We help our community live life with confidence by providing accessible and targeted physical and occupational therapist treatment options to address the source of the problem and wellness services to guide our patients to their greatest health potential.
A high-pitched ringing sound. A low rumbling. Echoing. “EEEEEEE”. “Choo-Choo”. Tinnitus comes with a variety of sounds. It can range from an annoyance to preventing people from sleeping to “Satan couldn’t make a better punishment.” Whatever it sounds like, it’s a phantom sound that can be heard only by you in one or both ears.
Many people experiencing tinnitus ask us “what causes this (tinnitus)?” and like we all dreaded in school, the answer is: “it depends”. Tinnitus can generate from trigger points (muscle knots) in the sternocleidomastoid (SCM) or masseter, which are muscles in the face and neck. Tinnitus also can be associated with clenching/temporomandibular dysfunction, hearing damage, or overactivation of the trigeminal nerve. It could be a side effect of medications or sometimes there is no reason at all.
Because tinnitus has such a variety of causes, it can be tricky to treat. I always tell patients that tinnitus is fickle and that what works for one person may not work for another and what is not effective for the two of them may work for a third person. Some people will see great results, some will experience decreased volume, and sadly some will not experience any improvement.
With that in mind, one of the best things you can do to reduce the ringing or rumbling is to optimize your posture. When the head is forward, the masseter and SCM muscles are under more stress, as well as all the surrounding structures. Demonstrating good posture means ears over shoulders, shoulders over hips, and tongue up on the roof of the mouth. This has the added benefit of reducing neck and low back pain and makes you taller.
Self massage can also help with knots in the SCM and masseter that may be contributing to tinnitus. You can help reduce tension in the masseter by grasping the cheek muscle and holding for 20 to 30 seconds. Repeated several times over the span of a couple days, you might be amazed at how much they loosen up. A physical therapist specializing in craniofacial conditions can help release these muscles and others that may be problematic in tinnitus. More information about our specialized tinnitus treatments is available on our website.
Tinnitus can be a stickler, but you will never know if you can get peace and quiet unless you try!
Dr. Carl Wharam is a physical therapist specializing in craniofacial conditions at PhysioPartners’ Renaissance CranioFacial Group. You may schedule a consultation with Dr. Wharam by calling (773) 665-9950.
By Mandie Martuzzo, PT, and Maureen O’Connell, PT, DPT
We were saddened to hear of Brooke Shields recent femur fracture on Instagram. Femur fractures can be located in one of three portions of the bone, the proximal femur (upper portion), femoral shaft (middle portion) and the distal femur (lower portion). Because the femur is the longest bone in the body, most fractures are results from high force trauma, such as motor vehicle accident or a fall. Femur fracture following fall is more likely to occur in patients over 65 years of age.
Most femur fractures require surgical fixation in the form of Open Reduction Internal Fixation (ORIF). A reduction refers to realigning the bone to allow for proper healing. The internal fixation hardware, such as screws, plates and rods, will keep the bone fragments in alignment as the bone heals. All patients will require significant rehabilitation following femur fracture due to the weightbearing demand of the longest bone in the body and the period of immobilization required following treatment.
What Will Brooke Shields Rehabilitation Be Like?
As demonstrated on her Instagram video, Brooke Shields has been taught how to walk with crutches while estimating the amount of weight she is putting through her injured leg. Too much weight will impede healing; not enough walking will multiply the effects of immobilization. Weightbearing may be restricted for as long as 12 weeks.
Initial therapy treatments may be aimed more at controlling pain and swelling with massage and gentle range of motion. Returning full motion to the joints of the hip, knee and ankle will be top priority, which will stiffen due to inhibition from pain and disuse. When enough healing has occurred, scar mobilization and strengthening the lower extremities will be initiated to address soft tissue restrictions and atrophy. Later stages of rehabilitation focus on restoring dynamic balance and return to patient-specific activity goals. Failure to fully rehabilitate this injury can increase the risk for complications such as chronic pain, inflammation and weakness that may cause difficulty walking and limit return to physical activities.
