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 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

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.

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.

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.

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

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!

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,

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.

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.

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!

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

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.

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!

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.


Shoulder Injuries in Swimmers

Around 70% of Americans will be treated for some type of shoulder injury in their lifetime.  If we narrow the focus to competitive swimmers, the percentage skyrockets.  Why, you ask?   Well, the repetitive motion inherent in the act of swimming combined with the complicated junction of muscles and tendons surrounding the shoulder joint can be a recipe for disaster in those swimmers who don’t yet have perfect technique.

A COMPLICATED JOINT: The shoulder joint is intertwined with many other muscles groups of the torso including the abdominals, upper and lower back, and pelvic muscles.  When one of these adjacent muscles is not working in harmony with the others, the instability causes increased wear and tear on the shoulder joint.  This can contribute to unnecessary fatigue and potentially cause injuries, like “Swimmers Shoulder”.   Beginners and those who swim with poor technique are especially susceptible to such injuries.

There are three distinct components of the shoulder on which we should focus when assessing strength for injury rehabilitation or prevention:

  1. Rotator cuff
  2. Muscles that stabilize the shoulder blades (upper back)
  3. Muscles of the lower back including the pelvic muscles and abdominals


Injury prevention techniques can be a good way to ensure you can continue to have fun in the water without pain, but the best advice is to slow down and use good form to avoid future injuries.

Strengthen Rotator Cuff: A great exercise to ensure rotator cuff strength is to place the arm at 90 degrees with the elbow at your hipbone and rotate to the outside.  This builds strength and muscle stamina

Joint Stabilization Exercise: For shoulder stabilization improvement, you can do a straight arm lift. Keep your arms out to your side as long as you can hold them.  This will strengthen the muscles behind and between the shoulders.

If you are a competitive swimmer or triathlete who is experiencing shoulder pain, we welcome you to stop in for a visit, even if only to get some tips on prevention and strengthening.  As a former Division 1 collegiate swimmer, Brian Hartz specializes in treating and preventing swimming injuries. HARTZ PT offers an endless pool in its Lititz office which is ideal for stroke analysis and modification.

Snap Krackle Pop…The Truth about Joint Cracking

It’s a long day. Tension is telling your spine that you need some relief so you decide to crack your back. Your mom’s voice echoes in the back of your head “Don’t do it! Cracking your joints is not good for you!” You ignore the voice and obtain a satisfying “pop” before returning to the workload, wondering if you did yourself a favor or contributed to future joint degeneration.

So what makes that sound anyway? And how can something that feels so good ever seem bad for you? One theory is that quick movements change joint pressures, moving nitrogen bubbles inside your joint fluid (synovial fluid) and resulting in that desired “pop”. Another mechanism that can cause noise is ligaments undergoing rapid tension. These sounds typically occur when a joint is in a position where it is running out of movement. This is why you may have to bend or twist your body in an unnatural position before you get a “crack”. These mechanisms are usually what are involved when joint cavitation (the medical term for pop) is discussed.

Joint pressure and ligament tension changes are the main causes we will discuss, however there are a few other sources of joint noise which may include tendon rolling, arthritis, or other conditions/mechanisms.

Let’s look at spontaneous popping first (the kind that happens with ordinary movements). Despite these sometimes ominous noises there are usually few reasons to be concerned. Most health professionals agree that cavitation is a very normal occurrence that doesn’t contribute to osteoarthritis or other degenerative joint conditions. So if things get noisy when you roll out of bed in the morning, stand up from a chair, or warm up for your next athletic event, don’t worry. It’s a normal occurrence that doesn’t necessarily point to a brewing joint problem.

Repetitive, intentional joint cracking (the kind your mom didn’t like) is a little different. This self-administered cracking is a little more controversial when applied to the spine. Why the concern? Looking back at the physiology, we see that joint cracking has the potential to apply stress to ligaments. This is due to those tight, end range movements. Concern arises when tight, irritated muscles and joint structures cause an individual to repetitively treat themselves with a crack multiple times per day. The problem is that muscle and other tissues get stretched (potentially) at the ligaments expense. This could create areas of instability in your spine if performed consistently and will not contribute to a long term solution for your stiff back.

So what’s the answer? Instead of twisting and manipulating your own spine, good posture, gentle stretching and strengthening can be beneficial in resolving your pain. See a physical therapist for treatment options on improving your painful neck, back, elbow, etc.

Cracking is only a concern when in conjunction with other problems. Medical examination may be warranted if joint cracking causes pain, results in restricted movement, or is accompanied by signs of inflammation such as redness or swelling. If any other abnormal joint functions occur (such as buckling) seek assistance from a doctor or physical therapist that is trained in joint care and can often see you without a prescription.

Bottom line: don’t worry if your body is determined to be noisy. If you constantly find relief from frequent cracking maneuvers you aren’t doomed to joint problems. However there are probably some other interventions that can fix the root of your problem like physical therapy. Finally, if you experience pain or concern involving a joint seek out a qualified medical professional.

Good Pain versus Bad Pain

For many reasons, I will never forget the first half marathon I ran.  In the spirit of full disclosure I will admit that I was never a runner (and by runner I mean slow jogger who could not hear the music through my ear buds over my own labored breathing). However I decided that with a little training and hard work, a half marathon would be a great challenge to undertake. After months of training, mostly pain-free, I completed a half marathon in Virginia with a time that I was only minimally embarrassed to disclose publically.

Along the 13.1 mile course, there were thousands of people cheering on the runners and holding up tons of signs that were a mix of motivation and humor. I remember one in particular that said in GIANT blue letters “Runners, enjoy your pain, you’ve earned it”. I laughed at the time and didn’t think more about it.

About a year or so later, while training for a full marathon, I often thought of that very sign when running became painful and I didn’t listen to my symptoms. I tried to continue running for a few weeks through foot pain by simply being, as my mother would put it, “a knucklehead”. As the pain got worse — which I would later learn was a stress fracture — I realized that some pain isn’t worth earning.

We’ve all heard the mantra “No pain, No gain”.  I’ve heard this phrase thrown around since my days of little league baseball, long before coaches monitored pitch counts and days’ rest for young growing arms. It’s popular in locker rooms, post-workout chats and even some physical therapy offices. The question we have to ask though is “Does this long held belief hold up when it comes to exercise? Sure it sounds great, heck it even rhymes, but does it still apply to individuals who are looking to get healthy and treat their bodies a little better in 2014? ”

Pain has a protective function in our bodies. Pain helps tip us off to tissue damage that is occurring and allows us the opportunity to change our activity so we may allow our bodies’ adequate time to heal. When exercising, it is normal to feel that deep burn in your muscles as lactic acid, a natural byproduct of muscle contraction, accumulates.

