When the Weather Gets Cold, Don’t Forget to Warm Up!

The man in sportswear is jogging through the winter country roadColder weather means some changes to how we exercise. Of course, it’s harder to motivate yourself to get outside for a run or bike ride when the temperature drops, and the shorter days compress our schedules, but there are changes in your body that affect your ability to exercise too. For many people with arthritis or other joint problems, cold weather brings more complaints of pain. To stay warm, our bodies narrow blood vessels to reduce blood flow to the skin, and more superficial muscles. That means that there is an increased risk of muscle strains in the cold. There is also an increased strain on the heart because of the narrowed blood vessels. This isn’t to say that you shouldn’t be active outdoors in the cold, it just means you may have to make a few changes to your routine. Here are a few to consider:

Warm up right

A good warm up is always important, but because of the tendency for joints to be stiffer, and blood flow to muscles to be reduced in the cold, it’s even more important that you do it right this time of year. To start, do something to get your heart rate up a bit, maybe a brisk walk or light jog. Follow that up with a dynamic warm up rather than static stretches. This could include walking or jogging while pulling your knees up high to your chest. Maybe some high kicks in front of you with straight knees to get your hamstrings loosened. A walking lunge with an upper body twist can get your whole body moving. Cater your warm up to what you have planned in your workout. If you’re not sure how it should look, ask your physical therapist!

Dress right

Dressing in layers allows you to adjust your insulation to your activity level. After you warm up, you might want to take off a layer to avoid getting too hot during your main activity. You’ll have it there later to put back on when your activity level drops and you start getting too cold.


Don’t forget about the sun either – just because it’s cold doesn’t mean the UV rays are gone. Sunscreen and sunglasses aren’t just for the summer. A lip balm with SPF can protect you not only from the sun but from the wind too.

Stay hydrated

Drink water before, during, and after your workout. The temperature may be down, but you’ll still sweat and you’ll still lose water vapor in your breath. The drier air in winter lets your sweat evaporate more quickly, so it’s easy to underestimate how much fluid you’ve lost.

Cool down

When you’re done, don’t rush to get inside and crawl under a blanket. Cool down properly. Keep moving with a walk or another form of active recovery to let your heart rate come down. After exercise is the right place for static stretching. You can also head inside for some foam rolling or self-massage.

The days being shorter and the temperatures being lower don’t mean you’re stuck inside for all of your exercise. If you follow these tips, you can safely keep moving outside. If you’d like a customized warm up or cool down, or have questions about your exercise routine, your physical therapist is a great person to ask!

Developing Physical Awareness

How are you holding up during these times? Are you doing well? Or are you stressed and feeling like you’re constantly performing a juggling act? No matter how you’re doing during these times, now is as good a time as any to be physically aware of what you’re doing and how you’re doing it. Since our bodies respond differently during times of stress versus relaxation, developing physical awareness will help you develop better habits to prevent future injury.

There are two systems at work within our autonomic nervous system, and it’s important to be aware of them: the parasympathetic nervous system and the sympathetic nervous system. The parasympathetic system is often described as the “resting and digesting” system while the sympathetic nervous system is often described as the “fight or flight” system. Each of these systems are meant to be in balance, but we as humans often tip the scale towards one system over the other. During times like these, it’s often our sympathetic system that is heavily weighted, mostly because we’re on edge and constantly responding to stimuli without being fully aware of our responses; we’re being reactionary rather than thoughtful. As clinicians at Hartz Physical Therapy, it’s one of our goals to help you reduce sympathetic nervous system activation and restore a more normal balance within your autonomic nervous system. So, how do we achieve this balance? One way is to develop physical awareness.

When we are physically aware of what we’re doing and how we’re doing it, we are able to focus on what’s important and allow our bodies to move through intentional movement patterns (such as walking, lifting and carrying) without issue. When we lack physical awareness, our bodies compensate. And because our bodies love to compensate, we often develop muscle imbalances. And if we let our bodies compensate for too long, these imbalances can lead to injury; however, we can alter the trajectory of these bodily compensations by becoming more physically aware of what our bodies are doing and how they’re doing it. Developing this physical awareness will reduce the tendency to compensate and therefore help prevent injury.

What are some practical steps to develop physical awareness? Firstly, breathe. Focus on slow, deep breaths. Some people find it helpful to close the eyes so that distractions can be eliminated. Try breathing when laying down or sitting upright. Concentrate on your inhales and exhales and allow your body to relax with each breath. Check out our blog post titled “The Importance of Breathing” for more tips. Secondly, do one thing at a time and focus on what you’re doing at that moment. Stop texting while driving. It sounds straightforward, but this principle can be applied to many areas in life. Doing too many things at once disallows your brain from fully being present in the moment and can potentially cause harm. Finally, exercise with slow and focused movement. Learn to isolate muscles in order to properly develop movement control, which is vital to injury prevention. Focused breathing while exercising can help facilitate this isolation.

Physical awareness is very important. We’d love to help you develop better awareness, so don’t hesitate to reach out to us for a consultation!

CLICK HERE to view a video about this very topic.

Adapting to Change in a Pandemic

Several months into the pandemic, we are all feeling a little weary…tired of the constant worry, tired of endless safety precautions most of all, tired of avoiding social connections for fear of getting sick. Coronavirus precautions are so draining!

Psychologist Carisa Parrish says, “Trying to adhere to anything extra is always a challenge,” says Parrish. “You can add extra steps to your routine for a few days, but sustained behavior change is hard. Especially when no one around you is sick, and you just don’t feel like wearing a mask or saying no to things you like to do. But the fact is, the precautions work.”

Here are a few tips that Parrish suggests in order to make it easier to safely make it through this pandemic:

Make a commitment: Many safety precautions are not convenient, but that doesn’t mean they aren’t worth the inconvenience.  Just like choosing to wear a helmet when riding your bike, make a commitment to keep yourself and those around you safe by washing hands, maintaining physical distance and wearing a mask in public.

Stay Flexible: Research about COVID-19 is constantly evolving and recommendations do change, which can be frustrating and cause confusion. Follow guidance from reputable sources and use your best judgement. It’s worth it to keep up with the changes.

Practice, Practice, Practice: Habits do not evolve overnight.  It takes many weeks and sometime months before a new protocol becomes habit. Stay the course and continue reminding children until they become accustomed to the safety routine.

Keep Supplies Handy:  Ensure you have enough masks in the house so that you can always locate one when you need it. Don’t forget to regularly wash those reusable masks too!  Keep hand sanitizer and wipes in your car or purse so you have them handy whenever needed.

Make it Fun for the Kids: Kids often have their own sense of style.  They will be more likely to comply with safety precautions if they have some say in the process.  For example, allow them to customize their own mask or pick their favorite design online.  By the same token, give them the option to select their favorite scented hand sanitizer with a cool clip they can add to their backpack.  Consistent reminders are also a good idea until these measures become habit.

As you continue to take these safety precautions throughout this pandemic, if you feel drained and stressed, check out these tips to help deal with Pandemic Fatigue.  The most important thing is not to give up.  The coronavirus is not going away soon, however continuing to comply with common safety precautions while doing our best to continue living our lives in the safest manner possible, is our best chance of success.

* If you are in pain, physical therapy can help. At HARTZ PT, we are taking extensive safety precautions in the clinic. We also offer free phone consultations and telehealth appointments for those who don’t yet feel comfortable coming into the clinic.  A pain-free life is worth it.

Source: Hopkins Medicine

Five Tips to Reduce Pandemic Fatigue

Six months after the onset of COVID-19 in the United States and the end is nowhere in sight.  It is not a surprise that many of us are dealing with Pandemic Fatigue.  It’s a very real feeling of exhaustion stemming from the effects of the pandemic on your life — from stay-at-home orders to the fear of getting sick to losing your job. Dealing with intense emotions, such as fear, anxiety, and loneliness day in and day out can wreak havoc on your energy levels.  You may be feeling edgy or nervous, having trouble sleeping or focusing or lack motivation.  Know that you are not alone.  Here are some tips to help you cope.

#1: Take care of yourself: When we are feeling drained by all of this and have so much on our minds, don’t forgot to take care for your physical and mental well-being.  Make sure you are getting enough sleep and maintaining a nutritious diet. Though it may be difficult to drum up the motivation, exercising every day is important too. Doing these things will boost your energy, lift your mood, and strengthen your immune system.

#2: Limit your news intake: It is a good idea to ensure you are up to date on the latest coronavirus information, however too much news can overload you with negative emotions and zap your energy. Take a break from the news for a day or two and see if you feel better.

#3: Lower your stress: Focus on activities that lower your stress levels and bring calm.  Whether that’s practicing meditation, playing with your pets or taking scenic pictures on a nature walk, anything that takes your mind off the pandemic can be helpful.

#4: Create New Traditions: Many of our former traditions have been turned upside down by social distancing and fear of contracting the virus.  Consider creating new traditions, either just with your family unit at your house (ie: Junk It Up Friday Movies Nights, Family Hikes or Game Nights) or with your greater community through virtual happy hours, socially-distanced walks with a neighbor, or online book clubs.  These new traditions will create new ways to connect with others and potentially be something to look forward to.

#5: Learn a New Hobby: Learning new things can be a great mood booster.  With the new wealth of online resources, you likely won’t even have to leave your house.  You can learn to play an instrument, practice a new language, take an online course, or study photography.  As a bonus, you can show off your new skill and impress your friends with what you’ve learned at the next socially distanced get-together!

These tools can provide you with additional tools to make it through this unprecedented time and come out on the other side a stronger happier person.  If persistent pain is adding to your fatigue or lack of motivation, consider scheduling a free phone consultation with a physical therapist.  Physical Therapists are musculoskeletal experts who can find the underlying cause of pain and develop a plan to help you reduce or eliminate that pain. Don’t delay! Call today.

Source: UCLA Health

Why You Need a Physical Therapist on Your Healthcare Team

With health in sharp focus as a result of the pandemic, now may be a good time to look at the team of experts you have in place and see if there are any improvements you could make. You probably have a family doctor, dentist, and optometrist. Maybe you have some specialist physicians, a trainer, or a massage therapist. If a physical therapist isn’t a part of your healthcare team, you’re missing out on taking care of a big part of your health. To understand why you need a physical therapist, you need to understand what they do.

Physical Therapists Help You Do Things

The American Physical Therapy Association defines PTs as “health care professionals who diagnose and treat individuals who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.” So physical therapists help you do things that you have trouble with. That could be going for a hike, playing with your kids, or getting through a day of work without pain.

Physical Therapists Reduce Pain

Chronic pain is a huge problem worldwide. A big part of that is low back pain. Statistically, around 80% of people will have low back pain in their lifetimes. Physical therapists are trained to treat pain without surgery or medications. If you have back pain, an arthritic knee, neck pain, or an old injury that won’t go away, a PT may be able to help.

Physical Therapists Keep You Healthy

The APTA goes on to say that “PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.” That means that a physical therapist can help you determine your risk for injury, choose the right fitness program, and improve the quality of your life by improving your health and ability to move.

Physical Therapists Can Help You Live Longer

It’s well known that the risk of many of the leading causes of death can be reduced by exercise. Some of these conditions would include heart disease, cancer, lung disease, diabetes, and stroke. By helping you move better with less pain, finding the right exercise program, and helping you to make healthy lifestyle choices, a PT could help you live longer.

Physical therapists have a unique set of skills and expertise that can do a lot to improve your health and quality of life. If you don’t have one, consider adding one to your healthcare team.

Can Standing a Certain Way Cause a Muscle Imbalance?

Have you ever thought about how much time you spend on one leg throughout the day? Is your weight equally distributed between each leg, or is your weight shifted to one side more than the other? Whether walking, running or standing, spending an equal amount of time on each leg is important to maintaining proper muscle balance. 

Whether you realize it or not, we spend a great amount of time on a single leg during a typical day. Every time you take a step, your body needs to shift weight onto that leg for a brief moment in time. It is during this time that single leg stability and strength needs to be adequate, otherwise a stumble or fall might occur. Practicing a single leg stance can therefore be an effective exercise to develop a proper weight shift and better stability. The beautiful thing about this exercise is that it can be performed anywhere! Next time you brush your teeth, try standing on your right leg for 15 seconds, then on your left. Maybe try balancing on a single leg while you clean the dishes or while you throw a ball for your dog. The opportunities are endless! There are many progressions of the single leg balance and we’d love to show you some in the clinic.

Balancing on both legs is very important because if your weight shift favors one side of your body, a muscle imbalance may occur. Muscle imbalance is a common issue we see in the clinic. While not always the case, an imbalance may be the result of spending more time bearing weight on one side of your body versus the other. This week, pay attention to how you stand. Pay attention to how you walk. And pay attention to how you negotiate steps. Do you favor one leg versus the other? Do you bear more weight through one side of your body? If you find yourself shifting your weight more to one side of your body, shift your weight to the other side. It may feel odd, but keeping an equal weight shift through both legs may help improve performance and decrease symptoms that you may be experiencing in the hips or low back.

As with most things in life, balance is essential. The more awareness you have of your weight shift, the better your muscle balance will be. Equal weight shifting may just keep the physical therapist away!

CLICK HERE for a brief video explaining more about this concept

Physical Therapy: A Cost-Effective Method of Treatment for Pain

Achy joints, stiff neck, back pain, creaky knees… sound familiar? If you are experiencing any of these bodily sensations, you are not alone. Musculoskeletal pain affects one out of every two people in the United States ages 18 and over. That is well over 100 million people every year! It is the most common cause of disability and the primary reason people seek healthcare. When left untreated, it can become chronic, and will likely negatively impact a person’s quality of life.

Between visits to doctors and specialists, diagnostic tests, pain medications, and lost wages from time off from work, people with chronic pain spend a lot of time and money in quest of answers to their problems. And worst of all, as a result of physical inactivity – they become subjected to comorbidities such as cardiovascular disease.

But there is good news! Physical therapy can help with all of the above – from pain relief to savings on health care costs.

Physical therapy is a healthcare service that is highly effective in alleviating pain and supports patients throughout all levels of healing – from initial diagnosis all the way through to the restorative and preventative stages of recovery

Proven Benefits of Physical Therapy: Evidence-based studies support the following benefits:

  • pain reduction
  • improving outcomes and optimal levels of function
  • improving strength and flexibility
  • stimulating the healing process
  • restoring movement
  • injury prevention and pain management

Value-Based Healthcare Option: Physical therapy is a health service that delivers proven value for every dollar spent.

For instance, the average cost of one round of PT at a total of 10 visits is $1000 while compared to an MRI at $2,611 or $6,754 for a year’s supply of opioids.

Pursuing physical therapy prior to a primary care physician can result in:

  • lower costs on claims for patients
  • early access savings of $5,000 in annual health care costs for every patient
  • up to 72% drop in medical costs per year

Holistic Approach to Prevention and Wellness

Physical therapy takes a preventative and holistic approach to health. In fact, the American Heart Association recommends patients participate in physical therapy as their initial plan of care. Research demonstrates PT can:

  • serve as a highly effective alternative to opioids and in some cases, surgery
  • empower patients to take control of their pain
  • promote physical activity and overall health and well-being
  • play a critical role in solving the opioid crisis

Direct Access: Since pain is frequently managed first in primary care settings, most people don’t realize that some states, like Pennsylvania, allow direct access to physical therapy.

Direct access allows a patient to contact a PT directly, without a referral and saves a significant amount of wait time for an appointment. The average wait time to see a PT is 24-48 hours compared to 24 days for an appointment with a primary care physician.

Additionally, research has shown that patients who visit a physical therapist directly for outpatient care had 86 percent fewer visits on average than those who were referred by a physician.

If you are currently in pain and are not sure where to begin, try calling your local physical therapy clinic and use these questions as a guideline for the help you are seeking:

  • Does the provider accept your insurance plan?
  • Is the provider Direct Access licensed?
  • Is your insurance plan applicable to Direct Access?
  • How soon will it take to get an appointment?

