Sitting while on a road trip riding in a car or airplane for extended periods of time can leave your body stuck in one position...but we are made for movement! These long trips confine us to our seats often leaving us with cricks, creaks, aches, and pains at the end. Then, to add insult to injury, when we finally reach our destination we have to unload the luggage and explore. Ouch!
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Here are a few strategies to help minimize your road trip pains:

• Bring a small pillow or a rolled up towel and use them to support your back. Shift the position of the pillow or towel to alter the pressure on your back. Be sure to adjust the seat position occasionally to redistribute your weight during the trip.
• Keep your muscles active by:
  • Squeezing your “cheeks” to tighten your glute muscles. Hold for 5-10 seconds.
  • Pulling your navel in towards your spine to tighten your abs. Hold for 5-10 seconds.
  • Sitting tall stretching the back of your neck towards the headrest. Hold for 5-10 seconds.
• Prolonged sitting will inevitably make your muscles feel tight. Take time to stretch when you pull over at the next rest stop by performing the following stretches:

To help avoid neck and shoulder pain, you should be able to perform a wall angel.  This especially goes for lifting weights, swimming, painting, reaching overhead, etc.

Not only are strong shoulders important but proper shoulder, upper back, and neck range of motion (ROM) is key.

Look no further than the Wall Angel to test (and as an exercise):

Lay up against a wall with your feel about 6 inches away and knees slightly bent.  Your butt, back and head should all be able to touch.  Next, place your elbows up to 90 degrees with your forearms and hands touching the wall.  This is no easy feat folks.  You can see even when I do it, my wrist comes off of the wall and I cheat by bending my hand back to touch the wall.

There are MANY ways to compensate and cheat.  Here are the more common ones.

THE EXERCISE
If you are able to have good form, like the top pic, the exercise is to just bring your elbows down and back up, like a snow angel! Perform 3 sets of 10 with each rep taking 3-5 seconds.  This will help strengthen muscles in your back and shoulders and assist with good posture.

You shouldn't have to strain too much to get into this position.  If you are, then there is probably some limitation in your neck, back, and/or shoulders that is preventing you from getting there.  We can certainly help!

​If you have questions, please feel free to contact me at dominick@sanramonvalleypt.com.

Having good balance is extremely important. It allows us to walk faster and decreases are chances of falling, limiting potential injuries.

What balance exercises are you doing??

Here are a few of my favorites:

1. Single Leg Balance with a twist
2. Stair Taps
3. Leg Swings 

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Single leg Balance
This one is obvious but if your balance is poor, standing on one leg is a challenge.  So we need to dumb down the exercise so we are SUCCESSFUL.  Introduce the kickstand! 

Hold for 30 sec for 3-6 times.

Stair Taps
AKA "march holds."  Start standing feet shoulder width apart in front of a step.  Slowly, with control, tap the top of the step then return your foot to the starting position.  Each movement should take 3-5 seconds...that's how much control is needed!

Too difficult? Instead of tapping the top of the step, allow the foot to settle on the step for a 2-5 seconds while you regain your balance then return your foot to the original position.

10 taps per side; 2-3 reps.

Leg Swings

Pretty self explanatory! But make it so you are successful!! If you need the help of a counter, but a finger or two down for a little help.  The swinging leg can be front to back or side to side.  10 swings each leg for 2-3 sets.

Hopefully these simple exercises can improve your balance and make you feel more confident moving around.  There's so many great activities that you should be participating in, especially this time of year with friend and family.  Don't 

Let me know if you have questions.
dominick@sanramonvalleypt.com

47% of adolescents aged 15 years old in a recent multinational study reported having experienced back pain – much more common than you would think. Despite being a common condition among children, adolescents and adults, the etiology of back pain in children and adolescents is unknown. One of the most commonly cited causes of low back pain is loading/biomechanical factors, such as the amount of exercise one does, common physical tasks and the equipment used to complete them. Recently, groups like the American Academy of Pediatrics and The American Occupational Therapy Association have recommended that school bag weight not exceed 10 to 15% of the child’s body weight, otherwise they are at greater risk of low back pain..  

