COVID-19 & Capitol Rehab

Garrett Sanders PT, DPT

23 March 2020

"The mission of Capitol Rehab is to provide excellent patient-centered care by a dedicated and innovative healthcare team."

This is the goal by which all of our employees act upon every day that we come to work, and very often, outside of the work setting.  This also remains true during these very challenging and uncertain times.  The Coronavirus / COVID-19 has challenged all person's to be better in how we prepare for the unknown and also how keep ourselves and work areas clean.  While Capitol Rehab has always taken great pride in our presentation and our cleanliness, we have and will continue to exceed expectations during these difficult times.  Whether you are a current patient, a previous patient, or a new patient looking into whether now is a safe time to be treated, please note that Capitol Rehab will always be focused on our patients.  This includes not only providing them with excellent care but also providing that care in the cleanest environment that we can.  Below you will find some of the steps that we have taken to ensure this.

1. All doors to our facility are open and will remain propped during business hours.

2. Patient check-in is strictly verbal

3. All common items have been removed from the waiting area. (magazines, coffee, water, etc)  These items are available on request.

4. All providers will be wearing gloves and will replace gloves between patients

5. Providers wash their hands before and after working with each patient, regardless of glove use

6. All equipment and tables are cleaned before and after the patient's visit

7. In common areas such as the PT gym, a patient's area is clearly defined by tape on the ground.  Patient's are required to stay in this space            during their visit, with all required equipment being brought to them.  No one other than your provider will enter this space.

8. Patients are encouraged to exit through the back exit to maintain social distancing and limiting contact

9. The use of hot packs will be suspended with all heating being perform via infrared light

10. Patients aged 65 and older and those with compromised immune systems have been placed on treatment holds with all at home programs          being provided

While Capitol Rehab employees will strive to maintain the safest and cleanest working environment, we recognize that our patient's must do their part as well.  We ask that all patient's follow the recommendations below.  This will help maintain your safety, our safety and other patient's safety.

1. If you are feeling ill, have a fever or belief in anyway that you have a condition that may be contagious, please do not come to the office.                Please be cleared by your PCP first.

2. Show up at exactly your appointment time.  The less time that wait in the reception area, the less chance that you will come in contact with          other people

3. Wash your hands with the provided hand sanitizer when you arrive for your appointment

4. If you have someone coming with you and they are able to safely wait in their vehicle, please have them do so

5. Stay in your designated treatment area or room unless designated by your provider or support staff

Capitol Rehab will remain dedicated to our patient's and be a place where they can receive the care they need.  It is required of all us to take necessary steps to ensure that we are able to provide effective care in a safe manner.  If you have any concerns about your care or potential care, please do not hesitate to contact our office to discuss those concerns.  We will be happy to accommodate any treatment requests that we are reasonably able to.  

Pain: The Tip of the Iceberg

Garrett Sanders PT, DPT

2 February 2020

What is pain?  Answer: Pain is an unpleasant sensation and emotional experience that links to tissue damage. It allows the body to react and prevent further tissue damage. 1

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The most important thing to recognize about pain is that it is a symptom.  It can be a symptom caused by either an acute or chronic underlying cause.  In both physical therapy and chiropractic care we treat patients who are in pain because this is what the majority of people respond to.  Something hurts and is stopping me from performing the activities that I want to perform, thus I need help getting rid of it.  Most conditions that are treated in both disciplines are attributed to chronic conditions that have been present for years but only recently have started to cause pain.  An example of this is the most common condition that we treat in physical therapy; primary shoulder impingement.  This occurs due to mechanical changes that lead to decreased subacromial space.  We have a large amount of patient's who travel out Route 7 or 66 and then work in a field that requires large amounts of sitting.  Prolonged sitting to and from work, and then for most of your work day, can lead to postural deficits.  If an individual has poor posture and then is compounded by prolonged sitting, they most likely will suffer from shoulder impingement at some point in their lifetime.  When this person comes to therapy, they are in pain, and want the pain to stop.  After 2-4 weeks of treatment, pain levels are down and the patient is feeling much better and, against advice of their provider, stop therapy due to work schedule, ease of treatment, etc.  Now a couple weeks later, the person is back into their normal routine and the pain returns.  Why?  Because the patient has responded to pain only and has felt that because the pain levels are gone, I am all better.  They have only seen the 'tip of the iceberg' and not the whole thing.