What to Expect: Whichever way you come to physical therapy, you can expect to:

  • undergo a physical exam and evaluation through a series of functional tests
  • receive a clinical diagnosis, prognosis, plan of care, and a set of goals
  • receive physical therapy interventions and self-management strategies

When patients have greater control over their bodies and the type of care they need, medical adherence increases and health outcomes improve. With the added perks of decreased medical costs and time saved, it’s a win-win!

As healthcare continues to trend more toward prevention and wellness, why not climb aboard and test the waters of physical therapy? You’ve got nothing to lose and everything to gain.

The bottom line is, movement is medicine. When you move, you feel better. When you feel better, you are more likely to eat better, more motivated to move more, to socialize more, and to get outdoors more. So what are you waiting for?

The physical therapists at HARTZ PT are excellent resources for patients to learn new ways to care for themselves so they are able to achieve their most optimal levels of functioning.  The best part is, with a no obligation phone consultation, they will answer your burning questions for free!  Feel free to contact one of our offices to learn how you can begin your journey towards greater health!

Lyme Disease: How to avoid it and how we can help treat it

Last year, my family and I moved to a beautiful patch of woods in Lititz, PA.  It is very scenic and my twin daughters love playing in nature.  However, there is an unseen danger lurking out there that we all need to be aware of…ticks!  Unfortunately, a few months ago, we did find a tick embedded in the back of my daughter’s neck. After hearing so many stories of people getting bit and not knowing what to do or what resources to use, it inspired me to dig deeper into what is out there as far as resources to help individuals with Lyme Disease. You may be surprised to learn that physical therapy can be a source of reprieve to many who are living with Lyme’s Disease.

First, let’s identify it: Lyme disease is the most common vector-borne disease in the United States. As many of you know, it is transmitted by a bite from a blacklegged, infected deer tick.

What to look for: If you think you may have come in contact with a tick, it is important to look for a few signs of a bite. The most common symptoms include: a red circle around the area in which you were bitten, fatigue, headaches, fever, red rash. If not caught and treated early, symptoms can then progress to joint pain, affect the nervous system, and your potentially your heart.

Prevention: Prevention is the best form of defense. Here are a few tips:

  1. Wear long pants and long sleeves when working outside, especially if you live in the woods or if you know it is an area in which ticks like to hide (tall grasses).
  2. Tuck your pant legs into your socks. This sounds weird and it may not be a fashion statement, but the less skin exposure, the better.
  3. Some bug repellents contain chemicals that repel ticks and can be an added measure for prevention.
  4. Always, always search your body and head for those creepy crawlers afterwards.

These are just a few simple ways to decrease your chances of getting a tick. This website has some other great measures that can be taken around your home to help decrease the chances of ticks being attracted to your backyard.

If you find a tick: Try your best to remove the entire tick. Take tweezers and grab as much of the tick as you can, pull with constant pressure. Do not twist or yank as this can cause the head of the tick to break off and become stuck within your skin.

In my daughter’s case, we were not able to remove the entire tick. Don’t panic. If you cannot get all of it, just leave what is left under the skin. The body will do the work for you. Eventually the skin will shed the rest of the tick and it will heal. This is exactly what happened with my daughter.

Make sure to save the tick in an airtight container, so that you can take it somewhere to be tested for different things like Lyme. I used Tickcheck.com which sent me a label to put on the envelope.  In PA, it will be sent to the Wildlife Genetics Institute. If positive for Lyme Disease, it may come back saying positive for Borrelia burgdorferi.

Treatment: In the early stages of Lyme disease, oral antibiotics are frequently used as a treatment. However, if not caught early, treatment can vary based on symptoms, age, and medical history. Here is a good site for additional information and research about Lyme’s Disease. It is also important to see a Lyme-Literate doctor who can perform very specific testing to confirm that you have Lyme.

Here is a list of a few Lyme literate doctors in Pennsylvania (this list is not all-inclusive):
Smith, Regina DO, Internal Medicine           (717) 795-4862       Mechanicsburg, PA
Rhoads, Rita, CNM, NP, Obstetrics               (717) 468-7491      Bart, PA
Makous, Marina, MD  Chronic Disease         (484) 876-1362      Exton, PA
Noonan, Frank C., DO, Integrative Medicine (717) 866-0055     Myerstown, PA

How could physical therapy help those with Lyme’s Disease? Symptoms of Lyme may include joint pain, muscle tightness/ soreness, and fatigue. All of these symptoms can be evaluated and treated in physical therapy:

  1. Muscle soreness: for muscle soreness we often utilize techniques such as stretching, soft tissue massage (STM) and instrument-assisted soft tissue massage (IASTM) to help decrease the tone and to lengthen the muscles. At Hartz Physical Therapy we have several providers that are IASTM trained.
  2. Fatigue: When addressing fatigue, a physical therapist will assess you during the initial evaluation to check your baseline with various activities. Your therapist be able to customize a home exercise program (HEP) that is specific to your needs. At the following visit, the HEP will be reviewed and the exercise regime may be tweaked to progress, if necessary.
  3. Joint pain: For joint pain, the use of aquatic therapy to help unload joints will allow freedom of movement and therefore strengthening of surrounding muscles. It is important to build the muscles that help support your joints so there is less pain. We can also use one of our many available modalities as an adjunct to pain control, if deemed appropriate upon your initial evaluation.  Modalities include moist heat, ice, game ready, electrical stimulation and ultrasound.

The therapists at Hartz Physical Therapy strive to help you achieve your best outcome, no matter the diagnosis. We listen to what our patients have to say and collaborate with them to  create goals that are challenging but achievable.

Additional Resources:




Wildlife Genetics Institute
562 Independence Rd, Suite 114
East Stroudsburg, PA 18301

Blood flow Restriction Training (BFRT)

Blood flow restriction training is becoming more popular in the training and rehabilitation world. It is a very useful technique that helps patients recover faster and more efficiently, especially for those who are limited in lifting heavier weights. This is great news for people who might not be able to tolerate heavy weight, such as the elderly, people with chronic diseases and those rehabbing from injury or surgery. BFRT has also been shown to decrease the effects of muscle atrophy (loss of muscle) for those who cannot lift heavy weights. When used correctly, BFRT can be a key component of any rehabilitation.

The Evidence: BFR training originates from the creation of Kaatsu training by Dr. Yoshiako Sato, and since then, a growing body of evidence has supported the use of blood flow restriction training. The theory behind BFRT is to partially occlude blood flow to a limb, as well as to allow blood pooling in the limb. This deprives the muscle tissue of oxygen, which may sound like a bad thing but this environment is similar to that of a high intensity workout. This reduction in oxygen leads to an increase in anabolic hormones, cellular swelling, and larger type II muscle fiber recruitment. Muscle tissue, blood vessels, and bones use anabolic hormones to facilitate repair, hypertrophy and increase strength. Muscle fatigue during BFR training stimulates the brain to release growth hormones which will circulate through the bloodstream, targeting anabolic receptors on all muscles that were used. This creates a “systemic response” and so BFR training will have a positive effect on all muscles in the area, not just those muscles below the level of occlusion. These hormones have a protective role for tendons and muscle collagen structures as it increases collagen synthesis. This makes BFR a great tool for recovery in athletes. For safety purposes, it’s important to understand we’re not cutting off blood flow all together for extended periods of time, as this would be dangerous.

Typically normal hypertrophy and strength gains are seen at lifting loads greater than 60% of a person’s 1 repetition max. BFR training hypertrophy and strength gains are seen at loads 20-30% of 1 repetition max. In other words, half the weight with similar results! With BFR training we are also able to see strength and hypertrophy gains in as little as 4 weeks, whereas normally it would take 8-12 weeks.

Would you benefit from BFR training?  Although we do not recommend replacing high load resistance training with blood flow restriction training, it can be used in the rehab setting to increase muscle strength and size when a person is unable to lift heavier weights. For example, after most surgeries there is a period in time when a patient is restricted from using heavier loads and low load exercises are not enough to stimulate muscle hypertrophy. Studies have also shown that BFR training increases sprint speeds and muscular power.

Although BFR training is very safe under a physical therapist’s supervision, it is important to take precautionary measures. Those with a history of vascular compromise, history/risk of DVT, pregnancy, and varicose veins should not try BFR training.

A Stay at Home Start Up Workout for Beginners

As we all spend more time at home during this pandemic, it is more important than ever to stay active to ensure our health and wellness.  While we all may be feeling a bit stir crazy throughout this time, what better time to get started with some activities at home?  You may surprise yourself and feel more energetic and less stressed as you progress!  This blog is meant to provide a few basic exercises which will constitute a Start Up Exercise Program.  Exercise is a wonderful thing for the body, mind and soul – try it, you might like it!

There are many things that you can do at home to get yourself moving without the need of a treadmill, dumbbells or weight machines.  A nice stroll around your house, while social distancing yourself from friends and neighbors, will allow you to enjoy some sunshine and the beauty of the spring season.  It would also be a great warm-up to the following suggested exercises.  If you’d prefer, some of the exercises herein can be done outside in a safe and level grounded area.

Start by selecting 7 or 8 exercises on the list to do throughout the day – if you choose, spread them out throughout the day.  Try 2 sets of 10 repetitions each, holding a squeeze for 5 seconds.   Perform the exercise SLOWLY and CONTROLLED.  As you ease yourself into this Start Up program, if you continue to feel good, consider starting to increase your repetitions or add some resistance.  Here are some simple household items that would work:

A can of soup = 1 pound
A half jug of water = 4 pounds

Start slowly to get your body used to these exercises slowly and gradually – there is no better time like the present!  Most importantly, have fun!

  • Laying on back on floor/bed/sofa – Core Marches (stomach squeeze and marching lying on back)
  • Laying on back on floor/bed/sofa – Ball/pillow squeeze between knees (Lying on back or seated position)
  • Laying on back on floor/bed/sofa – Butt Squeeze
  • Laying on back on floor/bed/sofa – Stomach Squeeze
  • Seated Chair Leg Kicks
  • Standing Heel Raises (at a counter top to hold onto)
  • Standing Hip Kick to side (holding on to secure object)
  • Standing Butt Kick (holding on to secure object)
  • Wall Pushup (Make sure it does not bother wrists)
  • Standing or seated Shoulder Pinches
  • Both Shoulder Flexion (1/2 to 1# wt…. can of soup 8oz-16oz would work)
  • Both Biceps Curl (1/2 to 1# wt…. SOUP)

CLICK HERE to view illustrations of these exercises

A couple things to always keep in mind:

  1. Form, Control and Slow progression are important.
  2. If you have any discomfort or pain with an exercise, STOP! The adage of “no pain no gain” does not hold true here.

Lastly, in terms of progression, perform these exercises 2-3 times per week at a gradual progression, assuming you are feeling good (hold for 5 seconds each):

Week 1: 2 sets of 8-10 repetitions
Week 2: 2 sets of 12 repetitions
Week 3: 2 sets of 15 repetitions
Week 4: 3 sets of 12 repetitions

We hope you enjoy this home workout!  If you feel you are ready for a more consistent workout regimine, we encourage you to consider our Medically-Adapted Gym, currently available at 90 Good Drive, Lancaster.




Understanding Pain

Pain in general can be difficult to explain to others, and sometimes patients experiencing chronic pain are faced with colleagues or loved ones that don’t understand. You know that when you stub your toe that pain will usually follow, but why is it that it sometimes lingers on? Have you ever wondered why we feel pain?

Pain is a signal to your brain that something is not right. Nerves throughout our body send information about what is happening in our environment to the brain through the spinal cord. The brain then sends information back to our nerves, helping us to perform actions in response.

Acute pain vs. chronic pain: There are two major categories of pain: acute pain (short-term) and chronic pain (long-term).

Acute pain is a severe or sudden pain that resolves within a specific amount of time. You might feel acute pain when you experience an injury, have surgery, or are sick. An example of acute pain is when you sprain your ankle. The nerves in your ankle respond by sending signals to the central nervous system (your spinal cord and brain) to let them know that something is wrong. The brain then decides how bad the injury is and what to do next. Think of your brain as an extensive database stored with every event like this in your life. Your brain decides whether to invoke tears, raise your heart rate, release adrenaline, or perform one of a million other possible responses.

With chronic pain, however, the initial pain receptors continue to fire after the injury. Chronic pain is generally defined as pain that lasts more than three months. Chronic pain can be caused by a disease or condition that continuously causes damage such as arthritis. Sometimes though, there is no longer a mechanical cause of pain, but the pain response is the same. In these cases, it is difficult to pin down the cause of the chronic pain and thus difficult to treat.

What influences pain? Each person’s response to pain is unique. Because pain messages pass through the thought process regions of your brain, your experience of pain is shaped not just by the physical stimulus, but by psychological, emotional and social factors as well. Memories of past painful experiences, genetics, health problems, coping strategies, and attitude towards pain can all contribute to how you feel pain and how your brain decides to respond.

What should I do about chronic pain? Research has shown that movement is one of the most effective ways to treat chronic pain. Although many people are initially fearful of motion, physical therapy and exercise that is slowly reintroduced is key to managing chronic pain. A Physical Therapist can analyze an individual’s total pain picture and provide services that allow you to better manage your pain, as well as restore your mobility and function.

Simple Tips to Help You Make it Through the Pandemic

Just a little while ago, many of us were living our lives without restrictions.  We joined friends and family for dinner and entertainment.  We were starting to see breaks in the weather which inspired shopping trips for spring clothing or trips to get pedicures.  Children were breaking free of the indoors; the familiar sound of bicycles and laughter was filling our neighborhoods once again.

And then it all just stopped.

Our new mandate requires an end to most of what we used to think was normal behavior…human contact, freedom, independence and perhaps general happiness.  This allows for an increase in less than desirable conditions, such as isolation, depression, anxiety and grief.

Let me be clear in saying, you are allowed to grieve and to appreciate the lives we lived so freely before.  Going forward, we need to take each of those steps to accept the reality of life as it is now, even if it is temporary.  We can use this time as an opportunity to ground ourselves and really focus on what is important…because life will go on. We have the time to do better, be healthier, love more openly and live with gratitude. Consider these helpful tips to combat the mental cobwebs and physical limitations of our space:

Yoga is a connection between mind, body and spirit.  It focuses on meditation and breathing.  It forces your mind to focus on the body’s capabilities which in turn allows for a mindful  meditation.  Meditation is helpful to relieve the symptoms of anxiety and depression, as it allows you to categorize your thoughts.  Almost like a card catalog or a thought rolodex- organization of your mind will help ease anxious overthinking.  Yoga is also a great way for all ages to increase their flexibility, circulation and muscle tone.  Yoga emphasizes on controlled breathing, which has shown to increase immunity and decrease stress on the cardiovascular system.

Walking  Exercise releases endorphins, tiny hormones that make your brain happy.  Besides the pure joy of walking, a 30 minute stroll has been proven to help strengthen your bones and muscles, help reduce stress, improve your balance and coordination and help reduce other cardiovascular ailments.  As we spend more time with Netflix and our couches, a daily walk becomes even more important to keep up our muscle tone and mood!

Sunshine: A daily dose of sunshine and some outdoor air will not only increase your mood but it will also stimulate your body to make Vitamin D.  That’s right, your body uses sunshine to stimulate Vitamin D synthesis from the cholesterol in your skin cells.  Most of us (roughly 42% of Americans) are deficient in Vitamin D as well.  Vitamin D has been proven to fight depression, help aid weight loss and boost immunity.

B Complex Vitamins (with Zinc): These are the powerhouse vitamins.  They are beneficial to general health and stress reduction.  They promote healthy cell function, increase of red blood cells and energy levels.  Zinc has also been proven to aid the immune system.  Most B Complex vitamins have the addition of Vitamin C and Vitamin E, these are increasingly important during cold and flu season because of their antioxidant and immune support.

Technology: Take advantage of virtual resources for interactions with friends and family.  Facetime, Zoom, Skype or even Facebook messenger allow for face to face communications.  As humans, we are a social species.  It is a core human need.  It is so important now to continue to connect with our loved ones even if it is on the other side of a screen.

