Welcome to Advance Physical Therapy, Inc. Newsletter

Finally, football season is here!  Are you rooting for the Niners to get to the Super Bowl?  Maybe for the Raiders to have a more respectable season?  Or, who really cares as long as teams make the games exciting as they grind down the time?  For all you diehard fans, it's always good to be the spectator looking in, rather than the recipient of a full speed mack truck knocking the wind out of you at every down. Rather than offering protection, a helmet and some shoulder pads seem to encourage more hard hitting action at each and every play. You wonder how they actually get up for the next play, when their ears are ringing, heads are pounding, and necks are straining from five plays ago. "This is what it feels like each Sunday. There's never enough time during the week to actually recover from the previous Sunday's event as you prepare for the upcoming game for more head to head combat.  We are constantly nursing neck and body injuries," as one of our retired NFL player-patient shares. 

Even though most of us don't play football, we can, in some way, identify with the ears ringing, heads pounding and neck-straining sensations at one point or another.  For some, this is a constant occurrence due to a traumatic injury, while for others, it's become a chronic, progressive-worsening issue from poor posture, desk work and stress.  Whatever the situation might be, neck pain is a very common complaint that manifests in all shapes and sizes.  And the longer we ignore the symptoms, the worse the pain can get. 

Enjoy watching your favorite teams this time of year, but watch your posture and make sure to get up often to stretch. This September issue will highlight how physical therapy plays an integral part of the healing process from neck strain and injuries.

You don't have to be a football player to benefit from our services.


To Your Health,
Advance Physical Therapy, Inc.
Physical Therapy & Medical Exercise Therapy Optimizes Healing of Neck Pain
At Advance Physical Therapy, we see many patients with neck pain. Neck problems are one of the most debilitating.  The aches generated by sensitized structures in the neck can appear on the side of the neck, top, front, side of the shoulder, inside edge of the shoulder blade, and anywhere on the head.  When a nerve is pinched or inflammed, the pain can spread down the arm to the hand, cause numbness and tingling and/or cause weakness in the shoulder, arm and hand.  Many people afflicted have pain and difficulty sitting, using their arms, lifting, focusing on tasks and sleeping.  While it may be challenging to "undo" the pathology that is already present, we can address the biomechanical factors that affect loading on these sensitive structures to restore pain free neck movement, strength and resolve inflammation. 

When patients come in for an evaluation, they can expect that we will look at the motion of the neck, assess the strength of the shoulder, elbow and wrist muscles, use our hands to determine which muscles and joints are tight and restricted, and perform a thorough neurological exam.  A plan of care is determined at this time.  The treatment plan includes soft tissue mobilization to relieve tension and guarding in the typical muscles which are overworked in the painful neck, including the upper trapezius, levator scapula, the scalenes, and the sternocleidomastoid.  Since these muscles cross multiple neck joints from the skull to the shoulder girdle, when they shorten and get tense, they have a compressive effect on the spine.  The cervical discs and nerves can get pinched, and as a result, perpetuate a vicious cycle of pain and tension.  Soft tissue treatment is followed by gentle joint mobilization techniques to unload and decompress sensitive cervical discs and facet joints which lie deep to the guarded muscles.
  These hands-on techniques help decrease muscle tension, decrease nerve pain by creating space between facet joints, and restore normal bone and joint alignment necessary for proper head and shoulder posture.  In this way, the first half of our typical treatment session attempts to restore passively what is not occurring actively in the painful neck.

As muscle tension and joint motion is being restored, the goal of the second half of treatment is to strengthen the muscles of the neck and the shoulder girdle that are "inactive" and weak.  This strengthening process involves retraining the deep layers of small postural neck muscles, called the deep neck flexors, to be able to hold the head and neck upright. They consist of slow-twitch muscle fibers to give a steady "anti-gravity" lift to the cervical spine. Research has demonstrated that people with neck pain, no matter the etiology, have weakness of these muscles, specifically, the longus capitus, longus colli, and rectus capitis anterior. The training program involves a graded, light resistance training regimen guided by your physical therapist. Very often, people with neck pain also have weakness of two important scapular stabilizer muscles, the lower trapezius and serratus anterior. With proper guidance, we can also train the the deep postural muscles to coordinate with other muscles simultaneously. This process ensures that the neck, head and shoulder girdle achieves pain free movement for return to functional activities.