When kids and adolescents carry around large books and equipment (particularly into high school), it’s not a stretch to think that backpacks are a potential contributing factor to back pain. When I was in high school, my mum paid all this money for a fancy ergonomically designed backpack to carry all my school equipment. The argument was that with a properly designed backpack, my small 13-year-old spine could handle carrying my school gear around without any excess strain on my back. But this wasn’t necessarily true, many days I came home with a sore lower back from the very back pack that was ‘designed’ to prevent it. 

Recent research on the matter seems to support the ‘hunch’ I had as a 13-year-old. In a recent review in 2018 of 69 studies with over 72 thousand participants in total, showed no convincing evidence that aspects of schoolbag use increase the risk of back pain in children and adolescents (1). Despite the assertions of various guidelines and statements that endorse specific weight limits and metrics for schoolbags – there appears to be no clear association between schoolbag (weight, size, design & method of carrying) characteristics and back in in children and adolescents.

Schoolbag use just does not appear to be an important risk factor for back pain in children and adolescents. However, like all things in science, nothing is certain, and due to the lack of quality data and research into schoolbag size, weight, use etc – the authors of the paper remarked that the conclusion should be taken with ‘a grain of salt’, with more higher quality research needed to confirm the findings.

But surely carry a backpack long enough and anyone is bound to feel a strain in their back? The only factor around schoolbag characteristics and use that was related to pain in the research was the perception of heaviness of the bag – but not the actual weight of the bag. This finding has interesting potential implications – depending on how you interpret it. I personally expect the difference to be associated with the level of capacity of the student to hold their backpack (arm and back strength, endurance etc), which then affects their perception of how heavy the bag is. All conjecture though. 
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The authors of the review concluded that various professional bodies and clinicians that endorse or recommend specific backpacks do so without any good scientific evidence behind them. They aptly reaffirmed that It is important that such endorsements are made on the basis of firm evidence and free of financial conflict.   So, when you next go to purchase a backpack for your child at school, worry less about the ergonomics – it doesn’t matter.  

This article was written by Oliver Crossley at POGO Physiotherapy in Australia.

"Whole body immersion cryotherapy (WBC) has become very popular in the last few years.  Like all things that become trendy in the public realm, it is associated with all sorts of sales.  Or as some call it…benefits.  Some of these “benefits” have been: decreased soreness, improves mood, lessens depression, boosts immune system, stops the flu, activates regeneration, treats autoimmune disorders, reduces pain, increases collagen production for better skin, reduces cellulite, and decreases body fat.  I haven’t done an a ton of research on WBC.  But it seems you can support your preference either way.  So for me, it’s not something I recommend or have a strong opinion on.  As long as it’s administered safely, I see it as an n=1 situation."

I couldn't agree more with the above from Aaron Swanson's take on cryotherapy, especially his last line.

I have friends and patients who like going to US Cryotherapy in Danville/San Ramon.  Check them out!

There is something you don't hear every day....but it is true!

A study in Spine Journal looked at low back CT or MRI images of 3110 ASYMPTOMATIC (no back pain) people from 20 to over 80 years old and found (among other things):

• The prevalence of disk degeneration (arthritis) increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals
• Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age.
• Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years in age.

Here is the chart by age and percentage, from the study:

Your diagnosis does not always hinder your movement!! You can restore normal movement and participate in life WITH all these scary diagnoses.

If you have questions, we're always here!

Dominick
dominick@sanramonvalleypt.com

Insomnia has been shown to increase pain. It can be a difficult situation for patients who find it difficult to get to sleep because they are in pain, and then their pain is exacerbated because they are unable to sleep. Sleep deprivation in healthy individuals can even bring on whole body symptoms of fibromyalgia and can decrease descending inhibition (pain is more sensitized) (Choy, E 2015).