Pain is not a normal byproduct of exercise. Typically after an appropriate workout, you can expect to experience what is known as delayed onset muscle soreness. Most commonly experienced 24-48 hours after a good workout, this is simply soft tissue inflammation caused by asking your body to do more than it is accustomed to doing. If you experience no soreness, you can probably ramp it up a bit. If you’re sore for greater than 48 hours, you likely overdid it. When you experience pain sooner than 24 hours after your workout, it is an indicator that you are doing something incorrectly.

If you are having pain, consider getting it checked out by a physical therapist. Physical therapists are experts in how the body moves and can evaluate your pain to determine good vs bad and get you started on the path to exercise health.

Signs You May Have Injured Yourself

  • The pain you are feeling is sharp.
  • The pain you are feeling is shooting or accompanied by
    numbness, tingling, pins and needles
  • There is a sudden onset of pain.
  • The pain developed in association withpopping, clicking,
    snapping or giving way underneath you

~ Hayden McDevitt, DPT, OCS, CSCS, ART

What Can be Done about Bunions?

We have all seen them.  The painful looking big toe that is twisted and misshapen, sticking out from a flip flop.  Bunions (or hallux valgus) are the most common problem affecting a person’s forefoot (front of the foot), and can significantly impact the quality of life for those suffering from the problem.  Studies have shown that approximately 23-35% of people are affected by bunions and that those rates increase for individuals over the age of 60.

A hallux valgus deformity typically includes a medial shift (moving towards the inside of the foot) of the first metatarsal joint and a lateral shift (moving towards the outside of the foot) of the big toe.  There has been debate about whether footwear can cause the deformity, however the most common cause of the issue can be traced back to bad genes (yes, blame your parents) and results in biomechanical instability of the joint due to arthritic changes or laxity (looseness) of the ligaments around the joint.

Symptoms include:

-swollen, inflamed tissue around the joint
-mild to severe pain in the big toe
-difficulty tolerating footwear
-pain with pushing off the big toe or rising up on the toes

So, how can physical therapy help?  There are a number of ways that physical therapy can aid in reducing some of the symptoms associated with painful bunions.  First, your physical therapist will be able to provide information regarding footwear and modifications that can be made to footwear.  Certain types of shoes (such as high heels) can make the pain worse by increasing the pressure on the painful joint.   A large toe box, toe spacers, splints, and metatarsal pads are all options that can be used to help alleviate pain.

Secondly, stretching the muscles in the back of the leg can help to decrease the amount of stress that is placed on the foot.  Tightness in the back of the leg can lead to increased pressure on the ball of the foot and can make symptoms more severe.

Finally, moving the joint (mobilization) can help to reduce some of the stiffness found in the joint and can be an effective way to reduce pain.

Unfortunately, sometimes physical therapy is not enough to reduce pain levels and improve motion in the joint, and surgery cannot be avoided.  Following a bunionectomy surgery, physical therapy is an essential part of your recovery to help restore motion to the foot and big toe, and will help improve your gait mechanics so that you can return to the activities that you love.

Postpartum Abdominal Separation…Is this Normal?

If you or someone you know still has a protruding belly several months after giving birth, chances are that you (or she) has diastasis recti.  To be clear, we are not talking about the flabby, loose skinned belly that plagues us all after pregnancy.  The bulge I am speaking of is most evident when the abdominal muscles are contracted, such as when coughing or sneezing and becomes more obvious once a woman returns to normal exercise.  Sometimes, it may even look like a hernia.

Diastasis recti is a separation of the two sides of the outermost abdominal muscle, called rectis abdominis.  During pregnancy, the same hormones that allow the pelvis to expand in preparation for delivery also sometimes allow other tissues to expand beyond their normal threshold.  This combined with the increased pressure (ie. a growing baby inside) on the connective tissue that binds the two sides of rectis abdominis, can lead to the separation.

The literature is still unclear as to who is at risk for diastasis recti and the prevalence of it.  What I can tell you is that in the last 6 months I have seen five women– at various points of postpartum– for diastasis recti.  In addition, I have been involved in three separate facebook threads of women seeking more information about it.  Of those five women I saw in my office, only one of them was referred to me by her healthcare provider.  The other four women– and actually the 3 women on facebook as well– had very similar stories of recognizing the symptoms on their own and being somewhat brushed off by their providers.

So, when is it time to seek treatment?  To some degree, a separation is a normal part of pregnancy and most often will return to normal within the first several weeks of healing after delivery.  First and foremost, you should seek treatment if you have symptoms associated with the separation.  Symptoms might include low back pain, pelvic pain or an overall sense of decreased stability throughout the mid-section.  Without the presence of symptoms, you should seek treatment if you still have a 2+ finger width separation 2-3 months postpartum.  If left untreated, the lack of core stabilization may lead to back and pelvic pain down the road and the most severe cases may in fact lead to an abdominal hernia.

Despite what you may think, the goal of treatment isn’t actually to close the separation completely; in fact, many women will continue to have a 1-2 finger width separation and that’s perfectly normal.  The main goal is actually to create improved activation of the deeper abdominals– most specifically Transverse Abdominus.  This muscle acts like a corset.   Imagine that corset pulling everything in… allowing the top muscles to move closer to midline.

It is critical to learn how to recruit the appropriate core muscles.  Some traditional “core” exercises can in fact make it worse.  These include– but are not limited to– crunches, planks and torso twisting exercises.  The benefit of a physical therapy consult is that the exercise program will be tailored to your strengths and weaknesses and will provide very clear guidelines for exercise progression.

The assessment is simple.  While lying on your back, place your fingers at your belly button.  Perform a small crunch and if your fingers sink in between the two sides of the abdominal muscles, then you have a separation.  This same assessment is repeated both above and below the belly button.  The degree of separation is often measured by how many fingers fit into the separation.

Unfortunately, not many OBs and midwives are including this assessment in their routine 6 week postpartum check-up.  If you have recently given birth, I urge you to ask your healthcare provider to check you.  If you are past that 6 week check up and believe you might have a separation, I would highly recommend calling your physical therapist to assess it.


Osgood-Schlatter Disease

knee pain

Osgood-Schlatter Disease (OSD) is a common cause of knee pain in active adolescents. Historically, it was more often diagnosed in boys between the ages of 10-19, however as more girls are starting to participate in sports at an early age, that is changing.  Patients will typically experience pain and swelling just below the kneecap, most notably after performing activities that involve running or jumping.  Children who often participate in sports and activities which require consistent running and jumping are at a higher risk for developing OSD. It is typically described as a “painful bump” just below the knee cap.

