Welcome to Advance Physical Therapy, Inc. Newsletter

We hope everyone is enjoying their summer and can find some time to step away from the office and vacation.  The reality of all work and no play can inevitably wear us down and our ability to restore ourselves become more difficult.  We've gained so much insight learning from our clients especially when it comes to living out the secrets to healthful living.  Some of them travel across the world to France and Italy and reside in the countryside for weeks and months to get away from their familiar surroundings in order to recharge.  Now most of us may not have the time to do so, but just imagine, waking up in the morning without having to rush and the only necessary planning for the day is deciding what you're going to have for breakfast, lunch and dinner while having a glass of wine or two.  Sometimes it takes the physical act of stepping away from the familiar in order to successfully "detox" ourselves and rejuvenate our mind and body.  It doesn't have to be a long vacation (although it would be nice) or an exotic getaway to nurture us back to health; often times it's about taking more frequent, shorter timeouts that allow us to refuel.  It's amazing how our European counterparts find ways to close down their business for the summer and yet stay economically and financially productive all year long.  It seems that their secret to more productive work is to take more productive breaks. 

Summer is a time to relax, enjoy family and friends, plan healthier goals to stay fit and maybe even purge the home of old junk to make room for new must haves.  In this issue, we will continue our preventive medicine series on identifying common shoulder injuries and how physical therapy can effectively treat these conditions.

And if you are gearing up to run, we'll highlight the best running shoes on the market that you should know about.  And if you are cleaning out a room in your home, you may be interested in knowing how to buy a mattress and actually sleep better at night.

Be well and have a great summer!

Advance Physical Therapy, Inc.
What are the Most Common Shoulder Injuries in Adults?

Last month, we described the basic anatomy of the shoulder girdle, which is composed of four joints, the sternoclavicular, the acromioclavicular, the scapulothoracic, and glenohumeral joint.  Shoulder pathology can result when some or all of these joints are subjected to overuse, extreme range of motion or excessive force, which can cause disruption of the normally well-orchestrated mechanical interplay between these joints.  The common diagnoses that require medical intervention or physical therapy are rotator cuff tears and tendinopathy, impingement, and glenohumeral joint instability.


The rotator cuff tendons must pass through an arch or under “wing” known as the acromion of the scapula to attach to the humerus.  Some individuals have a “hooked” shape to their acromion, which narrows this arch that the rotator cuff tendons must traverse through.  This is called a “primary impingement” problem.  When there is inadequate space under the arch, the supraspinatus tendon can become pinched, or “impinged” which often results in sharp localized pain on top of the shoulder joint when raising the arm over head or when reaching to put on a shirt.  If this impingement continues without intervention, the sharp pain can develop into a constant dull ache over the top of the shoulder which can lead to tendonitis (tendon inflammation).  Over time, the repetitive use of the shoulder going up and down may "sandwich" and fray the tendon.  If this occurs, often the complaint is inability to lift the shoulder completely or that it fatigues quickly, "feels heavy," and/or presents with persistent weakness for lifting tasks.

More common factors that lead to narrowing of the space under the acromion include the loss of the ideal “rhythm” of muscle activation around the shoulder that is necessary to keep the glenohumeral head (ball joint), scapula (shoulder blade) and glenoid socket (shoulder socket) congruent with each other.  Poor posture, as discussed in last month’s newsletter, is a contributor, as is lack of upper back, rotator cuff, scapular strength and overall fitness.  This is called a “secondary impingement.”  Rotator cuff muscles weaken and the ball joint becomes more unstable in the socket, and often, a primary impingement or secondary impingement coincides with a tendinopathy (tendon inflammation/injury).

Impingement and tendinopathy can cause a sharp pain on the side or front of the upper arm at rest, but more often, when the arm is elevated, put behind the back or with lifting motions.  It can also be quite painful to sleep on the affected side.  A pain-dysfunction cycle is perpetuated when the glenohumeral joint and scapulothoracic joint lose the ideal “rhythm” of activation that is necessary for proper glide and rotation of the glenohumeral “ball” in the glenoid (“socket” of the scapula).  When the rotator cuff tendons are not pulling at the proper angles at their attachment on the humerus, the tendon fibers, made of collagen, loses its quality and quantity.  As a result, a rotator cuff tear is the natural progression from this type of degenerative process.  Many tendinopathies develop painlessly, so an individual may not not know that the rotator cuff muscle and tendon are weak until it actually tears.
  Once a tear occurs, noted weakness or inability to raise the arm, lift objects or hold against resistance are present.  Sharp or dull pain localized along the top of the shoulder joint and/or referral to the outer upper shoulder may also be present.

