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Happy Halloween! It's October again and it's the time of year that marks the beginning of a busy holiday season.

Do you feel that your joints are "wearing thin" from repetitive overuse or maybe from years of neglect? Most of us are likely to experience some level of bone and joint stiffness, aching, decreased movement and strength that limits us from feeling eighteen again. Listening to our bodies and acknowledging the early signs and symptoms often takes a back seat to our busy work schedules. But early intervention is key to preventing long term degeneration.

Patients ask us if we have the "quick fix" or the "magic cure" to an old joint problem. Unfortunately, we don't have a that magic pill yet, but what we can offer are preventive strategies in this month's newsletter that may be helpful in minimizing tissue degeneration and injury.

To Your Health,
Advance Physical Therapy, Inc.

Manual Therapy for Pain Relief

Many patients arrive at their first physical therapy appointment expecting to receive hot packs, ultrasound and instructions on how to complete a series of exercises. While these modalities may may seem to help in some instances, active exercise is needed to help restore muscle imbalances and create the necessary stimulus for injured tissues to heal. Manual therapists focus on why a muscle, bone, joint, tendon or nerve tissue isn't functioning properly and implement a comprehensive assessment strategy in order to identify the causes contributing to the primary, secondary and tertiary problems that limit proper tissue healing. For instance, a patient complaining of elbow pain requires a thorough assessment of the neck, shoulder and upper back to identify the source of the elbow pain or a patient complaining of knee pain requires an accurate assessment of the mid to lower back and hip to identify the true source of the referral knee pain.

Manual physical therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to palpate and identify tissue structures that are injured in order to specifically apply the correct amount of pressure on muscle tissue to release muscle guarding, spasm or tension and the correct amount of force to mobilize or manipulate joints to restore alignment and reduce muscle strain and joint compression.

Manual therapy is effective in treating joints that lack adequate mobility (hypomobility) and/or joints that have too much mobility (hypermobility). Too little or too much joint movement can alter proper muscle, bone and joint alignment in various musculo-skeletal conditions. This limitation can cause discomfort, pain, compensation in function, posture, and movement. Manual physical therapy involves restoring mobility to restricted joints, reducing muscle tension and retraining proper muscle-tendon recruitment necessary to return the patient to normal movements without pain. Thus, manual physical therapy is effective in providing pain relief and restoring function quickly for patients experiencing acute and chronic pain.

Manual physical therapy implements the following types of treatment techniques:

  • Soft tissue mobilization applies pressure to the soft tissues of the body such as the muscles and tendons. This pressure helps decrease muscle spasm and guarding, increase circulation, break up scar tissue, and ease pain in these tissues.
  • Joint Mobilization/manipulation uses measured movements of varying speed (slow to fast), force (gentle to dosed force), and distances (called 'amplitude') to twist, pull, or push bones and joints into position of proper alignment. This helps loosen tight tissues around a joint, reduce pain in a joint and surrounding tissue, and help with flexibility and alignment.
  • Medical exercise therapy (MET) is a calculated exercise program designed to optimize tissue healing and regeneration by implementing the correct dosage of resistance training, frequency and intensity necessary to allow the tissue to tolerate varying stress loads from activities of daily living, work and sports.
Manual therapy treatment implements very specific hands-on assessment and treatment techniques to individual tissue systems and is highly effective in restoring normal pain free function. If you would like to learn more about how we implement our manual therapy approach to healing, please contact us or visit us at for more information.
Recognizing "Fall"-ty Habits: Fall Prevention Strategies

Do you find yourself frequently catching your step as you walk? Do you tend to lurch out of bed in the morning? Is it difficult to sit or get up from the chair? Often we employ easy techniques to move around our home and fail to recognize that these habits may contribute to our likelihood of injury. Whether its from jumping up off the floor or shuffling across the hall, these "fall"- ty habits can aggravate existing back problems or lead to a dangerous fall. In addition to staying Alert in your environment, incorporating Balance exercises in your routine, and Calling your physician about changes in your medical status, learning the following movement strategies can help prevent falls.

Getting out of Bed - How to Log Roll
  • Lie on your back with both knees bent and feet flat
  • Roll onto your side towards the direction you will get out of bed
  • Bring your legs forward over the edge of the bed and lower them
  • Use your arms to push your body up to sitting
 Sitting to Standing
  • Scoot to the edge of the bed or chair. If it's a very deep chair, slide to the edge of the chair
  • If you're sitting in a recliner bring chair to fully upright position
  • Place your hands on the armrests
  • Lean your trunk forward and press down on your arms and legs to stand up
Climbing Stairs
  • Always turn on the stairwell light or use a wall-plug-in light
  • Use the handrail when available for stability and balance
  • Going Up: Start with the stronger leg first, then follow with the weaker leg up onto the same step
  • Going Down: Step down with the weaker leg first, then lower the strong leg onto the same step
Getting Down to the Floor
  • Stand in front of a sturdy chair, hinge forward with your hips and bend your knees, grasp the seat for support
  • With your arms supporting you, lower one knee at a time slowly and gently to the floor
  • Hang on to the chair while you lift your other hand off the chair and placed at your side
  • Bring your other hand near your body so that both hands and arms support you
  • Lower your hips gently down into a kneeling position on the floor
  • Support with your arms as you lean to the side and straighten your legs out in front of you
Getting Up from the Floor
  • Use the Log Roll technique to roll to your side, then come up to a kneeling position with your hands on your chair for support
  • Straighten your legs from the kneeling position one at a time
  • Steadily push up with your arms to stand
Keeping these strategies in mind and practicing them can help reduce your likelihood of falling and developing other injuries. Getting rid of "fall"-ty habits will enhance your ability to move safely in and out of your home. Contact us to learn more about our Fall Prevention Program and how you can minimize your risk of falling.
 Tips to Prevent Work Out Injuries

