Avoiding Injury as We Return to Activity

Photo by samer daboul on Pexels.com

By Mandie Martuzzo, PT
Board-Certified Clinical Specialist Orthopedic Physical Therapy

During the stay-at-home period, we have all been much less active than we are used to. Even if we have made an effort to exercise, we are still engaging in much less daily activity than normal. Going to work, walking around, running errands, all add physical activity to our days.

Tissue responds to stress placed on it. So, less stress on the tissue (e.g. inactivity) can lead to muscle atrophy or decreased strength in muscles and tendons and decreased bone density.  Decreased physical activity can also reduce the motor recruitment of muscle fibers, meaning it takes more effort to turn the muscle on than it did before.

Alternately, physical activity and exercise will increase circulation around muscle fibers, allowing more oxygen and greater muscle performance during endurance training. Resistance exercise increases muscle fibers (e.g. muscle mass and strength). Tendons also become stronger to prevent tendon damage, as the force produced by muscles is transferred to tendons that attach the muscle to bone.

Keeping in mind the importance of loading on muscle and tendons and the effects that it can have, it is important that we cautiously return to our normal activity and exercise so we can avoid strain and sprain injuries.

If done improperly, resistance training can lead to overuse injuries of the muscle, tendon, or bone. These injuries can occur if the load is too heavy or if the muscles are not given sufficient time between workouts to recover or if joints are not aligned properly during the exercises. It is also common for an injury to occur when there is a sudden increase in duration, intensity, or frequency of an activity. (American Academy of Orthopedic Surgeons. Available from: orthoinfo.aaos.org. Accessed 26 February 2019).

muscle strain occurs when muscle fibers cannot cope with the demands placed on them by exercise overload and leads to tearing of the fibers. It is a contraction-induced injury in which muscle fibers tear due to extensive mechanical stress. This mostly occurs as result of a powerful eccentric contraction or over stretching of the muscle. Therefore, muscle strains typically occur during non-contact sports with dynamic characteristics, such as sprinting and jumping. (Garrett WE. Muscle strain injuries. Am J Sports Med. 1996; 24:S2-88)

Some considerations or things to keep in mind as you increase your activity levels to prevent injury include:

* Heart rate variability and fitness level: Training too hard/too fast can lead to muscle injury. Monitor your heart rate and how quickly your heart rate lowers from 125 bpm after intense exercise. How fast your resting heart rate climbs and then lowers after activity is a good indication of your current cardiovascular performance. Then you can ensure that you are working out at an intensity level that is within a moderate range.

* Eccentric strengthening: This type of exercise trains your muscles to maintain strength and tension while they are lengthening. This helps prevent tears, which often occur when a muscle suddenly elongates and must absorb a high amount of force.

* Vitamin-D can impact muscle strength/performance, and deficiency can cause premature muscle fatigue leading to injury. If you think you may have low Vitamin-D levels, check with your doctor and get recommendations for a supplement if needed. (https://www.hindawi.com/journals/bmri/2015/953241/)

* Warm up before and stretch after: A short period of warm up activity prior to exercise will help to prevent an injury. Save the stretching for after exercise to help reduce chemical build-up in the muscles and reduce soreness.

* Consider a Wellness360 exam with a physical therapist. PhysioPartners offers the Wellness360 Annual Exam for an evaluation of strength, mobility, and function that can help find areas where you can improve to avoid injury.

Your physical therapist is here to keep you moving and return to your life with confidence!

Get Physical Therapy First During the COVID-19 Pandemic

annual_musculoskeletal_examBecause of the closures of physician’s offices, stoppages of elective surgeries, and social distancing guidelines resulting from COVID-19, many people with pain or joint issues have had appointments or surgeries delayed. If you’re one of them, and you haven’t seen your physical therapist yet, you should. Here are some reasons why:

Early Physical Therapy Leads to Better Outcomes

Studies have shown that people who receive physical therapist care sooner have better outcomes, lower costs, are less likely to have surgery, use opioids or have unnecessary testing. Because back pain is so common, there is a lot of outcome data from people with back pain. A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit. Unfortunately, only 2% of people with back pain start with physical therapy, and only 7% see a physical therapist within 90 days.