The end of your treatment often concludes with a rest period with the transcutaneous electrical nerve stimulator (TENS), which is placed on the skin over the most painful area. The tingling sensation delivered by the TENS competes with pain inputs from the joints to blunt the message of pain to the brain.  Ice is applied over the area to decrease muscle spasm, reduce swelling and pain.
Our goal is to restore the neck to pain free function and prevent symptoms from reoccurring.

If you are experiencing neck pain or have any questions about possible symptoms, please feel free to contact us.
Balance, Vestibular and Fall Prevention Programs at APT

At Advance Physical Therapy, Inc., our goal is to promote the highest level of preventive care that keeps our clients healthy and enjoying their active lifestyles.  Alongside our manual therapy, orthopedic and neurological rehabilitation background, we also specialize in balance, vestibular and fall prevention rehabilitation.  As mentioned in the next article in this newsletter, balance deficits and falls are a public health problem that affects many people.  Fortunately, these problems are highly preventable with the proper physical therapy intervention.  We provide comprehensive assessments to identify the causes that impair balance, gait and reaction time.  Through manual therapy, exercise, postural stability adjustments, cognitive focus, visual tracking, head-neck control, upper and lower body coordination and decreasing the fear of falling, our clients successfully overcome their risk for falling. 

Vestibular dysfunctions or dizziness disorders are common among US adults.  An estimated 20% of the general population is affected by a vestibular disorder.  At least half of the overall United States population is affected by a balance or vestibular disorder sometime during their lives.  Vestibular dysfunction significantly increases the likelihood of falls, which are among the most morbid and costly health conditions affecting older individuals.  This disorder comes in many shapes and sizes and can easily impair us from being able to sit, stand, walk, drive, focus on tasks or even maintain an upright posture.   We provide comprehensive assessments necessary to identify vestibular deficits and treatments to reduce fall-related injuries.

If you currently have balance and vestibular concerns or have chronic fluctuating symptoms, please contact us and see how our program can help.
Fall Risks Among Older Adults
The Center for Disease Control and Prevention explains how falls are a public health problem that is largely preventable.  Each year, one in every three adults age 65 and older falls.  The are a myriad of reasons that cause falls in the older population and it's important to rule out the factors that inevitably lead to fall injuries that include hip fractures and head traumas, and can increase the risk of early death.

How big is the problem?

  • One out of three older adults (those aged 65 or older) falls each year but less than half talk to their healthcare providers about it.
  • Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
  • In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.
  • In 2010, the direct medical costs of falls was $30 billion.

What outcomes are linked to falls?

  • 20 to 30% of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.
  • Falls are the most common cause of traumatic brain injuries (TBI).
  • In 2000, 46% of fatal falls among older adults were due to TBI.
  • Most fractures among older adults are caused by falls.  The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many people who fall, even if they are not injured, develop a fear of falling.  This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.

Who is at risk?

Fall-related Deaths

  • The death rates from falls among older men and women have risen sharply over the past decade.
  • In 2010, about 21,700 older adults died from unintentional fall injuries.
  • Men are more likely than women to die from a fall. After taking age into account, the fall death rate in 2010 was 40% higher for men than for women.
  • Older whites are 2.4 times more likely to die from falls as their black counterparts.
  • Rates also differ by ethnicity. Older non-Hispanics have higher fatal fall rates than Hispanics.

Fall Injuries

  • People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.
  • Rates of fall-related fractures among older women are more than twice those for men.
  • Over 95% of hip fractures are caused by falls.  In 2010, there were 258,000 hip fractures and the rate for women was almost twice the rate for men.

How can older adults prevent falls?

Older adults can stay independent and reduce their chances of falling by adhering to the following guidelines:
  • Exercise regularly.  Consult with your physical therapist on the best appropriate ways to progress a safe and effective exercise program for increasing leg strength and improving balance that progressively gets more challenging with time.
  • Ask your doctor or pharmacist to review your medications (both prescription and over-the counter) to identify medicines that may cause side effects such as dizziness or drowsiness.
  • Have your eyes checked by an eye doctor at least once a year and update your eyeglasses to maximize your vision.  Consider getting a pair with single vision distance lenses for some activities such as walking outside.
  • Make your home environment safer by reducing tripping hazards (flat carpets), adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in your homes.

To lower their hip fracture risk, older adults can:

  • Get adequate calcium and vitamin D—from food and/or from supplements.
  • Consult with your physical therapist regarding progression of weight bearing exercises.
  • Get screened and, if needed, treated for osteoporosis.
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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