January 21, 2018

How do I manage stress?

iStock_stress (640x486)How do I manage stress?

What is stress?

Is stress detrimental to your health?

Stress is a common health risk factor commonly experienced by everyone (Campo et al., 2009; Shapiro et al., 2005; Manotas et al., 2014; Howard, 2008). Stress is your body’s physiological and psychological response to anything your body may perceive as threatening or a specific reaction to a life changing event which may be perceived as positive or negative (Christ, McVay, Marocco, 2013). The effect of stress is highly individualized and may have a detrimental impact on one’s health while having a minimal impact on another’s (Howard, 2008, p. 105). There is evidence that suggests stress can contribute to psychological disorders (depression/anxiety), cardiovascular disease (hypertension/stroke), as well as have a negative effect on the immune system (Campo et al. 2009; Miller et al. 2001; Shapiro et al, 2005). Stress in the work place can come in a variety of forms including work load (caseload/hours worked), lack of resources (staffing/ equipment), loss of autonomy, frustration with customers or clients, and interpersonal relationships (supervisor/co-workers) (Campo et al., 2009; Howard, 2008). In healthcare workers, stress has not only been linked with depression and cardiac disease, but also leads to “burnout” and reduced quality of patient care (Campo et al., 2009; Howard, 2008, Shapiro, 2005). Howard (2008) suggests that social support in the work place is the most crucial buffer against job stress (p. 107). Stress in the work place can also lead to poor coping strategies leading to excessive use of alcohol, drugs or tobacco (Howard, 2008; Miller et al., 2001).
Prevention strategies to deter stress may include: facilitating the development of a social support system (e.g. family/friends/special groups), promotion of self-care (e.g. nutrition, smoking/drug cessation, exercise), learning specific relaxation techniques (e.g. deep breathing, imagery, affirmation, biofeedback, and medication), and/or the enhancement of self-efficacy.
Mindfulness-based stress reduction (MBSR) training has become popular over the last couple of decades and has been shown to be a successful stress reduction intervention (Manotas et al., 2014; Shapiro et al., 2005). MBSR is a form of mediation, derived from Buddhism, and is designed to teach individuals how to become aware of the present (Manotas et al., 2014; Shapiro et al., 2005). This is accomplished by a multi-faceted approach consisting of observing, describing, acting with awareness, non-reacting and non-judging (Manotas, Segura, Oggins, & McGovern, 2014, p. 208).

S. White

Campo, M.A., Weiser, S., & Koenig, K.L. (2009). Job strain in physical therapists, Physical Therapy, 89(9), 946-956. doi:10.2522/ptj.20080322
Crist, M., McVay, D. & Marocco, S. (2013). PHT 712, Module 6 tutorial. Utica College.
Miller, G. E., & Cohen, S. (2001). Psychological interventions and the immune system: A meta-analytic review and critique. Health Psychology, 20(1), 47-63. doi:10.1037/0278-6133.20.1.47
Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management, 12(2), 164-176. doi:10.1037/1072-5245.12.2.164
Manotas, M., Segura, C., Eraso, M., Oggins, J., & McGovern, K. (2014). Association of brief mindfulness training with reductions in perceived stress and distress in Colombian health care professionals. International Journal of stress management, 21(2), 207-225. doi:10.I037/a0035150
Howard, F. (2008). Managing stress or enhancing wellbeing? Positive psychology’s contributions to clinical supervision. Australian Psychologist, 43(2), 105-113.

What causes tension headaches?

Tension headacheWhat is a tension headache?

How do I treat a tension headache?

A tension headache is a pain along the scalp, neck or shoulders that is typically mild to moderate in intensity.  It is sometimes referred to as a stress headache, and muscle tightness may be associated with it.  There are a number of factors that may contribute to tension headaches, including poor posture, eye strain, fatigue, and over exertion.  The following are a few tips to help you manage your tension headache pain.
Start by correcting your posture.  Poor posture will add increased strain to the muscles in the head and neck, which will likely worsen your pain.  For the same reason, you should minimize or take frequent rest breaks from tasks that involve forward, sustained head positioning (e.g. computer work, knitting, sewing, reading a book on your lap).
Gentle stretching of your neck muscles may be helpful as well.  To stretch, tilt your ear to your shoulder or your chin to your armpit, and hold 10 seconds.  Repeat stretches frequently to alleviate muscle tightness and/or soreness.  If your headache pain is located at the base of your skull where the top of the neck meets the scalp, you may benefit from laying on your back and resting for 5 to 10 minutes with a tightly rolled hand towel placed beneath your head in that region.  Taking a hot shower can help loosen tight muscles as well, while alternating heat and ice can help reduce tension headache pain.
In addition to tension headaches, several other types of headaches exist.  If you experience a severe, sudden headache or have other abnormal symptoms, such as numbness, weakness, or visual disturbances, you should consult your physician or physical therapist promptly as it is unlikely you are experiencing a simple tension headache.