Early Physical Therapy Saves Money

The rising cost of healthcare is well known and early physical therapy is something that has been shown to reduce costs without reducing the effectiveness of treatment. A study published in the Journal of Orthopaedic and Sports Physical Therapy showed that patients who obtained physical therapy via direct access had significantly lower medical costs—an average of $1,543 less per patient than those who chose referral from a physician. They also had significantly fewer visits and spent significantly fewer days in care.

Surgery May Not Be as Effective as You Think

Many patients look to surgery as the fix for their pain, but surgeries are not always as effective as patients believe. A large study looking at worker’s compensation patients with back pain found that people who have surgery have a 1 in 4 chance of having a repeat surgery, a 1 in 3 chance of a major complication, and a 1 in 3 chance of never returning to work again. Recent large studies of arthroscopic surgeries for meniscal tears have shown no difference in outcomes between people who have surgery and those who don’t. Other procedures with questionable effectiveness include kyphoplasty, vertebroplasty, and injections for nonspecific back pain.

So, if you were planning on seeing your primary care physician or a specialist for an orthopedic condition or pain and you have not seen a physical therapist yet, you should consider making physical therapy your first stop. You could end up getting better faster for less money and you might avoid riskier treatments like opioids or surgery.

Request an in-person or Telehealth appointment with one of our physical therapists today! 

How Much Physical Activity Do Older Adults Need?

Aging AthleteMost people know that physical activity is important. In fact, not getting enough has been linked to illnesses like heart disease, stroke, diabetes, Alzheimer’s, high blood pressure and lung disease. So, the important question is not if you need to be doing some form of physical activity to protect against diseases like these, but how much is enough?

The US Department of Health and Human Services answered that question for us in 2008 with their recommendations for physical activity. To improve or maintain health, adults over 65 need to do two types of physical activity: Aerobic Exercise and Strengthening.

Aerobic Exercise

To meet the recommendations for aerobic exercise you should be active daily and perform your aerobic activity for at least 10 minutes at a time. Each week you should aim for

  • 150 minutes of moderate intensity activity


  • 75 minutes of vigorous intensity activity.

The general rule is that 1 minute of vigorous activity is equal to 2 minutes of moderate intensity activity, so a combination of moderate and vigorous activity can also be used to satisfy the recommended 150 minutes each week.

Some examples of moderate intensity aerobic activity that can be done during the current COVID-19 crises:

  • Walking
  • Riding a bike on a level surface
  • Gardening

Vigorous intensity activities include:

  • Running or jogging
  • Riding a bike fast, or on hills
  • Singles tennis
  • Hiking uphill


Muscle strength is important for all daily movement, and in older adults it can help to maintain strong bones, as well as reduce the risk of falling. The recommendation for strengthening is to work each major muscle group twice a week.

Examples of strengthening activities include:

  • Carrying heavy loads
  • Lifting weights
  • Exercises using your own body weight like push-ups, sit ups, or squats

For each exercise you should try to perform:

  • At least one set
  • 8 to 12 repetitions in each set

Your resistance should be heavy enough that the last repetition is hard to complete.

These guidelines are general recommendations and do not consider previous injuries, medical conditions, or limitations that individuals may have. Your physical therapist is an expert in exercise and physical activity who can help design a program to maintain or improve your health while considering your past medical history, limitations, and goals. Your physical therapist can teach you safe exercise technique, and help you safely progress your program as you get fitter to continue making improvements in your overall health.