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It is important to always view pain as a symptom and to find a provider who will search for and treat the cause of the pain.  In the case above, the proper course of treatment is to stretch anterior structures (chest), strengthen posterior structures (back) and address lower extremity tightness that is likely forcing the shoulders into a poor position.  Attending physical therapy or chiropractic care is an investment of your time and money, we want you to have the largest return on your investment; to solve the problem and thus remain pain free.  If you have noticed a loss of range of motion in a joint, you are unable to do something you used to be able to do, or just feel that something is not moving the correct way, it is time to have it evaluated.  It is always easier, quicker and cheaper in the long run to resolve a condition before the pain starts.  

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Therapeutic Exercise; It's As Easy As Brushing Your Teeth!

Karrie Wratchford, CPT

7 July 2019

Make it part of your day.

One of the most enjoyable things about my work is encouraging patients to make their world a playground.  I look to find fun, easy ways to get the 30 second exercises we teach you into a 16-hour waking day.  These exercises work if you do them consistently enough to get your body and brain on board.  They help create a better-balanced body and provide a reprieve from what you do more than anything else, work (or whatever repetitive, adult patterns you do all day)!  The reason I say therapeutic exercise is like brushing your teeth is because it should be quick and easy, and hopefully you brush your teeth 2-3 times a day.   I'm not asking for an extra 20-40 minutes for exercise that none of us have in our busy lives.  I encourage you to create the habit of doing a 30 second stretch or exercise every hour of work.  If you're not good at creating the habit on your own, then tag your exercise with something you already do every day like looking in the mirror or putting on your shoes.  Another method of training that might work for you is setting an alarm on your phone or watch to go off throughout the day.   That's 4-5 minutes total throughout an 8-10 hour workday, which is enough over time to add up and create change. 

Instead of thinking 100% for 2-3 days (about the attention span of good intentions) think 1% for 100 days.  Home renovation is never pretty, but the end result is beautiful and permanent.  Think of your body renovation the same way.

If I haven't shown you how to modify your therapeutic exercises to seamlessly fit in your working day, whatever it is- commuting, sitting, standing, walking, lifting, diapering, etc - then come see me and we'll get started.  I'll quash any excuse or roadblock you have to therapeutic exercise.  

Cheers to your clean teeth and body renovation as you put a new spin on your workdays!

The Importance of Good Form.  All the Time

Garrett Sanders PT, DPT

24 October 2018

The importance of proper weight lifting form has been well discussed, reviewed and should be ingrained in just about everyone when it comes to sports and gym training.  The purpose of this blog post is to shed some additional light on areas that do not receive enough attention.  In particular, what you do with that weight when your set or movement is completed.  Do you drop it? Do you set it down quietly? Have you ever even thought about the importance of HOW you put your weight away?  When I was in high school, I was involved in a front end car accident where the front end of my car was lifted off the ground and then slammed back down on the road.  This resulted in my seat-belt getting caught under my rib cage and dislocating several ribs in my back.  I was fortunate to have an excellent PT and chiropractor back home who were able to get everything back in place over the course of a couple visits.  In the years that would follow with training for baseball and general gym programs of various types, I was doing pretty well.  Prior to becoming a therapist, I would be able to complete all of my workouts without issue, however, occasionally when putting my weights away I would 'pull my back out'.  This term can mean various things to everyone but for me, it is exactly what it felt like, I had pulled my back out of place.  So back to my therapist and chiropractor I went, to correct the same issue I had dealt with during high school.  I always wondered why was I able to lift so much during my set and then hurt myself after the 'tough part'.  What I came to learn later on was it was because my functional movement patterns were off.  The way in which I bend and move throughout the course of my daily life was incorrect, and this is what was leading to my re-injury.  

When we exercise, the skeletal muscles demand more blood and oxygen.  When the skeletal muscle require this oxygen, it is decreased to other areas in the body.  Important areas like your brain.  Research has shown that at rest 20% of oxygen is used by the brain and during moderate to heavy exercise this number can drop to 12% or even lower.  This means that towards the end of your workout your mental clarity is decreased and thus your ability to perform thought forward movements is decreased.  This also means that that the way in which you move on a regular basis comes out when it is time to put that weight away after a movement.  An example of this that we see in our office is when evaluating a patient for posture.  When the patient is aware of what we are looking for they will nice and upright.  However following the exam or exercise the 'true self' starts to show because they are no longer thinking about sitting correctly and will start to slouch.  This is the same thing that happens during weight training.  When you first grab onto the weight (and mentally fresh) you may be thinking about using proper mechanics,  However, after your movement is complete and the oxygen levels in your brain are lower, this thought about using proper form may no longer be there, and thus the movement pattern is incorrect and can be dangerous.

How is this corrected?  