~K. Collins

What is Runner’s Knee?

Runner's kneeWhat causes runner’s knee?

How do you prevent runner’s knee?

Its summer time, which means many people are out participating in local 5k, 10k, half and full marathons. Consequently, runners are training more often, and may become susceptible to repetitive use injuries in the knee. The two most common knee injuries in runners are patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS).
PFPS is pain under or along the knee cap itself, while ITBS is pain along the outside of the knee that may or may not extend up the side of the thigh toward the hip. PFPS can be caused by misalignment of the knee cap, or a variety of other factors, including hamstring and/or calf tightness, quadriceps or hip weakness, or altered foot/orthotic mechanics. ITBS can be caused by iliotibial band tightness, or other factors such as weak hip muscles, improper footwear, or repetitive overuse, (which means running too often or too far). Both PFPS and ITBS can be aggravated by poor running form.
To combat knee pain when running, first warm up with a brisk walk and dynamic stretching. Wear proper footwear, and alternate your running program with cross training workouts (think squats, lunges, planks, etc.) to help keep hip and core muscles strong and flexible. Cross training is also helpful in avoiding repetitive overuse injuries, because your body is not constantly being stressed by the same repetitive movement patterns incurred with running. Gradually, yet consistently increase your running distance, and avoid over-striding, which can contribute to or worsen existing knee pain. If you are having persistent pain, take some time off, and if necessary seek help from your local physical therapist.

K. Collins

Shinny Shin Shin……Why does my shin hurt?

shin painWhat are shin splints?

What causes shin splints?

Have you ever went for a long run, or done an intense workout and had tenderness or swelling along your shin bone afterwards? It is possible that you have suffered from shin splints, also known as medial tibial stress syndrome. Shin splints can be caused by an inflammation of the periosteum of the tibia, muscle overuse causing swelling, and stress fractures of the bone. The periosteum is the covering surrounding the bone, which can become irritated from the repetitive forces of the muscles on the lower leg. These repetitive forces and constant loading can sometimes cause minute fractures in the bone that can lead to a stress fracture. The increased stress on the tissues could be from overuse, improper training techniques, poor shoe wear, poor foot mechanics, and muscle weakness.
Shin splints are very common in runners and dancers. It is also common if someone has recently ramped up their workout, or changed their routine. Running downhill or on uneven terrain increases your chances as well. People suffering from shin splints will often complain of an ache on either side of the shin bone, and the pain can be constant. The pain often develops during exercise, and some swelling may be noted. They may also notice that their muscles are tender, and may complain of numbness and weakness in the feet.
To treat shin splints, it is often recommended to rest from high impact activities and ice your legs. Over the counter anti-inflammatories such as Ibuprofen are often recommended, as well as wearing a compression stocking. Physical therapy is often prescribed to aid in stretching and strengthening the appropriate muscles in the leg, as well as identifying the causative factors and making adjustments to the patient’s exercise regimen.

H. Tipsord

What is carpal tunnel?

Closeup on business woman with wrist painWhy does my wrist hurt?

Why does my hand and fingers go numb?

Why does my hands go numb at night?

