Taking Care of Yourself in the Kitchen

Are you reluctant to cook anymore because of back pain, foot pain, or neck pain? It is difficult to get in the kitchen to make healthy meals or wash dishes when you are in pain after a short amount of time. We have put together a few ways to help manage or even decrease your pain to get you back in the kitchen!

Low Back Pain
Back pain in the kitchen is very common due to our position and the hard floors we stand on. When standing at the counter to cut up food or standing at the stove, our backs are not always straight. If you are tall, you are in a slight forward bend to reach down and if you are short, you may have to reach up more. Because of this, our backs can take a lot of stress.
In order to help manage pain, the first thing you want to do while standing is to “engage your core”. To do this, you are attempting to pull your navel in toward you spine and tighten your deep abdominal muscles. It should feel as if you are on the verge of laughing or coughing, or bracing yourself as if you were going to get socked in the stomach. Engaging the core helps to stabilize and protect the low back and also helps you to stand up taller so you are not leaning over as much.
Another option is trying to prep ahead of time. If you are able, cut vegetables in the morning, or prepare the meat early so you are not on your feet for extended periods. You may also find ways to prep vegetables or meat while sitting.
Prior to cooking and standing you may want to stretch your hamstrings and quads. These muscles can tight with standing in one spot to help support the lumbar spine. With the core engaged while cooking and the hamstrings and quads stretched, you are helping to manage the low back pain.

Neck Pain
Neck pain can be common in the kitchen as well due to looking down at the counter to cut, stirring a pot, or lifting heavy pots can even put stress on the cervical spine. To help manage some of the symptoms, here are a few things to try.
Check you posture often while cooking. It may be difficult to stand up tall the whole time because you have to look down, however if you keep your shoulder blades back instead of rounding them forward, it will help keep your neck in a more neutral position while looking down. It is always good to take a break in between activities and when going from cutting to sautéing then make sure your posture is good during the transition.
As mentioned with low back pain, attempt to prep what you can ahead of time so you don’t have to look down as long while cutting then cooking immediately after.
If you feel the neck gets tight and stiff, stretching your upper traps (first picture), levator (second picture) and scalenes (third picture) will help to decrease some of the tightness and relieve pain.

Foot Pain
Another common issue with standing in the kitchen is foot pain, usually plantar fasciitis, though can also be tendonitis, post-surgical, or arthritis.
To help with manage foot pain, make sure you wear supportive shoes while standing for long periods. Wearing just any shoes, sandals, or slippers will not work, rather you need to make sure they are supportive tennis shoes.
Getting an anti-fatigue mat will also help to protect your feet in standing, and dually will help with low back pain as well! Place a few of these around the kitchen where you may be standing the most to help soften the floor and protect the feet.
Lastly, you can stretch the calf and the bottom of the foot to increase the flexibility. Also using a frozen water bottle to roll on the bottom of the foot can help. Doing this before helps to keep the pain down during and doing it again after will help with any pain from standing long periods.

Along with all of these tidbits, don’t be afraid to take an anti-inflammatory or use ice or heat (whichever is most comfortable and helpful for you) in order to manage the symptoms.
Now that we have given you ways to manage the most common pain areas in the kitchen, don’t be afraid to get in there and make those healthy meals!

Taking Care of Yourself in a Car

It’s that time of year again. The time of year where school starts, which means sports, clubs, programs, and extracurricular activities are starting as well. This also means more time in and out of the car, helping the young ones get in and out, and lifting the babies in car seat carriers in and out. All of it adding up to stress on your body, specifically your low back.
There are many ways you can start feeling back pain in the car. So when can you get the pain and how can you prevent it?

Sitting for long periods
Sitting in the car where your lumbar spine is in a “flexed” position is a large proponent of low back pain. You may get this by driving long periods or by simply sitting in the car waiting to pick someone up/drop them off.
When the lumbar spine is put in more of a “flexed” position, meaning the spine is more curved, the low back can get very painful. To help ease or prevent the pain, use a lumbar support in your car. The easiest way is to roll up a towel, tape it together, and set it in the small of your back against the seat of the car. This helps create more “extension” or arching of the back, restoring the spines natural curvature.
Many of you may say, “My car seat has a built in lumbar support,” or “I can increase the lumbar support in my seat.” Yes, you may be able to do this and have no issues. However, there are cases when the seat does not provide enough and the towel works better. There are also instances in which you “cannot feel” the lumbar support. In this instance you need to look at your posture, which brings us to our second point.