Impingement and rotator cuff tears can affect anyone over the age of 40. Younger people and athletes can suffer from shoulder pain as a result of poor scapular stability leading to glenohumeral instability and sometimes, even repeated dislocation with falls or sudden forceful movements of the shoulder.

Identifying the early signs and symptoms of these common shoulder injuries and following up with early intervention are key to resolving these problems quickly and preventing them from getting worse over time.  If you have any questions about shoulder injuries or feel that you may have something similar, contact us and we'll gladly direct you to seek the appropriate intervention.
Physical Therapy & Medical Exercise Therapy Optimizes Healing of Shoulder Pain

Not all exercise prescriptions are created equal.  Our therapists implement a system of exercise training known as Scientific-Therapeutic-Exercise-Progression or S.T.E.P.  This program involves a series of highly specific “dosed” exercises tailored to heal your injury and/or movement dysfunction.  More importantly, these "dosed" exercises specifically target the tissues (muscle, tendon, ligament, nerve, bone, fascia, etc.) that need repair and healing.  Each type of injured tissue requires a specific amount of exercise intensity and set up in order to achieve quicker healing.  Therefore, prescribing the correct "dosage" of exercise is essential since not all tissues in the body will respond to the same intensity, frequency and form of exercises.  There is no "one size fits all" program or "cookbook" protocol for any two individuals with a shoulder impingement, rotator cuff tear or a rotator cuff tendonitis. 

First, a thorough physical therapy evaluation is necessary to differentiate the specific shoulder tissues that are causing pain and dysfunction.  Postural alignment is carefully assessed to see how the head/neck and shoulder is positioned relative to the back, hips, knees and ankles.  The rotator cuff, pectoral, neck, upper to mid back, and shoulder blade muscles are analyzed for spasm, tension, weakness and compensation.  The shoulder joints (glenohumeral, scapulo-thoracic, sternoclavicular and acromioclavicular) are examined for any restrictions that may cause pain and limit shoulder motion.  After the initial evaluation, specific hands-on palpation and soft tissue and joint mobilization techniques are implemented to release muscle and joint tightness around the rotator cuff that contribute to shoulder pain.  These manual therapy techniques restore the shoulder and surrounding muscles and joints back to its pain free range of motion.  

In order for the shoulder joint and surrounding musculature to heal well, the appropriate exercise set up and resistance training dosage (intensity, sets, repetition and frequency) are implemented to stimulate the rotator cuff and scapular muscles to contract correctly and to stimulate the shoulder joints to stabilize and move freely without pain. 
Our system of exercise training ensures that the shoulder musculature achieves this by improving good vascularity (blood circulation), coordination, endurance, strength, agility, speed and power in a sequential order essential for optimal healing and for return to functional activities (work, sports, activities of daily living.)  Each set and series of repetition and resistance training is specific to each muscle that is weak and to each joint that is stiff.  Our pulley system allows us to adjust the height and angle of the pulley and the amount of resistance (from as little as 100 grams of weight to as much as 100 pounds of weight) depending on what's required to engage the shoulder muscle-joint system towards stability and pain free function.

What's equally important to prescribing effective treatment programs in the clinic is creating effective exercise programs that can be easily set up and implemented at home, at work, and on-the-go.  Compliance and consistency are essential for shoulder injuries to heal well, so we'll create custom programs and educate our clients about proper body mechanics, postural alignment and joint protection strategies that will ensure better outcomes. 

Please feel free to contact us about how we can be a part of your healing process through movement and exercise!
How to Buy a Mattress & Still Sleep at Night

Nothing compares to getting a good night's sleep.  But finding the right mattress that will ensure a good night's sleep is notoriously difficult.  Many stores sell very similar mattresses under different names and model numbers which make it difficult for consumers to compare prices.  Salespeople often steer shoppers towards more expensive products and manufacturers highlight features that consumer can't easily evaluate.  The end result is shoppers spend hundreds of dollars more than necessary or wind up sleeping on mattresses that they hate.


