Welcome to Advance Physical Therapy, Inc. Newsletter

It's summer time!  We hope that the summer months ahead means that we can take more time off and plan vacations.  All work and no play doesn't keep the doctor away.  The Silicon Valley culture breeds a fast paced, work mindset that often times leaves us little downtime to decompress.  We're glued to our chairs for hours on end, stagnate and focused on the next project deadline while our legs and arms go numb.  We've become more immobile, by choice of course, since technology has made it so much easier to handle all of our daily tasks simply by a push of a button without having to move.  We send texts and press "send" as opposed to write letters and walk to the post office and we shop for stores online and don't shop at stores.  We don't have to move around if we don't want to.  But movement is essential to healthful living.  Stagnate posturing and immobility leads to a cumulative breakdown of our joints, muscles, circulatory and organ systems. 

A common
orthopedic problem that we treat in our clinic is shoulder injuries.  Shoulder pain often is result of  immobility, poor postural mechanics and deconditioning.  Our next two series will bring you insight on shoulder disorders that are common in the workplace, in sports and in daily living and how you can minimize your exposure to these injuries.

Let's commit to being more active!

To your health and a great summer,

Advance Physical Therapy, Inc.


"My Doctor Told Me I Need to Strengthen My Rotator Cuff"

The shoulder joint is a functional union of four joints.  The joint we point to when referring to "the shoulder" is the glenohumeral joint.  It’s the interface between the glenoid, a contour on the outside of the scapula/“wing bone” and the humerus, the upper arm.  It is a ball and socket joint, with a fibrous, connective tissue capsule.  Synovial fluid bathes the joint to keep the joint surfaces well nourished.The head/top of the humerus forms the “ball” and the glenoid is shaped like a shallow socket.  The second shoulder joint is the acromioclavicular joint, a horizontal meeting of the clavicle/"collarbone", and the acromion, a superior wing-shaped landmark of the scapula.  Although we don’t see much motion here, or at the third joint, the sternoclavicular (where the sternum/"breastbone" meets the clavicle,) there is a modest degree of twisting, shearing and compression that must occur here to get full range of motion in the shoulder.  The last shoulder joint, is not a true joint, where bony surfaces come together, but rather a virtual joint.  The motion relationship formed between the scapula and the posterior rib cage and thoracic spine is called the scapulothoracic joint. The scapula should be able to rotate, depress, elevate, tilt and move toward and away from the spine to give the glenohumeral joint its full motion.

Full motion includes elevation to the front and side (about 180 degrees), and reaching across the body to the back of the opposite shoulder.  Rotation also occurs in the glenohumeral joint, and functionally is usually combined with other motions.  You need full range of inward rotation, for example, to put your hand behind your back. You need full range of outward rotation to reach with your left hand to grasp the seatbelt.

Physical therapists call the coordinated motion between the scapulothoracic and glenohumeral joint “scapulohumeral rhythm.”  For every 2 degrees of glenohumeral elevation, there should be 1 degree of scapulothoracic upward rotation.  The muscles between the spine, ribs, scapula and arm must work in concert, or an imbalance can occur, and an injury follows.

Most people with shoulder problems need to strengthen the rotator cuff, which is a collection of four muscles that attach the scapula to the arm.  The reason why is that the shoulder socket is extremely shallow which only allows one-third of the glenohumeral ("ball") joint to fit into the socket and the other two-thirds of the joint fits outside of the socket.  This makes the ball and socket joint very unstable by design.  Therefore, shoulder stability depends on four muscles to “steer” the ball within the socket to enable the arm to move in a wide range of movement (see 3-D Video).  These muscles are called the supraspinatus, infraspinatus, subscapularis and teres minor and often are the weakest portions of the shoulder that leads to many shoulder injuries. 
The fibers of these muscles blend in with the tough, fibrous joint capsule of the glenohumeral joint.  In addition, the trapezius, serratus anterior, levator scapula and rhomboids muscles which attach the scapula to the ribs, neck, and upper back move in a strong and controlled way to allow full motion without excessive wear on the glenohumeral joint.

Stay tuned for next month, when we’ll discuss the more common acute and chronic injuries to the glenohumeral joint and how to prevent them from occurring.
    Impact of Posture On Shoulder Injuries

Are we sitting at our desks at home or in the office for hours on end?  It's difficult to maintain good posture with prolong sitting and over time, poor posture can lead to many potential shoulder issues that are preventable. 

After age 40, the tendons of the rotator cuff muscles easily show signs of wear and breakdown of the collagen fibrils.  These fibrils give the tendons their tensile strength but as they breakdown, injury becomes more common.  Patients will comment that their shoulder is bothering them for no reason.  They didn’t “do” any heavy lifting or repetitive loading to cause the pain onset.  This may be true, but sadly, even poor posture can blaze the trail for a rotator cuff tendonitis or a tear to develop.

When we sit properly, and are observed in profile, the ear, the shoulder (glenohumeral joint) and hip should be in a vertical line.  Also, the nose should be angled slightly downward.  If the glenohumeral shoulder joint is in ideal position, the scapula, then, is also situated properly resting on the back of the rib cage, not on the side of the body and not pulled forward toward the chest or sternum.  The less-than-ideal "slouched or humped over" posture, slides the scapula (shoulder blade) towards the side of the body and causes the space where the rotator cuff tendons pass through to narrow under the subacromial arch.  Blood circulation is impaired under this space and the rotator cuff tendons start to impinge, irritate, inflame and weaken.  The body’s usual repair processes are adversely affected.  And now, we have the common situation of poor scapular muscle function affecting the health of the rotator cuff muscles and tendons.  When your arm needs to elevate, for example, to throw a football, or downwardly rotate, to tuck in your shirt, the space which has become narrowed already through years of poor posture becomes more cramped, and degenerative processes are accelerated, sometimes resulting in tendinopathies, rotator cuff tears or inflammation of the fluid-filled sac (bursitis.)