SOURCE OF PAIN: OSD is caused by a pulling of the patellar tendon on the tibial tubercle which is located on the shin bone (tibia). Growth spurts make kids more vulnerable due to the rapid changes in bone, muscle, and tendon growth which may not occur at the same time. When certain muscles are stronger than others, this will place unusual stresses on the growth plate, which is a layer of cartilage where the bone grows. This cartilage is rapidly changing in the several years of bone growth throughout adolescent years. The area of “soft” cartilage in children becomes “hardened” as the child grows and becomes solid bone by full maturity. The growth plate at the bottom of the femur (thigh bone) serves as a place where tendons attach muscle to bone. The quadricep muscles form into the “patellar tendon” which attaches to the tibial tubercle. When a child is constantly activating their quadriceps muscle while performing sports, this pulls on the patellar tendon and subsequently on the tibial tubercle. This repetitive pulling can cause inflammation at the growth plate which can lead to a more prominent tibial tubercle.


  • Pain that worsens with exercise
  • Swelling or tenderness under the kneecap
  • Tightness of the quadricep and hamstring


  • Ice: Ice the knee for 15-20 minutes at the area of pain immediately after activity will help to decrease swelling
  • Rest: Take a short break from the activity and give it time to rest.
  • Stretch: Tightness in the quadricep and hamstring can be alleviated by performing stretches before and after activity.

If pain continues after trying these treatments, you may benefit from further evaluation by a physical therapist. A physical therapist will evaluate you and develop a plan of care. Your program will be a combination of strengthening the leg muscles and stretching to reduce tightness and restore any lost range of motion. Knee pain caused by OSD is treatable and should not limit you from doing what you love!



The term “vertigo” is often used incorrectly as a synonym for dizziness. When vertigo is lumped together with dizziness, confusion and poor treatment often result.  Correct utilization of the word vertigo will allow patients to receive fast and appropriate clinical assessment by practitioners, so let’s clarify the difference.

Vertigo is clinically defined as the patient feeling as though the environment is rotating, or as though they are rotating within the environment. This is the only time the word vertigo should be used.   The most common type of vertigo for which patients seek treatment is BPPV (Benign Paroxysmal Positional Vertigo). BPPV is caused by otoconia (or “ear rocks/crystals”) that become displaced and move into the wrong portion of the inner ear. BPPV is easily treatable utilizing canalith repositioning maneuvers. Proper physical therapy assessment is often the most successful way to treat BPPV because physical therapists can accurately diagnose the location of the displaced crystals and typically can resolve the vertigo symptoms within the first visit.

Dizziness should be defined much more globally and can include: vertigo, lightheadedness, imbalance, and disorientation.  Other symptoms are often prevalent as well when a patient reports dizziness and should be relayed to a healthcare professional. This includes hearing changes, loss of balance/falls, blood pressure changes, historical head injuries, and nervous system changes. How often, how long, and to what severity these symptoms are occurring is also pertinent information that should be given to health care professionals. Properly defining what subset of dizziness, as well as any other corresponding symptoms the patient is experiencing, will best allow practitioners to direct appropriate care.

The cause of vertigo is unsolved. What we do know is crystals form in a person’s ear; these crystals can get lodged in one of the three rings within the ear canal, causing the imbalance. Certain positions, collectively known as the Epley Maneuver and created by Oregon ophthalmologist Dr. John Epley, help move the crystals to a location in the ear that does not affect balance. There are other maneuvers that can also be done to help alleviate vertigo, but the Epley maneuver is one of the more commonly practiced — and is the method I practice for treatment. After successfully treating hundreds of patients with vertigo, and seeing a 90 percent success rate of diminish symptoms after only 1 visit, I invite you to improve your quality of life with a visit to our office.

HARTZ Physical Therapy is happy to assess all patients that report dizziness. Our therapists are specially trained to treat a wide variety of dizziness disorders, including forms of vertigo, and are always willing to refer to another specialist, if indicated. Many insurance plans allow you to be seen as a Direct Access patient and therefore, do not require a physician’s referral prior to beginning physical therapy.

Frozen Shoulder

FrozenShoulder picture

Are you dealing with a pain in your shoulder during the day and at night? Are you noticing stiffness and decreased motion in your shoulder, making it difficult to perform your daily tasks? There is a chance you may have Adhesive Capsulitis, also known as Frozen Shoulder. Adhesive capsulitis commonly affects women more than men and it usually occurs between the ages of 40-70 years old. There is no known cause why people develop frozen shoulder, but studies show that those with diabetes, stroke, or Parkinson’s may be at a higher risk. It also tends to develop in those that have had an injury to the shoulder, or during periods of immobilization.

The shoulder is a ball-and-socket joint. It is made up of three bones, the humerus, scapula (shoulder), and clavicle (collar bone). The head (top) of the humerus fits into a shallow socket in the scapula. There is connective tissue that surrounds the joint known as the shoulder capsule. Within the joint is synovial fluid, which helps to lubricate the capsule and helps to ease movement. When Adhesive Capsulitis is present, the shoulder capsule thickens and becomes tight. Stiff bands of tissues called adhesions form and there is a lack of synovial fluid. This can lead to pain and decreased range of motion within the shoulder joint.

There are 3 stages of frozen shoulder; the progression can last 18-30 months:

  • Freezing: There is a slow progression of pain and gradual reduction in shoulder range of motion. Pain can be noticed during the day and at night and can even be noticed when the arm is at rest.
  • Frozen: The pain begins to slowly improve but the stiffness remains. The lack of motion can make daily tasks difficult to perform.
  • Thawing: The shoulder range of motion begins to slowly improve and the focus is on getting the shoulder back to normal or as close to normal as possible.

Treatments for adhesive capsulitis include anti-inflammatory drugs (NSAIDs) or moist hot packs to help with the pain and stiffness. An Xray or MRI may be recommended to rule out other potential causes of pain.  A manipulation or arthroscopic surgery may be suggested for patients who see no improvement after non-surgical measures are taken. During a manipulation, the patient is put under anesthesia and the shoulder is stretched to help break up scar tissue. An arthroscopic surgery could also be performed to cut through the tight portions of the joint capsule.

Physical therapy has been proven to be one of the most effective ways to help improve frozen shoulder symptoms. Studies show that there is a 90% success rate with non-surgical treatment approaches (oral NSAIDs and Physical Therapy) for patients with frozen shoulder. The focus of physical therapy is to restore the range of motion within the shoulder joint and to help manage pain. The patient will go through gentle stretching programs and manual therapy techniques to help achieve these goals. Patients will be given home exercises and stretches to perform on their own. As symptoms improve, the patient will begin a strengthening program to help restore the strength that was lost.

Adhesive capsulitis can be a very painful and limiting condition. So, don’t wait to get it checked out, for best results – the sooner you get it looked at, the better. Physical therapy has proven to be the best treatment method to help you get back to your happy lifestyle!

