat eye movements faster until vision blurs or you get dizzy.
  5. Slow down but don’t stop, then resume speed.

Performing these exercises daily will train your Vestibular Ocular Reflex and help with maintaining your balance. They are safe to do on your own without the need for assistance. I tell my patients that they are simple yet powerful. It is definitely a different form of exercise from doing a squat or a lunge, but it the right tool for the job. In the next entry I’ll talk about ways to improve balance through your feet.

5.12.21 – Balance 101.

We all get our balance from three sources of input. If any of these systems is challenged, we rely on the other two to compensate. Oftentimes we aren’t aware of a deficit in one system because the other two do such a good job picking up the slack.

The first is visual, what our eyes can see. It is much easier to maintain our balance in a well lit room versus in the pitch black. Similarly, we challenge our balance every time we close our eyes.

Commonly impaired by:

  • poor vision/need for glasses;
  • Poorly lit room

The second source comes from our feet and their ability to feel the ground and report back to our brains. Somatosensation and proprioception tell us if we are on a flat surface or rocky surface, how our weight is distributed, and what angle the ground is at according to the level of bend in our ankles.

Commonly impaired by:

  • Diabetes (or neuropathy from any source)
  • Cold feet / Reduced blood flow to feet
  • Shoes with poor support

The third input comes from our inner ear. In each ear resides a vestibular organ with semicircular canals that send signals about our position in space directly to our brain (Imagine a carpenter’s level but more complex).

Commonly impaired by:

  • Ear infections
  • Use of antibiotics (and some other meds)
  • Head injury/impact
  • Stroke
  • Normal aging

General tips:

  • Don’t ignore your poor balance. Whether you are 20 yrs old or 80 yrs old, one bad fall and its ‘curtains’ for you.
  • Keep walkways well lit during the day and install a bathroom nightlight.
  • Avoid standing or walking with your feet touching each other, a wider base of support will provide more stability and internal feedback about where you are standing.
  • Wear your glasses
  • Ask a therapist how to compensate for ‘Vestibular Hypofunction’.
    • *** I’ll be writing about this next***

5.11.21 – Selfish > Lazy (Story Time).

As a Home Health Physical Therapist I visit many different neighborhoods. I’ve never felt in danger but I definitely know which part of the city I’m in whenever I get there. Last week I needed coffee so I went through a McDonalds drive through in an especially rough area.

The pot holes in the street were bigger than some of the cars, the apartment buildings were in disrepair, and there was evidence of homelessness whichever way I chose to look. The car in front of me was occupied by a woman locked in verbal combat with her kids over an issue with Happy Meal toys. (I could here everything clearly even though I was in a different car.) It was an area that most people would typically shy away from if given the choice.

I got to the drive through menu and a low and flat voice said ‘go ahead.’

Me: “I’ll have a medium black coffee please.”

*(indistinct mumbling)

(I wait a few seconds)

Me: “Did you get that?”

“Pull through.”

So I pull through. The lady ahead of me passed a handful of cash to the attendant while her kid simultaneously threw a little toy truck out of the passenger window. She storms out of the car, picks up the truck, get in slams the door and peels off screaming.

I pull up and say ‘hi’ to the cashier… He looks right at me, says nothing and holds his hand out. I give him the credit card, he scans it and hands it back without looking at me.

‘Thanks!’, I say.

He says nothing and closes the window.

OK… I pull up to the next window where the aforementioned lady was just screaming her head off.

I put on a smile and say ‘hello’ when the guy opens the window to hand me my coffee. He looks sincerely shocked at my greeting and says ‘hi, sorry about the wait’.

I told him it was no problem and to have a nice day. He told me to do the same and was smiling when I drove away. He literally leaned partially out of the window as I was inching away to say ‘have a nice day’.

In the middle of a terrible neighborhood, surrounded by angry people, a simple smile and a kind word can shine like a light in the fog and kindle happiness and a sense of togetherness.

The second guy got that. I get that. Even if you only do it for yourself, smiling is contagious and kindness spreads.

The first guy… I think he was lazy. It wouldn’t take much to put on a smile, or even to utter a kind word. Especially when it’s your job to interact with people. Even if he didn’t mean it he could have been selfish and tried smiling for his own good. Or acting differently in a self-serving effort to entertain himself. Even that would have been a welcome distinction.

At that point I wasn’t happy to be there, but a modicum of kindness made a lot of difference to both myself and the second guy.

Was it selfish on my part? Did I smile with intentions aimed at them or at myself? Doesn’t matter. In this case selfish turned out to be way better than lazy.

5.10.21 – Authentic Strength.

For slightly over 6 months I’ve been training in calisthenics. I’ll be honest, at first I thought that work meant jumping jacks and toe touches. Man was I wrong…

Roughly 7 months ago a new guy joined our gym. It was hard to ignore him when he was the only guy in the gym doing handstands, hand stand pushups, muscle ups (look it up if you don’t know), and pull ups with 180lbs hanging from his waist.

All impressive feats that caught my eye but hadn’t yet made me want to explore it. I was happy doing squats, bench presses, deadlifts, and curls. Now let me paint you a picture… I’m 5’11” tall, I weigh 175lbs and I used to be an amateur bodybuilder, I still have the basic shape. This guy is maybe an inch shorter, visually narrower, and probably wouldn’t catch your eye in a quick glance.

One day I was finishing up at the gym and went up to the bathroom to wash my hands before leaving. Handstand guy had finished in the shower and was shirtless in the locker room. He was chiseled: Abs, full chest, rounded shoulders, traps, and an admirable muscled back with a significant v-taper. Holy shit.

I went home and did a bit of Google-ing about calisthenics.

Calisthenics definition: “Gymnastic exercises to achieve bodily fitness and grace of movement.”

OK… but what else?

Well, it turns out that Calisthenics played a big role in how ancient warriors and the Famous Sparta Warriors trained. That makes sense, they didn’t have modern training equipment yet they are known to be at the peak of physical strength and agility. Walking weapons who were visually and practically imposing… now I’m more interested.

I made a basic plan and changed my training, I also quickly befriended Handstand Guy (whose name I learned is Chris). One day I saw him doing bench press and deadlifts. I asked him about that, ‘I didn’t think you did the basic lifts?’ He said something real interesting. He explained that he uses some of the ‘basic’ exercises as supplemental movements to build strength for the classic calisthenics moves. He then said this:

‘I’ve never weight trained. I started calisthenics a couple years ago and now I find that I can do everything that you all can do with equal weight, but you all can’t do what I can do’.

Now Chris is a very kind person and those words on the screen probably come off as self-absorbed but he presented it matter-of-factly with no mockery. It didn’t take much thinking to realize that this was absolutely true. He was benching more than most of the guys in here were able to. He was deadlifting more than most of the guys. Nobody in the place was able to hold a handstand with good alignment, let alone maintain balance while performing multiple handstand pushups. Nobody could rip off 10 strict muscle ups or do multiple chin ups with the equivalent of a large man hanging off his waist.

Since that realization I have trained almost exclusively in Calisthenics and realized first hand that this shit is way harder than he makes it look. It involves building immense ligament strength, an iron-clad core, more flexibility than I’ve ever had, Superman Shoulders, and incredible amounts of strength… Authentic Strength.

Plus, after decades of training I’ve found something new and endlessly interesting that challenges me in new ways. It is a huge thrill to learn a new skill and realize I now have control of my body in ways I never explored before. It doesn’t hurt that this training is yielding a significant level of improvement in my physique and overall gravitas. The unexpected thing is that I’ve even incorporated some of these principles in my therapy practice.

In another entry, I’ll describe how physical therapists can utilize Spartan Training when rehabilitating the geriatric population.

5.7.21 – No Reason Not To Own A Business.

I am from Ohio and live here currently but I have lived in Atlanta, GA and also Fort Worth, TX. When I was in Texas I owned a cryotherapy clinic called Celsius Cryo Spa. We had a physical location in a busy area with lots of traffic. I owned it for 2 years before selling it and returning to Ohio for personal reasons. We sold for a profit and walked away. That profit was modest. It helped us finance the return home and gave me a few months where I could tend to family without having to work, but it is gone now.

Flash forward to today and I own 3 businesses. Rehab Revolution is the only one that is traditionally profitable (so far). However, each business allows me to lower my tax burden and keeps a LARGE percentage of my income in my bank account instead of in Uncle Sam’s greedy palms… legally.

What I didn’t know back in Texas was that the tax code is designed to incentivize people to start businesses/create jobs/contribute to a productive society. The rules are written to allow us a break if we are adding value to the community around us. If you can do that, then you are legally allowed a tax break for things like education, marketing costs, a percentage of your home and utilities, any meal you eat while discussing business, travel expenses, the cell phone you use to conduct business, the car you use for your business, and many more business-related expenses.

With this in mind, there is no excuse not to start your own business. Whatever you currently do for your job, you can also do as a side hustle. Are you an electrician? Start a local service to fix peoples faulty light switches. Are you a teacher? Start a tutoring business. I could go on and on.

Setting up the business is cheap and easy. You can research how to do it online or you can reach out to someone who has already done it. Guiding you through the process is a piece of cake. After that, hire a tax professional to do your taxes at the end of the year and give you some guidance throughout. You’ll pay for their services but you’ll save more money than it costs and you can write that off too!

5.6.21 – A Simple Way To Work With Retropulsion.

Retropulsion is a tendency to lose your balance posteriorly, or backwards. Often it is associated with postural instability and a loss of postural reflexes as we age or as it relates to disease (Parkinson’s). Another cause that I happen to have seen a lot lately is CVA (stroke). Here, a persons sense of balance and proprioception (joint position in space) is disturbed due to the insult to the brain.

There is a simple way to work with this that I have been having a lot of success with. I will have the patients simply stand on a wedge. I have a semi-soft balance wedge that looks like a big piece of cheese. I assist them to stand on it at the tip of the ‘cheese’ with their heels on the thinnest part and their toes angling up toward the thickest part. This puts them in a position to be tilted backwards and they must subtly shift their weight forward to avoid falling.

It is very difficult at first and requires hands-on assistance to achieve a sense of balance, but with practice they can stand still on the wedge and eventually perform other tasks while on the incline. This seems to reset their positional sense and diminishes the tendency for retropulsion.

Another way is to sit on a chair and scoot to the edge. Position your legs wide and place an oversized bouncy ball (you can find in the kids section of many stores) on the floor between your feet. Reach down and grasp the ball with both hands before standing up. This promotes the sequence of leaning forward and keeping your weight shifted anteriorly during the sit-to-stand movement.

These are two examples of relatively simple ways to address a seemingly daunting impairment. If you or your loved one has suffered a stroke, has Parkinson’s, or any other form of retropulsion, these are interventions that you could try at home. Of course use common sense and be sure you are able to support them if they lose balance.

5.5.21 – Averaging Down.

Something that I’ve been thinking about lately is a particular aspect of Investment Strategy called ‘Averaging Down’, and I’m trying to look for parallels in my businesses, my family life, and in general.

If you’re not familiar with Averaging Down, here is my (admittedly simplistic) way of explaining it: Lets imagine you bought 1 share of Rehab Revolution Stock at a price of $100. At this price you make a profit at anything above $100. After a week of holding it, the price drops to $50. Shit! You took a heck of a loss, right?

WRONG… for two reasons.

1.) You didn’t lose money unless you sell your share and lock in that loss. You still own the same amount of equity in the company regardless of price.

2.) If you have done your research and TRULY BELIEVE in the company, this presents an opportunity.

I’m assuming you believe in me and my company so you decide to buy another share at $50. Now, you own two shares and your average price of purchase is $75. Therefore, you only have to see the price rise above $75 to see a profit.

Assuming you have researched well and believe in the company/investment, Averaging Down can be a powerful tool.

Surely there are parallels… how does this apply in my life? my business? my relationships?

5.4.21 – The Gift Of Presence And A Documentation Sandwich.

As it turns out, the Secret to Happiness is also the secret to being a good physical therapist.

We are told ‘Carpe Diem’, ‘live in the moment’, and ‘be present’. This is all good advice for husbands, fathers, brothers, friends, and physical therapists too.

In the 21st century, there is insidious ‘villain’ who steals our attention… technology.

I’m a father of two young girls and of course I love to play with them. There will come a day when they don’t want to play with me, so I’m enjoying this while it lasts. But the following happens way too often: I’ll be on the floor playing and one or both of them is doing something cute. I’ll reach for my phone to take a picture. I take the picture, then check the picture, then notice I have an email, then see there was a missed text message, then I think that I should put the picture on Facebook to show everyone the cuteness. Then I hear, “daddy will you play with me?”

“I am playing with you, dear”. Let me just put the finishing touches on this post… “daddy, will you play with me?”

Kids know when they don’t have your full attention. It literally makes A WORLD of difference to put your phone in another room and give them my undivided attention.

I see an obvious parallel in Physical therapy. Patients know when you are there for them and when your nose is buried in your work tablet. This seems obvious but we are also being pressured to complete Point of Service Documentation. In theory, this is a good idea: you start and finish your documentation while with the patient. However, we do A LOT of documentation and to complete it all while with the patient demands too much of our attention, attention that the patient needs and deserves.

To combat this I create a ‘Documentation Sandwich’. That is, I document before knocking on their door, and after I leave their home.

When I arrive at a patients house I immediately pull up the note and fill in all the (redundant) demographics and environmental questions. I finish as much of the note as I can before I even see the patient (remember, you can always go back and change something if new information arises). Hopefully this only leaves the objective measures, interventions provided, and assessment.

Upon seeing the patient I take vitals and record those, but the rest of the visit my tablet is in my bag while I attend to the patient and their needs. They have my full attention and they know it.

After completing the visit and exiting the house, I re-open the note and use the voice-text feature to record interventions provided, patient response, and assessment.