Poor posture
Poor posture can also contribute to low back pain. The next time you are driving and you come to a light, become aware of your posture. Are you slumped forward? Are your shoulder blades are touching the back of the seat? Is your low back is rounded? And are you slumped to one side resting on the door or the center council? If your answer is yes to one or more of these, your posture needs to be fixed.
Starting with a good lumbar support, such as a towel roll or increasing the air in the seat to its max, you can sit in the seat making sure you feel your low back beginning to arch. If it is exaggerated, then it is too much. Next, check to make sure your shoulder blades are touching the seat as well. At this point you can grab the steering wheel with arms high or low whichever is more comfortable. Your head should also be upright and not leaning forward. Below is a good picture of what to avoid and what you should look like.

Getting kids in and out of the car
Those of you struggling to get your toddlers in car seats and lifting the infant carriers into the base may have other low back issues.
When lifting young toddlers into the car, make sure you are bending at your knees, keeping your back straight, and engaging your core. When you use your legs to lift, you are taking pressure off the lumbar support and using your core to lift helps to protect the low back.

This picture shows exactly what you want to do, the knees are bent, the back is straight, and the core is engaged. After squatting down, you can pick up your child and use your legs and core to stand back up. Once you pick up your child, make sure to keep the child close to you. You can then transfer the child to the seat and buckle them in. If you have to bend over to buckle the child in, make sure you are bending at the knees slightly and engaging the core. We call this a “hip hinge”.

Notice just the slight bend in the knees, back is straight, core is tight and engaged, and she can reach her arms out to perform an activity, specifically buckling in your toddler.
“What do you mean by ‘engaging your core?’” you might ask. The muscles of the core consist of more than just the “6-pack”, the rectus abdominis. While this muscle may be appealing, it doesn’t do much for stability since its primary role is to curl the trunk. Contracting the spinal stabilizers, particularly the transversus abdominis (the deepest abdominal muscle) is the key to spine stability and truly engaging your core.
To practice, lie on the floor and place your fingertips one inch above your hip bones and one inch in towards your navel. Continue to breathe normally as you draw your navel in towards your spine and up towards your ribcage and then slightly bear down, imagine lowering the navel towards the floor. You should feel your abdomen tighten; you may feel like you’re on the verge of laughing or coughing. Another way to think of engaging your core is to imagine you’re bracing yourself for a punch in the stomach. After getting the idea of it laying down, you are now ready to do it in any position!
You are now ready to “engage your core” while lifting and buckling in your child!

Fussing with Car Seats
What about low back pain when lifting those heavy car seat carriers and clicking your infant into the car?
Just as before, you will want to bend your knees and “squat” down to pick up the car seat, engaging your core and keeping your back straight. When doing this, grab the car seat at the bar with the crease in your elbow rather than with your hand, then turning your hand over you can grab the side of the car seat. This will help you get more leverage to lift and keep the load closer to your body, not to mention it puts less strain on your shoulders and upper back/neck as well! Once you get to the car, make sure you get as close to the base in the seat as you can. You are then able to use your free hand to hold the bottom edge of the car seat and lift using both arms to click in the seat. Don’t forget to check your core again before attempting to lift and place the car seat in the base. This will ensure your back is protected as you reach more in front of you.

When doing these tasks over and over in one day, it can get taxing on the low back, however, now you should be able to protect yourself better with correct posture, correct form, and engaging the core.

Back to School Without Injury from Backpacks

With back to school being just around the corner it is important to make sure your child has a healthy start. When buying your child’s backpack there are several tips you need to know to help prevent injury to your child’s shoulder, neck, or back. One of the most important tips is the weight of the backpack.


Did you know?
It is recommended that a child only carry 10 to 15% of their body weight in their backpack?
Examples: 40 pound child = 6 pound backpack max
60 pound child = 9 pound backpack max
80 pound child = 12 pound backpack max
100 pound child = 15 pound backpack max

If your child is carrying more than the recommended weight then your child is more prone to injury. The excessive load can create a force to your child’s spine that will make him/her compensate and compress the spine unnaturally, leading to potential shoulder, neck and back pain.