Ankle Sprain

Drew foot analysis-small

A broken or sprained ankle is one of the most common injuries among all age groups.  An ankle break is commonly caused by twisting/rotating your ankle, rolling the ankle, tripping/falling, or impact from a car accident causing one or more of the ankle bones to chip, crack, or break. The classification of the break is determined by the area that is broken, ranging from simple breaks to more complex. A more severe break will cause the ankle to become more unstable. Symptoms may include immediate and severe pain, bruising, tenderness, inability to bear weight on the injured foot, and/or deformity (bone is out of place).

A sprain, on the other hand, is when the ligaments (fibrous tissue holding the ankle joint in position) become disrupted or torn. The most common causes of an ankle sprain include exercising on an uneven surface or playing a sport that requires cutting, rolling, and/or twisting action of the foot (running, basketball, tennis, football, soccer, etc.). Sometimes with a sprain you can hear or feel a “pop”, which is the ligament tearing. Sprains are classified by three grades which indicate how much damage has been done.
Grade 1 Sprain (Mild)
– Slight stretching or tearing of ligament(s)
– Mild tenderness/swelling

Grade 2 Sprain (Moderate)
– Partial tear of ligament
– Moderate tenderness/swelling
– On medical exam, the joint is abnormally loose

Grade 3 Sprain (Severe)
– Complete tear
– A lot of tenderness/swelling
– Substantial instability

For a grade 1, and some grade 2 sprains, a good first step is home treatment of R.I.C.E., which stands for Rest, Ice, Compression and Elevation.  In addition, it is important to schedule an appointment with a medical professional as soon as possible.  Through Direct Access, you may not need a physician’s referral to schedule an appointment directly with a certified physical therapist.  This often provides quicker access to care and therefore a faster recovery.

An evaluation by a physical therapist can help identify the type and severity of an ankle sprain by performing specific tests, palpation of the affected area, and identifying areas of laxity or weakness.  A therapist will also screen for more serious causes of pain and swelling (such as a fracture) and refer the patient to the appropriate physician should additional testing or imaging be required. Seeing a physical therapist can help speed the recovery of an ankle sprain which is typically 2-8 weeks depending on severity of the sprain.  A physical therapist will not only restore range of motion, flexibility and strength, but also improve balance, as well as provide instruction about how to safely return to a specific sport, occupation or hobby. While ankle sprains usually recover quickly, it is important to ensure full strengthening of the area and restored balance through a comprehensive physical therapy program, as recurrent ankle sprains and chronic instability have been reported in as many as 80% of cases.

Commitment to a home exercise plan following PT is a key to maintaining good muscle strength, balance and flexibility, which will help prevent re-injury and chronic problems.  And don’t forget…once you have put the time and effort into your recovery, follow these precautions to prevent future injury:

  • Warm up thoroughly before exercise or physical activity.
  • Pay attention when walking/running/working on uneven surfaces.
  • Wear proper footwear.
  • Slow down or stop when you feel pain or fatigue.

Joint Pain: Is it Osteoarthritis?

PT Picture2-crop-smallJoint pain can often be caused by Osteoarthritis, which affects more than 3 million people in the US each year.

WHAT IS IT? The most common form of arthritis, it plagues women more often than men.  Our chances of developing the debilitating disease increase with age. It occurs when the cartilage at the end your bones begins to wear down. The cartilage naturally helps absorb the stress that is placed upon the joint from daily activities. When the cartilage begins to wear down, a “bone on bone” sensation at the joint may occur. Osteoarthritis can affect any joint in the body, but most commonly affects the knees, hips, hands, and spine.  Usually the person will experience inflammation and redness along with pain and tenderness at the affected area.  Pain usually becomes more substantial with weight-bearing tasks.  In addition, the joint with often feel stiff.

WHAT CAUSES IT? There are many factors that could contribute to development of osteoarthritis, including:

  • past injuries to the joint
  • continuous repetitive movements
  • age, gender, weight, genetics

WHAT CAN BE DONE ABOUT IT?  If you start to notice symptoms similar to these, your doctor may suggest an x-ray which will reveal osteoarthritis. Once diagnosed, nonsteroidal anti-inflammatory drugs (or NSAIDs) could be prescribed along with a physical therapy program.  In addition, depending on the severity of your condition, injections, draining the excess fluid within the joint, or even a joint replacement surgery may be suggested.

WHY PHYSICAL THERAPY? Physical therapy has proven to be very successful for people suffering with osteoarthritis, and does not feature any of the potential side effects of the other treatment options. A typical outpatient rehabilitation program should include the following elements:

  • A gentle stretching program which will help to restore the range of motion within the joint
  • Strengthening the muscles around the joint will help take away some of the stress on the joint which will help to alleviate pain.
  • If a land-based exercise program proves to be too painful or challenging, an aquatic exercise program is a great alternative option. The buoyancy of the water takes the stress off of the joints, making it less painful to perform weight-bearing exercises and easier to move the joint through a pain-free range of motion.

Osteoarthritis is the most common form of arthritis and it can be very painful and difficult to maintain your normal daily living. Maintaining a healthy lifestyle of diet and exercise can help to manage symptoms. A regimen of physical therapy, including aquatic-based exercises, is a great treatment option to help you return to a comfortable lifestyle.

HARTZ Physical Therapy provides aquatic therapy in our Lititz office.  Call today for more information.  (A physician’s referral is not necessary for most insurances)


Woman with vertigo. Young patient suffering from dizziness

In recent years, high profile professional sports have made concussions the topic of frequent discussion and helped fuel public interest on their appropriate management.

WHAT IS A CONCUSSION?   A concussion is a change in brain function following a force to the head that may be accompanied by a temporary loss of consciousness.  It is identified in awake individuals with measures of neurological and cognitive dysfunction. A concussion, therefore, is actually a mild form of traumatic brain injury and something that needs to be taken very seriously. Outdated misconceptions such as, if you didn’t lose consciousness it’s not that serious of an injury, are thankfully being replaced by more education and awareness.

According to the American College of Sports Medicine, concussions have increased at all age levels of sports participation over the last few years. Therefore, it is very important that all athletes, regardless of age, are aware of post-concussion symptoms. Parents also need to be educated so that they may closely watch a child after injury for signs of impairment. A child should be monitored for days if a concussion is suspected even if he/she reports feeling okay.

HOW CAN I IDENTIFY A CONCUSSION?   Symptoms of a concussion may reveal themselves in many different ways and can occur days after the initial trauma. Immediate signs of a concussion include loss of consciousness, confusion or disorientation, vomiting, and/ or amnesia. Delayed symptoms include headaches, dizziness, feeling tired, nausea, and cognitive difficulties. If a concussion is suspected during a game or practice, the athlete should stop play immediately. Previously, athletes could be cleared to return the same day, but neurologists have determined that it is not possible to make accurate immediate assessments after the injury and it is too dangerous to risk returning too soon. Athletes under age 18 are managed more conservatively because recovery time after a concussion has actually been shown to be longer in adolescents than adults.