The Documentation Sandwich Method has allowed me to thrive as a Home Health Physical Therapist. It addresses two notorious concerns in home health: 1) It allows me to provide personal and intimate care where I give my complete attention and can work generously for the patient. 2) I do ZERO documentation at home. When my work day is done, it’s done. I go home and give my full attention to my wife and kids.

I train my employees to do this and I encourage you to try it.

5.3.21 – The Telehealth Movement.

Covid-19 has changed our world in many ways. This is true globally as well as locally. Physical Therapists had to adapt and change like everyone else. The rise of telehealth and virtual visits has fundamentally changed how we deliver services… or has it?

With telehealth visits there is obviously no hands-on treatment. No measuring, no palpating, no tactile cuing, and no massage. You would think that would severely limit our treatment options and more importantly, our outcomes.

Remarkably, we are finding that is not true. In one study published in the National Library of Medicine, the researchers looked at a cohort of 3883 telehealth visits over a period of 2 months. The study reported that 94% of patients were satisfied (based on a 5 Category Satisfaction Survey) and 92% said they would attend telehealth therapy again.

It makes me think… we can have the same success with our patients by delivering knowledge and direction over an internet connection and empowering them to take control. Sounds a lot like the mission statement of Rehab Revolution.

5.2.21 – It Doesn’t Have To Be Like This.

Is there rule that says you have to hunch over as you get older?

I feel badly for the generation prior to mine (I was born in ’84). Nearly everyone I encounter says some version of ‘it’s just part of getting older’. Well, that’s bullshit.

To my knowledge, there are 2 clinical studies that link genetics with spinal curvature/kyphotic posture. One was a twin-study that acknowledged its results may be inflated due to the congruity of the twins’ lifestyles. Another study found that slightly over 50% of people with Kyphotic posture inherited it, but then went on to state the genetic variable was actually paraspinal muscle size. TRANSLATION: Folks who have genetically smaller (and therefore weaker) paraspinal muscles tend to develop forward posture.

Side note: Vertebral fractures and disc degeneration accounts for only 12% of people who have kyphosis.

The solution, as I see it, is to educate the population that this is largely preventable and reversible if addressed early on. Mild amounts of targeted exercises can go a long way towards preventing postural decline and the cascade of subsequent problems.

Just like we all know we shouldn’t smoke, we also all know that we shouldn’t sit and be lazy. Yet here we are… most folks sit a lot. By choice or for work purposes, we sit a lot. I’m guilty of it too.

Here is a summary of what happens: Our hip flexors get tight and pull our pelvis out of alignment; our spinal musculature goes on vacation because they don’t have to work when you are sitting in a chair; our pectorals/chest muscles get tight from sitting and tighter from typing with forward-rounded shoulders; our rhomboids/middle back gets lazy as we slouch in our comfy seat; our scapula adopt a protracted position due to the tight chest and lazy rhomboids; our neck muscles (sternocleidomastoids and scalenes) get tight as we stare forward and downward at our screens; this forward head posture creates anterior translation and shear forces on the cervical vertebrae and leads to Dowager’s Hump (look it up).

Phew… that was a lot. Put it all together and you end up looking like the Hunchback of Notre Dame.

This is solvable! You are not doomed, there is no rule that says you must succumb. Simply stand up, strengthen your back muscles, stretch out the tight ones that I listed, and move your body. Instead of working hard at your desk job only to come home and collapse on the couch or recliner, exercise the aforementioned muscles for 10-15 minutes. Even if you are in the 50% of the population who is genetically ‘doomed’ with weak spinal extensors, you can strengthen them. I promise it is science, not magic. If you don’t know what to do or where to begin, contact Rehab Revolution and we will get you started on a program.

My big hope and the mission of Rehab Revolution is to change your thinking from ‘helpless-victim-of-aging’ to an empowered understanding that you have more control than you think.

5.1.21 – How Do We Thrive In An Age Of Abundance?

I think the answer lies in the notion of Gift Culture.

We truly live in an Age of Abundance. Almost anything you can think of, you have a LOT of it (or at least access to a lot of it).

  • Food can be found at any corner or even delivered to your door.
  • TV/movies/music/literature all reside in your pocket computer (aka cell phone).
  • (Too much) Information is readily available via Google, Twitter, and Facebook.
  • I’d even argue that money can be abundant since there are plenty of ways to hustle some dollars from your couch.

So what can we place value on? What more is truly unique? A commodity? Even a rare occurrence? Unfortunately the answer is kindness/gifts. If you can find a way to Gift someone with your kindness, then you can thrive.

Remember it’s not a gift if it’s paid for, but the kindness and sincerity with which you deliver services IS a gift.

Everyone wins with a gift:

  • The receiver is genuinely appreciative due to the gift’s rarity (kindness is something that is no longer abundant in our society).
  • You get to feel like you actually made a positive impact in the receiver’s day. Everyone likes to feel important and you are definitely important now that you’ve contributed to their day.
  • Also, the Universe tends to reward charity with more of the same.

Here’s an interesting analogy:

If you have a $100-bill and you clutch it and won’t let it go, there is no room for anyone to put another bill in your hand.

Similarly if you hold onto and don’t share your kindness, people will see that there is no room to give you any kindness.

4.30.21 – EVERYTHING We Do Has Value.

There is value and purpose in all of our actions, the difficulty comes in recognizing our true audience at any given point during the day.

Eating (selfish), having conversations (generous or selfish), checking your email generous, selfish, or lazy), holding the door for someone (generous or selfish), even sitting on the couch watching TV (selfish or lazy) has value… to someone. Are your actions generous, selfish, or just lazy?

Selfish actions are not inherently bad. Eating is selfish, that should be obvious and there is nothing wrong with that. We need to eat to survive and this is true for many other things, but we sometimes turn what should be a generous act into a selfish one. When the Physical Therapist stops attending to the needs of the client and simply shows up to get the job done and get out, that is selfish. When the Nurse doesn’t really listen to the what the client is saying and dominates the conversation in an apparent effort to demonstrate his/her knowledge or feel a sense of superiority, that is selfish. Selfish actions can feel right and good in the moment

Lazy actions are dangerous. They can be selfish: like when we walk past the trash on our floor instead of picking it up. This is a selfish conservation of energy and shirking of responsibility. When the physical therapist assumes his/her clients blood pressure is within normal limits and omits the vital sign assessment. That is lazy and dangerous. We should strive to avoid lazy actions so that we don’t find ourselves on a slippery slope.

Generous actions are how we serve others. Cook dinner with care and love for the benefit of your spouse’s and kids’ enjoyment. Hold the door for someone with a smile and kind word so they know you are giving your extra 10 seconds to them and not just holding it out of a sense of forced duty. Listen to your clients and respond to what they are telling you. Meet their obvious needs but also the underlying need to be heard and reminded that they are a person and not just a patient. As a physical therapist, do your Work for the client and not for the paycheck. You’ll find that acting this way is generous to them but also generous to yourself.

4.29.21 – The Difference is the Human Connection.

“People will never forget how you made them feel.”

That is part of a famous quote from Maya Angelou. It has been co-opted by countless others in the arenas of sales, marketing, and psychology. It applies equally as much to Physical Therapy, or any healthcare discipline really.

This has been the not-so-secret ‘Key’ to my success as a Physical Therapist. I say not-so-secret because I’ve done my best to teach all of my cohorts this concept. I was a clinical instructor when I lived in Texas. I would receive students from graduate programs and teach them how to deliver PT services. From Day One I would implore them to talk to everyone like a friend first and like a patient second. Don’t change your tone of voice and don’t condescend.

I have served as Program Director at an inpatient rehab facility. I tried to lead by example and let my team see my treatment and interview methods as often as possible. Currently I train new employees for the company I work for and I train employees of my own company, Rehab Revolution. My message remains clear: ‘Your patient must like you if you want them to do what you ask.’

It helps to remember that every patient you meet used to be like you… healthy, vibrant, and independent. Go back further: Every patient used to be a child, playful and full of energy. They never imagined they would have a limb amputated due to diabetes or that they wouldn’t be able to walk across the room because of congestive heart failure. Every one of these people is an actual person, deserving of empathy, respect, and friendship.

If you let them know that you still see them as an interesting person despite their debility, then they will follow your instructions to the letter and get better clinical outcomes. This is how we truly make a difference and how we work generously instead of selfishly.

6 Acupressure Points For Lower Back Pain [Fast Relief]

Do you remember when you were younger and could roll out of bed without that familiar twinge of pain or stiffness in your lower back?

morning lower back pain
Rise and… grind?

How about when you could sit down at your school desk all day and not have to pop an Advil?

anti-inflammatory for back pain
There has to be a better way.

It doesn’t seem fair that those days are gone, huh? Well don’t worry, the way things are going, the kids are having the same troubles these days due to childhood obesity and low-grade dehydration (but that is a different blog post).

lower back pain in children
The good news is that this is reversible.
Table of Contents
Statistics
Causes of Lower Back Pain
Current Treatment Options
The 6 Acupressure Points for Lower Back Pain Relief
Additional Acupressure Tips
Summary
References

Here are some quick statistics about chronic lower back pain:

  1. Experts estimate that up to 80% of the people experience back pain at some time in their lives.4
  2. The 2010 Global Burden of Disease Study estimated that low back chronic pain is among the top 10 diseases and injuries that account for the highest number of DALYs worldwide.1
    • DALY is the World Health Organization’s term for the loss of the equivalent of one year of full health due to disability
  3. Low back pain is the leading cause of activity limitation and work absence throughout much of the world, imposing a high economic burden on individuals, families, communities, industry, and governments.2,3
  4. 100% of people in the Unites States say chronic back pain sucks. (I don’t have a reference for this one, but you can trust me.)
chronic back pain
Look familiar?

Contributing Causes of Lower Back Pain:

  • Pregnant Women (Due to increased lumbar lordosis)
  • Excess Weight Gain (perpetually growing problem in the united states)
    • From 1999–2000 through 2017–2018, the prevalence of obesity increased from 30.5% to 42.4%. 5
  • Dehydration
  • Prolonged Sitting (Particularly relevant ever since COVID-19 has us all working from home)
  • Structural Issues at the Hip (Pelvic Rotation)
  • Functional Issues at the Hip (
  • Reduced Knee Cap mobility
  • Knee Pathologies (Arthritis, genu valgus, genu varus)
  • Flat Feet (Causes changes in posture from the ground up by functionally making one of your legs shorter)
  • Muscle Spasms
  • Blockage of the Large Intestine
  • Incomplete Emptying of the Urinary Bladder
  • Sciatic Nerve Involvement (Sound like you… see our 5 Proven Ways to Relieve Sciatica Back Pain)
  • Mechanical Back Pain
  • Older Adults

Current Treatment Options for Lower Back Pain:

  • Self Administered Acupressure Massage to Alleviate Chronic Low Back Pain (See below)
  • Topical Analgesics
    • CleBD will be your favorite. It uses a proven combination of Menthol, Capsaicin, and CBD.
  • Herbal Medicine
  • Acupuncture Treatments
  • Massage Therapy
  • Conventional Physical Therapy (Other than a hands-on massage, low back pain is a VERY treatable condition using virtual visits through Rehab Revolution.)
  • Costly Surgeries and Medical Treatment
  • Prescription Pain Medication Addiction

The 6 Acupressure Points for Lower Back Pain Relief:

Click each image to enlarge

Apply pressure on these points for 1-2 minutes each.

  1. Stomach Acupressure Point (CV6)
    • This stomach point (CV6) is located two fingers below the belly button.
    • Lie down or sit erect in a firm chair
    • Apply firm pressure with your index or middle finger.
  2. Lower Back Acupressure Points (B23 and B47)
    • These lower back points are situated on both sides on the lower back, two finger widths (B23) and 4 finger widths (B47) from the spine at waist level, on each side of the spinal cord.
    • Place your hands on your waist and move your thumbs towards the spine to locate the points, then apply firm pressure.
  3. Hip Bone Acupressure Points (B48 and GB30)
    • These points are situated on both sides on the hip bone, approximately two finger widths from the large bony area at the bottom of your spine (B48), and midway between the top of your hipbone and the base of your buttocks (GB30).
    • Apply gentle pressure with your two thumbs on these two pressure points on each side.
  4. Knee Acupressure Points (B54 and B53)
    • Two knee points are located at the center of the back of the knee (B54), and two are slightly towards the outer side of the lower leg (B53)near the head of the fibula. This is the influential point of the tendons.
    • Sit down with your legs straight or stand up and place your hands on the side of your knee.
    • With your index or middle fingers locate the points in the hollow of the knee and press firmly.
  5. Hand Acupressure Points (4GI)
    • The acupressure hand points (4GI) can reduce back pain, but only when you are lying down.
    • This hand point is located two finger widths from the joint of the thumb and index finger on the back side of the hand, sometimes called the web of the thumb.
    • With your other hand squeeze the center of the mound of flesh between the thumb and index finger as shown in the picture.
    • Apply firm pressure on this point for a few seconds and then release.
    • Repeat this 4 to 5 times. Then switch to the other hand.
  6. Foot Acupressure Point (Liv3)
    • Lie down and bend your right knee. Reach out for your foot with your right hand.
    • This point is located between your big toe and second toe (Liv3), two fingers widths above from where they join.
    • Apply medium to strong pressure with your thumb or index finger, as this point can be slightly tender.
    • Repeat on the other foot.