Physical Activities for Parents & Kids!

selective focus photography of three disney princesses figurines on brown surface

COVID-19 has eliminated the question of what stay-at-home moms/dads do forever! Now the bigger problem emerges:  How do they fit in the daily physical activities their children desperately need? Public resources such as playgrounds and parks are no longer safe, so the need to get creative for home activities is in high demand.

Running, jumping, and active movement is important for a child’s health because it reduces weight, increases muscle strength, improves bone density, and stimulates attention in school. The improvement in concentration is even more valuable as parents take on the role of the teacher as they now homeschool their children.

In order to remove another obstacle for parents to solve, here is a list of resources that will promote healthy, engaging, and entertaining physical activities that can be done in the home.


  • Fairytale Physical Therapy Dance Along


This company teaches online dances (that are secretly composed of therapeutic exercises) to some of the most popular songs amongst children. Want to learn a dance to “Let It Go” or “Kiss the Girl”? They have it! You can even play that part of the movie for your child to practice the dance as a reward for participating.

Resource: https://www.youtube.com/watch?v=TlqdErkox8g&list=PL7taw2nYgJPNqMUkgceZh9SYlx6CoPit8


  • Explore Nutrition and Physical Activity


LearntobeHealthy.org is an online health science learning site designed to help parents communicate important health concepts to their children in grades PreK-12. The site contains comprehensive lesson plans, interactive games and activities, Webquests, assessments, an individualized Health Log and more. The goal of the site is to inspire children and their families to make healthy choices that may last a lifetime.

Resource: www.learntobehealthy.org/kid


  • Little Sports


Little Sports is a youtube channel that provides entertaining workouts led by cartoons! These are 15 to 20 minute follow-along workouts that are great for challenging your child’s attention span and getting the blood flowing throughout their bodies. This is a great activity to utilize in place of running around the playground.

Resource: https://www.youtube.com/channel/UCTIwFB4ciFi5ZCIu-VlwaOg


  • Get Moving with Disney Family


Is your child a Disney fan? Get Moving with Disney Family is a great activity where your child gets to do healthy movements inspired by some cherished Disney movies such as Mulan, The Jungle Book, The Incredibles, and more! This is a wonderful activity to get the whole family moving together.

As parents keep their children safe at home, including healthy physical activities is extremely valuable. If you are unsure if the physical activities are safe for you child, check with a physical therapist to clear your child for participation. Every child needs daily physical activity to continue to grow and mature healthfully!

Physical Therapy During Quarantine: How to Manage Your Physical Health

The pandemic has changed the way many of us go about daily personal, social and work routines. The Center for Disease Control recommends social distancing, and depending on where you live you may have lost access to in-person visits with your physical therapist. While our daily lives have changed, good physical health should remain a priority and your physical therapist can help you stay on track with the following guidelines.

  1. To not regress, stay in touch with your physical therapist and continue with the home exercise programs that you and your physical therapist have discussed. This way, you can pick up again where you left off when access to your physical therapist returns.
  2. Many physical therapy offices are using telehealth services. This allows you to have access to your physical therapist from the comfort of your own home and with decreased risk of exposure to the coronavirus. Video conferencing or even checking in with your physical therapist via telephone on a weekly basis will make sure you stay on track and your home exercise program is adjusted based on your status.
  3. Many people have been asked to work from home. You may have to adjust to a new workstation which is not set up the same as your desk at the office. Poor ergonomics can lead to decreased productivity, decreased motivation to work and increased neck pain, low back pain or shoulder pain. Making sure your computer and desk chair are set up at the right height are initial adjustments your physical therapist can help you with. Neck and upper back exercises such as chin tucks and rows can help you offset pain created by poor posture.  Our occupational therapist is available for virtual ergonomics assessments of your home work station.
  4. Due to social distancing and many health clubs temporarily closing their doors, you may feel lost with your daily exercise routine. By contacting your physical therapist, he or she can provide recommendations to keep up with your health goals or just to stay active.
  • Walking: Walking 30 minutes a day, 3 times a week has been shown to improve cardiovascular endurance, reduce blood pressure and weight.
  • Physical activities you enjoy: Exercise causes the brain to release chemicals that can lead to a feeling of accomplishment and relaxation. Research shows exercise can be very effective in the treatment of depression and elevating your mood. In addition, exercise can boost your immune system.
  • Eight minutes of strength training per day can lead to many health benefits and can all be done without any equipment. Always check with your physical therapist if these exercises are right for you. A routine could consist of planks, pushups, the bridge, lunges, heel raises and squatting.