Eat Healthy!  Drink Water!  Get plenty of sleep! It has probably been said time and time again.  We tell our children, we tell our friends but rarely do we take our own advice.  A healthy, balanced diet, low in processed foods and sugar is the best defense we have to keeping our bodies healthy from the inside out.  Drinking at least 8 8oz glasses of water a day allows for hydration while your body flushes toxins and lubricates the mucus membranes and joints.  A good night’s sleep is vital for your body to continue checks and balances.  Sleep keeps the body’s metabolic functions working correctly, it is important for a healthy heart and brain.  Good sleep is the catalyst for so many self-nurturing habits.  Find the time to relax every night.  Adopt a routine that allows the brain to know it is time to unwind for a restful night’s sleep.

And it is important to remember we will get through this, one day, one hour, one minute at a time.


Ten Ways to Excel as a Teenager during Quarantine

Being a teenager during the COVID-19 pandemic hasn’t been easy.  Schooling has switched to online learning which is a challenge, social events have been cancelled and you can’t even go outside to play pick up with your friends.  The pandemic has changed our way of living, how we interact with our friends and forced us to stay home and spend more time with our families.  This may or may not be a good thing in the mind of a teenager.  However, it is important to find ways to get motivated and active again! Being a teenager presents many challenges, but with some encouragement, character, and grit, we can all make it through this pandemic.

Here are 10 tips to help you get through this unprecedented time.

  1. Get into a Routine. Since your standard school schedule is gone, let’s focus on getting back to the basics. Try to set an alarm to wake yourself up in the morning…maybe it’s not 6am as was typical to catch the bus, but something before noon is encouraged. Take a shower and make sure that you’re not wearing the same clothing every day. Eat breakfast, do some basic stretches to get the body loosened up, and go over a mental checklist of tasks/goals for the day/week. Communicate with your parents about what their expectations are for the day.
  2. Stay Active. Consider reaching out to your coach for workout ideas or preseason expectations. Go back to focusing on the basics for the sports you play and nail down your skills. (Juggling the soccer ball, setting the volleyball, nailing those 3-point shots for basketball, etc.) If you’re not a sports fan, there are a lot of great home workout ideas that you can complete at home without any equipment. Here is a link to a few exercise ideas.
  3. Set a Limit on Social Media/Phone time. We’ve all done it…had those moments where we glance at the clock and realize that we have been lost on social media for way too long.  While social media can be a great avenue for being able to connect with people, it can be a huge time waster and motivation discourager. Set a realistic limit for phone/TV/social media time each day and then if you stick to it, plan out a small reward for the end of the week.  You may be shocked by how much more you are able to accomplish.
  4. Help Out Around the House. Now that you are home the majority, if not all of the day, it can be easy to slack off and go through an entire day without feeling like you accomplished anything. I would challenge you to make a list of chores that need to be completed and then check them off one by one. Maybe it’s taking out the trash, organizing the pantry, or entertaining your younger siblings. All of these activities can help provide you with purpose for the day and aid in reducing stress levels around the house.
  5. Be Intentional About Schoolwork. This transition to online schooling may seem overwhelming and unconventional. Yet at the same time, look at this as an opportunity for you to better prepare yourself for the rest of your high school education or for college. Make daily challenges for yourself to increase your motivation levels. Ex: Complete my math assignment in under 45 minutes or read 30 pages of my book before lunchtime. Remember to take breaks to stretch and get up to move around after sitting for extended periods of time. Here is a link to some simple stretches to complete during breaks from schoolwork
  6. Check in on Your Friends and Family. This is a challenging time for many as we are isolated in our homes and are not able to see our friends and family on a regular basis. Make it a goal to check in “virtually” with one family member, neighbor, or friend a day. Let’s all work together to improve the mental status of the people we love and care about. A little intentionality can go a long way.
  7. Research Potential Job Opportunities or College Options. Having more free time makes for a great opportunity to fill out applications for college and learn more about different career pathways that you may consider for the future. When the restrictions from COVID-19 are gone, consider organizing a time to job shadow at a potential career field that piques your interest.
  8. Drink More Water . When our schedules change, it can be easy to forget about the standard activities that we would normally complete on a daily basis. Such as drinking LOTS of water in order to keep us hydrated. Try to aim for drinking at least ½ gallon of water per day. Find your favorite water bottle and then do the math in order to determine how many time you need to refill it in order to reach your goal.
  9. Get Creative in the Kitchen. Learning simple cooking skills can be essential for helping you gain independence and confidence which will come in handy when you transition into college living or start renting your own apartment. The pressure and busy lifestyle of society can make it very tempting to order out often but being able to cook simple meals can aid in a healthy lifestyle and healthier budget. During quarantine is a perfect time to be able to learn cooking skills from your parents as you are in a setting where you can make mistakes and ask questions. Start with something simple: master scrambled eggs, pancakes, and bacon or learn how to cook your favorite meal.
  10. Learn a New Hobby. Whether it’s baking, calligraphy, wood working, magic tricks or picking up a new musical instrument, the sky’s the limit. See this season of “more free time” as an opportunity to try something new.

Healthy Eating during Uncertain Times

As the days go by and we are spending extended time at home, many of us are wondering how to keep our bodies healthy. Maintaining proper nutrition and good eating habits can be extremely beneficial during times of uncertainty. Don’t let stress or boredom wreak havoc on your diet. It’s important to be mindful of what you are consuming to avoid binge or impulse eating.

PLANNING: Remember when there seemed to never be enough time to cook? Well, that’s no longer an issue! A great way to keep your nutrition on track is to start with a plan. What are you going to eat for breakfast, lunch and dinner? Everyone in your family probably has an opinion as to what they would like to eat. Involve the family in sharing ideas so that everyone has a voice in planning meals for the week. Perhaps you have some family favorites or you clipped a recipe from a magazine that you never got around to trying? If you need some inspiration, Pinterest is a great resource.

SHOPPING: Once the menu is planned for the week, it’s time to make a grocery list. Carefully list all items that you don’t have on hand. Sending one family member to the grocery store once a week for needed food is recommended at this time. Hang the weekly family menu on the refrigerator. When it’s time to cook, assign various tasks to each family member. Use it as a teaching moment with your kids, show them how to follow a recipe, how to measure, etc. Cooking is a life lesson everyone can learn and improve upon!

Need some help getting started? Below are a few tried and true recipes you may enjoy:

  • Frittatas are a great way to use leftovers in your fridge. The main ingredient is eggs. The rest of the ingredients are totally up to you, go ahead and toss in leftover veggies, beans, grains or even chopped meat. Feel free to experiment with what you have on hand. Here is a basic recipe, Vegetable Frittata.
  • Soups are the ultimate comfort food. Make a double batch so you have extra for future quick meals. Lemon Chicken Orzo Soup comes together quickly and is something the whole family will enjoy.
  • Snacks! Everyone loves to snack…it’s an added bonus if it’s healthy. Making protein energy balls is a fun activity the whole family can do together. Gather your ingredients and a few bowls and get those creative juices flowing. Energy Balls {The Ultimate Guide with 7 Recipes}

Preparing healthy meals for now and prepping meals for future use are great ways to stay busy and do something good for yourself. Remember, relax and have fun in the kitchen If your family occasionally eats freshly baked chocolate chip cookies for lunch, no worries, sometimes we all need to treat ourselves!

The Importance of Standing throughout the Day

As the days of being under quarantine lengthen, the phrase “I have nothing to do”, is becoming more and more common. In some cases, this is creating a lot of “couch-time” and not a lot of movement throughout the day. One of the easiest things to add into your daily regimen is to make a goal to stand up at least once an hour.

There are so many health benefits to standing every hour, one of them being boosting your mood and energy levels. At first, the quarantined sounded kind of nice…stay home to read a book, watch Netflix and take mid-day naps…however after 3-4 weeks (or longer) it may become lonely, and rather depressing. Being told to not do what you like to do and being away you’re your friends and family who don’t live with you, can make for a long day. Any little thing to help boost your mood and your attitude is worth it, and if standing is one way to help, then make it happen!

Standing once an hour also burns more calories than sitting. Again, with this extra time at home, an easy way to pass the time is to eat. Eating and sitting more is not a great combination for maintaining a healthy weight. While you are up, why not take a stroll through your house? Walk up and down the steps to get the heart rate up a little. The song that has been on repeat for me lately has been Supertramp’s “Take the Long Way Home”, a good reminder to take the long way to go places (bathroom, bedroom, mailbox, etc). Burning calories more frequently will help keep the weight down, which in return will make your joints less inflamed and more comfortable.

Another plus to standing every hour is it helps improve heart health. Sitting can cause increased blood sugar levels and increased blood pressure, so again, making it a point to stand up throughout the day can help keep these numbers intact, allowing for your heart to be happy and healthy.

Couches and recliner chairs may be comfortable in the moment, but in the long run, they can take a toll on your spine. This creates poor positioning and a lack of support for your neck and low back, causing tight muscles and painful joints. Making it a point to get up, move around, and change positions will help stabilize these muscles and prevent your spine from being in a bad position for too long.

I know it is easy to get caught up watching tv all day on the couch (I have done it as well!), but set a goal for yourself to stand at least 2 minutes every hour, and I can guarantee you will feel more comfortable and productive throughout your day!

The Benefits of Fresh Air on Mental Well-being

With the end of winter and the beginning of spring, many people are anxious to get outside. However, the recent spread of novel COVID-19 have required many to self-isolate, thereby increasing the amount of time that people are spending indoors. While many are feeling anxious, bored and stressed with the requirement to stay home, it is important to acknowledge the benefits of fresh air during this unprecedented time.

Spending 20 minutes outside each day, preferably in a green space, can reduce blood pressure, heart rate, stress and prevent development of psychiatric disorders.

A study published in the International Journal of Environmental Health Research found that simple being in a green space seemed to be enough to spark a change.  94 adults were given a fitness tracker and instructed to spend time in an urban park doing whatever they pleased.  In addition, each participant answered questions about their mood and life satisfaction to measure well-being both before and after the park visit.  On average, researchers found that well-being increased in 60% for participants who spent time in the park.

If you can’t get outside, another way to increase fresh air is to simply open the windows in your home. Even when the outside temperature is cooler, opening the windows in your home can achieve many benefits:

  1. Decreases water vapor in the air produced by humans and pets
  2. Increases oxygen
  3. Improves mental focus
  4. Allows for venting of airborne chemicals and odors

These small changes can improve quality of sleep, immune function, as well as the overall air quality within the home.

The importance of social distancing during a pandemic is of utmost importance; however, among other habits and precautions, the improvement of mental well-being in your daily routine should be a priority. Incorporating exposure to fresh air can be an incredible benefit to your physical health but also to the environment in which you spend much of your time.


Ducharme, Jamie. “Here’s What Being Outside Can Do for Your Health.” Time, Time, 28 Feb. 2019, time.com/5539942/green-space-health-wellness/.


Heat or Ice for Pain? It Depends…

When it comes to managing symptoms at home, many patients report they avoid utilizing adjuncts, including heat and ice, due to a lack of knowledge on which one they could, or should, be using. It is important to have more tools in our back-pocket for managing pain levels (and other symptoms such as swelling & bruising) especially for patients who are not able to make it into the office for an appointment. Both heat and ice work in different way to change the way our nerves sense pain and the way our brain processes the pain sensation. The goal of this post is to help you understand under what circumstances each is indicated.

Ice acts as a vasoconstrictor (ie: it makes the blood vessels smaller) to allow for less blood/fluid to pass into the surrounding tissues. This is especially important following a recent, acute injury, including (but not limited to) sprains, post-operatively or a gout flare up because these traumas initiate their own inflammatory process.  While some inflammation is necessary to the overall healing process, promoting extra inflammation through the use of heat during this time is not recommended. Ice is particularly important in the first 24-48 hours following a new injury, and while there are varying definitions of acute and chronic based on the type of injury, utilizing ice to decrease inflammation can often be a benefit to healing up until the six week mark.

Here are some additional tips to consider when applying ice:

  • Total time of use in one sitting should not exceed 15-20 minutes, as frostbite could occur.
  • Ice packs should never be placed directly on the skin. Instead try wrapping the ice pack in a thin towel.
  • Allow 2-3 hours in between sessions and then ice again.
  • For maximum inflammation reduction, it is recommended you elevate the affected area above your heart; keeping the area below the level of your heart, such as in a recliner, is not a sufficient elevation height to remove this excess fluid from an extremity.

Ice should be avoided if you have been previously diagnosed with: Raynaud’s disease, allergies to cold temperatures, impaired circulation (including peripheral vascular disease or blood clots), and on open wounds. It is important to be cautious with your use of ice if you have a history of hypertension, sensory deficits, such as from neuropathy, or Rheumatoid conditions.

Heat, on the other hand, acts as a vasodilator (ie: the circumference of the blood vessels expands) to promote an increase in blood flow to the tissues. Heat can be an important tool when dealing with chronic pain, muscle tightness, and arthritis. Heat helps to promote relaxation, relieve stiffness and reduce muscle spasm. As a result, you’ll often find increased motion at the impacted joint and improved pain levels.  If you find that your joints/muscles feel better after a nice warm shower/bath, heat is probably for you. If you are beyond the six week mark of an acute injury, you are also likely ready to try heat (if you prefer heat to ice).

There are many different heating methods for use at home, most commonly including moist heat and heating pads. Here are some tips for proper use of heat:

  • Heat should be applied for bouts of 15-20 mins as this gives the underlying tissues time to heat to their optimal temperature to have some of the effects previously mentioned.
  • There is no hard and fast rule of how many times per day you can heat, however it is important to monitor the skin for signs of burns (including redness, blistering) or to have someone in your home who can help monitor this if you do not feel you are sufficiently able to on your own.
  • It is important NOT to fall asleep while utilizing a heating pad, as this can lead to burns and presents a fire hazard.
  • Moist heat packs should be wrapped in 6-8 layers of towels to prevent possible burns; laying directly on a moist heat pack should also be monitored as this can speed the heat transfer process and lead to faster negative skin changes.

Heat should not be used in these instances: over an area of malignancy, presence of acute musculoskeletal trauma, arterial disease, bleeding or hemorrhage, over an area of compromised circulation, in presence of peripheral vascular disease or thrombophlebitis, areas where you have recently applied a heat rub/cream.

If you are at home without access to a traditional hotpack, here are some other ideas:

  • Fill half an old sock or ziploc bag with uncooked rice, tie or sew shut & microwave for 1-2 mins (start with less time and go up if needed, don’t put ziploc bag directly on skin)
  • Soak a kitchen towel in hot water and put in ziploc bag (or put wet towel in ziplock bag. (Do not seal bag when microwaving) Heat for 1-2 minutes.
    *Be sure to test heat prior to applying. If too hot, use a kitchen towel or paper towels as a barrier until it cools down.

Should you have further questions on managing your symptoms independently, please do not hesitate to reach out to the staff at HARTZ PT.

Practicing Mindfulness in Times of Uncertainty

The events occurring over the last several days have left many feeling anxious, worried, and unsettled. With worldwide news regarding the virus, COVID-19, changing so quickly each day, it can be easy to allow these emotions to dominate our daily lives. We resort to checking social media every few minutes for the latest updates, hoping to keep ourselves connected to the society from which we feel so isolated. We may feel as though we’ve lost control. This loss of control and uncertainty about what is to come can cause added stress which impacts your physical and mental health.

In times such as these, practicing mindfulness can help to calm the mind, comfort our spirits, and facilitate mental and physical well-being. But what is mindfulness? It has been described as drawing awareness to one’s present feelings and experiences, calmly acknowledging and accepting them, to better control our emotions and reduce stress or anxiety. The benefits of practicing mindfulness have been widely explored and include improved stress management, higher self-esteem, decreased anxiety and negative thoughts, and improved sleep, to name a few. In essence, mindfulness can help to balance our moods.