Additional Acupressure Tips:

  • Smooth Rounded Instrument: If you have pain in your hands, fingers, or limited use of thumbs, you can instead use a smooth rounded instrument such as:
amzn_assoc_placement = “adunit0”; amzn_assoc_search_bar = “true”; amzn_assoc_tracking_id = “rehabrevoluti-20”; amzn_assoc_ad_mode = “manual”; amzn_assoc_ad_type = “smart”; amzn_assoc_marketplace = “amazon”; amzn_assoc_region = “US”; amzn_assoc_title = “My Amazon Picks”; amzn_assoc_linkid = “c298c3f1fc98a60da3a22d4d5a0be025”; amzn_assoc_asins = “B0795ND4V3,B0811S5STK,B07P5PFFMZ,B077ZH452Q”; //z-na.amazon-adsystem.com/widgets/onejs?MarketPlace=US
  • Specific Points: Pay attention to the specific points. Use the pictures above as guidance so you can easily find the correct spot and apply the right amount of pressure.
  • Search for an Acupressure Practitioner: For best results try to find someone you can visit locally or even chat with online to provide some tips and insight.
  • Do not hesitate to use the occasional anti-inflammatory medicine to ease pain. Especially if your pain is chronic.

Summary:

Applying these oriental medicine techniques to these specific acupoints on a regular basis is an effective way and low-risk ways to reduce the recurrence of back pain.

There are multiple clinical studies and long-rooted traditions that the support Acupressure and Acupuncture as a safe way to not only relief pain, but also stimulate production of endorphins, provide relief of muscle tension, improve blood flow, aide in digestion, and provide a multitude of additional benefits.

Comment below or email me here if you would like custom options for hip pain, leg pain, neck pain, upper back pain, and even autoimmune diseases.

rehab-revolution-consult-with-therapist

Dan Kristoff PT, DPT is recognized as one of the Top Physical Therapists in Ohio. In his 10+ yrs as a physical therapist, he has helped thousands of patients recover from illness and debility. His company, Rehab Revolution, is less than a year old and has already helped hundreds of clients take back control of their health.

References:

  1.  Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2163- 96. doi: 10.1016/S0140-6736(12)61729-2. Erratum in: Lancet, 2013, 381(9867):628. Al Mazroa, Mohammad A.
  2. Taimela S, Kujala UM, Salminen JJ & Viljanen T. The prevalence of low back pain among children and adolescents: a nationwide, cohort-based questionnaire survey in Finland. Spine, 1997, 22: 1132–1136.
  3. Balague F, Troussier B & Salminen JJ. Non-specific low back pain in children and adolescents: risk factors. Eur Spine J, 1999, 8: 429–438.
  4. Rubin Dl. Epidemiology and Risk Factors for Spine Pain. Neurol Clin. 2007; May;25(2):353-71.
  5. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020

One of My Legs is Shorter! [All About LLD Treatment and Symptoms]

Do you feel like one leg is shorter than the other? Don’t worry, I am here to tell you… it probably is. This is referred to as ‘Leg Length Discrepancy’ and it is very common. In fact, it occurs in roughly 90% of the population1.

The Leg Length Discrepancy can range from a fraction of an inch to several inches. The excessive distance is usually what determines the severity of the symptoms (pain!) that you are experiencing.

This article will help you identify the causes, symptoms, and treatment options available. Like most things, I believe you can address this issue and treat it yourself with just a little bit of guidance.

Let’s get started…

Table of Contents
Two Types Of Leg Length Discrepancy
Causes
Symptoms
How To Tell If You Have It
Treatment For Your Unequal Leg Length
Summary
References

Two Types of Leg Length Discrepancy

1.) Structural Leg Length Discrepancy

Differences in leg length are categorized as structural when there is an actual difference in the length of the femur or tibia in one leg versus the other. This is usually present from birth but there can be other causes (see ‘What can cause a structural difference?’ below).

Structural leg length difference is when there is actual disparity in length of long bones.
Compliments of Foot Levelers.

2.) Functional Leg Length Discrepancy

In Functional Leg Length Discrepancy, the femur and tibia of both legs are actually the same length from top to bottom. However, one will appear longer (or shorter) due to dysfunction at the:

  • pelvis
  • hip
  • knee
  • ankle
  • or foot

What Causes Uneven Leg Length?

What can cause a Structural Difference?

Structural differences are usually discovered early on in life and usually due to a congenital anomaly that will alter the alignment of the hip, such as coxa vera or even a dislocated hip. Other causes can include:

Bone Conditions

  • Broken bones –
    • A broken bone can slow down its growth, especially if there is any shattering or separation of the pieces.
    • If there is a fracture, the risk is that the bone will heal and grow more rapidly then the rest of the bone, also leading to a difference in size.
  • Bone Tumors – The tumor itself as well as the required treatment can affect the rate of growth in a child’s bone. Unfortunately, uneven leg length ends up being the the least of the family’s worries.
  • Osteomyelitis – This infection of the bone marrow usually ends up damaging the growth plates (which ultimately leads to different rates of growth).

Growth Plate Injuries

  • These areas of rubbery cartilage at the ends of long bones are where new bone growth occurs in adolescents. Whether through physical injury or pathology, damaged growth plates will alter the rate of bone growth in children.
Uneven legs from Growth plate injuries: Salter Harris Classification
Growth Plate Injuries – Salter Harris Classification10

Arthritis

  • In children this is called ‘juvenile arthritis’. It is present in an estimated 300,000 children in the United States2. Like adult arthritis, it causes inflammation of the joints and their constituents. Unlike adult arthritis, juvenile arthritis can cause leg length discrepancies by affecting the rate of bone growth.
Leg length difference can be caused my juvenile arthritis.

What can cause a Functional Difference?

Although not exclusive to adults, we are more likely to experience functional leg length differences because we have had more time to alter (‘mess up’) our bodies. From the top down:

Leg length discrepancy anatomical causes
  • Scoliosis, slipped discs, or even bad posture can affect the alignment of you pelvis and hips and present as uneven leg length.
  • Prolonged sitting combined with tight hip flexors and rigid lumbar spine can lead to abnormal innominate rotation (rotation of one side of the pelvis about the other). This changes the elevation at which the femur will sit in the socket.
  • At the knee, genu valgus or varus change the angle at which the upper and lower leg bones articulate and present as an obvious functional difference in leg length.
  • Malalignment of the ankle or even a fallen arch on one foot will cause you to stand differently and perceive a difference in the length of your legs.
  • The other significant possibility is the presence of arthritis. A decrease in joint space at any of the above-mentioned joints will functionally change the length of your leg in stance.

Common Symptoms

The most obvious symptom of Leg Length Discrepancy is having one leg longer than the other. These different lengths can be easy to ignore. As stated at the top, 90% of the population experiences this phenomenon and go about their days quite normally.

If the limb length discrepancy is mild, the symptoms may also be mild and many of us will not be motivated enough to seek help/treatment. However, in 2017 Eliks, et al. found that a 2cm difference was enough to affect postural control and lead to a cascade of symptoms3.

Common symptoms can include:

  • Low back pain
  • Hip pain
  • Knee pain
  • Ankle pain
  • Associated abnormal alignment in all above-mentioned joints
  • Fatigue and chronic pain
  • Poor posture (which sets off a vicious circle of related symptoms)
  • Limping
  • Tilted Shoulders
  • Hyperextended knee on the short leg
  • Flexed stance phase on the long leg

How To Self-Diagnose A Leg Length Difference

Self Test #1: Observation

https://youtu.be/YXCufvAa0VM
Observation Method: Start of video until 1:45
  1. Lay face up on the floor with no shoes, relax.
  2. Ask friend or family member to place one hand on each of your hips and gently rock them back and forth for 45-60 seconds to loosen any tight muscles.
  3. Once completely relaxed, have friend observe your two ankle bones and note which is longer.

Self Test #2: Tape Measure

From University of Michigan Family Medicine
  1. Lay face up on floor.
  2. Have friend identify your ASIS (Anterior Superior Iliac Spine) and your Medial Malleolus.
  3. Using a cloth tape measure, measure the distance from the ASIS to the Medial Malleolus.
  4. Use the average of two measurements and compare to other leg.
    • The average of two tape measurements of the distance between the ASIS and medial malleolus appears to have acceptable validity and reliability when used as a screening tool for assessing LLD4.

Self Test #3: Blocks

Indirect Method using blocks.
  1. Stand in front of a seated observer and have them locate your ASIS as above.
  2. Add blocks under your foot of the leg that has the lower ASIS until the two landmarks are at equal height in the observer’s eyes.
  3. Step off of the blocks and measure the combined height of the blocks for your “indirect measurement.”
    • This method is actually ‘slightly more reliable and accurate than using a tape measure5.’

Treatment For Your Unequal Leg Length

What can you do right now?

  • Heel Lift – These are most successful if the distance between your shorter leg and longer leg is 1 inch or less. A relatively cheap treatment option, heel lifts can (sometimes) provide immediate relief to back pain, knee pain, and abnormal walking patterns.
$9.99 if you click through to Amazon
  • Stretch and Strengthen – If your legs are uneven due to a muscular imbalance at your low back or hips, the appropriate stretches to muscles such as multifidus, obliques, and hip flexors (to name a few) may help to lower the functionally-shortened leg to the level of the unaffected leg. Similarly, a fallen arch on one leg and not the other can be relieved with plantar fascia exercises for an ‘easy’ fix.
Request Custom Program

Do you need Physical Therapy for your LLD?

A Physical Therapist can provide a more in-depth evaluation and can be especially helpful if you are having trouble figuring out what is causing the leg length difference. As stated above there are innate structural causes and there are functional causes.

Sometimes the solution is easy and involves addressing just one piece of the puzzle (low back, hip, knee, ankle, or foot). More often, and especially in adults, there are multiple pieces of the puzzle that should be addressed to form the whole picture. This is where a professional physical therapy evaluation and consultation can be helpful to get you on the right track.

Yes, if you need a prosthetic.

Additionally, a physical therapist can help to arrange collaboration with a podiatrist and/or a prosthetic who can create you a custom shoe insert or prosthetic device.

custom shoe modifications
orthopedishoelift.com has many fine examples of custom shoe modifications.

Prosthetics can work very well for you if you have a very large leg length discrepancy but are not a candidate for surgery. An appropriate and custom-made prosthetic can ‘improve the gait as well as the appearance, could be fitted to the patient without the prior need of operative correction and could be well disguised under any loose fitting garment.9‘

Surgical Interventions

Surgery may be considered if the difference in your leg lengths is greater than 4 to 6 centimeters. Ultimately it will involve a comprehensive discussion between your orthopedic surgeon and yourself.

  • Leg Shortening Procedures:
    • Bone Resection: This is an option for adults or adolescents who are done growing. Your surgeon will remove a section of bone to equalize the length.
    • Epiphyseal Stapling: In the growing child, the surgeon will staple the growth plates on the longer leg, slowing its growth. When the shorter leg catches up, the staples are removed to allow both to continue to grow.
    • Epiphysiodesis: The surgeon will position a block of bone over the growth plate to stop further development. The other leg continues to grow. There is a much higher risk of ‘over-shooting’ or ‘under-shooting’ with a 7% rate of complications6.
      • This is a popular and proven option if there is an angular deformity7.
  • Leg Lengthening Procedures:
    • External Fixation: Your surgeon will cut the shorter bone into two pieces and attach an external fixator. The fixator will be manipulated every few days over the next several months to mechanically separate the two pieces of bone. The very minor separation will stimulate new bone growth. When the length is even, the bones are given a period of time to harden and the fixator is removed.
    • Internal Fixation: A magnetically telescoping nail is inserted in the bone and serves the same function as an External Fixator. The nail will telescope (lengthen) an average 0.5 +/- 0.1 millimeters each day8. This procedure also spans several months and includes non-weight-bearing status.

A Word From Rehab Revolution

Unequal leg length is very common and easy to ignore. You might think you are imagining the difference in leg length. Or you might figure that there is nothing you can do about it. This is a mistake that I want to help you correct.

Whether anatomical or structural, uneven leg length is a major cause for ankle, knee, hip, and back pains. It will affect how you walk, how you stand, and if left untreated… cause you great pain as you grow older.

In most cases, conservative treatment is well tolerated and successful. You just have to know where to start and also be able to look at the body as a whole, not just one piece at a time.

If you are not convinced you have a leg length inequality, take a look at the 11 Most Common Reasons Your Feet Hurt. Most people can also benefit from Proven Ways To Relieve Sciatica Pain.

If you still have questions or need guidance, feel free to just ask.

rehab-revolution-consult-with-therapist

Dan Kristoff PT, DPT is recognized as one of the Top Physical Therapists in Ohio. In his 10+ yrs as a physical therapist, he has helped thousands of patients recover from illness and debility. His company, Rehab Revolution, is less than a year old and has already helped hundreds of clients take back control of their health.

References:

  1. Murray KJ, Azari MF. Leg length discrepancy and osteoarthritis in the knee, hip and lumbar spine. J Can Chiropr Assoc. 2015;59(3):226-237.
  2. Prakken, B., Albani, S., and Martini, A. Juvenile idiopathic arthritis. Lancet. 2011;377:2138-49.
  3. Eliks M, Ostiak-Tomaszewska W, Lisiński P, Koczewski P. Does structural leg-length discrepancy affect postural control? Preliminary study. BMC Musculoskelet Disord. 2017;18(1):346. Published 2017 Aug 9. doi:10.1186/s12891-017-1707-x
  4. Gurney B. Leg length discrepancy. Gait Posture. 2002;15:195–206.
  5. Sabharwal S, Kumar A. Methods for assessing leg length discrepancy. Clin Orthop Relat Res. 2008;466(12):2910-2922. doi:10.1007/s11999-008-0524-9
  6. Makarov MR, Dunn SH, Singer DE, et al. Complications Associated With Epiphysiodesis for Management of Leg Length Discrepancy. J Pediatr Orthop. 2018;38(7):370-374. doi:10.1097/BPO.0000000000000835
  7. Wiemann JM 4th, Tryon C, Szalay EA. Physeal stapling versus 8-plate hemiepiphysiodesis for guided correction of angular deformity about the knee. J Pediatr Orthop. 2009;29(5):481-485. doi:10.1097/BPO.0b013e3181aa24a8
  8. Wiebking U, Liodakis E, Kenawey M, Krettek C. Limb Lengthening Using the PRECICETM Nail System: Complications and Results. Arch Trauma Res. 2016;5(4):e36273. Published 2016 Aug 23. doi:10.5812/atr.36273
  9. Devnani AS. The orthotic management of the congenitally short lower limb–a new appliance. Singapore Med J. 2000 Nov;41(11):534-7. PMID: 11284611.
  10. Cepela DJ, Tartaglione JP, Dooley TP, Patel PN. Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures. Clin Orthop Relat Res. 2016;474(11):2531-2537. doi:10.1007/s11999-016-4891-3.