There are several causes of shoulder, neck and back pain with carrying backpacks. Some possible cause are:
• Wearing backpacks over just one shoulder
o This can cause the child to lean to one side to offset the extra weight
• Too heavy of a load
o Leads to poor posture and excessive load to spine
• Backpacks with tight, narrow straps
o Straps can dig into the shoulders and interfere with circulation and nerves -may result in tingling, numbness, and weakness in the arms and hands
• Backpack doesn’t fit child properly
• Lifting backpack improperly
When you go out to buy your child’s backpack this summer consider the following tips before your purchase:
1. Start with a lightweight backpack made of lightweight material.
2. Make sure the shoulder straps are wide and padded. Wide, padded straps provide support and prevent the straps from becoming too tight or digging into your child’s shoulders. The straps should be snug, but not so tight that they cause discomfort.
3. The back should also be padded. Padding that sits against your child’s back will provide additional support and prevent discomfort.
4. Look for a backpack with a waist strap. A waist strap holds the contents closer to your child’s back, which will decrease the load and help him or her maintain balance.
5. Multiple compartments are a plus. If your child’s backpack has multiple compartments, it will be easier to evenly distribute the weight of the items inside. The heaviest items should be packed low and toward the center of the bag.
6. Both straps should be worn at all times. Make sure your child is always wearing both straps. Wearing both straps can also help distribute the weight more evenly and prevent your child from leaning to one side.
7. Do not overload! Remember the backpack should be no more than 15% of your child’s body weight. Anything more than that can force children to slouch or hunch to compensate for the extra weight. Remove any items that are unnecessary, and encourage your child to carry heavier items in their arms, if possible.
8. Make sure the backpack is the correct size for your child. The backpack should not be wider or longer than your child’s torso and should not hang more than 4 inches below his or her waist.

It is important as parents that we educate and instruct our children in backpack safety. Involve your child by weighing your child and then weighing the backpack. Figure out together what 15% of their body is. Then show them what that weight feels like in a backpack so they can understand what too heavy of a load is and how it can vary with the fit of the backpack. Encourage your child to use their locker throughout the day instead of carrying the entire days worth of books in the backpack. Help prioritize with your child items that are needed to be carried in the backpack vs. items that can stay home or be left at school. Instruct your child in how to pick up their backpack. As with any heavy weight, they should bend at the knees and grab the pack with both hands bringing their backpack close to their body when lifting a backpack to the shoulders.
We hope you found these tips helpful and help you get off to a healthy start to the school year!

Resources:
https://www.moveforwardpt.com/resources/detail/backpack-safety
https://kidshealth.org/en/parents/backpack.html
https://www.nsc.org/home-safety/safety-topics/child-safety/backpacks

7 Backpack Safety Tips

3 Most Common Golf Injuries

I. Elbow Pain – commonly known as “Golfer’s Elbow”

What is it?
Golfer’s elbow (medial epicondylitis) causes pain and inflammation in the tendons that connect the forearm to the elbow. The pain centers on the bony bump on the inside of your elbow and may radiate into the forearm.
What causes Golfer’s Elbow?
Golfer’s elbow can be caused by an acute injury or an overuse injury. Most often, golfer’s elbow is the result of an overuse condition where a specific activity performed many times causes a chronic irritation to the tendon. Golf is one common cause of these symptoms, but many other sport and work-related activities can cause the same condition.
How can you treat Golfer’s Elbow?
Golfer’s elbow is a problem that may heal with simple treatment. Treatment is rarely surgical, as this condition is well managed with a little rest and proper rehabilitation.
Lifestyle Modification – Lifestyle modification is important if golfer’s elbow does not resolve or if it recurs. With golfers, often a change in technique a change in equipment, such as a different size grip, can help to resolve the problem.
Changing Swing Mechanics – Golf clubs should be sized properly, including grip size. Swing mechanics should be evaluated to ensure patients are swinging properly. See a golf pro/instructor for a swing and club evaluation. Usually, the development of golfer’s elbow is a sign there is something wrong with the swing that can be addressed.
Anti-inflammatory Medications – Anti-inflammatory medications are often used to help control pain and inflammation. The oral forms of these medications are easy to take, and often help control the inflammation as well as manage the pain associated with golfer’s elbow.
Cortisone Injections – If these conservative measures fail, a steroid (cortisone) injection is a reasonable option. If a person has tried more than two cortisone injections without relief, it is unlikely that additional injections will benefit the patient.
Stretching & Exercises – Some simple stretches and exercises can also be helpful in controlling the symptoms of golfer’s elbow. These exercises should not cause pain, and if they do the exercises should not be done until the pain resolves. By strengthening the muscles and tendons involved with golfers’ elbow, you can help prevent the problem from returning.
Here are the most common stretches to perform to help alleviate the pain and stretch the muscles involved:

Passive Wrist Flexion/Extensor Stretch

With the elbow straight with palm down, use opposite hand to pull wrist back.

Passive Wrist Extension/Flexor Stretch

With elbow straight and palm up, pull wrist back using the opposite hand

If conservative measures do not help relieve the pain, consider Physical Therapy. We do a technique called Astym ® which specifically helps to heal the soft tissue in the muscle with overuse injuries. You can click here for more information and how it may help you: www.Astym.com

II. Shoulder Pain

What kind of shoulder issues can you have with golf?
The most common shoulder injuries with golf are:

Labral tears – Tearing and/or fraying of the cartilage ring around the socket of the shoulder joint
Rotator cuff tears – Tear of one of the 4 muscles (most commonly the supraspinatus) that make up the rotator cuff
Tendonitis – Inflammation of the supraspinatus muscle tendon
Impingement – pinching of something between two bones.

What can cause these injuries?

Shoulder injuries can be a combination of overuse and poor form which can cause inflammation of the rotator cuff tendons. Weakness in the rotator cuff muscles as well as poor posture may also attribute to the injuries.

How can you treat shoulder injuries?
The best way to treat shoulder injuries is strengthening, stretching, and posture changes. Below are some of our favorite rotator cuff exercises as well as posture exercises and pec stretches.

ELASTIC BAND SHOULDER EXTERNAL ROTATION (ER)


While holding an elastic band at your side with your elbow bent, start with your hand near your stomach and then pull the band away. Keep your elbow at your side the entire time.

ELASTIC BAND SHOULDER INTERNAL ROTATION (IR)

While holding an elastic band at your side with your elbow bent, start with your hand away from your stomach, then pull the band towards your stomach. Keep your elbow near your side the entire time.

STANDING ROW WITH THERABAND

Anchor the bands in front of you at waist height as shown. Begin with your arms straight in front of you, and pull your elbows next to your body, squeezing your shoulder blades. Slowly return to the starting position and repeat.

ELASTIC BAND SCAPULAR RETRACTIONS WITH MINI SHOULDER EXTENSIONS


While holding an elastic band with both arms in front of you with your elbows straight, squeeze your shoulder blades together as you pull the band back. Be sure your shoulders do not raise up.

PEC CORNER STRETCH


Upper arms should be parallel to ground. Don’t hyperextend low back. Shoulder blades should be down back and together. Lean forward to feel a stretch in the pecs. Can move arms up or down to get a different stretch of the pecs

THORACIC ROTATION


Laying on your side, keep your hips stacked and rotate your upper body so your arm is flat against the bed/floor.

III. Low back pain

Low back is the most common golf injury, not surprisingly.

What can cause the low back pain?

The repetitive action of the golf swing is the number one cause of low back pain in golfers. A ‘Reverse Angle’ swing fault is a common cause of back pain that occurs when the spine deviates from the vertical during the swing.
Numerous structures of the lower back can be affected – the discs, ligaments, muscles or Facet joints – but in golfers, particularly older ones, the discs are most commonly affected. A herniated disc or ‘slipped disc’ refers to a protrusion of gel material from inside the disc. This can cause back pain and / or Sciatica, particularly when bending forwards.
Weakness in the core and hips as well as decrease flexibility of the hamstrings, hip flexors and tight rotation can also cause more strain on the lumbar spine with the repetitive motion of swinging.

How can you treat the low back pain?
Correct any faulty swing you may have. Are you compensating because you are tight or because of weakness? If so, this compensation needs to be address and corrected.
The most beneficial treatment is doing core strength and stability exercises. This can help decrease your pain as well as prevent future injuries. Here are a few core exercises to get you started.