TREATMENT OF A CONCUSSION: If a concussion is suspected, an athlete should take the following precautions:

  • EVALUATION BY A MEDICAL PROFESSIONAL who is educated in concussion management. MRIs and CT scans are rarely able to diagnose a concussion, therefore testing will include a thorough clinical exam that includes symptom assessment, physical exam, neurological exam, and a balance exam.
  • PHYSICAL AND MENTAL REST in an effort to reduce chance of further injury and to allow for the brain to fully heal. It is even recommended that the injured athlete refrain from activities including school work, TV, and other device use that may stress the healing brain.
  • MONITORING of the young athlete for changes in mood, sleep habits, headaches and other symptoms is essential. Return to sports participation is considered once the athlete’s symptoms have resolved.
  • A CONCUSSION REHABILITATION PROGRAM that involves progressive and gradual return to physical activity could be an important step for full recovery. This program is often advanced under the guidance of a physical therapist educated in concussion management and starts with basic light aerobics such a walking, biking, and/or swimming. If the athlete continues to have no symptoms with a specific phase of activity they may advance to a more advanced phase. An example of such a progressive therapy program would be:
  1. Light aerobics but no resistance training
  2. Sport-specific exercises of variable intensity but no head contact
  3. Light sports practice, drills and progressive resistance training
  4. Full contact practice
  5. Return to competition

If you are an athlete or the parent of a young athlete, it is important to become educated on concussions, their symptoms, and their treatment so that athletes and the medical community can work together to reduce the chance of a long-term injury associated with head trauma.


Pelvic Pain

Pregnant and in pain? You’ve just joined the masses: 80 percent of pregnant women experience pelvic pain at some point in their pregnancy. But what can you do about it?

The cause. As a woman’s pregnancy advances, her uterus enlarges. This enlarging uterus moves her center of gravity forward of her feet. This shift in a center of gravity causes alignment adjustments and overcompensation, consequently causing pelvic pain. Furthermore, the additional weight being carried places pressure on the bladder, hips, and pelvis and spine (increasing stress on the bones, joints and muscles). No wonder this pain is so commonly seen.

What will help? A lot! There are varying exercises and stretches that will help minimize your pelvic pain during pregnancy. These exercises include – but are not limited to – pelvic rocking, child’s pose, kegel exercises, and squats. Here is a link to more information.

In addition to exercise, you may also find it helpful to purchase a belly sling to lessen the effect of gravity and help stabilize the pelvis. Swimming or simply movement in water can also be a beneficial way to minimize pain while pregnant. The natural anti-gravity effects of water give your body a break from bearing the extra weight.

Wishing you and your baby a healthy delivery!

Plantar Fasciitis

Pain in the female footPlantar foot pain, commonly referred to as plantar fasciitis, is a very common condition experienced in both the athletic and general population. The muscles, tendonsand ligaments of the arch and underside of the foot are placed under enormous amounts of stress with walking and weight bearing activities. Although the foot is naturally designed to accommodate these stresses, there are many factors, that place an individual at increased risk for plantar foot pain. These include improper footwear, faulty foot mechanics, poor flexibility, weakness, and obesity.

Typically, plantar foot pain will begin gradually with activities and be relieved with rest. Over time, as the soft tissues become tighter and more irritable, the pain will become more intense and occur more frequently.  It is likely due to this gradual onset and escalation of symptoms, that there is a common misconception that the pain will just get better on its own. Without proper early identification and treatment, the pain can become very debilitating, making ordinary tasks like getting out of bed and walking, feel very difficult.

The muscles of the underside of the foot are small, but very strong. They are designed to withstand large loads placed on them as they support the arch of our foot.  However, once they start becoming irritated from abnormal stresses placed upon them, they will tighten and become less flexible. This places them at even greater risk for continued damage and weakening. It is the classic example of a vicious cycle.

The first line of defense prescribed is often ice, rest, and gentle stretching of the plantar fascia and calf.  Early treatment for your foot pain increases the likelihood that you will make a quick recovery.  If your symptoms last longer than 2 weeks, it is a good idea to have your foot evaluated.

A thorough evaluation from an orthopedic physical therapist is instrumental in determining your specific gait mechanics, foot posture, areas of reduced flexibility, muscular weakness, and other factors that are causing you to have plantar fasciitis.

You will be instructed on proper exercises and stretches that will be most helpful for your foot posture, activities and symptoms. Hands-on treatment from your physical therapist is necessary to reduce adhesions in the plantar fascia and foot muscles, lengthen the tight muscles, and restore normal mobility to the arch. Advice on orthotics, proper footwear and night splints is routinely offered.

One hands-on approach that is available for plantar foot pain is Active Release Techniques (ART), a specific form of soft tissue treatment that addresses the underlying adhesions and scar tissue that impairs arch mobility and muscular flexibility. ART certified providers are specifically trained in how to identify areas of tightness in the muscle tissue and how to effectively treat those areas.  Fast, effective pain relief follows when individualized treatment is initiated for plantar fasciitis.

Successful treatment is rarely a “one size fits all” approach. See a physical therapist if you are suffering from foot pain.

Chronic Pain

Pile of assorted medicinesIt is estimated that 25 million people deal with chronic pain on a daily basis, meaning they have had this pain for greater than 3 months. Pain is a complex and individualized experience and one of the most common reasons why people seek medical care or consultation. Unfortunately, since 1999, while the amount of pain Americans report has not changed significantly, the prescriptions for opioid pain medication to treat pain have quadrupled.¹ With side effects like withdrawal symptoms, depression, overdose, and addiction, this new public health crisis of opioid use has moved the Center for Disease Control and Prevention (CDC) to release prescription guidelines earlier this year.

While there are times that opioid prescriptions are appropriate, such as for cancer treatment, palliative care, end-of-life care, and certain acute pain situations, the CDC recommends non-opioid approaches including physical therapy for their benefit of managing chronic pain without the harmful side effects.


The best remedy for chronic pain is to address it head-on and seek professional help immediately.  What may seem like small annoyances can manifest over time and before you know it, pain can incapacitate you in more ways than just the physical sense.

For chronic pain sufferers, exercise doesn’t come easily,  but by building your endurance, you can learn to move past pain and reap all the benefits that aerobic training can offer. In a study recently performed at the Cleveland Clinic foundation, patients who suffered from chronic pain participated in a 3-week aerobic training program.  They all reported that their pain became more manageable with consistent exercise.  They felt better prepared to deal with their pain, which resulted in an improved mood and self-confidence.

