Have you ever wondered why you have done 100 crunches and sit ups
and yet your abdominal muscles still look flabby andIMG 0049 your low-back still hurts?  If so, you may have a diastasis recti. 

After delivery of a baby or after a c-section surgery this issue can occur. A diastasis recti is the separation of the rectus abdominus muscles (6-pack abs) that are situated vertically extending from the rib cage to the pubic bone.  If there is a space between the abdominal muscles greater than about two finger lengths when a person is lying on their back with their knees bent and head lifted from the floor, this could be the problem.  Additionally if a “hump” is seen in the abdomen between the “6 pack abs”, this could also indicate that a diastasis is present.  In the case of a diastasis, the connective tissue between the abdominal muscles has been lengthened and has not returned to the original length, creating limited ability to produce force with the rectus abdominal muscles.  Many abdominal exercises done in the gym could actually worsen this condition.

Diastasis recti can occur in anyone, but the chances of having a diastasis are greater in women over 33 years of age, have been pregnant or delivered multiple babies, women who have carried large babies or gained greater amounts of weight in pregnancy, and those who have had a c-section.  Individuals who have had multiple abdominal surgeries could also be at risk for this problem.



Joint Replacement 0014I think it is safe to say that many of us know of at least one or more people who have been affected by osteoarthritis resulting
 in joint replacement. Surgeons are able to replace many joints from the shoulder to the hip, knee, fingers and even joints within the toes. Technology has come a long way over the years and made joint replacements simpler and less invasive, resulting in shorter recovery period over all. However, during my short career as a clinician so far I have seen a common theme among many joint replacement patients: recovery is much harder and takes longer than anticipated.

I have heard on more than one occasion “I thought this would be a 6 week recovery,” or “I didn’t’ realize how painful this would be.”  I have even had one patient allude to the fact that their surgeon told them the recovery would be only a few weeks. The reality is that joint replacement, especially knee, hip and shoulder, are very involved surgeries and can take up to one year for full recovery.

Maybe you are reading this knowing that you are facing one of these joint replacements in the near future. My intent is not to give you doubt or make this a negative experience, but to help you enter this challenge with eyes wide open. Your surgeon may have a very good reputation and while they may perform the surgery perfectly, the body will always react to trauma the same… With swelling, inflammation and pain. But don’t worry! There are things that can be done to help! And physical therapy is an important part.

First, you will want to educate yourself before arriving for your surgery date. Often there are classes that are offered through your surgeon or the hospital that help to prepare you. I think it is important to do your own research as well. The internet is a great tool to use to understand the process of surgery itself. You may even want to find a video on Youtube (if you can stomach it) to watch whatever surgery you are about to go through. It will also be important to know what is expected of you in the 1-2 days following your procedure. For the lower extremity, many surgeons have requirements such as the ability to walk a certain distance or going up or down stairs before they will sign discharge documents.



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Bike Fitting - Make Your Ride More Enjoyable

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My first road bike was a bright yellow hand-me-down from my grandpa. At that time I was a volleyball player turned tri-athlete BikeFitout of an ambition to have something competitive to train for. I ended up really liking cycling! My passion for cycling and physical therapy led me to pursue biking fitting. It all really starts to make sense why it is so important for a bike to fit correctly. For the most part we are asymmetric individuals riding for miles on a symmetrical bike- SO many revolutions in one ride!

Finding a comfortable ride can be difficult when there are so many adjustments that can be made. One of the areas that is not as commonly addressed is how to set up your cleat position. One of the key aspects to a good bike fit is the position of the cleat/pedal interface. Steve Hogg writes “Every watt a rider produces is transferred to bike via feet on pedals and cleat position has an affect on the pattern of muscular enlistment of the legs and the quality of proprioceptive feedback to the cerebellum from all the links in the kinetic chain involved in applying force to the pedals. In turn this can affect performance, propensity to injury and recovery time.”(Bicycling Australia, September/October 2008 “Footloose!”). When looking at the position of the cleat/peddle interface fore/aft, rotational, and medial/lateral adjustments can be made. We also look at correcting for varus in the forefoot with wedges to create an even distribution across the weight-bearing area of the peddle. Your cleat position affects the alignment of your knee and hip, so getting it right is important.

In addition to the foot/peddle interface an optimal position of your saddle can keep certain stresses off from your knee and help make sure the major players: gluteals, hamstrings and quadriceps, are all contributing to propulsion of the bike.

Another area addressed in properly fitting a bike is looking at the stem. While riding you want your upper body to be comfortable and not feel like you are over-reaching or more upright than you want to be for aerodynamics.

A ride is truly enjoyable when you can focus on your training goals or enjoy the scenery around and not which joint you are feeling pain in.

Additional resources:

http://www.apta.org/Media/Releases/Consumer/2009/5/13/



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TMD...What Causes It?

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How many bones in the human body have teeth at the end? Two...the mandible, the lower part of your jaw, contains the lower teeth which move up and down to make contact with the stationary upper teeth contained by the maxilla. The temporomandibular joint (TMJ) is made up of the junction between the mandible and temporal region of the skull. Teeth make the functions of the temporomandibular joint unique in the human body, as it has an integral part in many functional tasks such as eating and talking. Functions of the TMJ that do not include eating and talking are considered oral parafunctional activities. Excessive oral parafunctional activities are among factors which commonly lead to temporomandibular dysfunction (TMD). TMD symptoms can often be alleviated with the help of physical therapy.

Grinding of teeth, known as bruxism, is a common occurrence during sleep and/or waking hours. Bruxism requires active muscular contraction of the masticatory muscles, which compresses the teeth and loads the TMJ.  What happens when you hold a baby in one arm without moving for a few minutes? The muscles from your back down to your hand and the joints in between get sore! Apply this analogy to our jaw and you get the idea of how bruxism can lead to jaw pain, facial soreness, and even headaches.  Other common parafunctional habits which create mechanical stress to the TMJ include chewing bubble gum, nails, ice, etc. Recognizing and reducing or eliminating these repetitive stresses on the TMJ and masticatory muscles can significantly reduce strain and associated symptoms of the joint and soft tissues. 



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