Recovery times vary for each patient, but we would expect Ms. Shields to return to normal activities within 4 to 6 months. We wish her success in her recovery and rehabilitation!
Do you know someone who experiences poor sleep, constant snoring or even has sleep apnea? These symptoms could signal other issues developed over time by poor breathing. Read on to learn strategies that can help reverse these problems!
Snoring happens when you are unable to move air freely through your nose and throat during sleep. This makes the surrounding tissues vibrate, which produces the familiar snoring sound. People who snore often have too much throat and nasal tissue or “floppy” tissue that vibrates more easily.
Sleep apnea is a serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea. A common type of sleep apnea is called obstructivesleep apnea, typically occurring when throat muscles relax.
Most people do not understand why they snore. Snoring begins to develop through a common breathing habit — mouth breathing — either during the day or at night. This results in the tongue falling back and down to the floor of the mouth and where it can no longer support the airway. Next, the beginning of the soft palate drops down into the airway. As we mouth breathe at night, the airway tube becomes floppy and the soft tissue in the back of the throat vibrates. Mouth breathing at night has been tied to snoring and even to sleep apnea.
Those of you who snore may already have or are at risk for developing sleep apnea. The “gold standard” treatment for sleep apnea is called CPAP (continuous positive airway pressure), which has a very low rate of compliance rate due to how uncomfortable it is to wear at night. Another option is to be fitted for a mandibular advancement device that moves your jaw bone forward and away from your airway, creating additional space in the back of the throat, which may help reduce snoring. Those two mainstream treatment options unfortunately do not really address the source of the problem.
Breathing through the nose and breathing “slow and low” is the healthiest way to breathe. Heavy breathing during the day is a signal for those who snore and have sleep apnea. Those who snore tend to breathe heavily with chest and neck muscles, thus causing more tension in the head, neck and chest and resulting in additional tension and pain. The heavy breathing pattern contributes to an endless cycle of snoring, poor quality sleep and pain.
PhysioPartners Renaissance CranioFacial Group has developed a breathing retraining program that helps reduce and even eliminate snoring. Dr. Hobson and her staff teach the Buteyko breathing method, which when paired with tongue and airway retraining (called myofunctional therapy) can help break bad breathing patterns. Dr. Hobson has been collaborating with ear, nose and throat doctors (ENTs), sleep doctors, airway dentists, speech pathologists, and neurologists through participation in airway and breathing-related conferences since 2013, which has been instrumental in the development of the treatment techniques our therapists use to treat inefficient breathing patterns and the associated symptoms.
WHAT SYMPTOMS DOES BREATHING RETRAINING IMPROVE?
Symptoms associated with poor airway support:
Poor Sleep, Snoring and Fatigue
Symptoms related to poor blood chemistry that results from poor breathing pattern:
Low Energy Levels
Cold Hands and Feet
Symptoms associated with mouth breathing:
Ear, Nose and Throat Issues
Swollen Adenoids or Tonsils, Gum Disease
Crowded Teeth, High Narrow Palate, Tongue Tie
Attention Deficit Disorders in Children and Adults
Symptoms of snoring affecting your digestive tract:
Bloating and Gas
Symptoms of chest breathing and over breathing:
High Blood Pressure
Shortness of breath,
Chronic Annoying Cough
If you are concerned about your health and committed to improving it, we encourage you to understand snoring and the ways it can affect your body. We have an exciting opportunity to learn to transform sleep by improving your daytime and nighttime breathing.
Dr. Jennifer Hobson and the staff at PhysioPartners Renaissance CranioFacial Group have been treating snoring and sleep apnea since 2013. Our clinicians will train you to restore proper nose and diaphragmatic breathing, teach you how to rest your tongue in the proper position, promoting proper support to the airway, and restore proper breathing volume and rate. Our specialized physical therapists have helped many people reduce or even stop snoring and manage sleep apnea, which helps ease headaches and improve energy levels.