Some great exercise tips for dealing with chronic pain are:

  1. Walk: A simple walk to the mailbox may not seem like a lot, but this is a great place to start.
  2. Start slow! Most plans tell you that 20-30 minutes of continuous exercise are required, but even 5 minutes of continuous movement is better than none!
  3. Create a goal: Set attainable goals, but always be willing to adjust if necessary.
  4. Play Favorites:  Pick an exercise you enjoy!  You are much more likely to continue doing something if you like it.
  5. Be Buoyant!  The buoyancy of water provides many benefits that make exercising less painful on joints and therefore more effective.  Try a water aerobics class!  It might be more engaging than just swimming lap after lap.

Starting an exercise regimen can be a hard road, especially for chronic pain sufferers.  However, implementing an exercise plan can put you on the path to recovery.  If you don’t know where to start, contact a physical therapist for a consultation. (A physician’s referral is not necessary for therapists who are Direct Access certified.)  Physical therapists are musculoskeletal experts who can find and treat the source of your pain.  They will be able to educate you about what might be causing the pain and suggest ways to minimize or, in some cases, eliminate the pain.

For more information about exercise plans specific to your needs make an appointment with one of our Physical Therapists today!


1. Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management

2. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016


Low Back Pain

A Global Burden of Disease, Injuries, and Risk Factors study recently cited low back pain as the single leading cause of disability worldwide. Estimates indicate that 80% of us contend with the common ailment at some point in our lives. The intense and debilitating pain that accompanies low back injuries often prevents sufferers from going to work, participating in household chores and enjoying time with loved ones.

Low back pain doesn’t have to be a prescription for couch surfing. Current studies show no evidence that supervised physical activity increases the risk of additional back problems or work disability. Counter to the age-old recommendation of inactivity, a customized exercise program under the direction of a physical therapist is widely prescribed to reduce pain and disability.

Physical Therapist, Brian Hartz agrees “A common misconception among those who suffer from back pain is that they should rest and it’ll eventually go away. Instead, through the use of a customized physical therapy plan, back pain can be a thing of the past for many of our patients.”

Although back pain can affect anyone, the major risk factors include age, poor physical fitness, genetics, being overweight, and smoking. The National Institutes of Health suggests the following to prevent back pain:

• Exercise frequently and keep your back muscles strong.
• Maintain a healthy weight.
• Eat a balanced diet, including daily recommendations for calcium and vitamin D.
• Focus on body mechanics by standing up straight and lifting heavy objects with bent legs and a straight back.

According to the American Academy of Orthopedic Surgeons, low back pain sufferers should prioritize a supervised exercise program and a gradual return to everyday activities to restore back strength. Following an evaluation, physical therapists can recommend specific exercises to prevent and treat back pain, and provide additional treatment options to address pain and restore mobility.

Core Strength

Fitness class making sit-ups

Is Core Strength REALLY all that Important?  “Tighten your core”, “Core strength is key” …core strength, core strength, core strength!There seems to be a lot talk about core strength these days. What’s with all the hype anyway? Is it really that important? Well, the truth is, core strength can help everyone, from competitive athletes to senior who are at risk for falls. Let’s talk about core strength and some of the benefits a strong core will bring to an individual

WHAT IS IT?  Your core is made up of 3 layers:

  • upper abdominals
  • oblique muscles (along either side of your stomach)
  • a deep layer of muscles that attach to your spine (erector spinae, glutes, transverse abdominus, etc.)

WHY IS IT IMPORTANT? It is important to have a strong core because your core helps to maintain proper posture and keeps your spine in a neutral position. Balance is strongly correlated to core strength and will reduce the risk of falls. It also decreases low back pain and helps to lower the risk of injury for athletes.

WHAT CAN I DO ABOUT IT?  Here are some tips to ensure you are maintaining strong and supportive core muscles:
Get your Spine Back to Neutral Position: First you need to learn how to stabilize your core by putting your spine in a neutral position. The best way to do this is by perfecting the Abdominal Hollow stretch.  Start by lying on your back with your knees bent, feet on the floor. Simply pull your belly button down towards your spine, creating a hollow in your abdominals and pushing your back into the floor.  Be sure to breathe normally! Hold this for about 10 seconds and repeat 10 times. Once you begin to perfect this position, you can start to perform this when seated or standing. This is a key position that you will want to maintain when doing your core workouts.
Posture Counts!  Another simple way to get your core working is by just becoming more aware of your posture. Stand up straight and get into that abdominal hollow position. By doing these, you may already start to feel a decrease in low back pain. Now Strengthen: Here are two great strengthening exercises to get you started:

BridgeWoman Exercising

  • Lay on your back with knees bent up and feet shoulder width apart.
  • Pull your belly button down towards your spine and lift your hips up towards the ceiling
  • Once you are at a comfortable height, hold for 10 seconds and slowly lower
  • Work up to 20 repetitions.

Planks:Pilates exercise series

  • Lay on your stomach and gently push yourself up. Support your weight on your knees  (modified plank-beginner) or toes (full plank-advanced) and either your elbows or hands
  • Support your back by contracting your abdominal muscles. Be sure to keep your back straight. You should not feel any pain in your back, only muscle tightness in your abdominals
  • Hold for 20 seconds and repeat. Work up to 10 repetitions.
  • A variation of this exercise is side planks, where you will rolls to one side or the other.
  • Don’t forget to maintain your abdominal hollow which will help maintain proper form. These are wonderful exercises to work your core muscles!

A Balancing Act: Balance and a strong core go hand in hand. Consider adding some balance exercises into your core routine. Some examples:Exercise Ball
A. Stand on one leg, balance for 20 seconds, repeat with other leg. B. Perform squats or lunges utilizing a BOSU ball. (picture at right)
C. Sit on an exercise/physio ball, kick one leg out, hold, and then the other
D. Advance a bridge position so that your feet are resting on a physio ball and lift up your hips.

The Benefits:  By working your core you will notice several useful benefits:

  1. Your back will feel better and stronger
  2. It will be easier to maintain better posture
  3. Your balance will improve, thereby reducing your risk of falls.
  4. Athletes risk of injury will decrease

So no matter how old you are, what sport you are training for, what you may be trying to rehabilitate, strengthen or slim down, you can always benefit from adding a core workout to your regiment!   For more information about how physical therapists can help you get started on the right foot, call us today at 717-625-2228


Image courtesy of stockimages at

Sciatica is a commonly misunderstood diagnosis that can be extremely unpleasant. This little word is often batted around like a birthday piñata with few people penetrating the exterior to truly understand its meaning. Sit back, relax, and take a moment to kick your sciatica misconceptions to the curb!