1. Incorrect Technique
The most common weight-training injuries are those related to the use of poor exercise technique. Incorrect technique can pull, rip or wrench a muscle or tear delicate connective tissue quicker than you can strike a match. An out-of-control barbell or stray dumbbell can wreak havoc in an instant. Each human body has very specific biomechanical pathways. Arms and legs can only move in certain ways, particularly if you're stress-loading a limb with weight. Strive to become a technical perfectionist and respect the integrity of the exercise —no twisting, turning or contorting while pushing a weight. Perform the rep using perfect technique and learn how to bail out safely.

2. Too Much Weight
Using too much weight in an exercise is a high-risk proposition with much injury potential. If you can't control a weight on its downward, loading trajectory; if you can't contain a movement within its biomechanical boundaries; and if you have to jerk or heave a weight in order to lift it. An out-of-control barbell or dumbbell assumes a mind of its own; the weight obeys the laws of gravity and seeks the floor. Anything in its way (or attached to it) may be in danger.

3. Inadequate Warm-Up
A warm-up is usually a high-rep, low-intensity, quick-paced exercise mode used to increase blood flow to the muscles. This quick, light movement raises the temperature of the involved muscles, while also decreasing blood viscosity and promoting flexibility and mobility. A warm muscle with blood coursing through it is more elastic and pliable than a cold, stiff muscle. Riding a stationary bike, jogging, swimming, stair climbing and some high-rep weight training are recommended forms of warm-up. Try a 5-10-minute formalized warm-up before stretching. If you choose high-rep weight training, try 25 ultralight, quick reps in the following nonstop sequence: calf raise, squat, leg curl, crunch, pull-down, bench press and curl. Do one set each with no rest between sets. This can be accomplished in fewer than five minutes and warms every major muscle in the body.

4. Not Stretching
Stretching is different than warming up. Properly performed, a stretch helps relax and elongate a muscle after warm-up and before and after weight training. As a result of warming up and stretching, the muscle is warm, loose and neurologically alert — at its most pliable and injury-resistant state. In addition, stretching between sets actually helps build muscle by promoting muscular circulation and increasing the elasticity of the fascia casing surrounding the muscle. Finally, if you perform muscle-specific stretches at the conclusion of your workout, you'll find that this will virtually eliminate next-day soreness.

5. Bad Spotting
If you lift long enough, you'll eventually get to a point where you need to have a spotter for a number of exercises, like the squat and bench press. When you work hard, you may occasionally miss a rep. Nothing wrong with that — it's a sign that you're working to your limit, which is a good thing when it's not overdone. Your training partner can also give you a gentle touch that allows you to complete a rep you'd normally miss. A top spotter needs be strong, sensitive and ever alert to the possibility of failure — not looking around or joking with friends.

6. Training Too Often
How does over training relate to injury? It negatively impacts the body's overall level of strength and conditioning. Over training saps energy that, in turn, retards progress. You can't grow when you're over trained. It also interferes with both the muscle's and the nervous system's ability to recuperate -- ATP and glycogen stores are severely depleted when an agitated metabolic status is present. In such a depleted, weakened state, it's no wonder that injuries are common, particularly if the weakened athlete insists on handling larger weights? The solution is to cut back to 3-4 sessions per week and keep session length to no more than an hour.

7. Poor Nutrition
If you under eat and continue to train hard and heavy, you're likely to get hurt. This relates to your overall health: Beware of heavy training when in a weakened state due to intense dieting or restricted eating. It's best to save the big weights, low reps, forced reps and negatives for non diet growth periods. While dieting requires reduced poundage, this doesn't mean you can't be intense in your workout -- it just means you need to use lighter weight.

8. Negatives
Negative (eccentric, or lowering) reps are one of the most difficult and dangerous of all weight-training techniques — and very effective at stimulating muscle growth. What makes negatives so risky? The poundage you can handle in negative exercise is likely to be the highest you'll ever lift.
Normally, we only lift what we're capable of moving concentrically. In negative training, we handle a lot more weight. Most bodybuilders can control approximately 130% of their concentric maximum on the eccentric phase of a lift. Someone using 200 pounds for reps in the bench press, for example, would bench roughly 260 in the negative press. Because of the increased weight with negatives, you need strong, experienced spotters. Use extreme caution. If the rep gets away from you, the spotters need to grab the weight immediately.

9. Lack of Concentration
If you're distracted, preoccupied or lackadaisical when you work out, you're inviting injury. Watch a champion bodybuilder train and you'll notice his or her intense level of concentration. This is developed over time, and the athlete systematically develops a preset mental checklist that allows him or her to focus on the task at hand. More concentration equates to more poundage. More poundage equates to more growth.

Often times it's easy to sacrifice quality of training for quantity of training. These two principles don't always correlate well and, in fact, can lead to injury and slow tissue growth and regeneration.

Be smart, be careful and have fun working out.
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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