In the next installment of the newsletter, we will discuss common diagnoses that afflict people with shoulder pain and describe how you can minimize this from occurring.

In the meantime, we should all pay close attention to our posture in sitting and standing which will help us  avoid many of the common shoulder pains that arise.

Please contact us If you have questions about proper body mechanics and postural related issues.  Our rehab team is ready to improve your posture.

The Fruit that Fights Insomnia and 6 Other Surprising Food Cures

We all know that some foods are healthier than others but often times we don't know which foods are best for specific problems.  When it comes to "food cures," most of what we read is questionable.  David Grotto, RD, LDN, dietician and founder of Nutrition Housecall, LLC. and nutrition science have found some surprising "food cures"  proven to be effective for the following disorders:

1) INSOMNIA.  Warm milk is often thought to help with sleep since it does produce some of the relaxing hormone serotonin, but it is not helpful by itself.  The best food is tart cherries which proves to be among the richest food source of melatonin.  This is the same sleep-inducing hormone that is produced by the pineal gland in the brain.  The body's production of melatonin declines with age which is part of the reason why older adults often have trouble sleeping.  The Journal of Clinical Endocrinology & Metabolism showed that small doses of melatonin (0.3 mg) helped insomniacs achieve better sleep.  Have one cup of tart cherry juice or 1/8 cup of dried tart cherries about an hour before bedtime.

2) HIGH CHOLESTEROL. Oat bran has been known to lower LDL "bad" cholesterol because they're high in soluble fiber.  Other best foods that have shown plaque-fighting potential are Benecol spread, Lifetime Low Fat Cheese and Heart Wise Orange Juice which are enriched with phytosterols - plant based compounds that can lower LDL by 14%.  The National Cholesterol Education Program recommends two grams of phytosterols daily (One tablespoon of Benecol spread provides one gram of phytosterols).  Avocados also help increase HDL "good" cholesterol which has been helpful in fighting heart disease.  Studies have shown that adding avocado to diets has an increase in HDL of 11% in one week.

3) CANCER.  It's often thought that brocolli and cruciferous vegetables are the best cancer-fighting foods.  But the best foods are actually black beans.  They're high in anthocyanins and triterpenoids, potent antioxidants that reduce cell-damaging inflammation and increase destruction of abnormal cells.  Other beans include kidney beans, pinto beans and adzuki beans.  The recommended diet is 3 cups of cooked beans per week.  Studies have shown that people who ate beans more than twice a week were 47% less likely to develop colon cancer than those who ate them less than once a week.  Tomatoes in all forms including tomato paste and ketchup reduces the risk for prostate cancer due to the compound lycopene.  Cooked tomatoes actually provide more lycopene that fresh tomatoes.

4) MEMORY LOSS.  Do you often forget names or forget where you put your keys?  If so, it may be time to enhance your diet.  The best food is blueberries.  Studies show that patients with dementia have improved memory when they eat more blueberries.  Berries contain flavanoids and other antioxidants that reduce inflammation in the brain responsible for decline in memory and cognitive functions.

5) HYPOGLYCEMIA.  This is a condition commonly associated with diabetes in which blood sugar levels drop below 70 mg/dL.  The best food is apricots.  Seven dried apricots provide 15 grams of a fast-acting carbohydrate when an individual experiences a blood sugar crash.  Fresh apricots help but the dried apricots provide a more concentrated level of carbohydrates (sugars) that are easy to store and take with you.  Other fast-acting sugar foods include jelly beans, honey and fruit juices. 

6) STOMACH PAIN.  Do life stresses or eating too much affect your stomach?  Antacids may help but also can cause side effects like diarrhea or constipation.  The best food is actually hot peppers.  They contain capsaicin, a pain reliever that has great effects on the inside as well as externally.  Studies have analyzed patients with dyspepsia (stomach upset) and found that those who consumed 1/2 teaspoon of dried red pepper daily for 5 weeks had a 60% reduction in symptoms.  Hot peppers also help with heartburn.  To help prevent stomach troubles, eat meals daily that contain chili powder, hot curry, hot peppers and the like.  Also consider adding a small amount of cayenne pepper to hot water for a spicy tea.

7) GUM DISEASE.  Periodontal (gum) disease is a leading cause of tooth loss.  This inflammation process of the gums is also linked to heart disease.  The best food is Kefir.  Kefir is a fermented milk that is high in calcium (great for tooth enamel).  It contains probiotic organisms Lactobacillus, which produces hydrogen peroxide to kill bacteria that causes gum disease.  The recommendation is to drink Kefir instead of regular milk two or more one-cup servings daily.  Live cultured yogurt also contain high concentration of Lactobacillus.
Balance and Fall Prevention Programs

One of the leading causes of spinal, hip, shoulder, wrist and ankle injuries and fractures in seniors involve falling and loss of balance.  Whether falling occurs by accident, as a result of distraction, weakness and fatigue or due to a neurological deficit impacting coordination and stability, the end result can be devastating.  One fall can lead to a cascade of orthopedic and neurological problems that may not be easy to overcome.  The best way to treat this problem is to prevent it from happening.  Our Fall Prevention Rehabilitation Programs provide our participants the necessary tools and strategies to improve their balance, coordination, endurance, strength and reaction time necessary to minimize their risk from falling.  Our treatment strategies and exercise programs are easy to learn and adapt into daily living and can be the difference between living life actively and free from falling injuries.

Contact us about our Balance and Fall Prevention Programs.  It will make a difference!
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
(F) 650.261.0331                                   (F) 408.720.8755

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