How-to practice mindfulness in less than 10 minutes:

  1. Find a comfortable position: often lying on one’s back in a dimly lit room.
  2. Close your eyes.
  3. Focus on slowing your breath, breathing deeply in through your nose and out through your mouth. Your chest and abdomen should rise and fall together. This may last for several minutes.
  4. As you are drawing attention to each breath, you may notice that thoughts start to pop into your brain. When this happens, imagine your thoughts as a cloud moving through the sky. Acknowledge each thought, but then allow yourself to let it go by picturing each thought (or cloud) floating away.

This process allows you to gain better control over emotions and stressful thoughts through the process of acknowledgement and release. The more often you practice mindfulness, the better control you will have over your thoughts.

Other avenues to improve health and overall well-being during these times of trial include proper sleep hygiene, appropriate nutrition, and engaging in physical activity as is safe and appropriate. As we await a resolution to this crisis and send our best wishes to those who have been affected, remember also to engage in self-care measures to maintain our own health and wellness.

Arthritis + Aquatics = Pain Relief

It is no secret that most of us take our bodies for granted, assuming they are going to work when and how we want them to work.  However, the reality is, at some point, after using and abusing our bodies year after year, it is just going to scream, “Stop!”.  That “voice of reason” may come in the form of joint pain, commonly caused by arthritis.

Believe it or not, osteoarthritis is alive and well in every single one of us in some form or another.  By definition, osteoarthritis is the painful inflammation and swelling of a joint.  However, let’s not sugar coat the reality.  Simply put, arthritis hurts!   So, what can we do to manage those painful symptoms?

When working in the physical therapy world, arthritis has a daily presence.  Therapy professionals are always studying and researching ways to best treat arthritic joints. Time after time, there is one that just makes the most sense – Aquatics!

Why Aquatic Therapy? Well, aquatic therapy eliminates the weight-bearing stresses that we experience every day, reducing stress on the joint and therefore, less pain.   If fact, when standing in water up to your calves, you are already putting 15% less weight on your joints, at your knees, 35% less, hips 50%, shoulders 75% and neck 90% less stress on your joints!

Reducing the stress on these joints, will also reduce the pain you experience when moving the joints.  With the joints now given the ability to move pain-free in the water, patients are able to begin strengthening the muscles surrounding the arthritic joint.  Why is this so important?  Several long-term benefits will come from increasing the strength of the surrounding muscles of an arthritic joint:

  • Increased stability and balance
  • Reduced need for compensation by other limbs
  • Less demand on the arthritic joint resulting in a decrease in inflammation
  • Reduced pain when on land

We would suggest starting an aquatic exercise program with slow walking in shallow water at a comfortable depth.  For some variety, you can walk forward, backward or sideways…you can even march or jog if you are feeling good!  All walking motions are able to be duplicated in the deep water for a complete non weight bearing exercise.

If you are looking to focus on upper extremity joints, arm raises to the front and side are both easy to perform.  These are also easy to incorporate with walking for an added total body strengthening experience.  Besides walking, a patient favorite exercise is grabbing a noodle, placing it under the arms and gently moving your legs in a bicycle motion.  This exercise is best performed in deeper water with varying rates of intensity.

Aquatic therapy is one of the most effective means of treatment for an individual of any age suffering from arthritis.  HARTZ Physical Therapy offers aquatic facilities at our Lititz, Lancaster-East and Mount Joy locations.

What is a Net Promoter Score (NPS)?

Net Promoter Score®, or NPS®, measures customer experience. Calculate your NPS using the answer to a key question, using a 0-10 scale: How likely is it that you would recommend HARTZ Physical Therapy to a friend or colleague?

Based on the answer, respondents are grouped as Promoters (score 9-10), Passives (score 7-8) or Detractors (score 0-6).  Subtracting the percentage of Detractors from the percentage of Promoters yields the Net Promoter Score, which can range from a low of -100 (if every customer is a Detractor) to a high of 100 (if every customer is a Promoter).  Given the NPS range of -100 to +100, a “positive” score or NPS above 0 is considered “good”, +50 is “Excellent,” and above 70 is considered “world class.”

HARTZ Physical Therapy is proud to have achieved an
average Net Promoter Score in 2019 of 96.

Aquatic Therapy Isn’t Just for Older People

Aquatic therapy is often an overlooked form of rehabilitation when it comes to individuals with sports related injuries. In today’s world, we all want results faster and quicker, especially competitive athletes who routinely excel in their sport.  But an injury setback can be extremely frustrating, especially when it happens mid-season.  Immediate access to care is essential, but even then, typical rehab on land may be slow and difficult to see progression, especially for injuries which are weight-bearing or involve damage to muscles, tendons or ligaments.

Water can be a crucial component to the recovery process because it allows athletes to gain confidence in their performance, while also recovering in a safe manner.  Due to the unique properties of water, athletes will be able to perform key movements far sooner than they would on land, making it an ideal medium for beginning rehab. Buoyancy, or the ability to float in water, reduces weight bearing on all joints, allowing athletes to perform sport specific movements while reducing the impact. For example:

  • Basketball players can work on jump shots
  • Baseball players on swinging
  • Soccer players can work on kicking

The water also provides resistance to athletes in all planes, which improves both cardiovascular and muscular endurance.

If you are suffering from a sports related injury and want to add diversity to your rehabilitation program in a safe and fun environment, get in the water!

HARTZ Physical Therapy has aquatic therapy  in Lititz, Lancaster-East and Mount Joy.

Physical Therapy Can Help With Your Resolutions

As one year comes to a close and another begins, people begin to set goals and make resolutions. Losing weight, getting to the gym more often or getting into “better shape” are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly after a holiday season of eating, drinking and being merry can lead to pain, injury and disappointment if your body isn’t ready for it.

Your physical therapist is an expert in human movement and can help you safely reach your fitness goals. People think of PTs as the person to see after an injury, but a visit before you change your activity level could prevent injury in the first place. The most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your evaluation which will include an assessment of your strength, range of motion, and functional movement patterns – think jumping, running, squatting, carrying. They can then prescribe exercises or movements to address the issues found and get you safely moving into the new year!

So stop only thinking of physical therapy of something you need only after you’re injured and plan ahead!  In this case, it’s true that an ounce of prevention is worth a pound of cure. Seeing your physical therapist before you start on your resolution can keep you on track, injury free, and help you reach your goals for the new year!

PS: If you are looking for a unique monthly membership program which provides members with an individualized exercise program that is monitored and progressed by an Exercise Physiologist, consider our Medically Adapted Gym, available at Lancaster-West office and Mount Joy office in January 2020!   All new clients receive a comprehensive evaluation by the physical therapist to identify weaknesses and risk areas (billed to insurance).

Recovery after a Concussion…A True Story

In the fall of 2016, our son sustained a concussion on the football field as the result of a direct hit. While he had been well-coached in how to hit and block properly to avoid injury, there was little that could be done to avoid sustaining a bad hit.

Thankfully, he never lost consciousness, but immediately experienced significant headache, dizziness and extreme sensitivity to light. He was checked out by the on-site EMT and was recommended to see a doctor the following Monday. Over the weekend, his symptoms increased significantly, to the point where he was wearing sunglasses indoors and experience general confusion. Riding in a car was painful, as was listening to music and any type of reading or viewing on a screen.

Our family doctor recommended the standard concussion protocol at that time: no school, no sports or physical activity, no reading, and no screens until he was symptom-free. He was 14 at the time and might as well have been told not to breathe, but we committed to following the protocol in hopes of his quick recovery.  Within a few days of this recommendation, he became restless, frustrated and discouraged. His football season was over, basketball was uncertain, he would miss a total of 18 days of school, and worst of all, symptoms were not changing and he had no outlet for his angst.

At that point, we pursued additional input at Hartz Physical Therapy and were introduced to Drew Nesbitt. The first thing that impressed us was Drew’s ability to interact with a teenager. He treated our son with respect, communicating directly with him and not through us, and he knew the culture of local sports and was easily able to talk recent scores, player highlights and top teams. He instantly put our son at ease.

Up to that time, we felt that we basically had to wait in a dark tunnel for symptoms to disappear until there could be any return to normalcy, and it was maddening to feel so helpless in the recovery process. We quickly learned that Drew was highly educated and well-researched in the concussion arena, and several studies were just beginning to reflect that some physical activity might increase the pace of recovery and strengthen brain function. He developed a multi-faceted plan that allowed our son to re-introduce activity (cognitive, vestibular, physical) that slowly re-strengthened what had been damaged. More importantly, the opportunity to DO something to work toward recovery created motivation and hope!

While Drew initiated the plan, many on the team at Hartz walked it out with our son and their commitment to his success was evident. We were truly impressed with their research and constant willingness to push our son to, but not beyond, his limit. As they worked with him, they were educating him about the injury itself, what each exercise or activity was aimed to strengthen and how he could protect himself from re-injury. In all of this, they maintained realistic goals with a hopeful perspective. It was an experience that created a deeper level of maturity and personal responsibility in our son for his own health and well-being.

We are truly grateful for Drew and the entire team at Hartz PT. Looking back, our one regret is that we didn’t go directly to their office the morning after the injury. We believe our son’s overall recovery would have been shorter with the application of current research and strategy.

~ Testimonial written by Kelly M. whose son was seen by Drew Nesbitt, DPT

Heat Stroke: It can Happen to Anyone…A Personal Reflection

Every summer throughout my entire life I have heard the repetitive warnings that as the heat and humidity increases, there are dangers of heat exhaustion and heat stroke. With those warnings, I tended to shrug them off with the ignorant mindset of “that isn’t going to happen to me.” I wasn’t totally belligerent…I prepared myself as best I could with proper hydration prior to activity and avoiding direct sunlight during activity; however it was not unheard of for me to go out for a 20 mile run in >90 degree weather with no supply of water with me. I had gotten away with that mindset for years including multiple marathons/ultramarathon and a bike ride across the country which included crossing the Badlands in 120+ degree weather. However, in the summer of 2018  the effects of the heat got the best of me in a scary way.

Hindsight is 20/20 and thinking back on how this day went, I feel foolish sharing the mistakes I made, but understand I’m lucky the situation did not end worse and feel that this is a learning opportunity. To set the stage, myself and a friend that were both training for fall races decided to attempt to run around Blue Marsh Lake  in the afternoon on a 95-degree day. We both knew it was going to be hot, however with work schedules and other engagements, beginning at 1 PM was the only time we could run together. Rushing to the starting location directly after working in the morning I scarfed down a PB&J and drank a 20 oz bottle of water. We drove straight to the trail and each had 16 ounces of water with us. The heat that day was oppressive and there was a constant flow of sweat coming off of our bodies. Being the middle of the day, the sun was piercing through the tree canopy and we were running with a real feel topping 100 degrees. We both sipped our water, but only slowly in an attempt for it to last the entirety of the run. We both felt ok for the first 13 miles, however on the return trip my legs slowly began tightening, my vision got darker and body began to feel a cool sensation. Understanding this as the early signs of dehydration, I quickly consumed the rest of my water. Unfortunately, it was too late. Those initial symptoms began to worsen to the point I wisely began walking and taking breaks cooling off my body in small brooks; running was not an option anymore. It took over an hour to complete the last 3 miles with no water for re-hydration and the sun continuing to beat down on us as we walked back to the car.

When we arrived to the car, my vision had continued to darken, muscle cramps increased and speech began to slur. My friend helped me into the car and quickly began to drive me to Sheetz for replenishment and air conditioning. As we drove, every muscle in my legs began to cramp/tense, my vision was almost entirely blank and I began to lose voluntary control of my hands. We arrived at Sheetz and my friend got 2 Sheetz employees to aide him in carrying me inside as I was unable to do so myself. Laying on the floor at the entrance of Sheetz my friend got bags of ice and placed them all over my body. It felt like an eternity, while customers coming into the store stared at me while I lay unable to move, it was actually about 20 minutes.  As my body began to cool off, control of extremities began to return.  I slowly regained full control of my body. During that period a concerned patron of Sheetz had called 911 and an ambulance arrived. The EMT checked me out and cleared me.  The next few hours were kind of a daze with a dull headache, a fever and sporadic cramping of my legs and arms. After replenishing with solid nutrients and liquids and a good night sleep, I felt much better the following day.

I fortunately made it through this episode with no lasting impairments, but was humbled and learned a few lessons in the process:

  • A heat stroke can happen to anyone
  • To avoid heat related illness do not participate in activity on excessively hot days with high humidity
  • Avoid prolonged exposure to the sun on days > 85 degrees
  • Replenish with fluids at 8 oz an hour
  • Be aware of signs related to heat illness: Headache, Dizziness, Nausea/Vomiting, Muscle Cramping
  • If any of these symptoms are present rest, replenish with fluids and seek medical attention if they persist.

For more information about Heat Stroke, please check out this post


Physical Therapy 1st Option to Treat Low Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.  Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication: Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging: Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common. 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not. In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge.  Just getting an image increases the chances that you’ll have surgery by 34%

Surgery: The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are not good! A worker’s comp study looked at a group of 1450 people with similar symptoms: half had spinal fusions and half didn’t. The surgical group had:

  • 1 in 4 chance of a repeat surgery
  • 1 in 3 chance of a major complication
  • 1 in 3 chance of never returning to work again

Physical Therapy: Current clinical practice guidelines support manual therapy and exercise. Research proves that early PT leads to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids. A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.  Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. With direct access, patients can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

The No. 1 Thing You Can Do to Improve Your Physical Therapy Experience

Dealing with the pain and limited mobility associated with an injury or illness can be stressful for so many reasons. You might have questions like, “How long will I be sidelined?” and “What do I need to do to get better?” Or maybe you’re worried about how you’ll pick your children up from school, walk to the train for your commute or prepare meals for your family.

These are all perfectly normal concerns. Luckily, there are some ways that you can gain control over the situation and ensure that you return to the activities you care most about—especially if physical therapy is part of your plan.

What you can do before your very first appointment—and during physical therapy—to take control of that injury-related stress? First and foremost, it’s important to come prepared for physical therapy. And no, I’m not talking about dressing appropriately and arriving on time (or even better, 15 minutes ahead of your scheduled appointment). That stuff is important, of course, but there’s one thing you can do in the days leading up to your appointment that will set you up for success.

Any guesses? I’m talking about starting a list. What kind of list? Well, every time that you feel pain in the affected area or notice an activity that is harder than it was pre-injury, add it to the list! And the more specific you are, the better. Here’s an example to help drive this point home: Let’s say that you’re recovering from a moderate meniscus tear and you have an appointment with your physical therapist in three days. Take notes on how your knee feels first thing in the morning after you’ve been off your feet. How does your knee react when you stand up from a chair—does it feel unstable? Or do you find that you need to clutch the back of the couch on your way to the bathroom? Sharing each of these details helps your physical therapist understand your limitations beyond the injury printed on your intake form.

Now let’s take that list a step farther and add some details about the activities that you typically participate in on a regular basis. Let’s say that you normally play a weekly round of golf, spend your mornings weeding your garden or meet up with friends for a four-mile walk two evenings a week. These activities have become an important part of your life so let’s make sure that they’re factored into your list, perhaps in the “what you hope to get out of physical therapy” category. Painting a clear picture of how active you are—and what types of activities and sports you participate in—can help your physical therapist design an individualized treatment plan and to better help you on your road to recovery.