You may have heard of the recent best-selling book “Breath” by James Nestor, which highlights the effects of many of the interventions we provide. James describes his and his colleagues study of mouth breathing at Stanford in which they placed silicone plugs deep in the nose, requiring ONLY mouth breathing for a period of 10 days. In only 2 days, he developed sleep apnea and high blood pressure, highlighting the detrimental effects of mouth breathing on your entire health. Click here to view Dr. Hobson’s interview with James Nestor)
Prior breathing clinic participants also share their responses to the breathing training in the following videos:
Jennifer Flage Hobson is a European-trained physical therapist. She earned her degree in physical therapy with an emphasis on manual therapy at the Hogeschool van Amsterdam, The Netherlands. She completed Hogeschool internships in Holland and Madrid, Spain, and then concluded with a clinical residency in Advanced Orthopedics in Chicago. Dr. Hobson earned a Manual Therapy Certification, a Cranio-Facial (Rocabado) Certification, and a Doctorate in Physical Therapy under the direction of the renowned New Zealand expert Dr. Stanley Paris at the University of St. Augustine, Florida. Fluent in the Spanish language, Dr. Hobson continues to train and teach in Santiago, Chile, with Dr. Mariano Rocabado, a leading Cranio-Facial, TMJ, Neck and Spine rehabilitation expert. Dr. Hobson is the first instructor to teach the Rocabado Method in the United States through the University of St. Augustine. She received certification in Trigger Point Dry Needling, by the renowned Dr. Jan Dommerholt, through Myopain Seminars. Dr. Hobson has been instrumental in introducing this technique to the state of Illinois and is proud to say that her office is one of the original offices performing this technique in the Chicagoland region. Her staff has advanced skills in dry needling to the head and neck region along with the entire body.
Dr. Hobson trained with Joy Moeller, BS, RDH, and Sandra Coulson, MS, ST, ED, COM, two of the leading instructors in the field of Myofunctional Therapy. Dr. Hobson enhanced her knowledge of restoring not only the head, neck and jaw, but also the tongue and its functions related to proper development of the mouth, teeth, and throat. Along with Myofunctional Therapy training, Dr. Hobson is a certified reviewer of the GOPex program (Good Oral Posture Exercises) and works with children and adults all over the world through a simple phone app video online program to improve their overall spinal posture and tongue to palate posture for rest and training the resting position for a healthy swallow.
Dr. Hobson is a certified educator of Buteyko Breathing method (the simple idea of breathing volume reduction) through the instruction of Patrick McKeown, one of the few practitioners accredited by Professor K. P. Buteyko and is currently working towards certification for the Laynee Restorative Breathing Method. Along with the Buteyko breathing method, Dr. Hobson is also in the process of earning her certification for the Laynee Restorative Breathing method which re-synchronizes and restores the cranial nerve system which governs our body and its automatic functions. |
Lastly, Dr. Hobson’s drive to continue learning more about the head and neck and how it is connected to the whole body, she has led her to train with cranial osteopaths through Michigan State University, College of Osteopathic Medicine and the Upledger Institute. This has broadened Dr. Hobson’s understanding of the body and the cranio-sacral system which is a much gentler way of treating both infants to adults.
2020 was a grind–in some cases, literally! Between the pandemic, trying to engage children in eLearning instead of Youtube or TikTok, and not to mention having life drastically altered, we have a lot of stress right now. Stress affects the body in many ways, including preventing sleep, giving us grey hair, making us moody, and sometimes we even clench or grind our teeth. Grinding your teeth is called bruxism, which can be voluntary or involuntary and can occur when you are sleeping or awake.
Stress has been shown to be correlated with bruxism, and we have seen an influx of patients coming in with problems related to clenching or grinding their teeth1,2. The big difference between clenching and grinding is that clenching is compressing the teeth together, whereas grinding is essentially clenching with movement. Normally, humans use less than 100 pounds per square inch (PSI) of force while chewing. For example, eating a pork chop requires about 20-25 PSI3. But when you grind during the day, you can create up to 160 PSI and grinding at night can reach about 500 PSI4! To put that in perspective, a lion usually exerts about 600 PSI per bite5.