Carpal Tunnel Syndrome is a common disorder that involves compression of the median nerve.  The median nerve and the tendons that bend your fingers pass through a structure called the carpal tunnel in the wrist.  The carpal tunnel is made up of bones on 3 sides and a ligament.  The median nerve can be compressed in this tunnel due to many reasons: an inflammation of the tendon sheaths, shortening of the ligament that covers the median nerve, prolonged positioning of the wrist in a bent or extended position, repetitive hand movements, repetitive shaking of the hands or wrist, fracture or sprain of the wrist, rheumatoid arthritis, gout, diabetes, lupus, hypothyroidism, pregnancy, Raynaud’s disease, and obesity.
Common symptoms of carpal tunnel syndrome include loss of grip strength, frequent dropping of objects, inability to make a fist, sharp pains that shoot from the wrist to the elbow, as well as tingling, numbness, or burning pain in the thumb, index finger, middle finger, and half of the ring finger.  Often times it is described as feeling like your hand went to sleep, and patients “shake” their hand to try to relieve the symptoms.  Symptoms are typically felt in the hand and forearm, but can spread up to the shoulder.
Carpal tunnel can typically be treated with conservative treatment.  Initial treatment consists of activity modification, as well as limiting the performance of the suspected aggravating activity.  When performing activities involving your wrist, it is important to pay attention to your mechanics and keep your wrist in a neutral or slightly extended position.  Application of a wrist splint at night to keep your wrist in a slightly extended position is often times beneficial.  To reduce inflammation, ice can be applied for 10-15 minutes 2-3 times a day, as well as taking an NSAID such as ibuprofen.  If these suggestions do not improve your symptoms, physical therapy may be indicated.
Physical therapy treatment for carpal tunnel commonly involves soft tissue mobilization, such as the ASTYM technique.  This is a noninvasive treatment that helps to break down soft tissue adhesions (scar tissue) and promote your body’s normal healing process.  Treatment also involves a stretching and strengthening program to help restore normal range of motion and strength to get you back to your normal activities without pain.

H. Tipsord


What is the right shoe for me?

iStock_shoewear(640x480)Does the shoe matter?


What should I look for in a shoe?


What is flat foot or low arch?


What is a high arch?


Wearing proper foot attire is key to avoiding foot/ankle pain, not to mention reducing the risk of knee, hip and low back pain. So, what exactly is “proper foot attire?”  Obviously high heels are tough on your feet, while athletic/tennis shoes provide cushion and support.  However, there are a lot of tennis shoe brands and styles available, which means you have to do some legwork to find the right shoe for you. Here are a few tips to make the process a little easier.

– Choose a shoe with a heel less than 2 inches. Higher heels put more pressure on the ball of your foot, which can lead to calluses.
– Choose a shoe that is wide in the toe box (versus pointed). Wearing shoes that scrunch your toes together can contribute to the development of bunions.
– Choose a shoe that is snug around your heel. If your foot is slipping in and out of the back of your shoe you may develop blisters.
– Choose a shoe with adequate arch support. If you have high arches, you will need more arch support than if you have medium or low arches.
– Try on both shoes before purchasing them. Your feet may be slightly different length, which will affect the fit.
– Not all shoes are created equally. Do not assume all manufacturer shoe sizes are the same.
– Walk around in the shoes before purchasing them. Choose a shoe that is comfortable from the first step versus planning to break them in.

– Choose a shoe that fits your lifestyle. If you are a runner, choose a running shoe. If you’re a construction worker, you will need a quality, supportive boot that meets the fit criteria mentioned above.

K. Collins

1st Place Reader’s Choice Award

Best CHOICE blue grunge vintage seal isolated on whiteThank you Whitley County, our patients and the Post and Mail readers, for awarding us the top choice award for physical therapy.  It has been an honor to serve our community and help those return to their Peak Performance!

What should I expect during my physical therapy evaluation?

Sports Physiotherapist Treating Male ClientHow do I make the most of my physical therapy evaluation?


What questions will I be asked by my physical therapist?


As physical therapists we cannot be so blind to assume everyone knows what services we can provide and what diagnoses we are capable of treating.  So whether you have been through therapy before or are going for the first time here are a few things to consider before your first visit with your therapist:

-Where is your pain and how does it change based on activity?
While this may seem like a common sense question sometimes its difficult to pin point. Giving your therapist an accurate “map” of your current symptoms, (whether they seem related or not) and knowing how those symptoms respond to activity (like sitting, walking, yard work, housework etc.) or time of day (less pain in the morning vs. evening etc) can help your therapist guide treatment to best fit your complaints.

-Do you have any imagining?

If you have had any traumatic event or surgical procedure any imaging can be helpful in helping your therapist understand the problem at hand. If you have any pain that came on in the absence of trauma and have related imaging it can help confirm what your therapists finds in the exam.