The first step towards proper movement patterns is ensuring that your joints and muscles have the ability to achieve the required range of motion and length to perform the desired activity.  The second step is to learn how to properly perform basic movements that give your body the best mechanical advantage.  The final step is to constantly perform proper movement patterns throughout the the course of your everyday life.  For example; do not just think about using proper squat mechanics during leg day at the gym.  Think about using proper squat mechanics every time you get out of a chair, using the bathroom, and get out of a car.  This is important because when lifting or placing those dumbbells located on the ground at the gym, you should likely be performing either a squat or deadlift motion.  If you have been perfecting this movement on a daily basis and it is your normal movement, you will maintain it even when you are tired and not thinking of it.  If it is not, you open yourself up to injury and set backs from your physical goals.

Our professional staff are all trained in the Functional Movement Screen which can help us easily identify mechanical deficits and create a program to address movement deficits, reduce the likelihood of injury, and improve overall physical performance.

The Good Old Days?

Troy Swick, LPTA

17 October 2018

How many times have you watched someone perform a specific lift and wonder why do they do it that way? Usually if you ask the person their answer resembles "this is how my coach taught me and his coach taught him". This resembles what we call a historical model when approaching weight lifting techniques especially those taught to athletes during their adolescent years. Historical models are typically not based on current research and continue poor movement patterns which have been handed down through several generations. Scientific models are reliant on current research and continually strive to improve movement patterns based on the research results. Those who teach scientific models know each person is an individual and no two persons will lift exactly the same. They also understand what modifications are necessary to protect each athlete from injury during a lift.

Today we are specifically going to delve into a deadlift and the importance of proper knee and hip positioning. During a deadlift the posterior chain (glutes, hamstrings, spinal extensors) should be the predominant muscle group from which your power is being derived. Improper knee and hip position often causes this lift to be quad dominant. Most athletes or people in general, due to our cultural tendencies and poor training programs have excessive quad strength as compared to their hamstrings and posterior chain.  These muscle imbalances prove to be detrimental to knee ligamenture specifically the ACL. People who are quad dominant tend to 'squat their deadlift' rather than hip hinging for posterior chain activation. Squatting your deadlift decreases efficiency and places the bar path further away from your center of gravity.  This then results in poor spinal position during the lift, thus increasing the intervertebral disc pressure in the lumbar spine and anterior knee compression.

The moral of the story is it's ok to learn something new when performing old lifts. Historical models are not the enemy, but scientific models in combination with historical models drive forward the advancement of any area in society. Exercises, and in particular one as important as the deadlift, should not be avoided simply because you watched someone hurt themselves with improper form while performing the movement. It is important that your movement pattern be addressed by a qualified professional to reduce the likelihood of injury and maximize the benefits you are working for.   If you find yourself squatting your deadlift here are a few exercises to help improve your hip hinge and posterior chain activation:

Exercise 1:  Runner's Drill

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Balance on one leg, raise your foot and tap a bench/chair, now lean forward and tap your fingers to the same spot on the bench/chair while extending your leg behind you. When you tap the bench be sure to tap lightly so you have a nice controlled transition between the two points. Repeat this sequence 10 times twice.

Exercise 2:  Hip Hinge

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Standing roughly a foot length and a half away from a wall. Keep your knees locked, shift your weight through your heels and by bending at your waist and keeping your chest up. Shift back until your bottom taps the wall, then straighten up by driving your hips forward. Repeat 10 times.

It is important to note that the above exercises are meant to be incorporated into a balanced wellness program that meets your recreational and work demands.  If you have any questions about these exercises or would like to be evaluated by one of our therapists or chiropractors please contact our office at 540-665-4444.

Desk and Workplace Ergonomics

10 September 2018

Luke Skiff PT, DPT

For most people, a majority of their time during the week is at some kind of a job. If that job is performed at a desk, sitting for long periods of time, the workplace set-up could be a cause for mechanical stress. Evaluating your work space can, and should be performed for both your home and office settings, and can make a difference in how you feel at the end of the day.