Our teeth and jaws were not meant to handle a lion’s bite. The extra compression force on the temporomandibular joint (TMJ or jaw) and teeth can lead to a litany of problems including1,6:
Jaw/teeth pain or soreness
Ringing in the ears (tinnitus)
With people coming to the clinic for clenching, headaches and jaw pain during the stay-at-home period, I’ve seen people who fractured their nightguards, cracked their teeth, have headaches that rival migraines and even bitten through a mouthguard “like it’s a chew toy”, as one patient told me. The jaw is a resilient joint, but it’s not impervious to injury and when things are breaking, something must change.
The question is how do you prevent this from happening? One of the most common things I teach patients is where to keep their tongue. Where is your tongue as you are reading this? Is it hanging out on the floor of your mouth, floating in the middle or up near the roof? We aim to have the tongue up near the roof of your mouth to give good support to the mouth and prevent clenching.
Try saying “NNNNN”. This helps you understand where the tip of your tongue should be. Now say “siiiinnnnngggg” and notice where the back of your tongue is. It should be near your back molars. If you combine those tongue positions, viola, we have good oral posture. Just like you can have good sitting or standing posture, you can work towards good oral posture as well. It’s an invisible problem that few people understand.
When your tongue is flopped on the floor of the mouth, it’s easier to clench, but by placing your tongue in good oral posture, it makes it harder to smash your teeth together. Try it for yourself! See? It’s a lot harder to clench. Even when you are stressed, this will save your teeth and jaws some unnecessary wear and tear.
Stress isn’t going anywhere, and if you are suffering from jaw pain, facial pain or headaches, you may benefit from craniofacial therapy, which is physical therapist care specifically designed to address pain, dysfunction and injuries of the head, face and jaw. The staff members at PhysioPartners Renaissance CranioFacial Group have developed specialty skills in this area and have saved many a tooth from cracking under the pressure.
Your physical therapist will work with you to improve your tongue and sitting posture, strengthen and stretching your tongue, TMJ and neck, as well as help restore balance to your head and upper neck. We will also analyze your bite to make sure it’s not causing you to clench more or load more on one side.
A cracked tooth is no fun and getting it fixed can be costly. Schedule a consultation with a craniofacial physical therapist today, and your future self will thank you. The cost savings in dental work is a bonus!
Wieckiewicz M, Paradowska-Stolarz A, Wieckiewicz W. Psychosocial aspects of bruxism: the most paramount factor influencing teeth grinding. Biomed Res Int. 2014;2014:469187.
Ahlberg J, Rantala M, Savolainen A, et al. Reported bruxism and stress experience: Reported bruxism and stress experience. Community Dent Oral Epidemiol. 2002;30(6):405-408.
The power of the human jaw. Sci Am. 1911;105(23):493-493.
Most people would consider contacting a physical therapist if they have an obvious injury or severe pain, but what about those nagging symptoms that never become really limiting, yet never seem to go fully away. You may think you are too busy to see a physical therapist, or just think the symptoms will go away on their own or with time. However, these small problems can eventually develop into bigger problems and then become much more costly and time consuming to fix! And once they do, this bigger problem can really limit your ability to complete daily activities or participate in activities you love. Your physical therapist can help you address these small issues before they become limiting and expensive ones if you know the signs!
You are modifying daily activities, exercise or recreational activity You may notice that you are too sore to perform your normal level of activity or fatigue quickly with exercise, so you begin limiting yourself,
You are starting a new workout program or training for a race Therapists are experts in movement, and we can help you plan your progress and teach you how to increase at the right rate. Increasing difficulty and intensity of exercise too much too quickly can promote injury.
Your recovery from a new activity is longer than normal Are you experiencing new symptoms that occur with daily activities? Feelings of increased pain or symptoms that last longer than 3 days can be signs of injury.