PELVIC TILT – SUPINE


Lie on your back with your knees bent. Next, arch your low back and then flatten it repeatedly. Your pelvis should tilt forward and back during the movement. Move through a comfortable range of motion.

BRIDGING


While lying on your back, tighten your lower abdominals, squeeze your buttocks and then raise your buttocks off the floor/bed as creating a “Bridge” with your body. Hold and then lower yourself and repeat.

Hip Hinge Level 1


Stand holding a rod (or your golf club) in contact with your spine. Try to maintain the same points of contact as you squat down. Your butt should go backwards as you squat down and your knees should flex but SHOULD NOT move forward. Keep your stomach engage to keep your back as flat as you can.

Stretching before and after is also very beneficial. Below are some stretches you can do right at your golf cart warming up.

Hip Stretch:


Standing with one foot on cart. Place club behind back and bend forward on front knee. Lean into front leg and rotate trunk toward same leg. Repeat for other leg.

Trunk/Shoulder Stretch:


Standing in backswing position. Hold club at each end. Rotate further into backswing to feel stretch in chest, hip, trunk, and back of shoulder. Repeat for other side.

Hamstring/Chest Stretch:

Standing with one foot on cart, hold club behind your back. Raise arms up behind you as you lean chest toward extended leg. Should feel stretch in hamstring and chest/arms.

References: www.hep2go.com; www.verywellhealth.com; www.physioroom.com

Safety Tips to Help Avoid Injury doing Yard Work

It’s the time of year where we all love to be outside and of course yard work comes with it. We have compiled some ways to help you get through the hard yard work in the spring, maintenance in the summer months, and cleaning up in the fall without injury.

First, make sure you warm up. We know it may sound silly, however you are more prone to injury if your muscles are “cold” and not ready for activity. Warming up could be just taking a nice 5-10 minute walk around the neighborhood. After you are done walking, make sure to do some stretches: Stretch your hamstrings, quads, and calves to help you get more limber. These stretches below are the perfect ones!

Second, make sure to change positions often. If you have a lot of raking and weed pulling to do, then make sure you alternate them to give your body a rest from repetitive work. Switching activities can help to avoid any overuse injuries including tendinitis and bursitis, so be sure to give your body a break every 15 minutes by alternating your work.

Third, when doing ANY lifting, be sure to lift with your legs and NOT bend at the waist using your back. We highlight ANY as back injuries are often caused from even the lightest of lifting such as bending over just to pick up a stick causing people to “throw out their back”. To help avoid this, we suggest always bending the knees and lifting with the legs. Below depicts a great picture of how lifting should be done!

Fourth, when using equipment, such as a chainsaw or lawn mower, make sure it is sharpened, there are no leaks, and it works properly. When equipment does not work correctly, it causes you to exert more energy and effort in operating the equipment, which in turn can cause injury. In addition, when going to use the equipment, make sure your path is clear and it is clear around the area you are working on. You do not want to have to squeeze by chairs or step over debris on the ground with a heavy piece of equipment. This may cause you to lose balance and result in injury.

Lastly, use common sense when working outdoors! Common things you should think of and abide by are:
• Wear gloves and long sleeves to protect yourself from chemicals you may be spreading or to prevent any irritation and blisters from use of the equipment.
• Use knee pads when you are going to be gardening to prevent bursitis or tendinitis of the knees
• Wear sunscreen to protect yourself from the hot sun
• Wear goggles or head phones when weed-whipping or using loud equipment
• Stay hydrated! Drink a lot of water and make sure to take breaks to eat
• Do not climb or stand on an unsteady ladder or equipment
• Do not work on wet or slippery surfaces

When you have completed your yard work for the day, make sure you do some of the quick stretches above again as a nice cool down. If any body part is aching you, ice and rest to help relieve some soreness.
Yard work can be very taxing on anyone’s body so be sure to follow the tips above to avoid serious injury!

Picture Credit: hep2go.com
Other sources: https://fitbottomedgirls.com/2013/06/yard-work-without-the-backache/#_a5y_p=2880911
https://www.thestatenislandfamily.com/safety-tips-to-help-avoid-injury-while-doing-yard-

Understanding Your Insurance

When seeking health care services, it is important to know and understand your insurance benefits so there are no surprises when it comes to your financial responsibility.