Staying active during these uncertain times is important. Exercising will help improve your mood and stress from the pandemic. Your physical therapist can help you enhance an exercise routine with creative exercises to keep you engaged and excited.

8 Minutes a Day!

photo of woman doing yoga

Photo by Li Sun on Pexels.com

You know that exercise is important for your health. It helps you feel better physically, gives you energy, and helps you deal with the stress of your busy life.

But what do you do when your life suddenly changes! Quarantine, social distancing and the closing of gyms!

It’s easy to start skipping exercise, but this may lead to less energy and aches and pains cropping up. This makes you feel like exercising even less and leads to a downward spiral. That means that committing to exercise, even during challenging times, will ultimately have long term benefits.

Exercise does not need to take lots of time. In fact, your 8 minutes do not even have to be completed in the same session!  You can break up your minutes throughout the day. Doing one exercise for one minute every hour while working counts just as much as doing 8 minutes of exercise after the kids are in bed. The following exercises use your body weight for resistance, so you do not need any equipment. They also use many muscle groups at once so you can maintain strength in your whole body in a short amount of time.

  1. The Plank: Lying on y:our stomach, with your forearms on the ground, elbows under the shoulders, and arms parallel to the body. Toes tucked under, engage your stomach muscles and lift your body up. Hold for 20 seconds, rest 5 seconds, and repeat 3 times.
  2. Push Up: (do on your knees if you need an easier version). 20 seconds of push ups, 10 seconds of rest and repeat.
  3. Bird-Dog:  Start on your hands and knees with your hands under your shoulders, and your knees under your hips. Lift and reach with one arm and the opposite leg, maintaining a stable core. Hold 10 seconds and repeat on opposite side. Repeat 5 times.
  4. Bridge: Lying on back, with your knees bent, engage your abdominals and lift your hips. Hold 20 seconds, rest 5 seconds, and repeat 3 times.  If this is too easy, try lifting your hips using only one leg for support.  Alternate legs.
  5. Lunge: Stand tall and take a large step forward with the right leg, shifting your weight forward. Lower your body until the right thigh is parallel to floor and your right shin is vertical. (do not let the knee shift past right toe). Return to the start and repeat on the other side. Repeat 20 times.
  6. Squat to Heel Raise: Start with feet shoulder width apart, core engaged, and arms raised high above the head. Perform a squat and return to standing then rise onto your toes. Repeat 20 times.

You never knew 8 minutes could go so quickly or be so effective!  Happy quarantine exercising!