-Write down questions.

So often there are questions we intend to ask ahead of a medical visit however when the time comes we easily forget or perhaps are too embarrassed/intimidated to ask. If you make a note of questions ahead of time you can address them more easily with your therapist. That said, you may find your visit generates more questions you didn’t know you had, about your diagnosis, about the home program etc. that may not occur to you that day. Write them down, and bring them for your next visit.

Consider how involved you want to be with your improvement. While there are numerous hands on activities/treatments that your therapist can perform to improve your pain/symptoms, much of the work is done at home with a specialized home program. If there are any conflicts with being able to perform a home program like long work hours, caring for your children or perhaps other physical limitations, let your therapist know so they can brainstorm the best way for you to maximize your home program.

K. Schultz

Biking and Back Pain

mountainbike couple outdoorsWhy does my back hurt when I ride my bike?

How do I adjust my bike to prevent my back from hurting?

Is biking bad for my back?

Summer is finally starting to come around, so you may be considering tuning up that bike and hitting the road. If you’re a seasoned rider, then the normal considerations are old hat for you: wear a helmet, wear reflective clothing if biking at night, ride with traffic and use hand signals etc.  However, have you considered how to protect your back when spending many hours and miles hunched over your handlebars?

Many studies have demonstrated the detriments created by frequent or sustained low back flexion (or the forward bend at the waist).  Each style of bike has a different degree of flexion.  Cruisers are a bit easier on your back as they hold you more upright, whereas road bikes maintain considerably more flexion as you ride.  Maintaining these flexed positions for long periods when you are conditioned is bad enough but if you’re one of the weekend warriors that tackle many miles without much training or conditioning it can create havoc for your back.

The following tips can help prevent any undue stress and pain for the biking season:
1. Perform standing back bends: Extension in the low back can be very effective in reducing low back pain as well as preventing any possible episode(s) of back pain.  These can be done in sets of 10 prior to, during and after a bike ride.

2. Ease into your mileage: Again, while sustained flexion is never great for our backs, any significant increase in exercise or activity can be detrimental and cause injury or pain, which leads into the next tip.

3. Train/ride year round: If long bike rides are your preferred source of exercise in the warmer months then you may consider investing in a bike trainer that allows you to hook your bike up and turn it into a stationary bike at home allowing you to keep up your level of fitness year round.

K. Schultz


What are overuse injuries?

Why do overuse injuries happen?

How do you prevent overuse injuries?

Wrist painRepetitive stress injuries (otherwise known as repetitive strain, repetitive motion, or repetitive use injuries) are just what they sound like – injuries incurred due to repeated stresses or loads on the body over time. These injuries are quite common in the workplace due to employees performing the same daily tasks or maintaining the same sustained positions for several hours each day. Repetitive stress injury is a broad, umbrella term for a variety of overuse conditions, including, but not limited to, carpal tunnel syndrome, elbow tendonitis, shoulder bursitis and trigger finger. While we may often think of repetitive stress injuries occurring in the upper extremities, they do occur throughout all regions of the body, including the spine and lower extremities. Typical symptoms of repetitive stress injuries may include pain, tingling, weakness and swelling.

In order to prevent the development of a repetitive stress injury, you must first consider your own personal job duties and/or recreational hobbies. For example, do you have an office job that requires you to sit in the same position at a computer, typing most of the day? Or do you have a more physical job that demands frequent and repeated lifting, twisting, drilling, or gripping? How about a favorite hobby such as knitting, or participation in a recreational sport such as tennis? All of these activities can lead to differing repetitive stress conditions. No matter which category you fall into, there are keys to helping keep your body free of injury.

To minimize your chance of developing a repetitive stress injury in the workplace or at home, take frequent breaks and/or change positions often, alternating the way in which you perform repeated tasks. Your workplace may have ergonomic recommendations for you as well. If you do experience pain from an overuse injury, then stop or minimize performance of the aggravating activity. It may also be beneficial to perform gentle stretching to the injured tissues in a comfortable range of motion. Icing the region for 10-20 minutes will also help reduce pain and inflammation. If pain persists, it may be appropriate for you to schedule a physical therapy evaluation to help alleviate your symptoms.

K. Collins
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