Do You Need Physical Therapy After Meniscus Surgery?[Feb. 2021 update]

Do you need Physical Therapy After Meniscus Surgery? Chances are high that your doctor already required you to take physical therapy prior to surgery in an attempt at conservative treatment. They do this for two reasons:

  1. Most insurances will require conservative efforts before they approve surgical intervention.
  2. Sometimes it actually works so well that you won’t need to go under the knife.

But honestly, if your meniscus is damaged, orthoscopic surgery is the best option. It’s minimally invasive and maximally effective.

is-meniscus-surgery-worth-it

Continue reading for insight into the two surgical options, or skip to ‘Do I need therapy?’

What Exactly Is The Meniscus?

what-is-the-meniscus
  • Each knee has two ‘C-shaped’ menisci that are made of strong, supportive, and flexible tissue. These menisci have three functions:
    1. Provide shock absorption and evenly distributes weight and compressive forces.
    2. Form a shallow cup to keep your femur and tibia stacked during movement.
    3. Helps to keep the knee joint lubricated and free to move.

Full Meniscus Repair Versus Partial Meniscectomy:

Torn-meniscus-surgery-vs-conservative
I generally say ‘if it’s broke, fix it.’ However, this depends on your level of activity.
  • Full Meniscus Repair – The surgeon makes a small incision and arthroscopically reapproximates the torn edges of the meniscus and sets them back in their proper position.
    • Note: This is only viable if the tear is near the outer edge of the meniscus therefore has good blood supply.
  • Partial Meniscectomy – The surgeon again makes a small incision and uses the ‘scope’ to trim off the damaged section of meniscus, leaving as much of the healthy tissue as possible.

How Long Does The Surgery Take?

  • Both are outpatient procedures. You will be home the same day.

What is the Recovery Time?

  • Full Meniscus Repair – Recovery will take 3-4 months, and up to 5 months to regain full athletic ability.1
  • Partial Meniscectomy – Recovery to running/jogging level usually takes 2-4 weeks. Full sport recovery shortly after that.2
how-long-is-recovery-after-meniscus-surgery

Will I Be Pain Free After The Surgery?

Pain-relief-after-meniscus-surgery

No. While the pain should be considerably less than before the surgery, you will have localized pain for the next 2-3 weeks. The pain can last longer based on individual factors but in general should be getting better with time. If pain persists without improving or gets worse, consult your surgeon to figure out why.

  • In 20-40% of cases, Full Meniscus Repair does not heal and requires a second surgery to remove the torn piece of tissue.3

Do I Need Therapy?

Up to this point, this article has presented facts. Now I will present a clinical opinion based on facts and experience. I believe that you do not need to standard outpatient physical therapy.

Meniscal Rehab is a safe process with minimal risk. Most of your rehab can be done at home after a consult with a therapist and occasional virtual guidance.

  • Full Meniscus Repair: You will likely be appropriate for a specific Rehab Protocol administered by your surgeon. A virtual visit with a therapist is all that is needed to walk you through the exercises and help you to manage your knee brace. You will likely require 2-3 follow-up virtual visits.
    • There are specific and time-sensitive benchmarks to reach to successfully rehabilitate after a Full Meniscus Repair. Whether you choose standard therapy or Virtual Consults, some professional guidance is necessary.
  • Partial Meniscectomy: The rehab process for this procedure is less intensive and can certainly be completed at home with as little as 1-2 virtual visits.
    • Specific exercises and manual techniques are considered to maximize knee stability and prevent reinjury.
    • Immediate weight-bearing is allowed and patients are typically back to performing all activities of daily living in three or four days.

Are you trying to figure out if you have a torn meniscus? Not sure if you want to go to the doctor office, pay that copay, and then pay for the X-rays? Consult with me and I can walk you through some specific diagnostic tests that can indicate a torn meniscus. (Zoom meeting/Virtual visit preferred for demonstration).

rehab-revolution-consult-with-therapist

Dan Kristoff PT, DPT is recognized as one of the Top Physical Therapists in Ohio. In his 10+ yrs as a physical therapist, he has helped thousands of patients recover from illness and debility. His company, Rehab Revolution, is less than a year old and has already helped hundreds of clients take back control of their health.

References:

  1. Ojedapo Ojeyemi, MD. “Recovering From Meniscus Repair Surgery.” Sports, Sports-Health.com, 3 Jan. 2017, www.sports-health.com/sports-injuries/knee-injuries/recovering-meniscus-repair-surgery.
  2. Cleveland Clinic. Meniscal Tears. 2021. https://my.clevelandclinic.org/health/diseases/17219-meniscal-tears
  3. Uzun E, Misir A, Kizkapan TB, Ozcamdalli M, Akkurt S, Guney A. Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears. Orthop J Sports Med. 2017;5(6):2325967117712448. doi:10.1177/2325967117712448

31 Best Home Health Care Jobs in Cleveland Area [February 2021]

Are you a Physical Therapist or a Physical Therapy Assistant? Has Covid-19 affected your work life and your paycheck? Don’t answer that second one… I already know what you are going to say. But fear not, I have a solution for you. It is one that seems counterintuitive at first, but you should consider Home Health Care Jobs (especially in the Cleveland Area). (Skip to the jobs)

You: ‘Whoa! I’m not going into people’s houses! People are generally gross and now there is a pandemic!”

Me: ‘Hey! Loosen your gait belt and do some deep breathing while I explain…”

Elective surgeries were cancelled, patients cancelled visits because they did not want people coming into their homes, and the switch to the PDGM payor model had already hamstrung PT reimbursement. Home health visits dried up and many lost their jobs.

But healthcare must go on! After the CARES Act passed, telehealth visits were reimbursable and we as a profession regained some of our client base. As time passed, we shook off the initial shock and let our professional judgement and critical thinking take over. Proper and adequate use of PPE, social distancing, and plain old common sense took center stage and dulled some of our fears.

Here’s Why:

  • We are eligible to be first in line for the Covid-19 Vaccine.
  • Agencies have been supplied with more than adequate PPE.
    • Sanitizer, masks, barriers, glasses, shields, gowns, shoe covers, gloves— We are safe.
  • Instead of working in hospitals or clinics that have had thousands of people filing in and out, we work in private homes who have been social distancing and receiving no visitors.
  • When people are discharged home from the hospital they have either:
    • been tested and are Covid-negative or…
    • have had Covid-19 and passed their quarantine period.
  • Facilities are discharging people ASAP to make room for Covid patients, so our home care census is through the roof.

To Recap: Home health jobs are the best right now because the pay is (and always has been) great, census is sky-high and there is plenty of work, we are arguably the most insulated setting against Covid-19 infection risk, and patients are grateful to have someone help them come and be successful in their homes instead of sit at the edge of a hospital bed and kick their leg ten times.

Best-jobs-in-ohio-salary
Courtesy of Salary.com

Here are the 9 Best Home Health Care Jobs in Cleveland:

1. Caretenders

  • Summary: Recently purchased by the Nationally-Renowned LHC Group/Almost Family, Caretenders of Beachwood has been servicing the greater Cleveland Area since 19932. It has had its ups and downs but in 2019 they hired a new Executive Director who has ‘trimmed the fat’ and established a superb team.
  • Why it’s on this list:
    • Booming Caseload with strong and experienced team
    • Excellent Leadership
    • Chance for salaried position (almost unheard of in Home Health)
  • What employees are saying:
    • “While my friends and colleagues were getting laid off due to the pandemic, I’ve been as busy as ever. Titi (our Executive Director) is great at steering this ship and we have had all the support we could ask for in this strange time.” – Dan K. PT, DPT
  • Pre-screen with Rehab Revolution to receive a recommendation

2. Total Rehabilitation Specialists

  • Summary: A privately held company, Missy Zahoransky only hires the cream of the crop. This is a contract-therapy company that has managed to survive and thrive for years on the strength of the service it provides.
  • Why it’s on this list:
    • Privately-owned
    • Sterling reputation for STRONG team
    • Consensus Best support team for field staff
  • What employees are saying:
    • “This is a family-owned company that treats us like people. Probably the best part is the back-office support that we have while we’re in the field. Jeanne, Nancy, and Sarah are the best team I could ask for.” – Karen Q. PTA
  • Pre-screen with Rehab Revolution to receive a recommendation

3. HMW Cleveland

  • Summary: Raven Carter founded HMW to provide holistic therapy and wellness services previously unavailable to Northeast Ohio. With over a decade of experience, this Massotherapy and Wellness Clinic is looking to expand their Physical Therapy Division. If you are still unsure about the Healthcare Climate or simply want a part-time job, this is for you.
  • Why it’s on this list:
    • High Pay
    • Modest hours commitment
    • Get in on the ground floor and help develop the therapy division of a rising star
  • What employees are saying:
    • “It is refreshing to be part of a team that actually has the gift of healing hands.” -Sandra B.
  • Pre-screen with Rehab Revolution to receive a recommendation

4. Building Blocks Therapy (Pediatric)

  • Summary: Building Blocks Therapy provides ABA therapy services to children with Autism, addressing and overcoming challenges in communication, behavior, and social and daily living skills. Building Blocks has experienced unparalleled success by providing these services to children in their home or school, where they are most effective.
  • Why it’s on this list:
    • Unique opportunity to make a huge difference in the lives of children during a time when they are struggling as much or more as the rest of us.
    • Competitive pay
    • Passionate and uniquely-collaborative team works towards the best outcomes for the kiddos.
  • What employees are saying:
    • A collaborative and client-focused environment that makes it fun for the kids – lots of toys and resources for therapy sessions! The job itself is very meaningful and Building Blocks is a great place to provide quality ABA therapy. – Faryl N. PT, DPT
  • Pre-screen with Rehab Revolution to receive a recommendation

5. Encore Rehabilitation Services

  • Summary: One of the fastest growing contract-therapy companies in the nation. Encore is owned and operated by therapists and former long-term care administrators who fully understand the rehab business and the complex challenges of long-term care management.
  • Why it’s on this list:
    • Established company with plenty of work
    • They service facilities as well, save drive time by seeing multiple patients in one place
    • Friendly and understanding management
    • They attempt to keep you in your local area
  • What employees are saying:
    • Management is greatly supportive and are always there for us. The setting is very easy going, The other therapists are very willing to share and assist in therapy. – (withheld) OTA
  • Pre-screen with Rehab Revolution to receive a recommendation

6. Jewish Family Service Association Of Cleveland

  • Summary: Certified by the CMS in 2000, this non-profit organization provides complete geriatric case management, Holocaust survivor support services, Philips Lifeline medical alert, Kosher home delivered meals, and a shuttle service. Not to mention their Dementia Caregivers Support Program and their teens and young adult empowerment program.
  • Why it’s on this list:
    • Positive culture
    • Meaningful work
    • Named a Top Workplace for the past 8 years in a row
  • What employees are saying:
    • ‘Jewish Family services is a quality company with a good reputation. JFSA is a wonderful workplace filled with good people. My experience there has been positive .’ – H.C. (current employee)
  • Pre-screen with Rehab Revolution to receive a recommendation

7. Omnicare Home Healthcare

  • Summary: Omnicare has been offering around the clock medical and nonmedical care since 2004. They are known in the Ohio Healthcare Scene as an up and coming agency who don’t hide the fact that their goal is to be the premier provider in Ohio.
  • Why it’s on this list:
    • Starting to attract the new-guard of therapists who are evidenced-based and lean on collaboration to achieve outcomes.
    • Census consistently growing, plenty of work even in these slow times.
  • What employees are saying:
    • ‘It took a long time, but I finally got caregivers that I like.” – Theodore, current client of Omnicare
  • Pre-screen with Rehab Revolution to receive a recommendation

8. HealthPro Heritage LLC

  • Summary: HealthPro Heritage is one of the largest independently owned, diversified therapy and related service providers in the country.3 A contract therapy company that partners with a diversified portfolio of providers.
  • Why it’s on this list:
    • Work in a variety of settings
    • Strong sign-on bonuses
    • Established provider with strong leadership in place
  • What employees are saying:
    • ‘As an on-site manager, I have the freedom to lead my team in my own way, yet I have the support of upper management behind me if I need it.’ – Elizabeth L. OTR
  • Pre-screen with Rehab Revolution to receive a recommendation

9. Fox Rehab

  • Summary: Tim Fox started Fox Rehab in 1998 with the thought that he can service geriatric clients in their homes under part B and remove the bureaucracy that normally holds therapists back.
  • Why it’s on this list:
  • What employees are saying:
    • “The more that I learned about their culture, the more I started to say ‘sign me up.” -Brett H. PT, DPT
  • Pre-screen with Rehab Revolution to receive a recommendation