NAMES ARE EVERYTHING:  First, sciatica itself names a problem, NOT the cause of your problems. The word is Latin for inflammation or irritation of the sciatic nerve which we often proclaim as pain in the butt. This nerve emerges from your lower spine and travels through the buttock and back of your thigh to the knee. The nerve continues past the knee but its name changes to the tibial nerve – much like a long road might. This road terminates at your toes. You have 2 sciatic nerves, one in each leg.  Point to remember: Sciatica is NOT a root cause of pain; it is just a structure that transmits pain and irritation. There is always another mechanism responsible for aggravating this nerve and causing sciatica pain.

A CAUSE TO GET BEHIND:  So what are some potential causes for sciatic pain?

Disc Alignment: Disc herniation is a great starting point. When a disc herniates (which can range from a bulging disc to a complete rupture of the disc), it can protrude and put pressure on one of the nerve roots that feeds into the sciatic nerve. The pressure on the nerve root irritates and potentially damages the nerve. This can create pain, numbness, burning, or many other symptoms that may travel down the nerve. Now that nerve becomes irritated. The pressure can cause problems further down the line (that road we talked about earlier).

Picture yourself grabbing a bare electrical wire (pleasant, I know). That current may have originated many miles away but you still experience a shock because the electricity travels. That’s why nerve problems close to the spine can cause pain farther down a limb.

Other Spine-Related: There are a few other causes of sciatica that involve the spine. These include bone spurs, stenosis, and some other less frequent causes. The bottom line is, all of these causes apply pressure on the nerve which causes, you guessed it, sciatica!

Piri-what? Sciatic pain does not always originate from the spinal area, however.  Let’s discuss another mechanism which causes sciatic pain AWAY from the spine.  The Piriformis is a small but very important muscle in the back of your hip/pelvis (AKA your butt) and sure enough, that sneaky sciatic nerve runs very close to it. In fact, a portion of the population has their sciatic nerve run directly through the muscle! So, if this muscle is tight or in spasm, it can harm the adjacent sciatic nerve. This cause of sciatica is called piriformis syndrome.

HOW DID THIS HAPPEN? Sciatica can occur gradually or suddenly with little to no warning. It sounds better to have had a good reason (saving a child in a burning building, making the winning TD… you get the picture) but sometimes it can happen when simply standing up from your couch. Frustrating, I know, but it happens.

HOW TO DEAL: If you, or a loved one, has sciatica, you could be in a lot of pain and wondering where to turn for help.  Physical therapy is a great starting point!  You may have been expecting to hear this from a physical therapy provider. However MANY health professionals (in addition to those directly in the field) view physical therapy as an important first treatment option. Let’s dig deeper into these strategies to fight sciatica.

FIRST LINE OF DEFENSE:  Physical Therapy is, in fact, one of the first lines of defense against sciatica.  Physical therapy utilizes exercises and manual techniques to promote nerve gliding, spine mobility, muscle flexibility and increased strength to heal the area of pain. Of course, the specifics vary from patient to patient. There is no magic list of procedures that cures every sciatic problem. Instead, a physical therapist will create a custom program that fits each individual’s specific needs. It all depends . . . . on YOU!

INJECT SOME RELIEF: If you have tried physical therapy, to no avail, there are other more radical approaches.  One such approach is steroid injections. It sounds intimidating, but it is a brief and relatively easy procedure. An injection places a steroid directly at the irritated nerve. The steroid is a way to force your nerves to be calm and decrease inflammation. Sometimes injections from your physician are a supplement to therapy and will help to increase its effect. Steroids can also be administered orally but they are usually less effective as the medication must be absorbed into your entire body, instead of focusing on the area causing pain.

WHEN ALL ELSE FAILS: Finally, surgery is the most invasive treatment option.  The actual steps in the procedure depend on the CAUSE of your sciatica.  Generally, the surgeon tries to remove the source of the nerve irritation and fix any other structural issues.

Well, that was a great start, but believe it or not, there can be much more to the problem! Now that you know the basics about sciatica and can use this term correctly. Hopefully you will never have to experience it yourself, but if you do, feel free to give us a call. We’d love to help you!

Rotator Cuff Tendonitis

Shoulder pain is most often caused by a condition called rotator cuff tendonitis. The rotator cuff is made up of four muscles surrounding the shoulder joint. Considering these muscles work as a collective, if one area is inflamed or injured, the whole shoulder is affected.

Rotator cuff tendonitis is caused by inflammation of the tendons of the rotator cuff muscles. The onset of pain is typically sudden and may limit you from being able to move your arm above shoulder level comfortably. This is a common ailment among athletes, such as softball and baseball players, as well as swimmers. Additionally, non-athletes may experience this pain if there is a history of heavy lifting or activities involving repetitive movements of the shoulder. Examples include the profession of a painter or carpenter.

Delayed treatment of rotator cuff tendonitis can lead to more severe pain and elongated recovery time. Treatment may include rest, anti-inflammatory medication, physical therapy and possibly steroid injections. Adequate and prompt treatment, however, can lead to complete recovery. Physical therapy will help improve flexibility and strength of the muscles surrounding the shoulder joint, allowing the patient to return to daily activities and/or work without pain.

After years of competitive swimming, I know the importance of shoulder strength and how shoulder pain can negatively affect life. If you are concerned about shoulder pain, no matter how slight or severe, don’t hesitate to contact me.

Brian Hartz, DPT, OCS, CSCS

Degenerative Disc Disease

Much of the lower back (lumbar region) and neck (cervical region) pain we experience can be linked back to degenerative disc disease. This common diagnosis is broadly misunderstood. In essence, degenerative disc disease describes the pain symptoms (including weakness and numbness) caused by a degenerated disc (in the spine).

This term, degenerative disc disease, is actually a term to define the changes in your spinal discs. Spinal discs separate the vertebrae that make up the spine. These discs are soft and compressible. Think of these discs as shock absorbers. Unfortunately, even shock absorbers on a car can get worn out – just like the spinal discs in your spine. When this occurs, pain is the result.

Over the years our spinal discs can degenerate or “break down.” This can cause degenerative disc disease in some people. Degeneration often occurs through the loss of fluid in the spinal discs, which makes the disc thinner, and the cushioning between the discs is no longer protective. Additionally, tiny tears can occur in the disc, ultimately causing the loss of fluid in the disc — also leading to a disc rupturing or breaking into fragments.

Unfortunately, falls and heavy lifting can lead to herniated discs which can spark degeneration. Treating a herniated disc, or treating the pain associated with degenerative disc disease, is the first step in preventing the condition from worsening. Not lifting excessively heavy objects can help protect the discs, too. Prevention is key!

If you have questions about your lower back or neck pain, don’t hesitate to contact us.

Herniated Disc

If you’ve ever experienced a herniated disc, you know the experience can be painful. In addition to low back pain, symptoms that radiate down the leg can include burning, numbness, and/or weakness. It is of utmost importance to receive treatment for a herniated disc sooner rather than later.