Telecommuting a Pain? Simple Strategies for Improved Work-at-Home Ergonomics

neck-painBy Caitlin Smith, MS, OTR/L, ODT
Covid-19 has made working from home the new reality for many Americans. Many employees who are new to telecommuting may find staying productive and comfortable a struggle.  While many companies provide ergonomic equipment in the workplace, most employees do not have the access to the same supportive seating or adjustable monitors at home. For those who will only be temporarily working from home, there is less of an incentive to invest in expensive home office equipment. The good news is that there are many adjustments you can make to your home work setup and routine to help prevent musculoskeletal injuries and pain, without needing to purchase an expensive chair.
1. Be aware of your home habits. Many of us are guilty of spending our day practicing good posture in the workplace, only to go home and spend hours hunched over our phone. While this may not have bothered you before, these bad habits may have more of an impact now that home is the new workplace.
First, notice your posture while you are working from home. Did spending the day lounging with your laptop on your stomach leave you aching? Try to find different spots to work from, such as a countertop to provide a makeshift standing desk and a table to provide a more supportive seated position. Are you checking your phone constantly? Try leaving it in another room when you need to focus. Sharing a workspace with other household members? Consider earplugs or noise canceling headphones.
2. Let the pain be your guide. Next, take a moment to notice where you are feeling any discomfort or pain. Is your neck aching? Check the height of your laptop or screen. Try propping your laptop on a thick book or three ring binder to minimize craning your neck downward while reading on the screen or during a Zoom meeting, and switch back to the surface when performing typing-intensive tasks.  Is your low back fatigued? Try positioning a towel roll or small pillow for some lumbar support. Or better yet, switch to a new position.
3. Develop a routine to alternate positions. While it might be tempting to work from your couch all day, your body will thank you if you develop a routine and alternate between work spots throughout the day. While your couch may be comfy, you are also more likely to lounge and not take breaks to move or switch positions. Instead, move to a new spot and vary between sitting and standing. However, if you are eyeing your bed as a good lounging spot to read through some work documents, think again. This can train your brain to be more alert when in bed, which is not conducive to a good night’s sleep! Practice good sleep hygiene and keep the bed reserved for sleeping.
4. Take breaks and make them count. Make sure you are still taking regular breaks and set a timer to remind yourself if needed. Our bodies are meant to move and change positions, which is not happening as much with stay at home policies. If you can safely leave the house for a short walk do so, if not take a couple laps indoors. Alternate walking with stretching or yoga poses. Consider adding regular meditation or mindfulness practice to your routine as well. These are stressful times for all of us, and proactively finding strategies to help manage that stress can help increase your focus and productivity with work tasks, and better yet–increase your overall well being!

Dr. Caitlin Smith is a licensed occupational therapist and is available for virtual ergonomic consultations during the Stay-at-Home period.  Email her at caitlinsmith@physiopartners.com for more information or to schedule.


Are Your Workouts Giving You What You Want?


How much thought have you put into the exercises you will use for your next workout?  Did you choose them yourself, or did you find them on the Internet or in a magazine? What’s your workout designed for? Do those goals match yours? Are the exercises even safe for you?

Using the wrong program can lead to wasting time in the gym, frustration, plateaus in progress and injury. Let’s take a closer look at what goes into program design and the costs of getting it wrong.

Exercise Selection
There are many things to think about when choosing specific exercises. Machine vs. free
weights, isolation vs. compound lifts, number of reps and sets, etc. Each one of these factors affects the results, so making the wrong choices could lead to wasting time working on the wrong things, limit your results or lead to injury.

If you choose the right exercises, but don’t know how to do them properly you will again limit your results, or worse, end up injured. Poor technique leads to inefficient movement and limits the power your muscles can generate. It also changes the load on your muscles, joints, and ligaments which can lead to pain and injury.

Volume is a way of thinking about how much work you’re doing during a workout. Doing a few reps with a heavy weight or a lot of reps with a light weight could end up being the same volume. Same goes for running a shorter distance quickly uphill versus a longer run at a slower pace on flat terrain. If your volume is too great, you won’t recover well between workouts and create the possibility of injury. Too little volume and you won’t see results.

If you’ve been doing the same exercises with the same weight and the same number of reps and sets, you’re not progressing. Same goes if you jump on the treadmill for the same amount of time with the same settings each time. To make progress, things have to change and the program that works for your first 6 months won’t work for you 2 years down the road.

Designing an exercise program is a complex challenge with a lot of factors to consider. Most people have a history of injuries to consider and don’t have perfect movement in every joint, which further complicates the process. If you’re not making progress or just want to make sure your workouts are as effective as they can be, have your physical therapist take a look at your program. Your physical therapist can help design an individualized program to help you reach your goals while keeping you safe
and injury-free!