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When seated in your chair, you should have equal weight distribution on the chair, and both feet should be resting on the floor firmly and equally as well. Then, sit as far back as you can, you should find approximately two finger widths of space between the front edge of the chair and the back of your knees. The seat cushion should tilt forward slightly so that there is a gentle, or slight slope downward. This should feel comfortable. One modification that can provide a tilt if your seat does not come with a manual lever or option, is to place a flat pillow across the back half of your seat, or wedging a rolled up towel in the space where the backrest meets the seat cushion. This will provide a natural anterior tilt to your pelvis. The seat back should provide support between the waist and lower aspect of your shoulder blades. If the seat back is adjustable with either a knob or rachet, the back should be positioned so that the lumbar support fits the contour of your back. If the chair is primarily used for computers, you may remove the armrests if possible, to allow your arms to remain at your side. Elbows should be at a 90 degree angle with arms at your side. A keyboard tray installed or pre-installed under the table portion of the desk is ideal, with a space to place the mouse to maintain arm positioning. Wrists should be in a neutral position, with a cushion or rest placed in front of keyboard or mouse to help maintain the position. Only rest your wrists during a break from typing, as you should maintain a neutral wrist as you slightly hover over the keyboard.

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The computer screen should be about an arms length away, and the top of the screen should be equal to a direct gaze forward. If the screen is adjustable, a 10-20 degree upward tilt is better. Wearing bifocal glasses may also promote head positions that extend your upper cervical spine and promote neck pain. Some have benefited from two different pairs of glasses with different prescriptions, however that depends on your case, and may be a question to ask your optometrist.​

Working at a desk is taxing to your neck, shoulders, and lower back. Proper workplace ergonomics will be beneficial to your daily work routine by reducing muscle fatigue, mental fatigue and likelihood of injury throughout the body. In many cases, we find that patients do not have the physical abilities to stand or sit in an upright position due to muscle tightness and weakness. Below are two exercises that are beneficial to start addressing your sitting posture. 

Exercise 1:  Hamstring Primer Stretch

Lying on your back hold onto one thigh and straighten leg as far as you can with foot in a nice relaxed position.  Hold this position for 30 seconds and then pump the ankle (on and off a gas pedal) 10 times.  Repeat series 3 times.

Exercise 2:  Glute Bridges 

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Lying on your back, bend both legs with heels dug into ground and toes pointed slightly upward. Place your hands at your side squeeze your glute muscles together and then lift your pelvis off of the mat until body is nearly straight. Hold the exercise at the top for 5 seconds , then repeat the movement 10 times.

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It is important to note that the above exercises are meant to be incorporated into a balanced wellness program that meets your recreational and work demands.  If you have any questions about these exercises or would like to be evaluated by one of our therapists or chiropractors please contact our office at 540-665-4444.

Rotate Like a Kid

Garrett Sanders PT, DPT

16 July 2018

If you have children, you likely remember the first time your child rolled from their stomach to back and then again from back to stomach.  This is an important phase of development and also represents a major milestone that facilitates additional physical abilities.  So it may come as a surprise that the you of 6-9 months of age, was able to do something that you cannot do today.  

Most adults have lost the ability to perform a segmental rotation (rotating your upper body while keeping your lower body still) which is the foundation of the golf swing.  In the golf swing, the take-away is performed by keeping the lower body mostly still, with the exception of backwards weight shift, and then rotating the upper body away.  This creates torque and creates stored energy, like a coil spring.  So what happens if you are unable to rotate just the upper body away, but instead move the upper and lower body together at the same time?  A loss of energy, which in turn results in a loss of power and performance.  With this loss of performance, the body will create compensations and can lead to injury.

This is not to say that most adults cannot roll from their stomach to their back and then return. However, most of us use our entire body to achieve this movement rather then having the ability to perform it one segment at a time.  In basic terms we can attribute this loss of ability to a combination of soft tissue tightness, muscle weakness, spinal restrictions, and  lack of motor planning.  Below are two exercises that will get you started on regaining your ability to rotate.  

Exercise 1: Sidelying Lumbar and Thoracic Rotation with Ball

As the picture below illustrates, you will start by laying on your left side with the left leg straight and the top leg bent to 90 degrees of hip flexion and 90 degrees of knee bend.  A small ball or towel will be placed under the right knee.  Your left arm will be straight out to the side and the right arm will be bent so that you right hand will be at the center of your chest.  The exercise is completed by compressing the towel or ball with the right knee into the ground gently while the upper body and right arm (hand still at the chest) rotate around to the right.  

Exercise 2:  Prone to Sidelying Rotation initiated with Arms

As the picture below illustrates, you will start this movement by laying on your stomach with your left arm up and your right arm out to the side.  Legs will be placed together and are dead weight, they do not move.  Forget you even have legs for right now.  The movement is initiated with raising the right arm and engaging the lumbar spine at the same time to achieve the finishing position of shoulders stacked on top of each other.  

It is important to note that the above exercises are meant to be incorporated into a balanced wellness program that meets your recreational and work demands.  If you have any questions about these exercises or would like to be evaluated by one of our therapists or chiropractors please contact our office at 540-665-4444.