Top Ten Tips to Avoid Injury while Spring Cleaning

Spring cleaning is a great way to recharge and get your house back in order, however organizing closets and cleaning out the basement can create achy, stiff joints, and tight muscles. Here are 10 tips to help you avoid injury while cleaning this spring:

  1. PACE YOURSELF: It can be a long, and physically demanding task to clean out the house, so space it out and do not try to do it all in one day. A common reason that patients come in to see us at HARTZ is because they over-do it with housework. For example going up and down the stairs all day, cleaning for 6+ hours straight, reaching overhead wiping shelves for an extended period, etc.
  2. HAVE A GAME PLAN: For example, if you are going to clean out the basement, avoid unnecessary trips up and down the steps by being prepared. Have the trash bags and cleaning supplies handy, make piles of what to keep and to donate, and then start making the trek back upstairs. Work smarter not harder, your body will thank you!
  3. PROPER FOOTWEAR: While cleaning you will want to avoid wearing sandals, flip flops or slippers because of the poor traction each has. You want to wear athletic shoes or shoes that have a rubbery sole to avoid slips and falls!
  4. PROPER BODY MECHANICS: If you are planning to move heavy objects, be sure to use proper lifting mechanics: bend at your knees, feet shoulder width apart, item close to body and keep a flat strong back (squatting motion). Avoid repetitive movements, use cushions to kneel on, keep your shoulders relaxed when working overhead and avoid tensing your shoulders up to your ears.
  5. START SLOW AND WARM-UP: This may sound a little silly to warm-up before cleaning, but you will be bending and testing your muscles trying to reach every nook and cranny in your home. Doing some light stretching will help you avoid any muscle strains that may come with cleaning.
  6. UTILIZE PROPER TOOLS: Instead of getting on your hands and knees to clean your kitchen floor, use a mop with a long handle. Vacuum cleaners can be heavy and can cause people to have back pain from pushing and pulling them. If you have a history of back pain, try using a cordless vacuum cleaner as they are usually much lighter and easier to move around. When cleaning at a high height, whether it be a ceiling fan, or a high window, be sure to use a proper step ladder to reach those spots.
  7. TAKE BREAKS AND STAY HYDRATED: Cleaning is not a race! If you are someone who cleans every day, you can overuse certain muscles which in turn can cause injury to that muscle. To avoid these types of injuries, it is important to take short frequent breaks. While taking these breaks be sure to drink plenty of water to keep yourself hydrated while cleaning. Keeping your muscles well hydrated is very important to avoiding injuries.
  8. BREAK UP A BIG JOB INTO SMALLER ONES: If you are attempting a big cleaning job, especially alone, it is important to tackle that job with a plan. Break the one big job down into more manageable smaller jobs and complete those one at a time.
  9. LISTEN TO YOUR BODY: If you are having pain while cleaning, then stop and take a break. I know we are inclined to want to finish the job, but fighting through the pain could turn a small problem into a larger one. Cleaning can be a strenuous activity on your body and your body will tell you exactly how it feels. If it is telling you to stop, listen!
  10. PAMPER YOURSELF: After you are done cleaning for the day, take time to assess how you are feeling and pamper those muscles that are a bit sore: utilize a heating pad or ice pack to a trouble area and perform some gentle stretches. Here are recommendations to stretch three areas that commonly take a beating from cleaning:
    1. LOW BACK: may be hurting especially with heavy lifting or even just sitting on the floor for extended periods of time. Lay on your bed and perform some easy trunk rotations, pull your knee in towards your chest, and then trial some hamstring stretches.
    2. NECK/SHOULDERS: may be sore especially if you are hunched over sorting through old files or paperwork. Gentle upper trap and pec stretches will help to relieve neck tension and improve a rounded shoulder posture.
    3. FOREARMS/WRISTS: always work hard when cleaning. To help, perform wrist stretches by holding arm straight out and pulling fingers up (flexor stretch) and then down (extensor stretch). Hold 30 seconds each.

By following these ten simple tips you will help prevent any injuries that may come with spring cleaning. If you ever find yourself in pain that just won’t go away, consider having a physical therapist look at the problem area and give you some tips for reducing pain!  Call us at HARTZ PT anytime!  Happy Cleaning!

~ Alicia Leeking, PTA and Melissa Potts, PTA Student

Keep up the Pace: Why Gait Speed Matters

Gait is the medical term for the way you walk and includes not only the mechanics of walking, but the speed as well.

Why is Gait Speed Important?

  • Gait speed is an indicator of your overall health and life expectancy. Improving your walking speed is associated with improved survival rates.
  • Senior walking ability begins to decline past 65. As we age our walking can become slower, less coordinated, less stable, less efficient, and have poor timing. With potential decline in vision and hearing as well as our posture becoming less upright and flexible, it makes it harder for us to respond to our environment when walking.
  • In order to be able to cross the street safely in time before the light changes, you need to be able to walk 1.14 meters/second. People who have a walking speed of less than 1 meter/second have reported ceasing involvement in any regular physical activity
  • You can assess your own gait speed and a program including strengthening, stretching, balance training, postural improvements, and task-specific exercises can ALL help to increase walking speed!

How to Assess your own Walking Speed using the 10 Meter Walk Test

What you will Need: 10 meters of clear space measured. Add a mark at the first 2 meters and then a mark at 8 meters (see below).  You will also need a stopwatch and a friend or family member to help time you (optional)

How to Perform the Test:

  • Perform 2 trials of walking: One at your comfortable walking speed and another at a fast walking speed
  • Begin walking: Start the timer when any part of the leading foot crosses the 2-m mark. Stop the timer when any part of the leading foot crosses the 8-m mark.
  • The time will be measured for the middle 6 meters.
  • You can use any assistive device that you typically use to walk (I.e. cane, walker).
  • Your gait speed will be the time divided by 6 m

Ways to Improve your Gait Speed:

There are 2 primary approaches to improving your gait speed.
1. Address the physical changes that occur in the body as we age. This works on the “machinery” we need to walk. This includes working on strengthening and stability of our legs and trunk as well as flexibility of our joints so our limbs can move efficiently.  A review of research studies showed that resistance training to strengthen lower extremity muscle was the most effective way to improve gait speed.

Exercise Examples
Strengthen muscles of legs -Repeated standing/sitting from a chair
-Heel raises (Standing with support, rising onto toes and then back down)
Improve flexibility in legs -Calf Stretch
-Hamstring Stretch
-Hip flexor Stretch
Aerobic exercise -Cycling, elliptical, treadmill, etc.

2. Train your brain to walk more efficiently. Practice makes perfect – by practicing we restore and improve the brain’s pattern to engage muscles to better meet the demands of walking.

Task Examples
Practice walking -Increase gait speed for short distances
-Walk forward, sideways, & backwards
-Practice walking while carrying objects
-Practice walking in a figure-8 pattern
-Practice walking while counting or to a beat to make walking more rhythmical
Add obstacles to walking -Place objects on floor and practice stepping over and walking around them
Varied surfaces -Practice walking on various surfaces (I.e. grass, carpet, gravel)

A combined and individualized approach always works best! If you have any questions or concerns about your gait or would like advice on what exercises you can do to help, feel free to contact a Physical Therapist at one of our offices to make an appointment. We would love to help you achieve your goals and get you right out of the gate again.

“If you don’t like the road you’re walking, start paving another one”   ~ Dolly Parton

Blog written by Natasha Clarke, PT, DPT


Chair Yoga for Balance and Overall Well-Being


We all know it’s true…cultivating a healthy lifestyle is a choice that we make on a daily basis.  But what if our bodies are making it more and more challenging to make that choice?  With age, our ability to participate in regular standing exercises can decline and  sometimes, just staying on our feet can be challenging enough!  This decline happens for many different reasons including pain from osteoarthritis or balance deficiencies.

However, the good news is, there are other options for those who have difficulty standing or balancing for prolonged periods of time.

Chair Yoga is one of those options.

Yoga is an excellent way for older adults to loosen and stretch painful muscles, reduce stress, and improve circulation. It also reduces anxiety, helps lower blood pressure, protects joints, and builds strength and balance.  Utilizing various modifications to traditional yoga poses and balancing exercises, chair yoga can achieve many of the same health benefits, while significantly reducing the stress on muscles and joints.  The chair provides support for traditional standing poses, which are modified to be performed while sitting in the chair.

A recent study on Chair Yoga conducted at Florida Atlantic University showed pain reduction, improved mobility and improvement of security and well-being.  This 8 – week program was the first to show Chair Yoga as an alternative treatment for lower extremity osteoarthritis.  In fact, the Arthritis Foundation recommends yoga to improve joint pain, improve flexibility, balance and reduce stress and muscle tension.

If you are someone who has osteoarthritis, trouble with standing exercise or are just looking for a new low impact alternative to regular exercise, you may want to consider adding a Chair Yoga program into your weekly routine.  Yoga adds not only a low impact physical component to your routine, but also a mental one by calming and relaxing participants.  Inevitably this can lead to a greater feeling of happiness and well-being…from which everyone can benefit!

If you’d like more information about Chair Yoga, please contact HARTZ Physical Therapy at 717-735-8880.  We are introducing a Chair Yoga class which will be held at 90 Good Drive, Suite 201 on Tuesdays from 12pm-1pm. The class will be led by certified yoga instructor and current PT Assistant at Lancaster-West, Michelle Newman!  We invite you to join us!  In the meantime, try some chair yoga stretches at home.  Be sure to avoid stretching beyond your comfort level.  Keep it gentle and breathe!

The ABCs of Medicare

If you are approaching the magic Medicare number of 65 years of age, chances are you have been thinking about how you will go about getting on Medicare and what your options are to get the coverage that’s best for you.  This blog is meant to be an introduction to the general options available to give you a starting point for your research.

TRADITIONAL MEDICARE: This in the most well-known coverage and it includes two parts:

  • Part A: coverage for hospital visits
  • Part B: coverage for doctor visits and therapy

MEDICARE ADVANTAGE PLAN: Sometimes called “Part C”, Medicare Advantage Plans wrap Part A and Part B benefits into a private plan administered through Medicare-approved insurance company.  This provides an alternative way to receive your coverage through private insurance companies approved by Medicare.  Most of these plans include additional benefits, such as vision, dental, and/or prescription drug coverage. When you enroll in a Medicare Advantage plan, you are still in the Medicare program, and you are still required to pay your monthly Medicare Part B premium; however, your Medicare services are covered and administered through a single policy.  Since Medicare Advantage plans are available from private companies that contract with Medicare, each plan sets its own premium; some have very low premiums, however, they might not be the right plans for everyone.  The costs and additional benefits vary widely among plans so it is essential to do your research to figure out which one is right for you.

MEDICARE SUPPLEMENT PLAN / MEDIGAP PLANS: Medicare Supplement plans are also offered by private insurance companies and act as just that, supplementing the coverage from Medicare.  In other words, they often pay the costs that Medicare does not. These are also known as Medigap plans. There are many different supplement plans to choose from, varying in cost and coverage. While Medicare Supplement plans may help with deductibles and other expenses not paid by Medicare, they do not cover services if traditional Medicare does not cover them, such as long-term care, dental care, or eye glasses. In addition, these plans do not provide prescription drug coverage.

THESE PLANS DO NOT WORK TOGETHER: Medicare Advantage plans do not work with Medicare Supplement plans. This means that you cannot use your Medigap plan if you enroll in a Medicare Advantage plan. You may enroll in a traditional Medicare plan with a supplement, OR in a Medicare Advantage (known as a replacement plan) BUT NOT BOTH.

MEDICARE PRESCRIPTION DRUG PLAN: If you are looking for a Medicare Advantage Prescription Drug plan, it is a good idea to check whether it covers your prescriptions. Each Medicare Advantage Prescription Drug plan has its own formulary (list of covered prescription drugs). The formulary may change at any time; you will receive notice from your plan when necessary.

CHOOSING THE RIGHT PLAN: When deciding on a plan, it’s essential to compare the benefits and costs in relation to your specific health care needs. The Medicare.gov website suggests considering these 7 things when choosing what coverage is best for you:

  • Costs: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
  • Coverage: How well does the plan cover the services you need?
  • Your other coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare.
  • Prescription drugs: What will your prescription drugs cost under each plan? Are your drugs covered under the plan’s formulary? Are there any coverage rules that apply to your prescriptions?
  • Doctor and hospital choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
  • Quality of care: Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services?
  • Travel: If you travel out of state or out of the country, is there any coverage available with any of the plans?

COVERAGE CHANGES / ELECTION PERIODS: Changes to your Medicare insurance can be made during the Annual Election Period, which runs from October 15 to December 7 each year. You can switch from Original Medicare to a Medicare Advantage plan at this time, and make other coverage changes. If you’re already enrolled in a Medicare Advantage plan and want to switch plans, in most cases a good time to do so is during the Annual Election Period.  When you change Medicare plans during the Annual Election Period, your new coverage generally begins on January 1 of the following year. If you’re enrolled in a Medicare Advantage plan and want to switch back to Original Medicare, Part A and Part B, you can do so during the annual election period or during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year.

This is a lot to think about and there are a lot of decisions to make – be sure to do your research to ensure that you are selecting the coverage that is right for you.  There are resources available online and many private insurance companies may be able to offer advice. If you have questions on what the physical therapy benefits are with your plan, please give us a call and we will be happy to get that information for you.

For more information about the Medicare Enrollment Process, click the links below:
Getting Started with Medicare
Medicare vs Medicare Advantage Plans: How to Choose

Who, Me? Three Factors that Increase Your Risk for Falls

When you were little did you like to think about monsters, thunderstorms, or sharks in the ocean? Unpleasant things are unpleasant to think about. But unlike the boogeyman, falls are a real occurrence and considering your risk for a fall now can save you from one big nightmare later on. Below we discuss three main factors that can substantially increase your risk for falls.  Assess your risk now and keep a potential fall from happening.

Multiple medications lead to massive instability. Sedatives and antidepressants can be culprits as well as seemingly innocent over the counter medications. Dizziness is a common side effect of many medications and can also occur due to drug interactions when taking multiple drugs. Check with your doctor or pharmacist to ensure all medications are necessary and will not interact negatively with each other.

Nerve pain and poor vision could inhibit your body’s natural ability to balance. Do you have poor sensation in your feet or nerve damage courtesy of neuropathy? Those important nerves send signals to your brain telling you how to balance and move reactively to your environment. Without these signals, you are at a higher risk for falls. Vision deficits also heavily contribute to fall risk, as your vision is the largest single sensory contributor to maintaining your balance. Eye care is crucial in preventing a fall.

Poor environment sets you up for disaster. That cute throw rug, poor lighting or a slippery tub could all lead to a fall. Take an honest look around your home environment to see what simple changes you can make to increase safety in your home. If you frequently get up in the middle of the night, a nightlight is essential.  In addition, ensure all electronic cords, books, and decor are out of walking areas prior to going to bed each evening.

If any of these risk factors apply to you, it means you are at an increased risk of falling. But don’t worry! Although some of these factors are beyond your control, there are several actions you can take to reduce your risk for a fall!

Balance and strength (which is necessary for good balance) can be improved, even if vision or sensation is impaired. CLICK HERE to view a video offering 5 easy exercises that you can do at home to help improve your balance (all you need is a chair!).  Please be have someone available to spot you the first time you try these exercises and start slow.

In addition, balance training is offered here at HARTZ Physical Therapy to keep you confident and stable. Our therapists are trained to push you beyond your limits while maintaining your safety at all times. In addition, our balance master is a unique machine that can aid in training you to react to a variety of situations. Free balance screenings with the balance master are available at our Lancaster office on New Holland Avenue. We would love to assist you with your balance goals, keeping you safe without worrying about the possibility of a fall.

Source: “Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2017, www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.

What is Causing your Elbow Pain?

A common form of elbow pain occurs when the muscles on the inside of the elbow (Medial Epicondylitis) or outside of the elbow (Lateral Epicondylitis) become inflamed and irritated.  You may have heard of “Tennis Elbow” or “Golfer’s Elbow”, as these names typically describe elbow pain based on its location.  However, despite the names, these symptoms can be brought on by a variety of different motions or activities that involve the elbow.  Both forms of elbow pain are typically caused by overuse from a repetitive activity.

Tennis Elbow (Lateral Epicondylitis) occurs when the extensor muscles of the forearm become inflamed.  Many of the muscles on the outside of the forearm attach to the outside of the elbow on the humerus bone at a spot called the “lateral epicondyle”. Symptoms may include sharp pain, swelling, and tenderness when the spot is touched or bumped.  In addition, repetitive motions of wrist extension, which is used when performing a backhand tennis shot, can aggravate symptoms.