10. Heartland Home Health Care

  • Summary: This not-for-profit, mission-based company uses proven care principles and protocols to provide top-of-the-line home health services across 27 states.
  • Why it’s on this list:
    • Specialized protocols to ensure Covid-19 safety
    • Multiple locations/positions open if you like to travel
    • Tuition assistance
  • What employees are saying:
    • ‘Heartland compensates its employees well along with flexible schedule and a team approach to patient care.’ – (current employee, PTA)
  • Pre-screen with Rehab Revolution to receive a recommendation

11. United Cerebral Palsy of Greater Cleveland

  • Summary: In 1950, UCP of Greater Cleveland was formed by a group of determined parents who saw few true opportunities for their children with cerebral palsy. UCP of Greater Cleveland serves children and adults with a broad range of disabilities through two Centers of Excellence:  LeafBridge for Children and OakLeaf for Adults. Their goal is to support the right for the disabled to have a fulfilling and inclusive life.
  • Why it’s on this list:
    • Non-profit with a meaningful mission
    • Competitive salary
    • Opportunities for professional growth and advancement
  • What employees are saying:
    • ‘The thing that I like most is the chance to work with a team more than 1-on-1 treatments. This helps to figure out all the pieces of the puzzle.’ -Rebecca F., Therapist
  • Pre-screen with Rehab Revolution to receive a recommendation

12. naviHealth, Inc

  • Summary: Since 2012, naviHealth has been a trusted partner for the nation’s top health plans. naviHealth’s high-touch, proven care model fully supports patients from pre-acute through to the home. Their goal has been to shift from volume to value.
  • Why it’s on this list:
    • Unique perks: Paid day of ‘giving back to the community’
    • Extra paid time off for new mothers
    • More paid holidays and combined PTO than other companies
  • What employees are saying:
    • ‘Great job, no micromanaging. Great pay and benefits. I would recommend working for this company.’ – Allison D., RN
  • Pre-screen with Rehab Revolution to receive a recommendation

13. St. Vincent Charity Medical Center 

  • Summary: SVCMC opened in 1865 and has grown with the city of Cleveland. They are committed to be a leading model for healthcare delivery in Northeast Ohio based on its faith-based mission, dedication to education, commitment to the communities it serves
  • Why it’s on this list:
    • Many proprietary in-home specialty programs to help you cater to your patient’s needs.
    • Provide accessible care to the under-served of Cleveland, make a difference
  • What employees are saying:
    • ‘It’s obvious to see that EVERYONE is involved in the healing process. No matter your position, we are all seen as caregivers.’ – Ted M., VP Human Resources
  • Pre-screen with Rehab Revolution to receive a recommendation

14. The Rising Workplace, Pllc

  • Summary: The Rising Workplace provides comprehensive on-site, remote and virtual ergonomic, injury prevention, and environmental health and safety (EHS) services, with outcomes proven to decrease workplace injury by 30%.
  • Why it’s on this list:
    • Ability to work remotely, especially in field of ergonomics
  • What employees are saying:
    • ‘I know I made a difference… It pays off in spades to look after people in this way.’ – Kaye T., OTR
  • Pre-screen with Rehab Revolution to receive a recommendation

15. Humanly

  • Summary: Our groundbreaking solution pairs licensed physical therapists with an artificial intelligence powered digital therapist to help people overcome chronic and post-surgical pain faster and more cost-effectively than anything out there.
  • Why it’s on this list:
    • Work Remotely
    • Be a part of a new service delivery protocol and help to usher in the future
    • Attractive salary for qualified therapists
  • What employees are saying:
    • ‘This is such a unique opportunity, I feel like we are on the cusp of something big in the rehab world.’ – (current employee), PT, DPT
  • Pre-screen with Rehab Revolution to receive a recommendation

16. Centra Healthcare Solutions

  • Summary: Technically Centra is a placement agency but they have a TON of Cleveland positions available
  • Why it’s on this list:
    • Excellent compensation
    • Take assignments on 13 week basis… a ‘trial run’
    • They almost always offer to go temp to permanent.
  • What employees are saying:
    • “I had one point of contact and he was great! I could call any time and text after office hours if I had any issues.” -Craig T., PTA
  • Pre-screen with Rehab Revolution to receive a recommendation

17. Lake Health

  • Summary: Lake Health’s first location opened in 1959 with a mission to provide comprehensive health care services to the residents of Lake County and neighboring communities in partnership with those who share a commitment to local access, healing with compassion and superior quality.
  • Why it’s on this list:
    • Multiple satellite locations in the Northeast Ohio area
    • Telehealth positions available
    • Locally recognized as a “Best Place to Work”
  • What employees are saying:
    • ‘The team atmosphere is very apparent. There are times to use your own intuition to take initiative and have creative ideas. Management acknowledges our hard work.’ – (current employee), PT, DPT
  • Pre-screen with Rehab Revolution to receive a recommendation

18. NOMS Healthcare

  • Summary: Founded in 2001 by physicians in Sandusky OH, NOMS currently comprises over 250 providers from Toledo in the West to Mahoning Valley and Western Pennsylvania in the East.  NOMS exists to provide the most advanced care for the lowest possible patient cost, and best outcomes. 
  • Why it’s on this list:
    • Opportunity to engage in multiple specialty paths: Aquatic, Hand, TMJ, Back pain, McKenzie, and more.
    • Flexible hours
    • Multiple locations/coverage areas
  • What employees are saying:
    • ‘The staff has been very welcoming. I feel comfortable having problems and asking for help. After two weeks of work, I feel important to the work environment and that I have an impact.’ – (Current employee), COTA
  • Pre-screen with Rehab Revolution to receive a recommendation

19. Alpine House Assisted Living Facilities

  • Summary: Technically part of the SAI Group, they believe “The ‘home’ helps define a person, and the role in life that one plays. It is, therefore, an important venue for healthcare when life disruptions are caused due to disease/injury.”
  • Why it’s on this list:
    • Just starting to offer in-house therapy… be a part of shaping the culture.
    • Plenty of locations, plenty of patients, no lack of work
    • Excellent benefits due to their affiliation with SAI.
  • What employees are saying:
    • ‘Its a great company to work for, clean and welcoming. The patients there are so loving and they make the day go by much easier.’ – C.P., SLP (former employee)
  • Pre-screen with Rehab Revolution to receive a recommendation

20. University Hospitals

  • Summary: University Hospitals is one of the nation’s leading health care systems, providing patient-centered care that meets the highest standards for quality and patient safety and have received numerous awards and recognitions4 from some of the most prestigious institutions in the country for our leadership and exceptional patient outcomes.
  • Why it’s on this list:
    • Large homecare division with lots of work to be had
    • Talented team
    • Excellent University Hospital benefits
  • What employees are saying:
    • ‘A great institution to be a part of! Our manager was always open to talk to and listen to any concerns.’ – Pete T., PT, DPT
  • Pre-screen with Rehab Revolution to receive a recommendation

21. Brookdale Senior Living

  • Summary: Brookdale Senior Living Inc. is the leading operator of senior living communities throughout the United States. The Company is committed to providing senior living solutions primarily within properties that are designed, purpose-built, and operated to provide the highest-quality service, care, and living accommodations for residents.
  • Why it’s on this list:
    • Lots of locations nationwide
    • Well established in the community
    • On a hiring surge!
  • What employees are saying:
    • ‘Flexible schedule and excellent PTO.’ – James B., PT, DPT
  • Pre-screen with Rehab Revolution to receive a recommendation

22. Soliant

  • Summary: A contract placement company most prevalent in California, Nevada, Dallas, and Miami. They now have multiple home-health positions in Ohio with a skew towards pediatric care and school-based settings. .
  • Why it’s on this list:
    • Currently has multiple contracts with school districts
    • Strong pediatric presence
    • Higher than average salary
  • What employees are saying:
    • ‘I can’t think of a better organization to work for. The best thing is, when I’m doing my job, there are no other pressures.’ – Tom. P., SLP
  • Pre-screen with Rehab Revolution to receive a recommendation

23. Cleveland Clinic

  • Summary: The Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was at the forefront of modern medicine when its founders opened it as a multi-specialty group practice in 1921. Now, 100 years later, the vision of the founders remains Cleveland Clinic’s mission: caring for life, researching for health, and educating those who serve.
  • Why it’s on this list:
    • Exceptional benefits befitting an organization this huge and renowned.
    • Ranked as the Nation’s #2 Healthcare System
    • Military-Friendly employer
  • What employees are saying:
    • ‘The hours and people are amazing. A lot of opportunity for growth in specific areas. Great company to work for with great benefits.’ – Sandra P., PTA
  • Pre-screen with Rehab Revolution to receive a recommendation

24. Residence Home Care

  • Summary: Residence Home Care is a 5 star, ACHC accredited agency that continues to grow and is looking for multiple  Physical Therapists now. This position is for a PRN position in Cuyahoga County and surrounding areas with multiple opportunities.
  • Why it’s on this list:
    • Stellar hourly rate
    • PRN opportunity with no commitment
    • Generous 401k plan and opportunity for bonus pay
  • What employees are saying:
    • ‘Great small-owned company. I love the flexibility of not working for a corporation.’ – (current employee)
  • Pre-screen with Rehab Revolution to receive a recommendation

24. MetroHealth Medical Center

  • Summary: The MetroHealth System has been recognized on Newsweek’s inaugural list of Best Physical Rehabilitation Centers for 2020.
  • Why it’s on this list:
    • Making transition to home care, lots of new opportunity.
    • Attractive sign-on bonus as they try to grow their staff.
  • What employees are saying:
    • ‘The care team at MetroHealth’s Rehabilitation Institute are miracle workers who help injured people reclaim their lives.’ – A. Boutros, MD
  • Pre-screen with Rehab Revolution to receive a recommendation

25. Select Specialty Hospital

  • Summary: Select Medical has helped to define the nation’s standard of excellence in specialized hospital and rehabilitative care. They have grown to more than 49,000 colleagues caring for nearly 78,000 patients every day across the care continuum. Select is one of the largest operators of critical illness recovery hospitals, rehabilitation hospitals, outpatient rehabilitation centers and occupational health centers in the United States.
  • Why it’s on this list:
    • Clinical Advancement program pays for CEUs AND gives incentives.
    • Competitive tuition-assistance program
    • Many locations and opportunities for advancement
  • What employees are saying:
    • ‘The benefits are great and there are a lot of incentives to advance.’ – Carolyn, M., PT, MSPT
  • Pre-screen with Rehab Revolution to receive a recommendation

26. Visiting Nurse Association of Ohio

  • Summary: Visiting Nursing Association of Ohio has been providing high-quality home care services for over 100 years. VNA of Ohio offers the largest scope of home-based health services in the state, promoting health and independence for those living in the communities that they serve.
  • Why it’s on this list:
    • Generous PTO
    • Flexible schedule
    • Great diversity of patients to hone your skills
  • What employees are saying:
    • ‘Great place to work. Advancement opportunities, development of jobs skills, and integrity are three keys to this job.’ – (former employee)
  • Pre-screen with Rehab Revolution to receive a recommendation

27. Advanced Orthopedics & Physical Therapy

28. Classic Home Care

  • Summary: Classic Home Care is privately owned and growing strong in the Northeast Ohio/Cuyahoga County region. They are placing and emphasis on compassion and results over being a ‘patient-mill’.
  • Why it’s on this list:
    • Urgently Hiring
    • High hourly rate
    • Setting high standards for Covid-19 protection
  • What employees are saying:
    • ‘I’ve been doing home health for 10 years and Classic is the best company I’ve ever worked for.’ – Janet G., PTA
  • Pre-screen with Rehab Revolution to receive a recommendation

29. Sword Health

  • Summary: This is exciting! Sword Health provides clinically-validated programs work for all the major musculoskeletal issues, at any point in the journey: prevention, acute conditions, chronic pain and post-surgical recovery. They match members with a Doctor of Physical Therapy who uses their medical knowledge to diagnose the condition, designs a treatment program that evolves as they progress, and educates and coaches them, virtually.
  • Why it’s on this list:
    • The only digital provider with an FDA-listed medical device.
    • Cutting-edge opportunity to work from home and be a part of the future.
  • What employees are saying:
    • ‘We’re building the future of physical health: giving people a roadmap for a healthier life, no matter where they are.’ – Kevin, PT, DPT
  • Pre-screen with Rehab Revolution to receive a recommendation

30. M&Y CARE LLC

  • Summary: M&Y Care has been providing home care services to families since 1999. M&Y Care provides licensed medical professional care, companion care, and personal care services that allow individuals who need living assistance to stay at home.
  • Why it’s on this list:
    • They own their own DME store… no more waiting and endless checking in with DME suppliers.
    • Locally-owned and based in Lyndhurst, Ohio
  • What employees are saying:
    • ‘I love the flexible hours and the pay helps me a lot. The people I work with are very nice and are improving with every visit. The company has very good standards and hold their employees to the same.’ – Charlie E., PTA
  • Pre-screen with Rehab Revolution to receive a recommendation

31. Bayada Home Care

  • Summary: In 2019, J. Mark Baiada oversaw the company’s unprecedented transition to a not-for-profit organization to ensure BAYADA’s mission, purpose, and business model would endure, and to help BAYADA realize its vision of helping millions of people worldwide experience a better quality of life at home.
  • Why it’s on this list:
    • $1000 sign-on bonus
    • Flexible schedule, mileage, and weekly pay(!)
    • Scholarship opportunities and career advancement.
  • What employees are saying:
  • Pre-screen with Rehab Revolution to receive a recommendation

Final Thoughts on the Best Home Health Care Jobs in Cleveland Area:

There you have it! There is a ton of opportunity right now for Physical Therapists, Occupational Therapists, Nurses, and caregivers. Many companies are transitioning to remote work, which is strange but it is working. Those that still provide in-person visits are meeting the high standards of Covid-19 protection.