When making an initial appointment, office staff will most likely ask to collect your insurance information from your insurance card so they can verify your policy is active. Some offices will even check your insurance benefits for the services you may receive at their facility. Please note this is a professional courtesy to you and not a requirement or a guarantee of payment. It is beneficial for you to call and also verify your financial obligation prior to being treated.

First, an office will verify that you are in-network with their providers. If a provider is in-network, that means they are participating with your insurance plan. If they are out-of-network, depending on your insurance plan, you may still be able to see the provider, however, your financial obligation may be higher.

Second, an office will check to see if you require prior authorization from your insurance to receive services. Not all insurance require this prior authorization, however if your insurance requires it, the office will request the authorization to make sure you are approved prior to being seen. Once the request is made your insurance will either approve or deny your visits. If approved, they will award you a certain amount of visits before a new request must be made to continue your care. Typically, your therapist and the office will track your visits and make sure you are covered prior to continuing your services.

Third, if the office is looking to obtain your insurance benefits, the following information is what they will be asking:

  • What is your annual deductible and how much of it has been met so far this year?
    • A deductible is the amount you owe for health care services before your health insurance plan begins to pay.
    • For example, you may have a $1,000 deductible per year. This means, you must pay the first $1,000 of medical bills before your insurance will pay anything.
    • In some instances, physical therapy does not go toward the deductible and may be covered. However, you may only be responsible for a coinsurance or copay. If neither is the case, your physical therapy services will be your responsibility until your deductible is met.
  • Do you have a coinsurance?
    • A coinsurance is a certain percentage you are required to pay after your deductible has been met.
    • What this means is your insurance plan will cover a certain percentage of the cost and you are responsible for the remainder.
    • For example, if you have a 20% coinsurance, your insurance plan will cover 80% of the allowed amount and you will be responsible for paying the other 20%. We call this an 80/20 plan.
  • Do you have a copay?
    • A copay is a fixed dollar amount you must pay to be seen at an office visit.
    • Copay’s do not go towards your deductible.
    • For example, if you have a $20 copay, you will be expected to pay $20 at each therapy visit and the insurance will cover the rest of the visit.
  • Do you have an annual cap for the services being received?
    • A cap is the maximum dollar amount that an insurance will allow on a service.
    • Primarily with Medicare insurance programs, there will be an annual cap instead of a certain amount of visits that we must stay under.
    • For example, Medicare has a $2010.00 annual therapy cap. The office keeps track of how much is used up so you do not exceed your benefit amount.
  • Do you have a maximum number of visits? If so, have any been used yet this year?
    • Similar to a cap, sometimes the number of visits will be limited annually.
    • For example, as part of your insurance plan, you may only be able to receive 30 visits of therapy per year before your benefit maximum is reached. Again, the office will keep track of this to avoid exceeding your limit.

How does this all work after we verify your benefits?

When a provider sends a claim, or an outline of services rendered along with a charge amount and a corresponding code to your insurance provider, the insurance company will adjust the amount the provider charges to an allowed amount based on a prearranged contracted fee schedule the provider has with the insurance company. The insurance company will then write off part of the charged amount and the remainder is what you are responsible for, what they pay, or a combination of what you and the insurance pay based on your benefits.

Let’s break down what this means into numbers.

Claim charge/billed amount: $200
Allowed amount by insurance: $100
If you have a deductible you will pay $100 toward the deductible until met. Once the deductible is met you will be responsible for a coinsurance if you have one or the insurance will cover the service for you.
If you have an 80/20% coinsurance you will be billed $20 per visit for your coinsurance and the insurance pays $80.
If you have a $10 copay you pay the $10 per visit for the copay and insurance covers $90.

Note: this is just an example. Each insurance company has its own “allowed amount” or “fee schedule” indicating how much you pay. We can predict some, however not all insurances are predictable and depend on the billed amount (claim charge) by your provider.

We hope this has helped you understand your insurance and how it pertains to your physical therapy. As always, we encourage you to verify your benefits with your insurance company to ask questions so your financial responsibility doesn’t come as a surprise.