Sleep and Health

Feel sluggish? Having an ache and pain that just won’t go away? Poor sleep may be to blame,as sleep is vital to health and recovery. A good night’s sleep is credited with restoring healthy brain function and physical well-being. Basically, the way you feel when you’re awake depends on how well you sleep. Disturbed sleep is often due to various stressors with the most common reported being persistent pain, depression, and/or anxiety. In fact, a recent study by the Centers for Disease Control (CDC) found more than 35% of adults are not getting enough sleep on a regular basis. The American Academy of Sleep Medicine and the Sleep Research Society recommends that adults sleep at least 7 hours each night to promote optimal health and well-being. Sleeping less than 7 hours is associated with an increased risk of developing chronic conditions such as obesity, diabetes, high blood pressure, heart disease, stroke, and frequent mental distress.

Does pain lead to poor sleep, and poor sleep leads to pain, becoming a vicious cycle? A study of sleep disturbance among chronic pain patients found greater self-reported pain intensity among those patients who rated themselves as poor sleepers (Morin 1998). It could be argued that more pain means less sleep, but the evidence points in the opposite direction. Experimental studies of healthy subjects suggest that poor sleep further exacerbates pain (Smith 2004). Sleep triggers healing and enhances tissue nutrition. Sleep helps restore balance to hormone levels, which keeps your appetite in check and strengthens the immune system. Sleep helps your brain form new pathways to learn skills and remember information, thus causing less stress. Sleep helps you make better decisions and improves your problem-solving skills. It sets the stage for improved mood and a positive outlook, so long as you wake with a good cup of coffee.

Sleep is a behavior, not an identity. Most of us have experienced some sleepless nights, but it is important not to accept disturbed sleep as the norm. Whether it’s recovery from surgery or healing from a chronic injury, sleep is a necessary element of the healing process. Once we have emerged alive and awake from the tissue trauma, the long journey ahead is far less difficult if we develop good sleep behaviors.

Looking to improve your sleep? Here are a few tips

#1: It’s tough to sleep if you’re not tired. Work up a sweat at least 10-15 minutes every day.

#2: Avoid alcohol and opiates as they are depressants. They will make you drowsy but the effect is restlessness and disturbed sleep. If you rely on any substance to sleep, consider trying some natural methods. A glass of tart juice or some chamomile tea will help relax you before bedtime. The use of aroma sticks with lavender oil has been shown to improve sleep quality in a recent study on sleep problems in cancer patients (Dyer 2016).

#3: Balanced nutrition is important to physical health and improved sleep.

Want to learn more about how sleep could be affecting your pain, lack of energy, or weight gain? Contact Travis today.

Breathing - Part 3

Breathing influences low back pain

We have all used or been told to use stabilization exercises to treat low back pain. While many people will improve with physical therapy, we too frequently experience recurrences of back pain, requiring more physical therapy or pain medications.

Several studies have demonstrated the role of respiration on postural stability. In one such study, individuals with low back pain were compared to pain-free subjects during an active straight leg raise, an exercise that requires core control. Real-time ultrasound was used to examine the activity of the diaphragm and the pelvic floor. The subjects with low back pain demonstrated an increase in respiratory rate, a greater descent of the pelvic floor, and decreased diaphragmatic excursion compared to their pain-free counterparts.

These results indicate that subjects with low back pain had to work harder to breathe during a core control activity, but they used their diaphragm less. As a result, they likely overused their accessory breathing muscles and they did not use their diaphragm for core stability. Additionally, the increase in respiratory rate indicates that sympathetic activity and stress increased as well.

This is a perfect storm for pain and decreased postural stability.

The result? Low back pain.

Similar results were found in a study that examined diaphragmatic activity during upper and lower extremity isometric activities with external resistance. Individuals with low back pain presented with smaller diaphragmatic excursion than pain-free control subjects during the resistance exercises.

Essentially, the subjects with low back pain were not using the diaphragm to its fullest potential. They were therefore more vulnerable to decreased core control and resultant low back pain. Collectively, these results highlight the role of breathing in physical therapy and call for stabilization interventions that involve the diaphragm.

In order to achieve optimal core stabilization, the diaphragm must be simultaneously involved in respiration and postural stability. Individuals who are limited in their ability to contract the diaphragm for stabilization have a higher risk of developing back pain.

Breathing dysfunction restricts mobility

Inefficient breathing patterns are often closely linked to mobility restrictions. If you present with a mobility limitation anywhere from the neck to the pelvis, we should consider the possibility of a breathing dysfunction.

