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Optimum Health Physical Therapy in Brooklyn, New York is always ready to offer you personalized and hands-on physical therapy and rehabilitation services. Read our blogs to find out what we can do for you.

Avoid slips and falls in icy conditions

Posted on Wednesday, February 08, 2017 10:47 PM

Avoid slips and falls in icy conditions :

Slips and falls in icy conditions are a common problem. But there are things that we can all do to reduce the risk of getting hurt. Follow the guidelines below if you do have to go out in icy conditions.

Tips for avoiding slips and falls:

You should:

  • Think about the best route to your destination and plan on a little extra time to get there
  • Avoid rushing or taking shortcuts over areas where snow or ice removal is incomplete
  • Select appropriate footwear - flat footwear with rubber soles provides better traction on ice and snow than leather-soled or high-heeled shoes
  • Use handrails where you can
  • Take small steps to keep your center of balance under you
  • Avoid carrying lots of heavy shopping bags, especially on steps
  • Walk slowly and never run on icy ground
  • Keep both hands free for balance, rather than in your pockets
  • Always be aware of your surroundings
  • Be particularly careful getting into and out of vehicles - and hold on to the vehicle for support
  • Keep paths clear of debris, water, ice and snow
  • Be sure to use floor mats when entering a building to remove moisture from the soles of your shoes - this will help protect you, as well as others who follow, from having to walk on wet or slippery surfaces

Helping the elderly:The elderly are particularly vulnerable during periods of cold weather. If you have an elderly parent, relative or neighbor, you can help them avoid injury. For example, you could offer to go to the shops for them or grit their garden path.

Frozen Shoulder

Posted on Friday, March 28, 2014 8:55 PM

Frozen Shoulder

Adhesive capsulitis, also known as frozen shoulder, is a condition characterized by pain and significant loss of both active range of motion (AROM) and passive range of motion (PROM) of the shoulder. While many classification systems are proposed in the literature, frozen shoulder is most commonly classified as either primary or secondary. Primary frozen shoulder is idiopathic in nature, and radiographs appear normal. Secondary frozen shoulder develops due to some disease process, which can further be classified as systemic, extrinsic, or intrinsic. Systemic secondary frozen shoulder develops due to underlying systemic connective tissue disease processes, and causes include diabetes mellitus, hypo- or hyperthyroidism, hypoadrenalism. Extrinsic secondary frozen shoulder occurs from pathology not related to the shoulder, such as cardiopulmonary disease, CVA, cervical disc pathology, humeral fracture, and Parkinsons. Intrinsic secondary frozen shoulder results from known shoulder pathology, including but not limited to rotator cuff tendinopathy, GH arthropathy, and AC arthropathy.

Frozen shoulder usually affects patients aged 40-70, with females affected more than males, and no predilection for race. There is a higher incidence of frozen shoulder among patients with diabetes (10-20%), compared with the general population (2-5%). There is an even greater incidence among patients with insulin dependent diabetes (36%), with increased frequency of bilateral shoulder involvement.

Problem List(identify impairment(s) and/or dysfunction(s)


1. Pain

2. Impaired joint play and ROM in capsular pattern

3. Postural deviations such as protracted scapula and anterior tipping of the scapula and rounded shoulders

4. Decreased arm swing during gait

5. General muscle weakness, poor endurance in glenohumeral (GH) musculature with resultant overuse of the scapular muscles.

Prognosis:Adhesive capsulitis can last 12 to 18 months, with 3 distinct phases. The first phase can last 2-9 months, the second phase 4-12 months and the last phase, the thawing phase, from 6-9 months.

Goals (measurable parameters and specific timelines to be included on evaluation form):

The patient will:

1. Demonstrate knowledge of self management of symptoms

2. Demonstrate independent knowledge of home exercise program

3. Increase ROM of all affected motions to equal ROM on the unaffected side

4. Demonstrate normal postural alignment

5. Demonstrate normal UE motion during gait

6. Demonstrate highest level of muscular performance on involved UE and scapular musculature.

Interventions most commonly used for this case type/diagnosis:

This section is intended to capture the most commonly used interventions for this case type/diagnosis. It is not intended to be either inclusive or exclusive of appropriate interventions.