If you are interested in one of these jobs, make sure you Pre-screen with Rehab-Revolution. I have been involved in talent-acquisition and I know a current employee in most of these locations. A thumbs up from me will not guarantee a job, but its a strong first step.

If you are working from home or plan to transition, make sure you learn the Best Ways to Stay Healthy Working from Home. You’ll see a concise list of stretches, exercises, and ergonomic adaptions to prevent nagging injuries.

Finally, you are invited to subscribe to the blog and join the ever-growing Rehab-Revolution. Times are changing and we will be ahead of the curve.

References:

  1. Impact-of-covid-19-on-physical-therapy-profession. Apta.org. August 17, 2020.
  2. Healthcare For People. Homecare/Ohio/Beachwood/Caretenders. healthcareforppl.com
  3. HealthPro Heritage. https://www.healthpro-heritage.com/about-us/vision-values
  4. University Hospitals. https://www.uhhospitals.org/about-uh/awards-and-recognition/2020-awards

11 Most Common Reasons Your Feet Hurt [and how to fix them!]

Do your feet hurt too?

Do they hurt right when you step out of bed?

Do they hurt after a long day of work?

Do they hurt only when you’re laying down?

If only you knew why they hurt maybe you could do something about it. This article will show you the 11 most common reasons why your feet hurt AND show you how to fix them!

Lets get to it!

1. Are your shoes sabotaging you?

This is going to anger some people… high heels and flip flops are not your friends. There… I said it.

  • Heels that are higher then roughly 2 inches will:
    • put unnatural stress on the pads of your feet,
    • will cause excessive shearing forces on the ankle and foot joints, and…
    • can lead to the dreaded ‘pump bump’ on the back of your heel.
  • Flip flops offer little to no support and will lead to flattened arches. Additionally, most flip flops cause you to tense your foot to avoid them ‘flopping’ off. This leads to unnatural footfalls that will cause pain over time.

How do I fix this?

Try to find a shoe that is comfortable, fits well, and (most importantly) supports your arches. Don’t be afraid to ask a Physical Therapist for guidance when it comes to using orthotics if you need to, your feet will thank you. Keep reading to #11 – Plantar Fasciitis to see my personal recommendation for the best orthotics.

2. Has ‘Uncle Arthur’ come calling?

Reasons-Why-Feet-Hurt
The dreaded ‘A-Word’… Arthritis! (Courtesy of CDC.gov)

Arthritis is commonly seen after the age of 65, but can occur in people as young as 20 and even in children! Usually, an earlier onset is associated with an underlying cause:

  • Repetitive stress (Irritation of the joint cartilage will eventually cause break-down)
  • Obesity (Increased pressure on the joints leads to accelerated inflammation)
  • Inflammatory conditions (pre-disposition to overactive inflammatory responses)

Basically, arthritis works like this:

Reasons-Why-Feet-Hurt
  1. The cartilage/padding between joints is worn down from the above-mentioned reasons.
  2. This leads to decreased joint space and increased likelihood that your bones start to rub together (‘eww’).
  3. This friction leads to a pain signal sent to your brain and an inflammatory response in which your body delivers increased blood flow in an attempt to deal with the ‘injury’.
  4. The increased blood flow leads to increased intra-articular (in-the-joint) swelling, which leads to more pressure on the already irritated joint.

How do I fix this?

  • 1.) Lose excess weight to reduce excess pressure.
  • 2.) Modify your daily repetitive stresses to decrease irritation.
  • 3.) Exercise to increase muscular support of joint and reduce the stresses it has to take.
  • 4.) Control the inflammation with ice or heat (See: Is It Better To Use Ice or Heat?)

3. Is your Bunion so big you’ve named it Paul?

Reasons-Why-Feet-Hurt

Bunions are hereditary. So don’t blame ya pumps, blame ya mom.

A Bunion is a painful lump right where your big toe meets your foot. It develops as the big toe pushes inward and stretches out the medial ligaments (which leads to inflammation and pain).

Contrary to popular belief, narrow shoes and high heels do not cause bunions, but they certainly make them worse.

How do I fix this?

Ice, bunion pads, and roomy shoes can all decrease the amount of inflammation, irritation, and friction (respectively) at the joint. If the bunion gets bad enough, the only real solution is surgery.

4. Do I Have Bursitis (the Arthritis Imposter)?

The main difference between arthritis and bursitis is the anatomical structures that each affect. While arthritis is a degenerative and chronic condition that affects bones and cartilage, bursitis is (usually) temporary and affects the bursa around certain joints.

A bursa is a small fluid filled sack located in many locations throughout the body. It’s function is to prevent friction and provide cushioning to bones and tendons.

In our foot we have one near the toes and one on the heel. When these get inflamed you’ll notice painful swelling and sometimes redness at the site.

How do I fix this?

Like all swelling and inflammation, ice is usually your number-one weapon. Other conservative treatments are orthotic padding, over-the-counter pain meds like tylenol or ibuprofen, and even corticosteroid injections.

Additionally, you could consult with a physical therapist to learn how to correct muscle imbalances and tight connective tissue that could be contributing to extra friction on the bursae.

5. Do you have a Stress Fracture?

Repetitive stress from running, walking up and down stairs, and weight lifting can cause small fractures in the long bones of your foot. There is usually not a significant event that you can determine as the cause. You’ll notice swelling and pain, especially with weight bearing.

There are some conditions that predispose you to this malady: Age, weight, sex (sorry ladies), osteoporosis, low vitamin D levels, and presence of other foot problems.

How do I fix this?

Usually a stress fracture will heal when you allow it to. This means changing your activity level for the next 6-8 weeks (typical bone healing time1). Additionally, you should be icing when you can and providing cushioning in the form of comfortable shoes.

6. Sprains/strains

Unlike a stress fracture, there is almost always a significant event that causes a sprain or strain of your foot/ankle. First lets examine the difference between the two.

Reasons-Why-Feet-Hurt
Courtesy of braceability.com
  • Sprains refer to the stretching or tearing of ligaments (between two bones). They are usually sustained when you fall or get hit.
  • Strains refer to the stretching or tearing of tendons (between a muscle and a bone). They are usually sustained when you roll your ankle or step awkwardly.

The most common spot for strains is the ankle but can also occur at the great toe and at the arch of your foot. These injuries can be mistaken for plantar fasciitis but have one tell-tale sign: bruising. When you get small tears in a ligament or in a tendon, it will bleed. That bleeding is visible in the form of bruising.

How do I fix this?

The ‘old standby’… RICE. (Rest/Ice/Compression/Elevation).

  • The foot will probably be swollen and definitely hard to walk on. If you can, stay off of it for 1-2 days while providing consistent ice in 10-15 minute intervals.
  • Compression wrapping can be beneficial to control the swelling and to provide comfort, but you have to take care not to wrap too tightly or create a tourniquet effect.
  • Elevate the foot to reduce swelling, ideally above the level of your heart.

After this initial period, you can usually begin some light range of motion and experiment with switching to heat to promote healing and reduction of swelling. If the foot still hurts so badly that you can’t walk on it, consult your physician.

*NOTE: Sprains and strains involve tearing, but not complete tearing, of the structural tissues. Surgery is usually not required unless a tendon or ligament is completely ruptured.

7. “Is it broken?”

Reasons-Why-Feet-Hurt

There are many small bones in the foot. Aside from your toes there are:

  • 5 metatarsals
  • 5 tarsal bones
  • 2 bones that make up your heel
  • and the distal end of your ankle bones

The design of your foot allows it to be subtly flexible in many different ways. This is an evolutionary adaption from a time when we didn’t have shoes and had to walk, run, and travel on uneven terrain to survive. The multiple bones and multiple articulation points give your foot amazing flexibility… but also many places to sustain a fracture or break!

How do I Fix This?

Broken bones can and will be confirmed with an x-ray, after which your doctor will likely recommend a cast to protect the break and allow it to heal.

Standard bone healing time is 6-8 weeks1 (assuming no other confounding factors). Depending on the severity and which bone is broken, sometimes you’ll be given a Walking Boot or Offloading Shoe and allowed to bear weight.

8. Are you having Achilles Problems?

Your Achilles Tendon is the thick band that runs down from your calf muscle and attaches to the heel and bottom of foot. It is the conduit that transmits the power of the calf muscle across the ankle joint and allows you to rise up on your toes.

As thick and as strong as this tendon is, it is still susceptible to overuse injuries that result in inflammation and pain. You’ll know something is wrong if your calf feels tight, the back of the ankle is tender, and if it hurts to stand up on your toes.

A jump, fall, or strong push-off (like performed in sporting activities) can even rupture the tendon. Oftentimes you’ll feel or hear a pop, accompanied by sudden and sharp pain. This will need immediate attention and likely surgical repair.

https://youtu.be/g2afNT_7c9o?t=4
Kobe Bryant was one of many athletes to tear his Achilles. RIP Mamba.

What are the common signs of Achilles Tendon injury?

  • Pain down the back of your leg
  • Pain worsens during and after activity
  • Stiffness in the Achilles upon waking
  • Difficulty flexing the foot
  • Swelling and tenderness behind the ankle
  • Feelings of the tendon “thickening”

How do I Fix This?

Wait for it…

Wait for it…

  • Rest and Ice. This is tried-and-true and by now you know how and why it works. The key is to control the inflammation and allow time to heal without adding stress to the injury site.
  • Other viable options are to use NSAIDs, or Non-Steroidal Anti-Inflammatories. Ibuprofen is the most common.
  • A Physical Therapist can show you how to gently stretch the muscle and maintain range of motion. When appropriate, eccentric exercises can be performed. Although the mechanisms aren’t completely understood yet, there is evidence that eccentric exercises will help to build the strength and function of tendons better than concentric2,3.

9. Tarsal Tunnel Syndrome

Most of us have heard of Carpal Tunnel Syndrome (affecting our wrists and hands) and up to 5% of the general population has experienced it. It is a nerve entrapment syndrome that pinches on the median nerve and results in pain, numbness, and tingling.

Reasons-Why-Feet-Hurt

As it turns out, we can also experience Tarsal Tunnel Syndrome in our feet.

In Tarsal Tunnel Syndrome, the Tibial Nerve gets entrapped as it passes through the ‘tunnel’ formed by your ankle bone and a group of ligaments (flexor retinaculum) in the foot. The

Tibial Nerve is responsible for your sense of feeling in the bottom of your foot.

Symptoms of Tarsal Tunnel Syndrome:

  • Numbness
  • Tingling
  • Sharp shooting pains/ ‘pins and needles’ / burning pain (usually at the bottom of the foot)

How do I Fix This?

  • RICE: If there is swelling, you know what to do. Rest it, Ice it, apply light compression, and elevate it.
  • Stretch your calves: That Tibial Nerve runs down the back of your leg. If your calf is tight it will put pressure on the nerve and could be the source of your problems.
  • Wear arch support: People with fallen arches or ‘flat feet’ will pronate their feet with every step. This pronation will put repetitive stress and stretching on that Tibial Nerve as it crosses the flexor retinaculum.
    • Arch support like these will prevent that:
  • Cross Friction Massage: Applied properly, this gentle massage technique can re-align and relax any bunched up ligaments at the flexor retinaculum and release the pressure through the Tarsal Tunnel. To perform, gently rub across the flexor retinaculum like you were strumming a guitar. DO NOT rub along the length of the ligaments, this will be counter-productive.
    • Notice the orientation of the ligament and remember to rub across:

10. Is Bad knee Alignment causing your feet to ache?

I had a patient earlier this year who was referred with chronic foot pain. I walked into his home (I’m a Home Health Physical Therapist) and he started telling me that he didn’t know why his doctor was recommending physical therapy again. He’s tried therapy before, he’s done the exercises, he’s had massages, but nothing helps and the pain keeps getting worse.

I asked him to walk for me and he looked exactly like this:

Reasons-Why-Feet-Hurt

I spent the next few minutes convincing him that we were going to fix his foot pain by spending most of our time on his hips and knees. Can you guess why?

As the picture above shows, he had knock-knees or what we call genu valgum ‘in the biz’. Imbalanced hip and knee musculature was creating that abnormal knee angle, which was in turn causing his feet to excessively pronate (flat feet). This was stretching out his ligaments, putting pressure on his Tibial nerve, and inflaming his plantar fascia.

How do I Fix This?

We spent the next couple of weeks stretching out tight hip and knee muscles, strengthening and toning their counterparts, and working on the mechanics of this man’s gait. We then got his podiatrist to prescribe custom orthotic inserts for his shoes. By the time I discharged him from my care, his foot pain was gone and I had a new raving fan.

Here’s what you can do:

  • Stretch and foam roll your hip adductors.
    • Tight adductors can lead to internal rotation
  • Stretch and foam roll your IT band.
    • Tight Tensor Fascia Lata/IT band complex can lead to internal rotation
  • Stretch hip flexors
    • Tight hip flexors can lead to internal rotation (are you sensing a pattern yet?)
  • Strengthen glutes (strongest external rotators)
  • Strengthen the piriformis (external rotator)
  • Strengthen quadratus femorus (external rotator… another pattern here.)
  • Purchase orthotic arch support (Again, I’m a huge fan of these.)These will set a proper base from the ground and support correct knee alignment all the way up your leg.
  • Consult (the best) Physical Therapy for guidance.

11. How do you know if you have Plantar Fasciitis?

Plantar Fasciitis is a very common cause of foot pain and one that is difficult to prevent. The plantar fascia is a ligament that runs lengthwise and connects the front and back of your foot, supporting your arch.

At it’s most basic, plantar fasciitis is a repetitive stress injury.

The hallmark signs of plantar fasciitis are:

  • Pain on the bottom of the foot.
  • Pain worse in the morning, specifically when first standing up out of bed.
  • Get worse with increased weight bearing or long-distance walking/running.
  • Feels much better when resting.