You wake up in the morning sore and painful, but didn’t do any strenuous activity Some general stiffness in the morning can be normal, especially in older adults or patients with arthritis, but once you get moving, the stiffness should resolve. However, it is not normal to wake up in pain. A therapist can help you with sleep positioning and determining the source of the problem.
You are noticing unusual pain, symptoms, or visible changes Swelling in a joint can be indicative of an injury and continuing to exercise or play sports can make the damage worse. You should check with a therapist to evaluate the symptoms.
Your physical therapist at PhysioPartners can help you determine the right level of care for you with options for your schedule and budget, including traditional therapy plans, PT Express Care and telehealth sessions!
Colder weather means some changes to how we exercise. Of course, it’s harder to motivate yourself to get outside for a run or bike ride when the temperature drops, and the shorter days compress our schedules, but there are changes in your body that affect your ability to exercise, too. For many people with arthritis or other joint problems, cold weather brings more complaints of pain. To stay warm, our bodies narrow blood vessels to reduce blood flow to the skin and more superficial muscles. That means that there is an increased risk of muscle strains in the cold. There is also an increased strain on the heart because of the narrowed blood vessels. You can still be active outdoors in the cold, but you may need to make a few changes to your routine. Here are a few to consider:
Warm Up Right
A good warm up is always important, but because of the tendency for joints to be stiffer, and blood flow to muscles to be reduced in the cold, it’s even more important that you do it right this time of year. To start, do something to get your heart rate up a bit, maybe a brisk walk or light jog. Follow that up with a dynamic warm up rather than static stretches. This could include walking or jogging while pulling your knees up high to your chest. Maybe some high kicks in front of you with straight knees to get your hamstrings loosened. A walking lunge with an upper body twist can get your whole body moving. Cater your warm up to what you have planned in your workout. If you’re not sure how it should look, ask your physical therapist!
Dressing in layers allows you to adjust your insulation to your activity level. After you warm up, you might want to take off a layer to avoid getting too hot during your main activity, but have it there later when your activity level drops and you start getting too cold.
Don’t forget about the sun either – just because it’s cold doesn’t mean the UV rays are gone. Sunscreen and sunglasses are not just for the summer. A lip balm with SPF can protect you not only from the sun, but from the wind too.
Drink water before, during, and after your workout. The temperature may be down, but you’ll still sweat and you will lose water vapor in your breath. The drier air in winter allows your sweat evaporate more quickly, so it’s easy to underestimate how much fluid you’ve lost.
When you are finished, don’t rush to get inside and crawl under a blanket — cool down properly. Keep moving with a walk or another form of active recovery to let your heart rate come down. After exercise is the right time for static stretching. You can also head inside for some foam rolling or self-massage.
Shorter days and lower temperatures don’t have to mean you are stuck inside for all of your exercise. If you follow these tips, you can safely keep moving outside. If you’d like a customized warm up or cool down, or have questions about your exercise routine, your physical therapist is a great person to ask!
Physical therapists are experts at human movement and create treatment plans that help you move better to feel better. The human body is a complex piece of machinery, and we love making all those parts work together in harmony and with efficiency.
But let’s be honest — sometimes you don’t have time or money for optimal efficiency and harmony and just want to make sure you don’t “break down” on the side of the road! We get it — no judgment — which is why we created PT Express visits and packages.
These innovative sessions are designed to give you fast relief of sprains, strains, tweaks and pains. Many studies have demonstrated that the earlier you see a physical therapist, the sooner they will resolve, the better the long-term outcome, and can ensure that you do not need more invasive and costly treatments down the road. They are a great alternative to walk-in clinics that may have limited treatment options to offer.
The session begins with a thorough evaluation so that you and your therapist know exactly what you are dealing with. If your symptoms and examination findings point to something more serious, we will refer you to someone in our amazing network of sports medicine physicians, orthopedists, internists and podiatrists. If physical therapist care can help, we will develop a tailored and focused treatment plan just for you. The 20-minute in-person or virtual follow-up sessions are easy to squeeze into your busy schedule, allow us to review your progress, update your treatment plan and provide hands-on interventions.