Many clients who present with head, neck, and shoulder pain are likely suffering from accessory respiratory muscle overuse. We need to retrain breathing in physical therapy in order to decrease accessory muscle overload and increase activation of the diaphragm.

Inefficient breathing patterns may also restrict the rib cage or thoracic spine or decrease general flexibility. In order to improve joint mobility, range of motion and/or flexibility, we may need to calm the nervous system down with breathing in physical therapy. The parasympathetic nervous system will allow our muscles to relax, whereas the sympathetic nervous system causes them to contract. By learning how to slow down breathing, prolong exhalation, and breathe through their diaphragm, we can increase flexibility.

Breathing determines movement patterns

In order to achieve optimal movement patterns, we need a stable core from which our muscles can generate movement. Lumbar and pelvic stability depend on coordination between the diaphragm, pelvic floor, and transverse abdominis. These muscles activate prior to purposeful movements in order to establish a stable base. This allows for optimal load transference along the entire kinetic chain and minimizes stress on passive structures, such as ligaments, joint capsules, and joint surfaces.

Failure to coordinate the core stabilizers with the regulation of intra-abdominal pressure makes it difficult to efficiently transfer force from the trunk to the extremities. If we can't properly activate the diaphragm during a simple activity, like an active straight leg raise, then we are certainly not recruiting it properly when kicking a soccer ball or performing a squat. This impairs both our core stability and the resultant movement patterns. If we send our patients back to sports or complex activities without having assessed and treated their breathing in physical therapy, then we have left them vulnerable to re-injury.

Breathing changes pain perception

People with chronic pain benefit from exercises that induce relaxation. Since deep breathing calms the nervous system, it will help decrease the stress response associated with pain.

Patients with chronic pain may have an up-regulated nervous system in which there is an increase in sympathetic activity. This increases their sensitivity to touch and heightens their perception of pain. Deep breathing will mediate sympathetic arousal and increase pain thresholds. By teaching patients how to diaphragmatically breathe, we can increase parasympathetic activity, thereby inducing relaxation and decreasing the pain response.

Additionally, dysfunctional breathing may predispose individuals to faulty muscular adaptations, resulting in chronic musculoskeletal pain. For example, people who overuse their neck to breathe will be more susceptible to neck pain. Similarly, weakness in the diaphragm and pelvic floor can lead to overuse of compensatory muscles and result in chronic low back pain. By addressing breathing in physical therapy, we can restore muscle balance and decrease pain.

Assessment of breathing patterns

A breathing assessment is an often overlooked component of an orthopedic physical therapy examination. However, breathing is the foundation of stability and normal movement patterns. Therefore, a breathing assessment should be a basic starting point for all orthopedic evaluations.

When assessing breathing, we must the first rule out structural problems, such as airway obstructions or a deviated septum. For example, before posture can be addressed, we should make sure that they are not standing that way due to an anatomical obstruction. Treatment of these respiratory health problems are beyond our scope of practice and will require referral to another specialist.

After we clear anatomical obstructions, we can examine breathing pattern itself. The easiest way to do this is by lying supine and placing one hand on the stomach and the other on the chest. If you are diaphragmatically breathing, you will see more movement through the stomach and less movement in the chest. If you are an apical breather, you will see minimal movement through the abdominal wall and excess movement through the upper chest. Also take note of the rate of breathing. Is the breathing slow or rapid? Are the inhalations longer than the exhalations?

There are of course more in-depth methods of examining breathing in physical therapy, but this is all that will fit in this blog post.

Re-training breathing in physical therapy

Breathing can be an essential tool in the treatment of musculoskeletal dysfunction. However, like any intervention, breathing re-training should not be done in isolation. Breathing dysfunction may be the cause, or result of, your primary complaint. Therefore we should coordinate mobility and strength interventions with breathing in physical therapy.

When first instructing diaphragmatic breathing, it is easiest to lay supine on a mat or plinth. Place one hand on the stomach and the other on the chest in order to compare the excursion of both areas. During diaphragmatic breathing, you should feel the stomach rise and fall and the lower rib cage should expand laterally. There should be minimal movement through the chest.

While practicing diaphragmatic breathing, watch for compensation of spinal extensors (excess lumbar lordosis) as well as overuse of the rectus abdominis. Also, make sure that you do not revert to the old patterns by using accessory respiratory muscles of the chest and neck. This can happen with fatigue.

After mastering simple corrective breathing exercises, proper breathing should be incorporated into functional activities. When participating in complex activities, like running, there are increased demands for stability and respiration.

Start breathing in physical therapy today

Breathing is the root of all movement. We must therefore respect the role of breathing in physical therapy. By incorporating breathing into our assessment and treatment of musculoskeletal impairments, we can improve outcomes and increase the likelihood of lifelong recovery.