1. ROM exercises including pendulum exercises, PROM, AAROM, AROM

2. TENS for pain relief

3. Strengthening exercises within pain free range

4. Joint mobilization: grades I-II used in the early stages to inhibit pain and to improve joint nutrition, grades III-IV to increase tissue extensibility

5. Moist heat

6. Stretching

7. Muscle reeducation to regain normal GH and scapulothoracic biomechanics.

Frequency & Duration:

Frequency and duration of treatment are both dependent on the stage that the patient is in. In the initial stages, physical therapy (PT) 2-3 times per week for instruction in home exercise program, patient education, postural awareness education so the patient is able to self manage symptoms and prevent secondary impairments in the UE and shoulder girdle musculature. In the later stages, when the patient is thawing, PT 3-4 times per week

Patient / family education:

1. Time Frames of healing and of each stage

2. Pathology and natural history of the disorder

3. Role of PT in rehabilitation

4. Home exercise program including strengthening and AROM/AAROM/PROM

5. Pain management techniques.

Staying in Shape This Summer !

Posted on Monday, June 10, 2013 11:06 PM

Staying in Shape This Summer !

Staying in shape during the summer months can be hard, especially if you’re on vacation. (Because who doesn’t “cheat” a little on a diet during vacation, right ? ) But there are a lot of fun summer activities you can participate in that have all the benefits of traditional exercise without feeling like exercise at all. As long as you’re smart, you can have fun in the sun while avoiding common summer injuries.

  • Jump In: Staying in shape is a lot easier in water. The water’s buoyancy makes exercises like water aerobics easier on joints, and you can use something as simple (and as inexpensive) as a beach ball to add a little oomph to your workout. Besides: what list of outdoor summer activities DOESN’T include swimming? Swimming is perfect for staying in shape during the summer because it works every muscle in your body. If you’re not much of a swimmer, you can try “water jogging,” which gives you the benefits of jogging with less impact on your knees, hips and ankles.
  • Hit the Beach: Even if you’re not a water person, a day at the beach is a must for fun summer activities. Walking or jogging on sand adds resistance, which allows for a better workout. Not a runner? Try grabbing some friends for a game of Frisbee: it has all the benefits of aerobic exercise, but you’ll be too busy having fun to notice. Just make sure that you liberally apply sunscreen throughout the day to avoid the worst of all summer injuries – sunburn. And stay hydrated! Nothing ruins outdoor summer activities like a trip to the ER.
  • Pedal On: Looking for ideas for fun summer activities the whole family can enjoy? Bike rides are the way to go. If you’re new to working out, pick a place that’s closer to your home, or find a park with bike trails, so that you don’t overextend yourself. A number of summer injuries come from people who give themselves too difficult of a ride, ending in muscle strains, muscle fatigue and dehydration. If you have kids, make sure that you have regulation-sized helmets for you and your children, and that little ones are strapped in correctly to a carrier seat.
  • Keep Climbing: There are ways of staying in shape AND feeding your brain, and a nature hike is one of them. Try contacting your local, county or state park to see what kinds of fun summer activities they have. Many offer nature hikes that range in difficulty, as well as summer-only programs for kids and adults alike. You can save some money by packing your own picnic lunch (and plenty of water), and many places have only small entrances fees, if they have any at all. They may even supply a map or “scavenger” list for particular plants and wildlife indigenous to the area, so you’ll learn something while you’re there. This can also help you avoid poisonous plants (like ivy and sumac). Make sure to wear appropriate clothing, to avoid bugs like lice that feed in the summer. Injuries can also occur with the wrong footwear, so make sure you’re wearing shoes that can handle hills or uneven terrain.

Tension Headaches

Posted on Tuesday, March 05, 2013 12:00 AM

Physical Therapy/ Neuro-musculo-skeletal Perspective:

This is a very common problem seen by me and Francis in New York City. Tension headaches commonly relate to the sub-occipital region where the vertebrae of the neck, the cranium, and the surrounding tissues come together. In anatomical terms this is known as the craniovertebral junction, which is a collective term referring to the atlas, axis, occiput, and surrounding ligaments and soft tissue.

The headaches arising from this region are also known as “Occipital Headaches” which according to many clinician’s, originate in the cervical region, especially if cervical traction decreases the headache pain. This type of headache typically has it’s origin from a structural source. In other words the structures of the neck and craviovertebral junction are strained from poor posture, overuse activities, or movements. The strain of the cervical structures can be associated with headaches.

According to the Mayo Clinic “tension headaches are the most common type of headache and yet the causes are not well understood.” With tension headaches, the muscles that supported the head, including the posterior and anterior sub-occipital muscles, deep neck flexor and extensor muscles are frequently found to be involved. Tense or constricted muscles of the neck often relate to headaches, which can be very intense and unrelenting, and often difficult to resolve. It is often throbbing, pulsating, and radiating in nature.

