Identifying and Engaging The Right Muscles

To expand on our last blog of importance of “core” muscles, I want to touch on how to get the “right” muscles on…                                                                           .core1

Step one = Identify the right muscles
In order to identify where your pelvic floor muscles are, you want to
tighten your muscles in that area. Identifying the muscles correctly is
the first step towards muscle engagement and increased control.


Step two = Learn to engage (contract) the pelvic floor muscles
Contracting the muscles is not difficult, but you want to be sure you
are doing it correctly.
Begin by contracting the muscle upward and inward. The best way to
think about this is – imagine you are going to the bathroom. You want
to stop yourself midway (or midstream) by actively contracting your
pelvic floor muscles. But don’t do these as an exercise when you are
actively using the restroom.


Step three = Pace yourself
You need to train your pelvic floor muscles just as you would any
other muscle group, through repetition.
If you have any questions, please get in touch with one of our skilled physical therapists and we will be

Importance of “Core” Strengthening


No matter what activity you participate in, your “core”core
is the center of all muscle activity. Your core is much
like the middle link to a thick, sturdy chain. The upper
part of the chain is your upper body; the bottom part
of the chain is your lower body and the two are
connected at the center. A stronger core will not only
give you a stronger foundation for your upper and
lower body, it will also enhance your stability and
Everything you do, whether you know it or not, uses
your body’s core. Let’s take a look…

  • Recreational activities and sports – Every single sport (football, baseball, tennis, golf and even
    skiing), depends on your body’s core for strength and stability.
  • Everyday movements – Simple movements like getting in/out of bed or emptying the
    dishwasher require the use of your core muscles.
  • Work/job tasks – Any job you perform relies on the core muscles for stability. There are some
    jobs (especially ones that involve repetitive lifting) that depend on core strength and stability
    more than others.
  • Balance and stability – Since your core is truly the “center” of your body and supports your
    body’s upper and lower extremities and spine, it is used in every single functional task you
  • A healthy back – Back pain can be excruciating and tends to limit many of your activities. It is
    estimated that 4 out of 5 people will experience back pain at some point in life. Strengthening the
    core muscles is the “secret ingredient” to keeping your back healthy.
  • Gardening and housework – Daily tasks like vacuuming, mopping a floor and making a bed all
    utilize the strength of your core.
  • Posture – Having a weak core can lead to poor posture, which in turn contributes to back pain.

You can see from the small list above that the core muscles play a vital role in keeping you
strong and injury free.

What Texting Does to Your Neck!


Due to the recent smart phone invasion, our clinic has noticed a significant increase in lower neck pain.  We call it the Smartphone Syndrome.  For some reason it’s in our human nature to bring our head toward our phone rather then bring the phone toward our head.  You can see in the picture above just how bad that can be for our neck and posture.  For short periods of time this increase in weight is negligible.  But when we are sending whole conversation over the phone, updating our fantasy teams, and checking the hour by hour weather report for the next 3 days, it start to become a problem.

Take a look at the picture above.  What skeleton human would you be?  I think most of us would have to say either the 4th or 5th guy on the right.  In order to avoid unwanted distraction during an intense game of words with friends, we tend to inch our head closer and closer to the cell phone screen.  Imagine carrying 50 to 60 pounds in your arms for 15 to 30 minutes.  How do you think your arms would feel?  Could you even do it?  Well now imagine that is what your neck skeleton is having to do when you are on your phone 15 to 30 minutes!

Hopefully we are all starting to get the picture now, and your probably wondering….well what can I do about it!?  Well, there are two ways to help improve our posture during smartphone use.  First, and easiest, lower your eyes to the phone without lowering your head.  Meaning, be the first guy on the left in the picture above.

Second, is to bring the phone to your head.  It may be a little more difficult on your arms, but those appendages are build for carrying a 1/4 lb weight.  Your neck is not made to carry a 50lb pound weight.  If you are sitting, then rest a pillow under your arms and bring the phone up to eye level.

If you find yourself forgetting to do either of these things, then the least you can do for yourself if some simple neck stretches.  Try do take breaks every 3-5 minutes to look up, take some breaths, and try a couple of these quick stretches…

shoulder retractions       neckretraction     mountain pose


Hold each of these for 3 to 5 seconds and do each one 2 or 3 times.


New Research Comes Out Supporting Pre-Surgery Rehabilitation

There is plenty of evidence supporting the use of physical therapy after total joint replacements, but the use of pre-habilitation has been in question.   New research comes out finding therapy before surgery can reduce the need for and cost of postoperative care.

knee pain

In a study that came out of Journal of Bone & Joint Surgery in October of 2014, it followed the care usage patterns of 4,500 total knee and hip replacement patients.  When patients received one or two sessions of physical therapy, or “pre-habilitation,” before their joint replacement (at an average cost of $100), their need for standard post-surgical physical therapy and other postoperative care decreased by almost 30 percent, saving each patient an average of $1,215 in postoperative care costs.

This study supports the use of having patients do a short course of physical therapy before undergoing a joint replacement.  It decreases their need for post-operative rehabilitative care, and leads to a savings in the total healthcare cost of their joint replacement.

This research comes out at a time when total hip and knee replacements are on the rise.  Between 2005 and 2030, the number of total hip replacements is expected to grow by 174 percent (572,000 patients) and the number of total knee replacements by 673 percent (3.48 million patients).  So the impact of just a few session of therapy before sugery translates to hundreds of millions of dollars in savings.  That’s a lot of dough!

What to expect when your expecting…..a total knee replacement!