Blood Flow Restriction Training

Did you know that On the Go Physical Therapy offers Blood Flow Restriction (BFR) Training?

Blood flow restriction (BFR) utilizes the application of an inflatable pneumatic cuff (similar to a blood pressure cuff) around a limb to limit the blood flow available to the exercising muscles. The goal is to fully occlude venous flow out of the limb and to also restrict a certain percentage of arterial flow back into the limb.

Evidence supports the use of using blood flow restriction combined with low-load resistance training to enhance hypertrophic (muscle growth) and strength responses in muscles.

BFR training can be using in any situation where the goal is to increase muscle hypertrophy and strength. We are able to induce significant hypertrophy and strength gains in as little as 4 weeks, as opposed to the 8-12 weeks of traditional training. Due to the low loads used with BFR and the limited muscle damage that occurs, athletes can have a physiological stimulus for muscular adaptation while utilizing decreased training loads.

Is BFR training safe?

As long as it is used appropriately, it is completely safe. The two biggest side effects are subcutaneous hemorrhage (bruising) and numbness. Both of these side effects are transient and will go away. At On the Go PT we use a doppler to make sure we are only applying safe pressures.

Can everyone use BFR?

While BFR training can be beneficial for a wide variety of injuries and for a wide age range, there are a few contraindications to its use including:

• History of deep-vein thrombosis

• Pregnancy

• Varicose veins

• High Blood pressure

• Cardiac Disease

• Rhabdomyolysis

Have any questions? Please contact me via email/text/phone/contact form

Do I need to be in SEVERE pain to schedule an appointment?

Absolutely not! We are also experts in getting you healthier and moving better than you were before.

Notice that your shoulders are tight with overhead motion? PT can help improve range of motion and show you exercises to promote mobility and overhead stability.

Do your shoulders hurt with pull-ups or STOH? PT can help improve shoulder and upper back strength that will decrease the pain.

It is always better address something sooner, rather than let it become a chronic injury!

When is the best time to get physical therapy?

Ideally as soon as possible! The sooner we can assess and begin treating the pain and restrictions that are present, the faster you will get better! This is especially important if the pain is not only affecting your workouts but also activities performed outside of the gym.

Discomfort that is present with movement can be quite complex. With a physical therapy evaluation we assess for limitations or impairments in strength, stability, joint mobility, flexibility, coordination, and much more.

Get back to the activities that your love and schedule an appointment today!

Now offering Class IV Therapeutic Laser!

On the Go Physical Therapy proudly announces the addition of Class IV therapeutic laser that delivers advanced pain relief and enhanced tissue healing. We are very excited to offer these treatments to our clients as laser therapy is an innovative drug-free and surgery-free solution for our clients. 

High-energy laser therapy with the K-Laser P4 safely penetrates deeply into the body to diminish pain and stimulate healing. Laser therapy provides a safe solution for many peoples’ pain.

 Laser therapy works by stimulating production of cellular energy in damaged cells and by enhancing the cell membrane permeability. This promotes the speed and the quality of healing, enhances the exchange of nutrients and wastes across the cell membrane and improves elasticity of injured tissues. Laser therapy also modulates pain and reduces inflammation. It can be used immediately on acute injuries, over broken skin and over metal implants. Laser therapy enhances the rate and quality of healing of acute injuries and can help with the resolution of chronic complaints such as arthritis.

 Clients interested in knowing more can contact Travis at 781-691-4378 or visit their website at www.onthegophysicaltherapy.com.  Additional information about laser therapy can be found at www.k-laser.com.

PT Can Prevent Unnecessary Surgery

Recent research is showing that surgery might not be needed as often as we think. A large review estimates that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. The reasons for so many unneeded surgeries being performed are varied, but the most common are that more conservative options aren't tried first, or lack of knowledge by the operating physician.

Physicians undergo long and rigorous training programs to become surgeons, but if they don't work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren't any better than a placebo. Two such examples are kyphoplasty - a procedure for spinal compression fractures, and partial meniscectomy - a procedure used to treat tears of the meniscus in the knee. If a surgeon hasn't continued to learn, they won't know that these surgeries often don't offer any more benefit than a non-surgical treatment and will continue to perform them.

Every surgery, even "minor" ones carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be.

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery. Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis.

Physical therapy can't fix every problem, and for some patients surgery is the best choice. However, research is showing that surgery isn't a cure-all, and is sometimes just a very expensive and risky placebo. In most cases, starting with physical therapy is the right choice, and for many patients, PT is the only treatment necessary.