The sensation of pain can also relate to areas of the neck, jaw, shoulders, upper back, back of head, and refer to the frontal region
of the head.

A brief overview of the anatomy involved in this area involves the following:

· Joints – Occipito-atlanto joint (O-A), Atlanto-axial joint (A-A), Mid Cervical Joints

· Ligaments – OA and AA ligaments, including Alar and Cruciform ligaments

· Muscles – Anterior Suboccipital Muscles (Rectus Capitus Anterio, Rectus Capitus Lateralis), Posteiror Suboccipitals (Rectus Capitus Posterior Major and Minor, Inferior and Superior Oblique), Splenius Capitus, Trapezius, Pectorals, and masseter.

· Nerves – Dorsal Ramus of spinal nerve C1 and C2 (Greater occipital nerve). C2 has a large cutaneous distribution and has a large dorsal root ganglion in a vulnerable location between C1 and C2. Cervical extension motions compress this region and thus Forward head posture can relate to Occipital headaches through this relationship. (ref below)


Abnormal posture has often been related to numerous musculo-skeletal and neuro-vascular impairments. In the area of postural mechanics there is a term that describes a very common position of the head and neck that relates to sub-occipital tension – known as Forward Head Posture. This position puts an abnormal load on the cervical, thoracic, and jaw regions places high amounts of stress on the muscular system. The further forward the head position, the higher the muscular force of the neck muscles must be to counteract gravity.

This posture causes excess mechanical strain on the neck region and results in a cascade of muscular and skeletal problems. As indicated above, it can relate to occipital and tension headaches due to the compression pressure that can aggravate the sensitive C2 nerves.

When working long hours at a desk or computer forward head posture often results- because the body posture will follow the eyes, usually forward, and the posture gets more and more flexed with time due to the force of gravity.

Common history and/or complaints of individual with tension headaches:

· Job that requires prolonged sitting, especially if using computer

· Recent life changes – change of job, living situation, relationship, ANY major change

· Under High amount or long duration of stress 

The main clinical objective findings for tension headaches:

· Postural: FHP (Forward Head Posture) with associated increased thoracic flexion and scapular protraction. Occipito-Atlanto
Backward Bending.

· Hyper tonicity and shortening of posterior sub-occipital and scapula-cervical muscles

· Tenderness to palpation of external occipital protuberance

· Taut bands and trigger points in mid belly of upper trapezius, sub-occipitals, and often upper cervical joints- especially the
transverse processes.

· Restricted Active Range of motion with Chin Tuck, Cervical Forward Bending, and often Cervical Side Bending to contralateral side

· Restricted Passive Range of motion with OA forward bending and often mid cervical up glide restrictions

· Functional Limitations: Varied, often related to increased pain with looking upward, computer work, prolonged sitting, sleep disturbance

Ayurveda Perspective

Ayurveda relates this type of headache to a Vata disturbance, related to the following qualities:

· You cannot have pain without Vata.

· The rough quality of Vata relates to muscle stiffness.

· The dry quality of vata relates to constipation, which sometimes accompanies this pain.

· You may notice these symptoms are worse during Vata times of day 2-6am and pm, and/or Vata seasons (Autumn).

· The mobile qualities of Vata relate to over-activity aggravating the skeletal, muscular, and nervous systems and cause headaches. Pain gets worse with certain movements and less if the body is at rest.

· Fear, anxiety, nervousness, stress can all aggravate Vata and relate to tension headaches.

· Typically Vata headaches are related more to the occipital region, whereas Pitta headaches will be more in the temporal region, and kapha headaches tend to be located more in the nasal/sinus regions of the head.

The treatment for these headaches varies depending on the type of health care practitioner you see. A Physical Therapist or movement specialist would certainly address ergonomics, posture, and physical restrictions with therapeutic exercises and body awareness. A stress management routine and breathing techniques would be indicated. This type of condition responds very well to manual and touch therapies – and in my estimation any treatment plan is incomplete without including it.

I will often use a combination of manual and touch therapies with great results in a short amount of time, including:

·Trigger point Therapy– healing points that can decrease muscles tension, stress, and pain.

The points right underneath the external occipital protuberance are considered the most influential points, called Krikitaka in Ayurveda, and well known in modern medicine for pressure relief because of the location and insertion of the posterior suboccipital muscles into the cranium.

· Manual Therapy – sub-occipital release and myofascial release techniques. These techniques can decompress to posterior joints of the neck and create more extensibility in the soft tissue.

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