Treatment of a herniated disc varies from patient to patient. Make sure a program is being designed specifically for your needs. The treatment will depend on a number of factors including age, symptoms, and activity level. Treatment may include heat or ice, exercises for back strengthening, physical therapy, and/or pain medicine.

Some believe a herniated disc means a one-way ticket to seeing a surgeon. This is not the case; in fact, surgery for a herniated disc only takes place for about one out of 10 people. Surgery may be the best option for those who have nerve damage that is worsening, or for individuals who experience pain even after more conservative treatment options are performed. It’s important to note that the majority of herniated discs resolve without surgical procedures, thanks to a combination of the aforementioned treatment options.

Preventative measures can also be taken to protect your spine. Make sure to use proper lifting techniques and always ask for help if something is too heavy. Maintaining a healthy weight can also help remove additional stress on the spine. Lastly, a back brace may be recommended by your physician. Be advised, however, that excessive use of a back brace can actually weaken the muscles that support your spine, making the issue worse.

–        Dan Herrmann, DPT

TMJ – Jaw Pain

What is TMJ?

TMJ is the acronym used to describe the temporomandibular joint. This joint is a hinge that connects the lower jaw to the temporal bone of the skull. (The temporal bone is in front of the ear on each side of your head.) Why is this joint so important? Well, it’s flexible, letting our jaw move up and down (for things like talking, eating, yawning and more!). If there is a disorder of the TMJ, you may experience varying levels of pain. These disorders of the temporomandibular joint are referred to as TMD.

What Causes TMD?

The cause of TMD is not conclusive; however, there are some suggested causes such as:

  • Injury to the jaw or muscles of the head and/or neck,
  • Grinding or clenching teeth,
  • Stress (regularly tightening face/jaw muscles),
  • Rheumatoid arthritis in the TMJ

What are TMD symptoms?

  • Pain while chewing
  • Swelling of the face
  • Limited flexibility in being able to open your jaw
  • Popping noises when opening or closing your jaw and/or the jaw being stuck in a slightly open position

Think you’re experiencing TMD symptoms?

  • As a precautionary measure, start eating soft foods to minimize the effort spent on chewing. Additionally, avoid chewing gum and yawning.
  • Learn your options in treating TMJ prior to signing up for a surgical procedure. There are varying treatment measures that can be taken – including physical therapy. (Remember, direct access helps you get treatment, fast.) Learn about more treatment options here.

-Wayne McKinley, PT, OCS 

Shin Splints

Drew outside runners1 (2)Shin splints are a common running injury that many people experience when getting back into training after taking a break. Shin splints are also common when runners quickly increase mileage or run on surfaces they are not accustomed to. Continuing to run through this injury may lead to heightened pain or increase the likelihood of acquiring a more serious condition. It is important to understand how to identify this injury and to take steps that will ensure optimal recovery.

How do I know I have Shin Splints?

Shin splints are more technically known as Medial Tibial Stress Syndrome (MTSS). The pain caused by shin splints, or MTSS, is from excessive stress placed on the muscles of the lower leg. This stress leads to pulling on the Tibia (lower bone) of the leg, causing irritation to the bone and connective tissues of the leg. These stresses are often due to weak or tight muscles of the calf and shin – and that, paired with repeated use – sparks irritation, causing pain.

Generally pain is felt in the lower inside part of the leg 1-5 inches above the ankle, or 5-7 centimeters lower than the knee on the outside part of the calf. The pain is usually not localized to one specific area. If the pain is specific to one point and does not subside with rest, it is important to seek a medical evaluation from a physical therapist or physician for the possibility of a stress fracture.

Actions to take.

With suspected shin splints, the first step is to allow your body to rest. Take a few days off from running, apply ice to the irritated area in order to reduce inflammation, and begin gentle stretches for the calf muscles. As the pain diminishes it is beneficial to continue stretching and begin incorporating lower leg strengthening exercises, such as heel raises. Once pain subsides and strength is gained, you may begin a gradual return to running; go shorter distances and run on softer surfaces (such as grass or cinder trails).

These are the basic tenets of recovery; however, for the greatest gains, and to reduce the possibility of re-injury, it may be beneficial to seek treatment from a physical therapist. Physical therapists will be able to address all strength or flexibility limitations, and can also help you learn about other possible contributing factors.

Bobby Longenecker, DPT

Knee Pain

knee pain

Knee pain is common and can stem from knee joint, kneecap, or cartilage issues. Depending upon the location of the knee pain, there could be swelling and you may experience difficulty walking. Other symptoms could include:

  • Locking of the knee
  • Swelling
  • Inability to squat
  • Difficulty going up or down stairs
  • Inability to straighten (extend) the leg

Not all knee pain stems from severe knee injuries (tears and breaks); in fact, overuse and arthritis are common culprits of knee pain. Even if you haven’t experienced an acute knee injury, you may need to receive treatment. Who wants to live in pain, after all?

Significant discomfort, swelling, and an inability to bend your knee (or extend it) are clear indicators you should head to a health care professional right away.

Your recovery may be in reach with strength exercises and monitored stretching – sure beats surgery! (Remember, Direct Access helps you get treatment, fast.) Learn about more treatment options here. Questions about knee pain? Feel free to e-mail us at

Brian Hartz, DPT, OCS, CSCS


Carpal Tunnel Syndrome

Carpal TunnelOver 11.5 million Americans suffer from carpal tunnel syndrome (CTS). The primary symptom associated with CTS is numbness of the fingers. Unfortunately, this numbness is only one of the negative effects associated with the condition. A decrease in hand function, along with decreased strength, are also symptoms of CTS.

But how does this happen?

CTS is a common overuse condition. Symptoms typically occur when the median nerve (the nerve that travels through the bony passageway in your wrist) receives pressure from swollen tissue. If left untreated, CTS can cause permanent nerve damage (and a nagging – as well as constant – pain).

Do not lose hope: you can prevent CTS.

Many times CTS can be brought on by repetitive processes that put strain on your wrists (e.g., typing at a computer for many hours, daily). Many people benefit from ergonomically designed keyboards that minimize pressure at the weakened area. You can help prevent acquiring CTS by stretching and taking breaks often. It’s also suggested that a healthy diet and regular physical activity can prevent CTS.

But what if you already suffer from CTS? Well, there’s hope here too.

Treatment may include any of the following:

–        Use of a splint to reduce discomfort

–        Heat/cold treatment for pain relief

–        Stretch and strengthening exercises

Physical Therapy should be able to help treat the most common symptoms of CTS. However, there are some severe conditions that require surgical consultation. It is important to communicate with your physical therapist about the level of discomfort you are experiencing to help determine next steps.

Questions about carpal tunnel syndrome? Contact us!