Above is a picture of a what the inside of total knee replacement looks like.  It’s definitely not all fun and games, but compared to not being able to walk, run, play, it’s worth it.

I frequently get asked, “What should I expect with a total knee replacement?” or “How long does it take to recovery from a knee replacement?”  Well, in this post I would like to share with you what I would say a normal recovery(with physical therapy) from knee replacement surgery might look like.

Day 1: The Surgery!

So depending on how extensive the knee arthritis and/or injury is to your knee, the actual procedure time may vary, but usually takes around 90 minutes to 2 hours.  If you have your surgery done in the morning, there is a very likely chance that you will see a physical therapist at least once, if not twice that day.  Crazy right!  Yup, we will get you up only a few hours after surgery to have you stand or even start walking.  This helps to get your bowels moving, blood pressure stabilized, and get you a little more oriented with your new knee.  Actually, most people will tell you the first day isn’t too bad, as you still have the anesthesia in place.  Nausea may be a problem however, as many times our stomachs don’t agree with the initial pain medication.  But overall, usually day 1 isn’t too bad.

Day 2-4: The Hospital Stay

The next 2 to 4 days you will stay in the hospital where you will have nurses/physicians/OT/PT all helping/pestering you!  Usually, you will have your nurse or nurses aids check on you every 2 to 4 hours for pain meds and vitals.  You may or may not see your physician, but in most cases you will, and he/she will be able to answer any questions you have at that time.  You will see a physical therapist at least twice a day, and an occupational therapist at least once.  With physical therapy you will work on walking with a walker, knee range of motion(ROM), car transfers, and even possibly stairs.  You may or may not be put in a continuous passive motion machine(new research shows it doesn’t lead to any improved outcomes, so don’t worry if you aren’t given one) which will bend and straighten your knee for you.  Your knee WILL become more painful over these next 2-4 days.  Remember what you had done!(see above picture), but the nurses will help to make sure your pain stays under control. Then discharge planning will come in on your 3rd or 4th day and decide where you will head to next.

Day 4-3 weeks: Early Recovery

So depending on what type of help you have in place at home, you will spend your next few weeks in 1 of 3 places.  If you have a spouse at home who can care for your, or friends and family that can stay with you, you will go home.  If you have this option, it’s usually the best, so try to find somebody who can help you out those first 2-3 weeks.  If you go home and have someone who can drive you, you will come to see me in outpatient physical therapy.  If not, you will get a home health physical therapist for 2-3 weeks until you can drive yourself to therapy.  If you don’t have anybody at home, you will most likely go to a skilled nursing facility where you will get therapy at least 1 time a day.  If you have both knees done at the same time(you crazy folks you), you are eligible to go to a rehab center where you will get therapy 3 times a day.

Now for the therapy part….let’s focus on those of you who went home and either received home health PT or outpatient PT.  Your therapist will see you 3 times a week for the first 3 weeks, and will mostly be working on regaining your ROM.  It is very important to get this back early in your rehab, before the harder scar tissue gets laid down.  I’m not gonna lie, you knee is going to hurt these first few weeks.  You won’t be able to sleep very well, and finding a comfortable position may be quite difficult.  It’s essential that you are consistently icing and keeping your knee bending and straightening.  I usually recommend getting a pedalor or recumbent bike that you can use 3 to 4 times a day to keep your knee from getting swollen and stiff.  Stay on top of your pain meds, and let your therapist know how your feeling.  What we do in therapy is going to hurt, but it should not leave you miserably sore for 3 to 4 days.

Days 3 weeks to 6 weeks: Middle Recovery

These are the days when you will start to see your swelling go down, and you will make some real gains in therapy.  Your knee will still hurt a good amount, but not as bad as the first 3 weeks.  You will hopefully start to get more sleep, be able to start driving(some will), and get a little of your life back.  In therapy, you may go down to 2 times a week.  You will still be working hard or regaining full ROM and especially full knee straightening.  Getting your knee straight is very important in being able to walk correctly, so focus a lot of your home exercise effort at regaining a straight knee.  This bring up another very important factor, you HAVE to be doing your home exercises/stretches!  Therapy is only about 3 hours a week, which isn’t nearly enough to get all your ROM back, so you need to be stretching it 3-4 times a day at least.  Don’t overdue it and make yourself really sore, but do work on stretching it as often as possible.

Days 6 weeks to 6 months/1 year: Late Recovery

After six weeks, most total knee replacement patients will tell you they seem to turn a corner.  The pain should get moderately to significantly less, and walking, standing, and doing some household chores will become easier.  Therapy will continue to work on regaining every last bit of ROM, but will also start to focus a lot more on strength.  Specifically functional strength, meaning your ability to do everyday things like stairs, getting out of low chairs, squatting, and walking longer distances.  You should still be doing your home exercises at least 2-3 times a day.  Outpatient therapy will typically last about 12 weeks, but possibly longer depending on how therapy went in early/middle recovery.  After 3 months, you will still notice stiffness every time you sit for a while and after getting out of bed, but the pain should be minimal.  It is still important to stretch and exercise your knee 1-2 times a day, to get the full benefit of having a new knee!

If you are consistent with your therapy, do your home exercises, and avoid any crazy last minute ski trips, falls, or biking accidents, almost all new knee patients are completely happy after 1 year.  The medical feat of a knee replacements is truly remarkable!.  For those of you who have had one done already, I hope this did some justice to what you went through.  And for those of you who need one, hopefully this gives you a better idea of what to expect when your expecting :).