Lie on the mattress for 10 to 15 minutes in the store to make sure that it feels comfortable and that it properly supports your spine.  Of course, lying 15 minutes on any mattress may not be enough time to make an accurate assessment but it will give you a good sense if the mattress feels supportive and comfortable when you compare other mattresses on the showroom floor.  Ask about the store's return or trial policy.  Often times, mattress sales are so competitive that the store policy will honor a 90-day trial with free exchange or full refund of the purchase price if you are not completely satisfied.  This will give you the necessary time to test the mattress before feeling locked into a big purchase.

The medical industry used to recommend firm mattresses for back health, but they've since concluded that firm mattresses actually provide poor spine support.  Backs do best in beds that allow the spine to remain straight and supported while you sleep.  When you lie on your side on a firm mattress, the problem is that your shoulders and hips don't sink into the mattress far enough to keep the spine in a neutral, straight position where the least amount of muscle tension is created.  And when you lie on your back, your hips don't sink far enough for the mattress to support your back. 

So the best medical recommendation is to find a medium-firm mattress which is the best choice for most sleepers. 

The mattress industry uses terms such as "firm," "medium-firm," "plush," and "pillow-soft" which can be confusing when it comes to making an objective assessment of what this really means.  It may be more helpful to use a 1 to 10 firmness scale with 1 labeled as firmest and 4 to 6 as medium firmness.  Then ask the salesperson where each mattress is   categorized on this firmness scale so that you can learn what firmness number you like best.  This will allow you to specify a number when comparing other mattresses and brands.

One exception to note regarding the medium-firmness recommendation: Side sleepers who may be sensitive to shoulder and/or hip discomfort may prefer a softer mattress.

It's very helpful to bring someone along with you when shopping for a mattress to make sure that your spine is straight when you lie on your side and to assess that there are no gaps between your back and the mattress when you lie on your back. 

Let us know if you need any further information or guidance regarding mattresses, sleep positions and proper pillow support for your neck and back.
The Best Running Shoes For You

Finding the right pair of running shoes can be difficult.  Like technology, shoe style, build and quality continues to change at a rapid pace and ranges from the ones that offer the most protection to the ones that offer the most performance.  Jeff Dengate of Runner's World Magazine describes what you need to know today about running shoes.

Protective running shoes focus on avoiding foot and leg injury and pain.  They provide the necessary cushioning under the foot and provide dense foam under the arch of the foot for added support during the loading phase of running. 

Top choice: Brooks Ravenna 4 provides much stability and cushioning while feeling light and flexible - the men's version weighs 10.8 oz while the women's weighs 9 oz.  It's relatively affordable for this quality ($110,  Alternatives: Other shoes that provide similar support and flexibility include Saucony Hurricane 15 ($140, and Asics Gel-Kayano 19 ($150,

These running shoes are lighter than protective running shoes and the emphasis is to boost running speed while still supplying a good amount of cushioning and foot support. 

Top choice: Nike Flyknit Lunar1+ provides a seamless, one-piece upper (top part of the shoe) that is knitted like a scarf and not sewn or glued together from multiple pieces of fabric like most other shoes.  This knitted upper conforms to the shape of the foot and does a good job holding the shoe in place as you run.  The sole provides reasonable cushioning yet the upper is so light that this shoe weighs just 8 oz for men's and 5.7 for women's ($160,  Alternatives: Addidas Energy Boost features an advanced thermoplastic plyurethane material in the midsole that's springier that most foam found in running shoes.  This provides a bit more energy return from each stride without sacrificing cushioniing ($150,  The New Balance 890V3 also provides good cushioning, flexibility and low weight ($110,

These type of running shoes are typically designed for performance on race day being that they are lightweight and provide limited cushioning.  Top choice: Asics Gel-Lyte33 2 makes you feel fast.  It's flexible and light but at 8.5 oz for men's and 7 oz for women's, it's not the lightest performance shoe on the market.  It provides a soft ride but may not be snug enough for narrow feet runners around the midfoot ($90,  Alternatives: Brooks PureDrift is an ultra lightweight shoe at 5.6 oz for men's and 5.1 oz for women's.  It provides a larger toe box than most running shoes to allow the toes to spread out as you push off for a more natural running feel ($100,  Sketchers GOrun2 is also a very flexible, lightweight shoe at 6.6 oz for men's and 5.2 oz for women's ($80,
If we can answer any questions or field any topics of interest regarding  physical therapy, health and wellness or about our programs, please contact us. We'd love to hear from you.
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2944 Broadway Street                         1208 E. Arques Avenue Suite #105
Redwood City, CA 94062                     Sunnyvale, CA 94085

(W) 650.261.0330                                 (W) 408.720.8225
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