The plantar fascia can be irritated if:

Reasons-Why-Feet-Hurt
  • Your arches are too high.
  • Your arches are too low.
  • Your calves are too tight.
  • You have a bone spur in your heel.
  • You subject it to repeated impact (running).
  • You start a new sport/activity.

(Image Courtesy of VeryWellHealth)

As you can see, your plantar fascia is a ‘sensitive flower’ that will require some TLC to prevent and heal injuries.

Here are the 4 ways you can fix your Plantar Fasciitis:

  1. Ice: Like all other inflammation, ice can ease the pain and reduce the swelling when your foot is especially irritated.
  2. Stretch: The targets of your stretching will be the actual plantar fascia (duh.) and the calf muscle. Dr. Jo does an excellent job of demonstrating in this quick and informative video…
  1. Night Splints: When we sleep our foot falls naturally into a position of plantar flexion (toes pointed down). This shortens the plantar fascia and lets it stay that way for hours until you wake up. This is the reason that your plantar fasciitis pain is worse in the morning. Night splints like this one help you to avoid that shortened position and can even eliminate that morning pain.
  2. Orthotics: Off the shelf orthotics can usually do the trick and support that tender fascia, but I advise you to consult with a Physical Therapist to choose the right one depending on your foot. Physicians can also order custom fitting orthotics in certain situations. There are lots of options, but I can personally vouch for Walk Hero. I switched to them early in 2020 and I’ll never stray.

Pssst… They also make Orthotic Flip Flops that completely negate the first point in this post.

So there you have it, folks. These are the MOST COMMON causes of Foot Pain and a few ideas on how you can take charge and fix yourself.

I encourage you to join the 1149 other people who make up the Rehab Revolution by entering your email below to receive Life-Changing Rehab Tips and Tricks.

rehab-revolution-consult-with-therapist

Dan Kristoff PT, DPT is recognized as one of the Top Physical Therapists in Ohio. In his 10+ yrs as a physical therapist, he has helped thousands of patients recover from illness and debility. His company, Rehab Revolution, is less than a year old and has already helped hundreds of clients take back control of their health.

References:

  1. “Stress Fractures of the Foot and Ankle – OrthoInfo – AAOS.” OrthoInfo, 2015, orthoinfo.aaos.org/en/diseases–conditions/stress-fractures-of-the-foot-and-ankle/.
  2. N. Maffulli, U. G. Longo, How do eccentric exercises work in tendinopathy?, Rheumatology, Volume 47, Issue 10, October 2008, Pages 1444–1445, https://doi.org/10.1093/rheumatology/ken337
  3. O’Neill S, Watson PJ, Barry S. WHY ARE ECCENTRIC EXERCISES EFFECTIVE FOR ACHILLES TENDINOPATHY?. Int J Sports Phys Ther. 2015;10(4):552-562.

Is it Better to Use Ice or Heat?

Is-it-better-to-use-ice-or-heat
  • You just crushed that workout!

  • You just hit the send button on that work email!

  • You just got the kids bathed and into bed!

#winning

Now you can relax… except you can’t. Your neck hurts, your knees hurt, your back hurts. Is it better to use ice or heat?

Quick, grab the ice pack. Wait! No, grab the heating pad. Now you can’t remember. You definitely don’t want to make this pain worse.

What do you do?

As a Physical Therapist I get asked this question all of the time. Whether I’m at work, in the gym, or talking to my friends and neighbors, people never seem to remember which thermal modality they should use.

This article is here to help you make the right choice, but first…

It is useful to understand two things:

  1. What happens (in general) when your body gets injured?
    • When you first sustain an injury, we call it the Acute Phase. This generally lasts 0-4 days but can vary depending on the injury.
    • Blood vessels local to the injury dilate or open up to allow increased blood flow. The purpose is to bring more blood/nutrients/healing factors to the injured site. It is a normal and necessary part of the healing process.
    • A side effect of this is edema, or swelling (which in itself can cause more pain).
  2. How does ice or heat affect this process?
    • Ice and Heat are referred to as thermal modalities.
    • They have significant affects on soft tissue, blood vessels, and nerve conduction.
    • They are underrated tools for facilitating healing and pain control, you just have to know how to use them.

When is it better to use ice?

Short answer: When you first get injured or after a specific event that leads to pain.
  • Ice will do two things. First it will control/limit the swelling.
  • Second, it will decrease pain according to the ‘Gate Control Theory’.

How does it control swelling?

Our blood vessels are made of smooth muscle. That is, they have the ability to contract and relax. And as it turns out, they behave the same way that we do when it comes to temperature changes.

Step into a snowstorm with no jacket and you immediately draw your arms in, hug yourself and try to conserve warmth. Your blood vessels will act the same way when you apply an ice pack.

This is useful during the acute phase because it limits (but does not stop) the amount of excess blood flow to the injured tissue. This will control the swelling and prevent further pain.

What is the ‘Gate Control Theory?’

Imagine a nerve route from your area of injury to the brain, where you would feel the pain. There are two types of nerve fibers that carry the ‘pain signal’. They are ‘A-Delta’ fibers and ‘Type C’ fibers.

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Note: You can see on the graph that A-Alpha and A-Delta nerves conduct signals to the brain the fastest.

These are responsible for Proprioception (awareness of body in space) and touch, respectively.

Courtesy of The Brain From Top To Bottom.

  • A-Delta fibers have faster conduction and are active when you first get injured. When you roll your ankle, the A-Delta fibers let your brain know there is an intial injury and that that it hurts.
  • Type C fibers are slower and transmit the continuous pain signal after the initial injury.

Gate Control Theory in its simplest form states that you can ‘shut the gate’ along that nerve route and stop the pain signal from reaching the brain.

is-it-Better-To-use-ice-or-heat
Pain-Health.com

Ice is one proven way to ‘shut the gait’. Temperature change is sensed by the A-Delta fibers, which are faster that Type C. So the sensation of cold races ahead of the sensation of pain and shuts the gate before it can reach the brain.

When is it better to use heat?

Short answer: When you are out of the acute phase or when the injury is chronic.
  • Heat will also do two things. Firstly it dilates your blood vessels, increasing blood flow to and through the area it is applied.
  • Second, it relaxes and eases tension in the soft tissues around the painful area.

I thought the purpose of ice was to control the swelling, won’t heat do the opposite?

is-it-Better-To-use-ice-or-heat

It is true that heat will open the blood vessels and therefore increase blood flow to the injured area. This is beneficial after the acute phase of injury.

  • Remember that the acute phase begins at time of injury and can last up to 4 days. During this time the body is shunting blood directly to the injured tissue in an effort to heal it.
  • After the acute phase passes, this redirection of blood is stopped (or significantly decreased towards normal levels), but now we have an excess accumulation of fluid, broken proteins, and other cellular debris at the site of injury.
  • Applying heat will open the blood vessels and allow all of this extra swelling and debris to be ‘washed away’ back into circulation.

Will it help with the pain?

Yes! In two ways.

  1. The washing away of the debris and swelling will decrease pressure on the injury site. Decreased pressure generally means decrease in pain.
  2. Heat will allow all of the surrounding tissues to relax.
    • Part of the initial protective response during injury is for the muscles to contract and be ‘on guard’ against further insult.
    • This protective state can persist either due to physiological reasons, or due to general apprehension from the person. When this happens we are at higher risk for chronic pain.
is-it-Better-To-use-ice-or-heat

How do I know if I’m applying heat too early?

Quite simply, your swelling will increase instead of decrease and you may experience an increase in dull or even throbbing pain.

But don’t stress too much. If this happens, it does not mean that you have done any extra damage. It just means you jumped the gun a bit and should switch back to ice for the time being.

Below is a fantastic visual guide from OrthoCarolina:

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By now you should have a better understanding of when to use ice versus heat. Hopefully you also know how and why each of them works.

If you’re like me, knowing how a tool works guides me to know when is the best time to use it.

Speaking of tools, here are some options for excellent ice and heat packs.

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These are FANTASTIC and very similar to the kinds used in outpatient therapy clinics.

They get cold and stay cold, and you can wrap them around your limb.

Get them from here at Amazon.

Is-it-better-to-use-ice-or-heat

When looking for your heating pad, you want adjustable settings, a flexible surface, and an automatic shut-off.

My Wife and I often fight over who gets to use this one!

If you are currently dealing with back pain (possibly as a result of the new work-from-home economy that COVID has necessitated), you might be able to fix it your self after reading 5 Proven Ways to Relieve Sciatica Nerve Pain.

Or if you are lucky and don’t have any pain to speak of, keep it that way by reading 7 Best Ways to Stay Healthy Working From Home.

If there is an issue that you have questions about, email me at contact@rehab-revolution.com I’d be happy to help.

And I’d be super grateful if you would take a couple of precious seconds to follow my blog. It really does mean a lot to me.

rehab-revolution-consult-with-therapist

Dan Kristoff PT, DPT is recognized as one of the Top Physical Therapists in Ohio. In his 10+ yrs as a physical therapist, he has helped thousands of patients recover from illness and debility. His company, Rehab Revolution, is less than a year old and has already helped hundreds of clients take back control of their health.

5 Proven Ways to Relieve Sciatica Nerve Pain

Lots of people think they understand your pain when you say your Sciatica is flaring up. But have they ever really experienced Sciatica before? Shooting pain from your low back, down your butt cheeks, into your hamstring. No relief, no comfortable position.

It turns out that yes, there is at least a 40% chance that they have.

Researchers at Harvard Medical School estimate approximately 40% of all people will get Sciatica in their lives. The percentage is higher as you grow older. My guess is that the percentage will climb further still as we become a population that sits down for longer periods of time.

The Sciatic Nerve is the thickest in your body, about the diameter of a finger. It exits your spinal column on either side of the lumbar region and travels through your pelvis and down into your legs.

It can be irritated at any point along it’s path and lead to pain in the back, the legs, or both. Typically (but not always) the pain will feel like its in the back of your thigh and up into your low back.

These 5 stretches will help you to treat Sciatica and/or prevent it:

1. Piriformis Stretch

When the thick Sciatic Nerve exits the spine on it’s path down through your leg, it must first pass around the Gluteus Maximus (‘butt muscle’) and the deep piriformis (small hip external rotator). In fact, in some people the Sciatic Nerve actually passes straight through the piriformis. If either of these are tight, the nerve will get squeezed and you will definitely feel it.

  • How do I do it?
    1. Sit upright on a chair and cross your painful leg over the other leg.
    2. With the opposite hand, pull the leg further across your body until a stretch is felt deep in the hip.
    3. Caution: the stretch should be gentle, just to the point of tension. Pulling too hard will further irritate the inflamed Sciatic Nerve.
proven-ways-to-relieve-sciatica-nerve-pain
Image courtesy of Prairie Lakes Healthcare System
  • Why Am I doing this?
    • Of all of the muscles involved in Sciatica, the piriformis is probably the most guilty of making things worse. It’s literally a pain-in-the-butt.

2. Hamstring Stretch

Tight hamstrings are INCREDIBLY common amongst athletes, sedentary people, and everyone in between. Personally, I think that is the result of chairs, but that is a topic for another article. The Sciatic Nerve runs through the hip and buttocks and maintains its structure through the hamstrings before branching off into distinct parts behind the knee. Therefore, tight hamstrings will certainly contribute to Sciatica symptoms.

  • How do I do it?
    1. Lay on your back with your non-involved leg bent and foot resting on floor.
    2. Loop a belt or towel around the ball of your foot on the painful or tight side.
    3. Lever the leg up with your arms (keeping your knee straight) until a gentle stretch is felt. Hold for at least 30 seconds.
    4. The stretch should be gently (achieve a feeling of tension but not pain).
    5. Repeat at least three times.
proven-ways-to-relieve-sciatica-nerve-pain
Image Courtesy of Shape
  • Why Am I doing this?
    • Not only do tight hamstrings make Sciatica symptoms worse, but they contribute to hip disfunction and low back pain.
    • This is easily a Top-3 Daily Stretch for those of us that sit a lot and drive a lot (ie. everyone).

3. Glute Stretch

Don’t be a tight ass!

The gluteus maximus and medius need to stay extensible and supple. If not, they can and will add pressure and irritation to the Sciatic Nerve. A tight gluteus can also cause pelvic rotation and lead to other forms of back and hip pain.

  • How do I do it?
    1. Lay on your back.
    2. Bring your knee up to your chest, using your arms to assist.
    3. Keep the other leg straight down to ‘set the pelvis’.
  • Why Am I doing this?
    • As stated, the sciatic nerve runs down through the pelvis and past the butt on it’s way into the leg. Keeping your gluteus maximus stretched and mobile is another piece of the ‘Pain-free-Puzzle’.

4. Sciatic Nerve Flossing

Ideally the Sciatic Nerve glides freely between muscles and soft tissue as the leg moves through its range of motion. When either the nerve or the muscle is inflamed, adhesions can form.

“Nerve Flossing” or “Nerve Gliding” is exactly what it sounds like. We floss the target nerve through the tight musculature like dental floss through teeth, clearing out any adhesions and promoting healthy movement that reduces pain.

  • How do I do it?

5. Contract-Relax Modified-Mulligan Stretch

Say what?!? Despite the weird name, this is an easy DIY treatment. It is a modified move that can be done alone or with a second person to assist. Research suggests that improving the range of motion in a Straight Leg Raise directly reduces the degree of low back pain.

  • How do I do it? (see image below)
    1. Lay on your back with both hips and both knees bent to 90 degrees.
    2. Reach both hands under the thigh of bent leg and lace fingers together. Pull up toward chest until stretch is felt. Hold this position as you push your leg down into your hands for 5 seconds.
    3. Relax and gently advance the stretch by pulling the leg further with your hands and add a slight pull to the side (this will now target the Adductor Magnus).
proven-ways-to-relieve-sciatica-nerve-pain
  • Why Am I doing this?
    • The Sciatic Nerve passes through the butt muscle and the adductor magnus (part of the hamstring) at the level of the hip. Stretching of these two is accomplished with this technique and will break any adhesions between tight muscles and the inflamed Sciatic Nerve.