Golfer’s Elbow (Medial Epicondylitis), on the other hand, occurs when the flexor muscles on the inside of the forearm become irritated.  Just like in Tennis Elbow, the flexor muscles on the inside of the forearm attach to a common bony spot on the humerus called the medial epicondyle and may become irritated and painful after overuse or repetitive motion.  A common motion is the gripping of a golf club, hence the name “Golfer’s Elbow”.

So, what can you do if you have this pain? The best approach is to rest and ice the affected muscles.  Since these symptoms are caused by overuse, taking a break from the aggravating activity is important.  Along with resting, decreasing the inflammation in the elbow is very important. Icing the elbow for 10-15 minutes every 3-4 hours can be an effective way to help decrease pain levels.  In addition, some gentle stretching may help to alleviate tightness in the muscles.  Finally, as symptoms decrease, strengthening exercises are important to help prepare the muscles for returning to the stressful activities.  In addition to these treatment plans, people may find relief from wearing a brace just below the elbow to help reduce the amount of strain placed on the affected tendons.





In more severe cases, NSAIDS may be needed to help reduce pain and inflammation in the elbow.   As the symptoms decrease, it is important to begin a stretching and strengthening program to help restore full strength and range of motion in the affected elbow.  A gradual return to activities is encouraged, however any increase in pain or soreness could indicate that the elbow is not ready to return to full activity levels.

If you have are having difficulty treating the pain and soreness in your elbow on your own, physical therapy can be very helpful in guiding you with appropriate stretches and strengthening exercises for either Tennis Elbow or Golfer’s Elbow.   In addition, PT can assist you in returning to the activities you love, including golf or tennis.

Benefits of High Intensity Interval Training (HIIT)

It seems like with every new year, comes new fitness trends and work out programs. Over the past few years, High Intensity Interval Training OR HIIT has been at the forefront of fitness magazines and news headlines and is becoming an increasingly popular topic at universities and research facilities across the world. So, what exactly is HIIT and what is so unique about this approach to training?

While there is no universal definition, HIIT is characterized by working at high intensities (usually, > 80% of your max heart rate) for moderate amounts of time with short intervals of rest in between. Due to the “all out” nature of these workouts, HIIT workouts typically last around 30 minutes. What is so unique about these intense, focused workouts, is the increased cardiovascular and muscular conditioning benefits that can be gained in the same amount of time verses traditional workouts.

 Research has shown tremendous benefits by replacing 1 hour of steady state cardio per week with two 30-minute sessions of HIIT in healthy adults who exercise consistently.

In a study completed at Penn State University, Dr. Jinger Gottschall researched the effects of HIIT training on already active adults.  Over a 6-week period, she found that participants who replaced 1 hour of steady state cardio with two sessions of 30 minute HIIT achieved the following gains:

  • Improvement of their VO2 max (maximum oxygen consumption rate) by 6.4%
  • On average, a 14.5% decrease in triglycerides
  • On average, a 2.1% decrease in body fat
  • On average, a 15.7% increase in leg strength

For the endurance athletes competing at higher level competitions, research has shown similar results in improving overall endurance, most notably in long distance runners.

So, what does all of this really mean? For the already active adult who may find themselves in a fitness “rut”, replacing 1 hour of steady state cardio with two 30-minute sessions of HIIT training may offer diversity and efficiency to your workout regimen, especially for those with limited time.

 IT’S NOT FOR EVERYONE: While the benefits of incorporating HIIT training into your daily workout routine are enticing, there are a few things to consider before starting. Due to the “all out” and often times high impact nature of HIIT, these types of workouts are generally not recommended for those who are just starting an exercise regimen. New types of HIIT programs are beginning to appear, incorporating cycling as a lower impact option to those seeking this alternative. While modifications can be made to reduce impact, it is best to consult with your physician or physical therapist to see if this type of exercise regimen is appropriate for you and your fitness goals.

While HIIT may not be right for you initially, a physical therapist can help prepare you for the increased physical demands of a HIIT program so that you can train intensely with reduced risk of injury. Hartz Physical Therapy also offers a Medically Adapted Gym program where you could initiate HIIT training, in a supervised setting to optimize your success. Happy training!


Gottschall, J. , Bopp, C. and Hastings, B. (2014) The Addition of High Intensity Interval Training Reduces Cardiovascular Disease Risk Factors and Enhances Strength in Active, Healthy Adults. Open Journal of Preventive Medicine, 4, 275-282. doi: 10.4236/ojpm.2014.45034.

Metabolic Adaptations to Short-term High-Intensity Interval … : Exercise and Sport Sciences Reviews. (n.d.). Retrieved from https://journals.lww.com/acsm-essr/Fulltext/2008/04000/Metabolic_Adaptations_to_Short_term_High_Intensity.3.aspx

Tai Chi and Improving Balance in Older Adults

A popular activity for physical fitness that has recently stepped into the spotlight in the therapy community is Tai Chi. Tai Chi originated in China and has been practiced there for generations. In recent years, it has gained traction as a style of exercise that not only has the traditional health benefits such as lowering blood pressure but also can help reduce fall risk, especially in the older population. Improved balance has even been noted when practicing Tai Chi at its most basic level. Another plus to Tai Chi, is that it can be practiced in the comfort of your own home.

The movements in basic Tai Chi are very gentle, and often require us to use muscles we didn’t even think we had. Muscles, incidentally, that are essential to maintaining our balance on a daily basis.   Because of this, Tai Chi has been shown to reduce risk of falls in all populations, specifically in older adults, by utilizing a regimen of wide stance movements, (strengthening those little muscle groups that are key for maintaining balance) and stretching that keeps the body limber and allows for more natural walking. Because of Tai Chi’s emphasis on controlled breathing, the activity has also been shown to improve how we breathe, reducing your chances of becoming short of breath.

You can find Tai Chi programs and exercises just about anywhere, especially with the use of the internet and fitness videos that can be viewed from your living room. If you’re out shopping, DVDs are also an excellent resource as you can usually find videos with classes at your local supermarket. But if you don’t consider yourself very tech savvy or would rather not sift through piles of DVDs, you can always discuss Tai Chi with your local physical therapist! Most, if not all, physical therapists understand the benefits of Tai Chi and will likely be able to point you in the right direction for classes or teach you the exercises themselves in a safe environment! Here are a couple of things to keep in mind if you’re practicing at home:

  • Make sure you have a wide-open space, too much clutter can result in bumping into objects and possibly tripping!
  • A yoga mat makes a good space for these exercises, as it tends to feel comfortable and will result in less impact on your joints.
  • Take your time! These exercises are all about breathing and meditation, go slow and steady for the best results.

Confidence is one of the most important factors for reducing the risk of falls. Research shows that the more confident we are in our balance, the less likely falls are to occur. One of the best ways to improve confidence is to give yourself options to better yourself. So, if you’re thinking of getting back into exercise for your New Year’s resolution or just want to be safer around the house and in your community, consider giving Tai Chi a try and experience the difference!

What are Therapeutic Modalities?

Therapeutic Modalities…it may sound like a term from Star Wars, but believe it or not, this is a medical term.  If you have been to a physical therapist, you may have experienced therapeutic modalities without even knowing it!  This blog is meant to help you understand what this term means and how therapeutic modalities might be utilized on your road to recovery.

WHAT ARE THEY? Therapeutic modalities are tools your physical therapist might use to help generate healing and assist with muscle reeducation.  This tool can help by decreasing pain and swelling or lessening muscle spasms which may be causing the pain. A few examples of the most common therapeutic modalities include hot and cold packs, devices which will apply pressure and cooling to the affected area (such as Game Ready equipment), electrical stimulation, ultrasound and iontophoresis among others.

HOW ARE THEY USED? It’s important to note, therapeutic modalities are not required to be used during therapy sessions. On the contrary, they are available for use at the therapist’s discretion, based on the patient’s needs.  Therapeutic modalities should never be used exclusively without other forms of therapy such as exercise, stretching and manual therapy.  As a matter of fact, the American Physical Therapy Association (APTA) released a position statement this past August on the use of Therapeutic modalities:

“The use of biophysical agents as a standalone intervention, or the use of multiple biophysical agents with a similar physiologic effect, is not considered physical therapy nor is it considered medically necessary without documentation that justifies the use of the biophysical agents for those purposes”

SO WHY USE THEM?  Therapeutic modalities have been used as a part of the practice of physical therapy for many years. The rationale behind their continued use is based on documented patient experience, or therapists witnessing an improvement in their patients following use of such devices. However, current research does not confirm or discredit the use of the therapeutic modalities as a way to achieve therapeutic goals.  There is some evidence to suggest that certain therapeutic modalities produce no physiologic benefit at all!

WHEN MIGHT THESE BE USED? As a patient who is actively engaged in your therapy, here are some things to keep in mind when talking to your physical therapist about their plan to use (or not to use) these tools:

  • Modalities should never be used exclusively during your therapy visit. For example, if your therapy session begins with a hot pack and Estim, it should be either preceded by or followed with manual (hands on) therapy and rehabilitation exercises or stretches during the same visit.
  • These tools are designed to have an immediate impact. If a modality does not demonstrate a change following the initial application (i.e. decrease pain or muscle spasm, improve a muscle’s ability to contract), it should be modified or discontinued.
  • If the use of a modality does not produce a carryover effect (for example: decreased pain) for >1 day after its use, it may not be medically necessary.

In the end, the choice to use therapeutic modalities, or physical agents, lies solely on the clinical judgement of your physical therapist. He or she may choose to utilize a particular modality initially to help you cope with your pain and then discontinue use after you demonstrate decreasing pain levels. Conversely, they may choose to add it to your therapy plan after several visits to help with muscle reeducation.   However these tools are utilized, it is important to have an open line of communication with your therapist about your progress and their evolving plan to get you back on track toward full function.

As a patient, you have the choice of where you go for physical therapy.  This allows you to be your own advocate. It gives you a voice in a medical world where patients often feel their questions and concerns are the last to be considered.  Choose a physical therapist that explains why they chose certain interventions, and why not, and don’t be afraid to ask questions. We, as physical therapists, are prepared to answer them, and happy to do so.

Are you a New Year’s Resolution Newbee, Master or Flunkee?

Turning the page on the new year is a chance to wipe the slate clean—and to be better versions of ourselves. And when it comes to what we want to improve, goals that fall in the health and wellness arena top all other New Year’s resolutions. In fact, three of the top four resolutions in a YouGov poll were health-related:
(1) eat healthier
(2) get more exercise
(3) focus on selfcare, (ie: get more sleep)

There are three types of people who choose a goal from the health and wellness category as a New Year’s resolution: the resolution newbie, the resolution master and the resolution flunkee.  Let’s see which category you most identify with—and how focusing on the right strategy can help you get healthier in the new year.

Resolution Newbie. Maybe this is your first time making a commitment to your health and wellness. Good for you! Did a recent event like a health scare or loss of a loved one make you see the light? Or perhaps you want to be more active to enjoy activities with your grandchildren or to carry your own bag on the golf course. Whatever your goals are, taking that first step is a big one so you’ll want to be sure that you’re prepared for the challenge. Particularly when exercising for the first time or returning to an active lifestyle after a long hiatus, it’s important to have the proper information and tools to be successful. And that means tapping the healthcare resources available to you.  Clinicians like nutritionists and physical therapists can make sure that your body is prepared to take on new challenges and work with you to a design a program that
will help you achieve your goals.

Resolution Master. Perhaps you fall into a different camp: You vowed to get healthy in 2018 and you achieved it! For 2019, your resolution is to continue the work you’ve begun. After all, living a healthy lifestyle is a lifelong commitment; it’s not something you do for a while and then revert back to your former habits. As you prepare to embrace the new year, are there any small tweaks you can make to advance your goals? Maybe you’re thinking about training for and running a half marathon, but don’t know where to begin. A physical therapy evaluation is a great place to start—PTs are trained to assess your movement patterns and identify any limitations or weaknesses. Based on that information, the PT can design a personalized exercise program to help you safely and effectively prepare for the grueling half marathon course.  We have a great option for those who desire personalized care when working out: check out our Medically-Adapted Gym!

Resolution Flunkee. Let’s say your plan for next year is to get in better shape and improve your overall health (we support that resolution!), but this isn’t your first rodeo. Your resolution last year was pretty similar but it’s one year later, and you’re in the same place you were last New Year’s Eve. What stood in your way—was it time? Affordable options? Access to healthy choices and activities? If any of these barriers sound familiar, then along with your resolution, you need an action plan. Without planning ahead, you’ll find yourself staring down the new year with the same goal in mind. But let’s not focus only on the negative—what went right last year? Maybe you made sleep a priority, which in turn helped you to make better food choices at breakfast but
by afternoon, you found yourself choosing to energize with a soda and candy bar when all you  probably needed was an apple and a 15-minute walk. Take some time to think about the previous year—good and bad—and take with you what you need, and leave the rest behind. Afterall, you can’t plan where you’re going without understanding where you’ve been.

So, Which resolution type are you?

Arthritis: It is Not Always the Same Animal

Arthritis is a buzz word coined for joint pain, however rarely is a difference delineated between the two different types of arthritis: Osteoarthritis and Systemic Arthritis. These forms of arthritis stem from different causes and are treated with different approaches. According the Centers for Disease Control and Prevention (CDC), it is estimated that Osteoarthritis affects an estimated 27 million Americans and develops later in life, whereas rheumatoid arthritis affects an estimated 1.3 million Americans and generally develops in patients anytime between the ages of 30 and 60 years old.

OsteoarthritisAs we age, normal wear-and-tear of our weight-bearing joints can often cause pain.  Cartilage is the tissue between joints that provides cushioning between bones and allows for smooth gliding of bones. Repetitive activities place continuous pressure on those same joints which may erode the cartilage. Furthermore, previous injuries that did not heal properly, increase the risk of developing osteoarthritis.  Symptoms include:

  • Joint pain and stiffness usually affecting hands, fingers or knees
  • Joints on one side affected worse than on the other side
  • Morning stiffness lasting fewer than 30 minutes
  • Possible spine and hip pain as well

Systemic Arthritis: Systemic arthritic (also called rheumatoid or psoriatic arthritis, depending on the location of the pain) is triggered by an autoimmune disorder whereby harmful antibodies are produced that attack the healthy joint tissue in patients. The triggering factors for systemic arthritic conditions are thought to be genetic, environmental, hormonal, and even certain lifestyle factors like smoking and obesity. Symptoms include:

  • Joint pain, stiffness, swelling affecting multiple joints
  • Symmetrical symptoms affecting both sides of the body
  • Morning stiffness lasting longer than 30 minutes
  • Additional symptoms like fatigue, fever, and malaise

Common Treatments:

  1. Thorough physical exam: Treatment generally begins with a visit to the family doctor or the physical therapist. A proper physical evaluation combined with the patient’s medical history will help to distinguish the proper course of action.
  2. Imaging: The patient is often required to get medical imaging (ex: X-ray or MRI) performed to evaluate the joint surfaces.
  3. Bloodwork: If signs and symptoms appear to be more consistent with a Systemic Arthritis, the patient is generally referred to a rheumatologist to undergo blood work and evaluation to properly diagnose. Systemic Arthritis generally requires medicinal interventions.
  4. Physical Therapy is generally prescribed for patients with both Osteoarthritis or Systemic Arthritis. Physical therapy can help alleviate stress on joints by increasing flexibility and strengthening muscle surrounding the joint which will ultimately reduce pain.
  5. Targeted Exercise: Believe it or not, a few simple exercises may quickly and effectively reduce pain and improve mobility.

If you think you have Osteoarthritis or Systemic Arthritis, call your physician or physical therapist to get an evaluation; a few simple exercises may be the difference between living with constant pain or doing the things you want to do!

HARTZ Physical Therapy has 4 convenient locations in Lancaster County and most insurances do not require a physician’s referral to be treated.  Don’t live another day in pain! Call today!

Keeping Kids Safe: 3 Hidden Dangers from a Musculoskeletal Expert

As a parent, one of our primary concerns is keeping our kids healthy and happy.  We make sure they are eating right, having an active lifestyle and not getting too much screen time.   Surprisingly, there are a few common kid-behaviors that we as parents may often see our kids doing, without even realizing the potential danger.