Fitness with a Side of Dysfunction?

image-assetThis time of year, many people are focused on fitness so it’s worth taking a look at what “fitness” really means. The dictionary defines fit as “sound physically and mentally, healthy.” Using that definition, many “fitness” routines fall short of the goal. If you don’t enjoy running and dread every workout, you’re probably falling short of the “sound mentally” portion. Exercise should be enjoyable, reduce stress, and leave you feeling better, not worse.

No Pain, No Gain?
Exercise should also leave you feeling better physically. If you can run a good time in a 5k, but have aches and pains for days after, you’re not “sound physically.” If you are increasing your PR in the squat rack, but your joint pain is increasing right along with it, you’re not “sound physically” either. Sure, some muscle soreness and fatigue after a hard workout is normal. But if you’re having pain that doesn’t go away, sore joints, or trouble moving after exercise, you’re probably developing movement dysfunction along with your fitness.

Movement Dysfunction
Go back to the dictionary and you’ll find that dysfunction is “impaired or abnormal functioning.” So movement dysfunction is impaired or abnormal movement. When someone has a movement problem like a sore joint, limited range of motion, or strength loss the brain finds a way to get the body to do what it wants. That usually means moving in a way that is less than optimal. For a while, it works. But eventually it leads to injury. As a concrete example, think of someone who has trouble bending one knee doing squats. When one knee bends further than the other, it will cause one side of the pelvis to drop lower than the other. Now that the pelvis isn’t level, the spine bends towards the high side to stay balanced. When that one side of the pelvis drops lower than the other one, it also usually rotates. Now the spine has to bend to the side and twist to keep you upright. This works for a while, but as weight gets added to the squat, and the
repetitions add up so does the risk for a back injury.

Preventative Medicine
Pain during workouts, or pain and soreness that don’t go away after can be warning signs of a movement dysfunction. If you’re experiencing any of these, your physical therapist is a movement expert who can help. PTs are trained to analyze movement, and figure out the root cause of problems. They can then design a program to treat the cause and correct the abnormal pattern. There is no need to wait until you’re injured to see your physical therapist. In fact, it’s preferable not to. Getting minor problems fixed early means fewer visits to the PT, less pain, and not having your workouts put on hold by injury!

Schedule a Wellness360 visit today or keep an eye out for new urgent care and express treatment plans, coming soon!

Start Your Year With a Wellness 360 Physical Therapist Visit


Your car needs regular maintenance, so you probably have a mechanic. Your eyes and teeth are important, so you see your optometrist and dentist regularly. You get an annual physical from your family physician. You might even be getting ready to see your accountant to get your yearly income tax done. What about your physical therapist? Do you and your family have one?

If not, you should! Your body is a lot like your car. It’s got multiple systems, all of which are complex, and all of which have to be working well for it to function. Physical therapists are experts in maintaining, diagnosing, and treating the movement system. Like the braking or ignition system in a car, most people only think of the movement system when it’s not working the way it should.

Don’t Neglect Your Movement System
Similar to the systems in your car, problems with your movement system are much easier to deal with if they’re caught and treated early. This prevents small issues from becoming larger ones. For example, if you have a little bit of weakness, and balance that’s not quite up to par, improving those early could prevent a sprained ankle, or a fall and a broken wrist.

An annual movement screen from your physical therapist can find small issues that you may not have noticed with your strength, balance, flexibility, or coordination. Many of these minor issues can be fixed with a few exercises at home, or with just a few visits.

What to Expect
A screen of your movement system is quick and easy. Your annual visit may include:
● A history of your injuries, as well as a health history
● Assessment of your strength, balance, flexibility, and posture
● A review of your movement goals (do you want to run a marathon? Get on and off the
floor easily when playing with your grandkids?)
● A review and update of your exercise program

Schedule your Wellness 360 Physical Therapist visit today!