Often enough, Sciatica can resolve on it’s own. However, that typically takes a month or more. That is a long time to have shooting pain in your butt and legs!

Even after it resolves it is likely to return if you have not treated the cause. An ounce of prevention is worth a pound of pain in this case. Please start doing these stretches, and feel free to reach out to me at contact@rehab-revolution.com or comment below.

Another population that is at HIGH risk of Sciatica is Pregnant Women. Weight gain, fluid retention, postural changes, and your baby practicing karate kicks can all lead to intense and persistent sciatic pain. Learn how to mitigate that pain with the Rehab Revolution RECTI-FY Protocol.

If you are expecting or have given birth, check out my article How I Fixed My Diastasis Recti… with my Hubby’s Help. It’s from my wife’s perspective and I think there is some solid value to all of you new (or repeat) mommies.

rehab-revolution-consult-with-therapist

Dan Kristoff PT, DPT is recognized as one of the Top Physical Therapists in Ohio. In his 10+ yrs as a physical therapist, he has helped thousands of patients recover from illness and debility. His company, Rehab Revolution, is less than a year old and has already helped hundreds of clients take back control of their health.

7 Best Ways to Stay Healthy Working From Home

Are you reading this article at home or at work? My guess is that because this is 2020, the answer is ‘Yes’.

Times have been a-changin’ for quite a while now due to improving internet connections, a burgeoning of work collaboration apps, and a willingness of employers to experiment with a potentially cost-cutting remote work structure. Now throw in a global pandemic and the government-mandated quarantine and the ‘work-from-home’ economy is the new normal.

(BLAH, BLAH, BLAH… Skip to the TIPS!)

Stanford Economist Nicolas Bloom first published a study in 2014 that examined the concept of working from home and it’s impact on labor economics and management practices. As a senior fellow at the Stanford Institute for Economic Policy Research (SIEPR), he has published a policy brief that expands on his findings in the backdrop of the COVID-19 Pandemic. Here is a telling exerpt:

“We see an incredible 42 percent of the U.S. labor force now working from home full-time. About another 33 percent are not working – a testament to the savage impact of the lockdown recession. And the remaining 26 percent – mostly essential service workers – are working on their business premises.

So, by sheer numbers, the U.S. is a working-from-home economy. Almost twice as many employees are working from home as at work.”

Nicolas Bloom PhD
Best-Ways-Stay-Healthy-Working-From-Home

So the good news is that you can trade in your suit and tie for your ‘good’ pj’s.

The not-so-good news is:

  • that you will be surrounded by tempting snacks,
  • you will lack the social stimulation of coworkers,
  • you may miss the oversight of a manager to keep you honest
  • you will most likely spend most of your day in a ergonomically-harmful position (propped up in bed or on the slouch-couch).

Here are the 7 ways to keep yourself pain-free, stay on task, and not miss the dreaded office:

Disclosure: Clicking on my product links may result in me getting a small commission. That being said, I personally own and use all of the products that I recommend.

1. Get Yourself a Standing-Desk

“Sitting is the new smoking.”

In 2012, Australian Researchers found that “sedentary lifestyles are themselves a risk factor for cardiometabolic morbidity and all-cause mortality, even when controlling for overall levels of moderate to vigorous physical activity1.”

TRANSLATION: Prolonged sitting increases that risk of cardiovascular or metabolic disease. The risk can not be erased with a few weekly trips to the gym when it’s convenient.

SOLUTION: Standing desks and adjustable-height desks like this one have been shown to:

  • Reduce weight gain: A work afternoon spent standing burns approximately 170 more calories than if you were seated2. That is almost 1000 calories per week!
  • Reduce Blood Sugar Levels3 and decrease risk of Diabetes by 112%
  • Reduce Heart Disease: Prolonged sitting has been shown to correlate with a 147% increased risk of heart disease4.
  • Dramatically Reduce Back and Neck Pain: Multiple studies support the use of standing desks for reducing orthopedic pain, with the CDC publishing 54% improvement in these areas after 4 weeks5.

Getting an adjustable height desk so that you can alternated between sitting and standing might be the single best ergonomic adaption you can make for working at home.

2. Get Yourself a Floor Mat

Anti-Fatigue Mats are designed to disperse a person’s weight more evenly and prevent aches and pains that can develop in the feet and knees. If you take my advice and get a standing desk (see tip #1), do yourself a favor and get an anti-fatigue mat like this one… your feet will thank you.

3. Use a Medicine Ball for a Chair

A common Physical Therapy intervention for people with Diastasis Recti, back surgery, or any kind of core instability is a series of progressive balance exercises performed while sitting on a medicine ball.

The mildly unstable surface requires you to activate your trunk muscles to maintain balance. This is shown to improve core strength, enhance your posture and postural muscles, and even burn calories.

While there are many ‘high end’ options like this one, I actually recommend a back-less and base-less chair like this more affordable one to maximize the use of your trunk muscles.

4. Use True Wireless Ear Buds

Bending your neck down and/or to the side can put tremendous extra stress on your cervical spine. In fact, a 15 degree head tilt can put 27 extra pounds of pressure and bending your neck down to look at your phone can add up to 60 extra pounds of pressure on the vertebral column6.

Remember the ‘old days’ when your office would attach a bulky plastic chunk to the side of your desk phone so that you could pin the receiver to your shoulder without cranking on your neck?

That was a valiant effort at office ergonomics, but technology has won the day with True Wireless Ear Buds. Hands-Free and neck-friendly is the way to go, I personally recommend these.

5. Never Skip Your Daily Stretches

Whether you are at home or have gone back to the office, the hazards of sedentary work to the musculoskeletal system are always present. Prolonged sitting postures, typing postures, and screen-reading postures all lead to a muscular imbalance that both causes pain and makes you look bad.

Here are the key muscles that will need your attention: (I’ve attached a pdf for a visual aid)

  • Hip Flexors: On the front of your hip, their job is to lift your leg forward. Prolonged sitting keeps them in the shortened position and gets them tight, which can lead to back pain. Solution: Hip flexor stretch (See PDF below).
    • HOW TO DO IT: Assume a lunge position with one knee bent and planted firmly on ground. Lean back until stretch is felt across the front of that hip. Hold 30 seconds.
  • Pectorals: Your chest muscles will get tight and your shoulders roll forward after a day of working at the computer. This will lead to shoulder pain, neck pain, sloppy posture, and eventual breathing difficulties. Solution: Chest stretch (See PDF below).
    • HOW TO DO IT: Using a straight elbow, place your hand on the corner of a wall or door frame. Turn away from that hand until a gentle stretch is felt in your chest. Hold 30 seconds.
  • Low back: Prolonged sitting or static standing greatly reduces the mobility of your back muscles. It won’t be long before you start to feel stiff. This can also be greatly minimized by using a medicine ball for sitting (See tip #3). Solution: Seated trunk rotation (See PDF below).
    • HOW TO DO IT: Sit erect in your chair. Rotate at the waist and reach your right arm to the left side of the chair back. Hold 30 seconds, repeat on other side.
  • Mid Back: Often neglected, the middle back and thoracic portion of the spinal extensors need your attention too. Solution: Quadruped thoracic stretch (See PDF below).
    • HOW TO DO IT: Get on all fours and reach your right hand under your body toward your left ankle. Hold the stretch in your back for 30 seconds. Repeat on other side.
  • Hamstrings: The primary function of the hamstring muscle (back of thigh) is to bend your knee. If you are sitting all day, the knee is always bent and the hamstring gets tight. Solution: Hamstring stretch (See PDF below).
    • HOW TO DO IT: Assume a lunge position, then extend your leading leg so it is straight in front of you. Reach forward toward your toes until a gentle stretch is felt. Hold 30 seconds. Repeat on other side.
Downloadable below.
Rehab Revolution: work-healthy-from-home-stretchesDownload
  • BONUS: Perform the ‘World’s Greatest Stretch‘ daily. It gets it’s name because it targets every major muscle group, especially those that are compromised by desk work.

6. Never Skip Your Daily Exercises

Repetitive and Prolonged desk work also leads to muscular imbalance and weakened postural muscles. Here are some key exercises to combat this: (again, there is a pdf at the end)

  • Rhomboid Activators: Weak rhomboids are a common problem in our modern and computerized world. Along with a tight chest (See Tip #5), weakened rhomboids contribute greatly to a hunched posture and eventual back, neck, and shoulder pain. Solution: Rhomboid Activators.
    • HOW TO DO IT: Hold an exercise band at arms length with your elbows locked and with your palms facing up. Pull the band apart, squeezing your shoulder blades together. Slowly return to the starting position and repeat 10-20x. (See PDF below)
  • Vacuum Pose: Very few of us can sit for an entire workday with the posture of Don Draper or Robin Wright . As the urge to slouch overcomes us, our core muscles relax and the transverse abdominis is the first to give out. Solution: Vacuum Pose.
    • HOW TO DO IT: While sitting or lying on the floor, suck your belly button in towards your spine. Hold 5 seconds, slowly relax, and repeat 5-10x. (See PDF below)
  • Deep squats: Whether you work sitting or have heeded my advice to get a standing desk, you’re still not moving. Your legs are simply stilts to hold up your working parts, or a foundation upon which you sit your butt on. They are not receiving adequate blood flow, they are getting stiff, and the huge muscles are being wasted. Solution: Air squats.
    • HOW TO DO IT: Start with your feet just a bit wider than shoulder width and toes pointed slightly out. Adjust to comfort. Squat down as far as you can go without pain. ‘Discomfort’ is ok, but no pain. Keep your back straight and keep your knees roughly above your feet (not forward past your toes). Push up into stance. Repeat 10-20x. (See PDF below)
  • Cervical Retraction: Desk work makes you look like this… Solution: Cervical Retraction.
    • HOW TO DO IT: Sit straight up in your chair. While keeping your eyes level/not turning your gaze upward or downward, retract your chin in towards your neck. Relax and repeat 5-10x. (See PDF below)
  • Superman: Poor sitting posture strikes again. There are small muscles that support lumbar extension, called the multifidus, that get to go on vacation when you sit all day. Use the Superman exercise to strengthen these postural powerhouses as well as all of your other spinal erectors. Solution: Superman
    • HOW TO DO IT: Lay on your stomach with your arms stretched straight over your head. Keep your legs straight while you raise them off of the floor and simultaneously lift your shoulders and arms into the air in front of you. Hold 5 seconds. Repeat 5-10x. (See PDF below)
Downloadable below.
Rehab Revolution: work-healthy-from-home-exercisesDownload

7. Set Boundaries and Stick To Them

There is no place like home… and there is no place like the office. When we are forced to (or when we have the privilege to) work from home, we must still be able to separate the two.

Enter: the Home Office.

  • Establish a home office and do your work there. Avoid working on the bed (sleep hazard), in front of the TV (distraction hazard), or on the couch (sleep AND distraction hazard).
  • Set and keep your work hours. Although it may be tempting to sleep in late or work late to finish a task, this will start to blur the lines even further and be a detriment to your mental health.
  • DON’T skip your breaks, but DO skip your snacking. When it is time for a break, step out of your home office and clear your mind. Establish a clear distinction so you can refresh your thoughts. Just be sure to keep your hand out of the cookie jar! It’s easier to snack at home and that insulin spike can lead to drowsiness and lost productivity.
  • Set limits with your family. I’m not saying you should ignore them if they need you, but make it clear that you need them to treat you like you’re at work. Constant conversations with them will distract your focus and your work will suffer. Set clear boundaries.

Following these seven tips will go a long way toward keeping you healthy, happy, and productive while working at home. You can avoid the pitfalls of poor posture and keep your body and mind in optimal condition.

And if America ever gets to go back to “normal”, these tips are applicable at most offices as well.

Comment below if you have any other good pieces of advice or cool products to recommend. And be sure to sign up for Rehab Revolution updates:

rehab-revolution-consult-with-therapist

Dan Kristoff PT, DPT is recognized as one of the Top Physical Therapists in Ohio. In his 10+ yrs as a physical therapist, he has helped thousands of patients recover from illness and debility. His company, Rehab Revolution, is less than a year old and has already helped hundreds of clients take back control of their health.

References:
  1. van der Ploeg HP, Chey T, Korda RJ, et al. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med. 2012;172(6):494–500.
  2. Buckley JP, Mellor DD, Morris M, Joseph F. Standing-based office work shows encouraging signs of attenuating post-prandial glycaemic excursion. Occup Environ Med. 2014 Feb;71(2):109-11. doi: 10.1136/oemed-2013-101823. Epub 2013 Dec 2. PMID: 24297826.
  3. Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, Khunti K, Yates T, Biddle SJ. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012 Nov;55(11):2895-905. doi: 10.1007/s00125-012-2677-z. Epub 2012 Aug 14. Erratum in: Diabetologia. 2013 Apr;56(4):942-3. PMID: 22890825.
  4. Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, Khunti K, Yates T, Biddle SJ. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012 Nov;55(11):2895-905. doi: 10.1007/s00125-012-2677-z. Epub 2012 Aug 14. Erratum in: Diabetologia. 2013 Apr;56(4):942-3. PMID: 22890825.
  5. Pronk NP, Katz AS, Lowry M, Payfer JR. Reducing Occupational Sitting Time and Improving Worker Health: The Take-a-Stand Project, 2011. Prev Chronic Dis 2012;9:110323.
  6. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014 Nov;25:277-9. PMID: 25393825.