Now we are not miracle workers — you will have homework! But if you are motivated to follow our self-care instructions and perform exercises on your own, many new onset conditions and minor injuries will respond very quickly. If at your evaluation you therapist recognizes that your injury, condition or prior history requires a more comprehensive plan of care, he or she will discuss it with you so you can make an informed decision about your health.
Packages including the evaluation and 4 follow up sessions start at $280 and is most likely covered by your insurance, so stop suffering in silence — or complaining loudly — and take action today!
We know that President-Elect Joe Biden had a mishap while playing with his dog over the holiday weekend, leading to a twist of his ankle and hairline fractures of 2 bones in his foot. The lateral and intermediate cuneiforms that were fractured are pictured here:
There is much discussion of President-Elect Biden’s advanced age, and two possible age-related risk factors may have contributed to his likelihood of experiencing this injury.
Low Bone Mineral Density
For men, bone mineral density is at its highest between the ages of 20-29. (Sezer, 2015) While men do not experience the rapid drop off in bone mineral density that women do following menopause, bone density does decline as men age. Osteoporosis in men is an underdiagnosed condition and increases risk for fractures.
Limited Ankle Mobility
Several studies have demonstrated loss of ankle range of motion in older adults, which is also considered to be a significant risk factor for falls. (Menz, 2015) When the ankle cannot bend through its normal range (imagine pulling your toes up towards your nose) because of calf muscle tightness or joint stiffness, other motions must make up the difference during an unanticipated movement. This potential for increased stress to the internal foot bones and foot and ankle ligaments could contribute to sustaining a fracture under the right conditions.
President-Elect Biden is anticipated to have full recovery with a few weeks of immobilization in a walking boot, but immobilization itself can also be problematic. Even just one week of ankle immobilization has a detrimental effect on calf strength and balance. (Caplan, 2013) Longer periods of immobilization may require consultation with a physical therapist to restore range of motion, strength, balance and gait pattern to ensure a full recovery and addressing any risk factors for future injuries.
By Joseph Ascher, PT, DPT, Board-certified Clinical Specialist in Orthopedic Physical Therapy and Mike Henderson, SPT
If you were able to stomach watching the video above, you will see the defender hit Joe Burrow on the outer front side of his knee, causing it to hyperextend and move inward. Our hinge-joint knees are not intended to move in that direction due to — you guessed it — the anterior cruciate ligament or ACL. The ACL restricts the lower leg bone (tibia) from sliding on the upper leg bone (femur), but when high forces like the ones observed here are applied. it can exceed the tolerance of the ligament, causing a rupture.
Unfortunately, in Joe’s case, the force was significant enough to not only rupture his ACL, but momentarily dislocate his knee, which we thankfully see reset in the abrupt shift in the knee later in the video. Joe said “see ya next year” in a Twitter post afterwards, which is probably accurate as it takes about nine months to recover from an ACL reconstruction surgery. Even then, he won’t be fully out of the woods as athletes who return to football after ACL injury have have a 4.32 higher chance of reinjury.
Joe and his Physical Therapist are about to spend a lot of time together, and we are certain that both will be working very hard this off season! Good luck, Joe!
Endurance athlete Ashley L. had many concerns after her ankle injury, but her path back started at PhysioPartners with physical therapist Mandie Martuzzo.
Physical therapist Mandie Martuzzo recalled Ashley’s first visits, noting that she was initially in an ankle brace and had difficulty walking normally. She was unable to stand for prolonged amounts of time, descend stairs, run or jump without pain. Ashley is very athletic and wanted to return to running races and competing in triathalons, which she enjoys.
She began therapy with decreased mobility and strength in her ankle and an abnormal gait pattern, and treatments were aimed at improving her gait, ankle mobility, ankle stability and strength, as well as balance. By the end of therapy, Ashley was back to all her normal activities without pain or difficulty and has returned to running for exercise. And hopefully she will soon compete again!
Though Ashley is still building back her mileage, she reports that she has never felt better or more confident in her ankle to tackle her next challenges, the first being wearing heels at her wedding last month!