SWINGING A CHILD BY THEIR ARMS: Picture the following scenarios:

  • Have you ever been playing the yard with your children and you grab onto their hands and swing them around in a circle? It’s a common thing that we do and kids love it.
  • You are shopping in a department store and your child sees something they really want and they take off for it. Your instinct, as a parent, may be to quickly grab their arm in order to catch them.
  • You are on a walk with your kids, but you’ve found that they have run off ahead of you. You are running to catch up when you see a car coming down the road so you quickly grab your child’s arm in order to protect them.

I’m sure we have all done one of these things at some point and to some extent, this may be a necessary risk, but it is a risk all the same.  Pulling a child abruptly by the arm or holding he/she up by his/her arms has the potential to cause radial head subluxation. Believe it or not, depending on the child, it may not take much force for this to happen. Also called Nursemaid’s elbow, this is common in children because their bones are still growing and have loose ligaments surrounding them.  A abruptly yank or pull could cause the annular ligament to slip over the round portion of the bone. According to KidsHealth.org this is most often seen in children between the ages of 1 and 4.

If your kids love to be swung around, something to consider is grabbing them under their shoulders instead or asking them pull up a little bit to create a slight bend in the elbow as they swing.  This muscle contraction will help protect their ligaments.  It’s a good idea however, not to engage in this behavior too often when your children are little.

THE “W” SIT:  Usually seen in toddlers, the “W” sit is when a child sits with bum resting on the ground between their legs, legs out to either side with both knees bent and their feet tucked under them. We may marvel at the fact that our kids can actually sit this way! Some kids prefer this position more than other and typically utilize it when playing on the floor. Moving in and out of this position for very short periods is not terrible, however, when the child is sitting in the “W” position for long periods, it can raise some concern.


  • Sitting in this position for long periods puts extra strain on the hips joints and ligaments which can lead to an increase risk for hip dislocation as the child grows.
  • If the child is prone to tight muscles, “W” sitting can cause an increase in muscle tightness in the hips, knees, and ankles.
  • The wide sitting stance of this position also makes it easier to keep the body in an upright position. This leads to decreased core engagement / strength of the abdominals.
  • A little-known potential side-effect of this positioning is its effect on hand preference. As noted, children have a lot more trunk control when “W” sitting which makes it easier for children to pick up items with either hand. You normally wouldn’t think anything of this. However, it can have an effect later when the child is learning to write.

In my case joint laxity and loose ligaments runs in the family, so when I saw my 18-month old daughter starting to sit in this position for long periods, I immediately corrected her. I simply would lift her up and put her into a better position that still allowed to play. For example, I would lay her on her stomach to color, or have her sitting with her legs stretched out and a toy between her legs.

TOE WALKING:  Toe walking, when the child walks on their toes or the balls of their feet, is very common in children that are learning to walk.  Typically, it is not something that should cause concern, however, according to Mayo Clinic, it should raise some concern when the child is still toe walking after the age of 2 years. Possible causes for kids to continue toe walking past the age of 2 include:

  1. Tight Achilles Tendon– this is the tendon in the back of the lower leg that attaches to the heel.
  2. Cerebral Palsy– this is a disorder of movement that affects muscles tone
  3. Muscular Dystrophy – this is a genetic disease in which the muscle fibers are prone to damage and weakening over time
  4. Autism– toe walking has been linked to this spectrum disorder

Toe walking does not necessarily mean that your child has one of the conditions listed above, however should this behavior continue past 2 years old, it is a good idea to ask your doctor about it.

Well there you have it, maybe you’ve seen these behaviors in your kids and maybe you haven’t, but either way, you are now a little more prepared to keep young kids safe!

3 Holiday Stressors that can be Reduced by Physical Therapy

Holidays are hard. And we’re not talking about buying gifts for the person who doesn’t need anything or putting up with difficult relatives. Holiday tasks are physically difficult be it shoveling snow, cooking big dinners, walking around town singing Christmas Carols, or lugging your decorations upstairs from the basement. Unfortunately, during the holidays, we often put aside taking care of ourselves, just like we put aside the fruitcake! In the clinic, we notice this from our patients who often reduce or avoid physical therapy visits until the new year, citing holiday stress caused by too much to do and not enough time to do it!

Here are three holiday stressors that can be reduced by physical therapy:

REDUCING THE 12 PAINS OF CHRISTMAS: Physical Therapy during the holidays will equip you to handle the holidays with grace – and less pain! Taking care of that pulled hamstring will improve your dance moves for New Years!  Finally resolving your tennis elbow will make icing all of those cookies so much easier!  We won’t even mention what a little back therapy will do for you the next time you have to pick up children while playing Santa Claus! During a holiday that is usually marked by increased activity, use the knowledge and healing of PT to make all of that activity more enjoyable.

REDUCING OUT OF POCKET COST: Money is always on our minds during the holidays. Paying for all those gifts, traveling to visit family and friends and funding your massive light display all increase the December budget. The opposite is true for physical therapy. At the end of the year, your PT may cost less if you have covered your deductible.  This makes your therapy a money saving experience! With the dollars you’ll save on PT you can buy that extra present or a few extra jugs of eggnog to keep you going into the New Year! Most health insurance plans renew in January, triggering a new deductible to meet. Squeezing in a few appointments before January 1st can save you some money in 2019. Now that’s a great New Year’s resolution!

REDUCING MENTAL STRESS: Physical care of yourself during the holidays is also good for you mentally. Taking some time for yourself calms you during a time that can be stressful. So get away for an hour and do something that makes you feel good both physically and mentally. It will help you feel calmer and in control of your health. It may even allow you to avoid “stress eating” that whole plate of cookies! If you need a break in the middle of your hosting duties, take five to complete your at-home therapy exercises and gain a little peace on earth.

The holiday season truly is a wonderful time of year for many things, including physical therapy. We are proud to make your holidays a little merrier and brighter here at HARTZ PT. Four locations in Lancaster County are eager to serve you this December and we wish you and your family a happy holiday and a healthy New Year!

Effects of Bad Posture & How to Fix It

Have you ever noticed that grandma or grandpa seem to lose inches as they age and sometimes may seem to have a rounded upper back?  Well, the truth is, some of this is just the natural aging process, but there are things we can do now to prevent and correct this curving of the spine before it’s too late!

WHAT CAUSES THIS?  Well, nature does play a role, however a sedentary lifestyle and time spent on computers and smart phones can accelerate the decline.   As Americans, we often don’t realize how easily we are sucked into the sedentary lifestyle due to our jobs and advances in technology.  Everything is just becoming too convenient! All these things have a detrimental effect on our posture, which, in turn, can have other consequences on our bodies.

THIS CAN LEAD TO OTHER ISSUES: Yes, that’s right, other than the physical effects posture has on your outward appearance, bad posture also affects you in other ways.

HEADACHES: Looking down at your desk, phone or computer causes a forward bend in your neck. Staying in this position for an extended period or even short periods several times throughout the day can cause headaches. Why?  Well, when you are hunched over and looking down, you are decreasing the curve in your cervical spine putting excess strain on the muscles in the back of your neck as they are working overtime to keep your head from falling. This excess strain on those muscles is one of the many reasons you can get headaches.

DIGESTION: Sitting with bad posture for longer periods can also have an effect on your digestive organs. Just picture your organs all curled up in the normal position and then picture them with them folded over on each other with an extra 20 lbs of pressure on them. Does that give you an uncomfortable visual? This bad posture is putting extra pressure on your digestive organs, not allowing them to function properly.

POOR MOTIVATION: Not many of us think of poor posture being related to motivation, but it is. Studies have shown that being hunched over causes increased emotions of fearfulness, low self-esteem and having higher chances of being in a bad mood.

BACK: Your body has 3 natural curves: cervical, thoracic and lumbar.  When slouching for long periods of time, whether in the car, at work, on the sofa, day after day this can negatively affect your back and put increased pressure/ stress on different areas. The longer the behavior occurs the more negative effects it can have on your body by putting your body in this unnatural position.

The bottom line is, proper posture keeps you in a position that causes the least amount of strain on your muscles and ligaments.

So, what can we do to improve our posture?

Maintaining the proper posture after having bad posture is work and it takes time, however it is worth it! You need to be consciously aware of your body’s position.  The following are suggested positioning for seated and standing posture.

SEATED: When in a seated position you should have your feet planted on the floor or a foot rest if your legs are too short for the chair. Keep feet in front of your body and do not cross your legs.  Your knees should be at a 90-degree angle with the seat of the chair far enough away from the back of your knees to create a gap. Your back should be in an upright position with low and mid back support. Shoulders are relaxed, and elbows bent at a 90-degree angle (forearms parallel to the ground).

STANDING: When standing, most of your weight should fall on the balls of your feet. Knees should be slightly bent and hip width apart. Your back should be upright and tall with your shoulders pinched back. Pulling your tummy in will give your back some extra support. Your head should be held high and level.

* images from www.health.harvard.edu

Again, improving your posture is not always easy. It will take a conscience effort!   Put a timer on your phone or a sticky note on your desk as a reminder for yourself. If your car or seat at work is not providing you with the correct amount of low and mid back support, you can roll up a towel and place in the area you are lacking support.  Over time good posture will put less strain on your body.

Here is a great video with some quick tips on proper posture while on the computer

CLICK HERE for some great workday stretches!

If you have any questions about posture or what exercises you can do to help, feel free to contact a therapist at one of our offices to make an appointment. We would love to help you achieve your goals!

Does your Growing Athlete have Knee Pain?

Patellar Femoral Pain Syndrome, otherwise known as PFPS, is common in adolescent athletes especially those who participate in sports year-round. This diagnosis presents itself with generic soreness in and around the front of the knee and/or kneecap. Since most athletes in their teens have growth spurts, their bones grow faster than their muscles. This causes an imbalance with the forces around the knee causing abnormal motion of the kneecap. Typically, this will cause pain with prolonged standing, negotiating stairs and athletic activity in general.

Physical therapy is one of the few avenues available to reduce the pain and accelerate a return to sports with full function. The typical plan of care is as follows:

  1. REDUCE SWELLING: Modalities, such as ice, heat or electric stim can help
  2. INCREASE FLEXIBILITY:  Chances are good that the ligaments surrounding the knee (IT Band, lateral retinaculum) haven’t kept up with the bone growth and are therefore very tight.  As a result, the patella moves laterally (to the outside) when running or walking, creating extra friction, and often pain.  Stretching the tight ligaments allows the knee cap to return to its normal tracking pattern and will reduce pain.
  3. STRENGTHEN WEAK MUSCLES:  As the therapist works to stretch tight ligaments, the patient must also strengthen key muscle groups, such as quadriceps, hamstrings, gluteus medius, gluteus maximus. These muscles help to stabilize the joint which provide increased endurance with sport-related activities and also help to keep the patella moving smoothly.
  4. ADD PLYOMETRICS:  As pain and swelling is alleviated, it is time to introduce a plyometric program, such as agility or sport-specific training.  This is the final step with therapy to help the athlete ease their transition back to his/her sport. This last step challenges the athlete with higher functional tasks in order to simulate game or field conditions. Quick steps, lateral jumps, and ladder drills are just a few of the techniques that a therapist may use to help move a young adult toward reentry to their sport or activity.

Don’t wait and deal with pain! Come in and see a physical therapist today.

Plogging: Jogging with a Dual Purpose

Yes, I know what you’re thinking, I am blogging about plogging. Well if that rhyme doesn’t convince you of the merits of this new trend, keep reading.

Plogging is a new spin on exercise that allows us to make the world a healthier place while making sure we stay healthy too. Originating in Sweden in 2016, this trend has generated increased attention over the past 2 years, and it’s easy to see why!

This activity turns a boring old jog around your neighborhood into a unique type of scavenger hunt, all while improving your community, one piece of litter at a time! Not a runner?  No problem! You can still participate with a simple walk while cleaning up the street, also known as plalking.

While jogging and walking are both fantastic aerobic exercises, plogging increases your workout potential by incorporating several functional activities, such as squatting, lunging, stretching, and maintaining balance. However, to avoid injury, follow these recommendations:

  • Ensure you maintain proper form as you bend to pick up items from the ground. This includes bending at the knees, not at the waist.
  • Be sure to come to a full stop before bending over, which will help avoid over-extension of joints and muscles.
  • Perform squats or lunges in a slow and controlled manner to avoid putting unnecessary stress on your back, knees, and hips.
  • When squatting, make sure you can see your toes past your knees, if you look down. Imagine you are sitting in a chair placed behind you.
  • Avoid motions that cause pain to reduce the chances of inflammation following exercise.

If plogging sounds like it’s for you, here are a few tips which will help ensure a safe and healthy experience before you set out to clean up your neighborhood:

GERM PROTECTION: A good pair of gloves are a must to ensure protection from bacteria and germs.  Some of stuff you’ll find can be pretty dirty!
PLASTIC BAGS:  This one is a no-brainer, but it might be a good idea to pack an extra bag or two…you never know how many “treasures” you’ll find!
WARM-UP/COOL DOWN: No matter your age, a light warm-up before plogging and brief cool-down afterwards are always a good idea.  Dynamic stretches (stretching as you are moving) before and static stretches (long holds in a stretched position) afterwards will help your muscles stay limber and healthy.
HYDRATION: Drink plenty of water! Our bodies love water and making sure you stay hydrated is an easy way to keep you energized and healthy.

The bottom line is, if you’re looking for a spin to your daily workout and would like to do your part to help clean up your community, get out and get plogging!  Interest in plogging is growing and you are likely to find others who are passionate about it in your community.  Check out the Lancaster Plogging Facebook page where like-minded people often plan group plogging outings for the community.  Happy Plogging!

3 Pitfalls to Avoid when seeking a Physical Therapist

Your favorite restaurant is closing due to a health code violation. A new teapot is shattered because the mailman dropped your package.  That “contract-free” phone plan has you tied down for two years.  Different industries have different shortcomings and physical therapy care is no different. Below are three key checkpoints to make sure that you are getting the care you deserve at your rehab facility:

  1. CHECK THE PATIENT FLOW: Shall we state the obvious? More patients create more revenue. With that reality it can be very tempting for clinics to attempt to pack in as many patients as possible, thereby increasing the payday. If you find that every time you see your therapist, you are rushed through your treatment, then maybe it’s time to look elsewhere. Sure, a productive clinic can be busy, however a quality clinic should make you feel heard and understood at your sessions. There should be appropriate time to have your complaints addressed and your questions answered without being brushed aside. In addition, ensure you have proper supervision while you perform your exercises. If your treatment team is burdening you with four exercises and consistently leaving (hopefully not for coffee breaks) you might also want to reconsider the quality of care you are receiving.
  2. APPROPRIATE EXPLANATION OF PAIN NECESSITY: Many patients have experienced self-described “torture” at the hand of physical therapists. Although there are some occasions where pain may be necessary, the rationale for pain provocation should be explained thoroughly.  The patient should be in control and have the power to say when “enough is enough”. Trusting your therapist and having them respect your pain tolerance is crucial. Pain in therapy must be productive.
  3. CONSISTENCY IS KEY: Consistent care by qualified professionals has been proven to result in better outcomes. In other words, seeing the same patient care team virtually every visit, including frequent 1-on-1 follow-ups with the Physical Therapist. Patient care being passed from clinician to unfamiliar clinician with no consistent follow up can lead to disorganized care, inconsistent treatment sessions, and a superficial understanding of you and your treatment regimen. Certainly, clinician vacations, illness, or unforeseen circumstances may change your treatment team temporarily but for the most part, having access to a consistent team of providers will facilitate continuity of care.

Three top pitfalls among physical therapy clinics are a “factory approach” to care, inconsistency in your treatment team, and pain without corresponding gain in function. If you think your provider is falling into one of these traps, it may be time to look around. As an independent small business, our values of focused attention, consistent care, and appropriate application of treatment intensity are keys to our success during the past 20 years. We invite you to Experience the Difference for yourself.