Sleep is a very hot topic at the moment, and understandably so. With technology at our fingertips and people being more wired than ever, sleeping less than 8 hours per night is becoming the norm. Unfortunately this is not at the benefit of our health.

A population who definitely understands the struggle of sleep is parents. Some new parents may not get more than an hour or two of sleep per night for the first 1-2 years – maybe longer. There could potentially be nothing more annoying than a new parent coming in to see their physiotherapist for back pain or neck pain – and being told that a large contributing factor for their pain is lack of sleep. News flash – they are aware they are getting less sleep. Something that may be more realistic is to acknowledge that the lack of sleep may increase feelings of pain, and not to panic about this. It is less likely that you have a structural issue going on, and more that you have some hypersensitivity due to lack of sleep. Sleep may not be the easiest thing to change, but things you can change is trying to fit in 5 minutes of exercise per day, drinking enough water and using a heat pack. Then when you do get some better sleep – you will probably feel a million dollars!
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Another population that comes into mind is people who are unable to sleep because of their pain. They end up in a vicious cycle because their pain makes it difficult to get comfortable, every time they roll over they wake up in pain, then they get less good quality sleep, and then their pain increases because that have not had good sleep. Some things that can help people get to sleep include:

• Use a heat pack when you go to sleep
• Apply some Fisiocreme (similar to BenGay, IceHot) on sore areas before going to sleep
• Try sleeping with a pillow between your knees, under your knees, or hugging the pillow
• Do not worry about what position you sleep in, find one that is comfortable for you

This article was written by Emily Georgopolous, who is a physical therapist at POGO in Brisbane, Australia.

It's pretty amazing.  I see tons of people with knee pain and I consistently notice decrease calf size (atrophy) of the involved leg.  Can you guess which knee is bothering the gentleman above? Patients don't believe me, so I have collected all these pictures of people's calves.  These are a few since March 2019.  Check them out:

The exercise to help??? Simple!! Calf raises but with a few important rules to follow:

1. Use a step or stair; something with a drop off
2. Explore the ENTIRE motion; let the heel drop down then go all the way up as high as you can on your toes
3. Do 10 single leg. Then 10 both legs.  Repeat 3 times.

​You may be sore the next day, but that will subside.  You should notice more stability and strength in the knee with it being easier going up/down stairs and walking a bit faster.

If you have any questions, please give me a holler!

Enjoy your weekend!
​Dominick

While running across the lifespan can help to slow the rate of decline of cardiovascular capacity and strength, as a runner enters the masters years they will experience an inevitable and unavoidable progressive decline physiologically, biomechanically and also in performance.

Here are 5 tips to help the runner who is looking to stave active:
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1. KEEP RUNNING! Running across the lifespan has been shown to add years to runner’s lifespan compared with non runners
2. STRENGTHEN YOUR CALVES! Between 20 & 60 yrs, runners will experience approximately 1/3 reduction in power generated at the calf when running...and your calves 
3. CHANGE UP YOUR SPEEDS!  It’s important to not get stuck in the ‘mid & comfortable running pace’ rut. Running at speed can assist with building tissue tolerance and running body resilience-which may be injury protective (when done with wisdom)
4. STRENGTH TRAINING! From 20-80yrs 30% of muscle mass is lost- resistance training can help to offset and even reverse this change .
5. MIX UP INTENSITIES! Adopting a hard: easy approach can assist with optimizing tissue health, thereby assisting with the development of a chronic training base while not being interrupted through injury 

TAKE HOME: By adding even just one of the above tips you may assist your running (P.S. Still very helpful also for runners sub 40yrs) 👍🏻

​Brad Beer, a physical therapist and owner of POGO Physio in Australia, wrote the following post.  He has tons of great information on his blog and Instagram.  Follow him @brad_beer