Sleeping Away your Pain

We know your type, you go above and beyond to advance, progress, and accomplish. You are up at dawn and burn the midnight oil to get ahead. And when an injury presents itself, you work with your physical therapist to recover, whether it be attending every visit in the clinic or doing your home exercise program ten times per day!  However, something you may not have considered, is how sleep deprivation can play into your recovery.

Sleep deprivation is widespread. The CDC considers it a public health problem. It is estimated that up to 90% of sleep pathologies are undiagnosed! Think you sleep well and long enough already due to tracking your sleep? Don’t be too sure. In trials of over 80 sleep tracking devices (think Fitbit) worn by consumers, only one withstood a clinical trial. Most of the devices overestimated sleep duration and quality and underestimated awakenings at night.

Sleep helps you recover. A recent article in Physical Therapy, a professional PT research journal, reviewed the correlation of quality sleep to injury rehabilitation. Not only does sleep increase cognitive function as we’ve heard so often, but it also facilitates increased immune function and tissue healing as well as decreased perception of pain.  Imagine, get your 8 hours of solid shut-eye each night and feel no pain (well, OK maybe just less pain)

We can help maximize your comfort to get more sleep! Our professionals know how to make you more comfortable at night. While we are not sleep specialists, we do know how to position you for maximum comfort in that recliner after shoulder surgery or baby that back to get as much deep sleep as possible.

Daily exercise aids sleep as well. This article reminds us that regular moderate exercise has a positive benefit on sleep quality as well. A physical therapist can recommend specific exercises which will be safe to perform, even if you have some limitations. A HARTZ PT, we also provide our signature Medically Adapted Gym and our Better Bones, Better Balance Class designed to help you achieve your goals.  Improved sleep may be a side benefit of trying out these programs.

Sleeping is crucial to your recovery and quality of life. So next time you find yourself skimping on sleep, do yourself a flavor and get a little shut eye. It might help you more than you realize.

Works Cited: F.Al-dughmi, Catherine, et al. “Sleep Health Promotion: Practical Information for Physical Therapists .” OUP Academic, Oxford University Press, 18 May 2017, academic.oup.com/ptj/article/97/8/826/3831304.

5 Easy Tips for Pain-Free Gardening

For most of us, spring and summer is the time of year when the weeds in our yard start calling!  When the weeds go crazy, we might feel overwhelmed and want to do it all in one weekend, however, as I’m sure you have figured out, this is not a great idea.  Overdoing it can often mean an increase in aches and pains, especially back pain.

Whether you are planning on weeding the flower beds, mulching, pruning, planting, or all of the above, there are a few steps you can take to help prevent residual soreness the following few days.

GET THE GEAR:  Before working in the yard, it is important to have to proper gear: hat, suntan lotion, sunglasses, and a water bottle.  You’ve all heard it before, staying hydrated and protected from the sun is a must!

WARM-UP:  Get those muscles warmed and loose by going for a short 5-10 minute walk.  In addition, it is a good idea to perform some dynamic stretches, such a walking lunges with a torso twist, skipping or high knee walking.  Yard work is hard work and skipping a warm-up will put excess strain on your muscles and joints, increasing your chance of an injury.

TAKE BREAKS: Don’t get so caught up in the work, that you forget to take frequent breaks. They don’t have to be long, but it is important to take time to stretch and get a drink of water.

CHECK YOUR FORM: Whether it’s bending over weeding, shoveling or spreading mulch or pushing a lawn mower, all of these jobs put extra strain on your back. By altering your form while you do some of these activities, you can decrease your chances of having back pain.  Here are some suggestions:

– Good idea: Kneel on a soft mat to save your back and knees.
– Better idea: Sit on a stool and rest your elbows on your knees
– Change positions frequently to avoid overuse

Trimming the Hedges:
– Keep your back straight
– Utilize small strokes to prevent strain in neck and shoulders
– Rest every 5-7 minutes to give you back a rest… it will thank you later.

Wheel barrel:
– Bend your knees to lift, NOT your back
– Try not to twist while holding the handles. Wheel barrels can easily be unbalanced…if it starts to go, you do not want to be pulled down with it.
– Push, do not pull.

– Keep feet firmly planted on the ground
– Keep hips forward, facing where you are shoveling to prevent twisting of the back
– If you are moving dirt from one place to another, pick up your feet and turn your entire body to face the side you will be placing the dirt. This may seem unnatural and may take a little longer, however you could be saving your back from days of soreness.

Lifting :
– As temping as it is to get it all in one load, save your back and take two trips with smaller loads.
– Make sure to keep the load close to your body.

COOL DOWN/STRETCHINGOnce you’ve had your fill, it is a good idea to take a few moments to cool down and stretch.  Often your body might tell you what body part could use a good stretch, but if you are looking for a few suggestions, we’ve got you covered:

Yard work can be fun, especially when you get the whole family involved, but taking a few steps to lesson injury risk can go a long way to keeping the garden weed-free all summer long!

Osteoporosis- Tips to Keep those Bones Strong

What is contentious, funny, serious, can be picked, has its own song named after it, and is only appreciated when broken? The answer: a 206 piece puzzle you carry around with you every day. Not only does it keep you from falling into a soft puddle of ooze on the floor, your bones also help form blood cells (red and white), store and release minerals, hold (and hide!) some triglycerides, and protect your brain and spine. When it comes to your bone health, osteoporosis is a chief concern to wrecking your source of stability. Here are key lifestyle changes that will reduce your risk for fractures, as well as a quick peek at the disease process itself.

What is osteoporosis? It all relates back to that mineral holding and releasing property mentioned earlier. If your body keeps stealing your bone minerals for other functions, the skeleton loses its density, causing bones to become more brittle, thereby increasing likelihood of fracture.

So where does this come from and who does it affect? Women are the strong favorites for osteoporosis, as well as the elderly. Other risk factors include: Family history, European or Asian descent, sedentary lifestyles, smoking, low calcium/Vitamin D intake, more than 2 drinks imbibed daily, as well as certain prescription medications which increase your risk.  Granted, some of these risk factors can’t be helped. Changing your family history or age is truly impossible, despite our best efforts!  However WE CAN focus on changing some lifestyle factors affecting the disease.

Medication may feel like the easy way out of bone compromise. There are generally two types of drugs: Antiresorptive drugs which slow down bone loss, and bone-building drugs, which promote increased bone mass. However some of these drugs can increase your risk of cancer, heart disease, and other side effects, warranting a discussion with your doctor before utilizing such medication.

A more natural option is focusing on mineral intake. Calcium and vitamin D are crucial in building bone mass. Calcium alone is difficult for the body to utilize without vitamin D. Once again speaking with a doctor or nutritionist is important in setting dietary goals and intake levels. Other dietary changes can include reducing alcohol consumption and ceasing smoking.

Finally, low impact exercises can be very beneficial in building bone mass. Walking, hiking, dancing, lifting weights, and biking are all excellent option to improve bone mass. However in cases of severe osteoporosis, low impact exercise, such as swimming, may be a better starting point. Talk to us, your local movement experts, for recommendations for a good exercise plan tailor-made to keep you happy and growing stronger! Here at HARTZ PT, we offer a Medically Adapted Gym (MAG) which is designed to customize your fitness goals with a supervising exercise physiologist.  Our Better Bones, Better Balance Class is also designed to keep you on your feet and reduce injury and the fear of falling, allowing you to move with confidence.

No matter where you are in your bone health journey, let us help you stay healthy or improve your health with our exceptional therapy services, tailored gym work-outs, or focused balance classes. Remember, you have a lot of bones to keep in working order!

Direct Access to Care Results in Cost Savings

Researchers in South Carolina have completed a 2-year study (click for link) comparing claims and outcomes data for a group of patients suffering from neck and back pain.  The patients were divided into two groups:

  • Those who selected treatment through physical therapy first (Direct Access).
  • Those who chose traditional routes to care, primarily consultation with a physician first.

They found that improvement in pain and disability was similar, but direct access patients with neck or back pain incurred $1,543 lower average costs than those who chose referral from a physician, with no adverse events.

What does this mean for me?   Patients should consider physical therapy as a first option for pain relief.  Physical therapists are experts at identifying imbalances and weaknesses in the musculoskeletal system, which often lead to pain.  At the same time, we know our limitations and will refer patients to the best physicians in the area, if necessary.

Getting the Most for your Healthcare Buck

Have you ever gone into a clothing store, picked out an outfit and made the decision to purchase it without knowing the price?  Of course not!   Price transparency is so important in this country, with one major exception, the healthcare field.

Sure, reimbursements can vary widely by insurance company, but there will always be a range.  Your healthcare provider and your insurance company should be able to provide you with a range prior to providing services.  You might be shocked by what you find out.

The healthcare environment today and specifically reimbursement rates of most large private insurers, favor large hospital-based organizations.  Smaller, independent clinics are not playing on a level playing field.  This price advantage given to hospital-owned entities is forcing insurance companies to raise premiums for members (and lower rates for independent clinics) without offering better coverage.

Believe it or not, outpatient physical therapy clinics at hospital-owned clinics are paid 2-4 times that of an independent clinic for a same exact service!

Why, you might ask?  The answer is simple…bargaining power.  When hospitals negotiate with insurance companies, they roll up all of the services they offer, including hospital stays, inpatient and outpatient physician visits and surgeries as well as inpatient and outpatient physical therapy, into the same bucket.  Insurance companies don’t want the hospital to stop taking their insurance for ALL of their services, so agree to pay a much higher rate for everything, including outpatient physical therapy.

Here is a recent example:  A local hospital charges $111 – $156 for 15 minutes of therapeutic exercise.  So, for a 1-hour outpatient physical therapy visit, the hospital will bill your insurance company between $444 and $624.  This charge does not vary by insurance company.  What does vary, is the rate of reimbursement.  Although insurance companies and clinics often will not share specific contract information with prescribers, we do have knowledge of price discrepancies in a couple of situations:

SELF PAY: Self-pay outpatient PT patients at this hospital are allowed a 25% discount from the total charge.  Therefore, a self-pay patient will owe between $333 and $468 for a 1-hour outpatient PT visit.  At an independent clinic, charges will range between $75 and $125 per 1 hour visit for a self-pay patient, resulting in a savings between $208 and $393 per visit.  Expanding that savings to a typical 10 visit plan of care, the patient will save $2,000-$4,000!

AETNA: Aetna pays 85% of what a local hospital charges them for outpatient physical therapy.  So, for a one-hour visit, Aetna will pay the hospital between $377 and $530.  FOR THE SAME ONE HOUR VISIT, Aetna will pay an independent clinic around $75 per visit. This is a total price difference of over 500%.

What does this mean for today’s consumer?  It could mean HUGE savings!

For those with high deductible plans and large out-of-pocket maximums, you could be paying for the first several thousand dollars out of your own pocket!  This means you could pay for an ENTIRE plan of care (8-10 visits) at an independent clinic for less than just 2-3 visits at a hospital-owned clinic.

Price transparency in the healthcare market has never been easy, however the information is out there.  Knowledge is power and the truth is, you have a choice.  It is ALWAYS your choice where to go to physical therapy.  Research your options.  Find out what you will pay.  With more and more patients paying higher amounts out of pocket, you can’t afford not to.

CLICK HERE to learn more about price disparity in the US healthcare market.

Heel pain? Read this.

Achilles Tendinitis can happen to both runners and non-runners alike.  People suffering from achilles tendinitis typically experience pain and soreness located on the back of the heel where our achilles tendon attaches our calf muscle to our heel bone (calcaneus).  The achilles tendon, sometimes called the heel cord is the largest and strongest tendon in the body.  It comes from the 2 big muscles in our calves (Gastrocnemius and Soleus) and helps us to come up on our toes when we walk or run. 

 Some of the symptoms of achilles tendinitis include stiffness in the back of the heel along with pain and soreness when there is pressure on the heel.  Often times, the back of your shoe can rub the sore spot and aggravate the area.  If the tendinitis lasts for a long time it can result in a thickening of the tendon and chronic achilles tendinitis places individuals at a greater risk for a rupture or tear of the tendon.

There are several possible causes of Achilles tendinitis but the most common is overuse of the tendon.  Runners and athletes are at a higher risk of developing achilles tendinitis as a result of increased forces placed on the tendon.  Sudden increases in activities such as running and jumping can also cause the tendon to become inflamed.  Tightness in the ankle and tendon can make an individual more prone to developing achilles tendinitis.  In addition, people with very flat feet who overpronate (ankles collapse inward) are also more prone to developing achilles tendinitis. 

Treating achilles tendinitis includes resting the tendon by decreasing activity or by immobilizing the ankle through a cast or walking boot.  Icing the heel cord for 10-15minutes throughout the day is a helpful way to reduce the inflammation present in the tendon.  Just make sure to place a towel / cloth between the ice and the skin to avoid skin irritation.  Other treatments include wearing a Dorsal Night Splint (DNS) to help promote a gentle stretch of the achilles while you are sleeping.  Sometimes, NSAIDS are needed to help reduce pain and inflammation in the achilles.  As the symptoms decrease, it is important to begin a stretching and strengthening program to help improve the integrity of the tendon and prevent the chances of having the issue reoccur.  In severe cases, surgery may be required to help repair the tendon.

If you are having difficulty treating the pain and soreness on your own, physical therapy can be effective in guiding you with appropriate stretches and strengthening exercises for the achilles.  In addition, PT can assist you in returning to the things you love including running and walking.

Finally, the best way to treat achilles tendinitis is to avoid it all together.  A proper warm-up of 5-10 minutes of very light activity to get your blood flowing is important.  Follow that with some gentle calf stretches and heel raises to ensure that the achilles tendon is ready for action.  And finally, remember to wear good supportive athletic shoes whenever you are going to be active.


Tips for Traveling after a Joint Replacement

The surgery is done and now is the time to get back to your life.  A joint replacement of any kind is not an easy surgery from which to recover. It takes time!  When the time comes to travel again via car or plane, here are some tips to help make the trip more enjoyable.

4-6 weeks post-surgery:  The majority of surgeons will recommend that you wait a minimum of 6 weeks post-surgery before traveling, however some say you can travel as soon as you are comfortable sitting down, but a minimum of 4 weeks.  This decision depends largely on the length of time you will be traveling, and what mode of transportation you will be utilizing.

Pick your Seat: If you are traveling by air, it is best to select what seat you have on the airplane.  Upgrading to first class is the best solution, but many times not financially possible.  The row of seats behind the partition (between first class and economy) tend to have a little more leg room.  Emergency exit rows also have a little more leg room but since you are traveling after a major operation you might not have the ability to move fast enough to perform the duties required in those rows in case of an actual emergency.  It would also be best to obtain an aisle seat if the other options listed are not possible.

Frequent Breaks: Sitting for long periods of time is very common when traveling. The affected extremity tends to grow tight and stiffen up.  If possible, while on the plane, attempt to get up every 15-20 minutes.  If your travels by plane take you across the country, try to split the trip up and make a stop along the way (at least one layover) to give yourself the opportunity to get off the plane and walk around until your next flight is called.

Security Woes: Going through security at the airport is challenging for anyone. Getting through security after a joint replacement may require a little more preparation. Some physician’s offices may give you a letter stating you have had a joint replacement surgery.  You should also inform the TSA agent upon your arrival at the security checkpoint, that you have received a joint replacement very recently.  You should be prepared to go through extra screening.  Wear loose fitting clothing in the case that you are asked to show your surgical incision.  The more prepared you are, the smoother the process.

Car travel does not have security component, but you still want to plan your trip with frequent stops to give yourself time to get up and walk around. This will help avoid stiffness and tightness at the surgical location and surrounding extremity.  Some knee replacement patients prefer to sit in the back seat to keep their leg elevated across the seat, while others prefer the passenger seat pushed back all the way leaving as much leg room under the dash as possible.

Traveling after a joint replacement is possible, it just takes a little more planning.  It is always a good idea to consult your surgeon or physical therapist prior to your trip for additional recommendations specific to your state of recovery.