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Shoveling Snow: Tips for Avoiding Injuries
Snow shoveling is a repetitive activity that can cause muscle strain to the lower back and shoulders. Back injuries due to snow shoveling are more likely to happen to people who may not know that they are out of condition. Following these tips can help you avoid injuries:
  • Lift smaller loads of snow, rather than heavy shovelfuls. Be sure to take care to bend your knees and lift with your legs rather than your back.
  • Use a shovel with a shaft that lets you keep your back straight while lifting. A short shaft will cause you to bend more to lift the load. Using a shovel that's too long makes the weight at the end heavier. Step in the direction in which you are throwing the snow to prevent the low back from twisting. This will help prevent "next-day back fatigue."
  • Avoid excessive twisting because the spine cannot tolerate twisting as well as it can tolerate other movements. Bend your knees and keep your back as straight as possible so that you are lifting with your legs.
  • Take frequent breaks when shoveling. Stand up straight and walk around periodically to extend the lower back.
  • Backward bending exercises while standing will help reverse the excessive forward bending of shoveling: stand straight and tall, place your hands toward the back of your hips, and bend backwards slightly for several seconds.
  • If you or anyone you know is experiencing back pain, consult a licensed physical therapist.

Physical Therapy and Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone needed to convert sugar, starches and other food into the energy necessary for daily life. While the cause of diabetes is unknown, factors such as obesity and lack of exercise play important roles. Diabetes can result in conditions such as: heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system disease (neuropathy), amputations, and problems with the skin, including ulcers and infections. There are 23.6 million children and adults living with diabetes in the United States. Of these an estimated 17.9 million have been diagnosed, while 5.7 million are unaware that they have the disease.*

How a Physical Therapist Can Help

Managing your diabetes can lower your risk of resulting health issues. Management includes controlling your blood sugar (glucose), lowering your blood pressure and cholesterol, maintaining a healthy weight, and exercising. Physical therapists are experts in restoring and improving human motion, and can play an integral role in the management of diabetes by establishing and, as needed, supervising exercise programs and providing treatment of complications.

Importance of Exercise

Exercise is an important part of managing diabetes. Regular physical activity can lower your need for medications, reduce your risk of heart disease and stroke, and help manage glucose levels*. The American Diabetes Association recommends 30 minutes of moderate exercise at least five days per week. Both aerobic and strength workouts are helpful. Your physical therapist can create an individual exercise program to help you achieve better health safely. You should see a physical therapist to help you with physical activity if you have:
  • Pain in your joints or muscles
  • Numbness or tingling in your feet
  • Calluses or sores on your feet
  • Pain or limping with walking
  • Used an assistive device such as a cane or crutches
  • Had a stroke
  • Questions about what type of exercise is best for you

Treating Complications

Diabetes that is not well controlled leads to problems in blood vessels and nerves, often in the legs. Low blood flow to the legs can create cramping pain when walking or lead to sores on the legs or feet. Diabetes can affect the nerves, which can result in tingling in the feet and may progress to complete numbness. This numbness can cause damage to the skin or joints because of the lack of pain sensation. These problems can lead to difficulty with daily activities, limit the ability to exercise, and also result in very serious consequences to one's health. It is best to take action to prevent complications, but if these problems occur, physical therapists can help restore your quality of life. Physical therapists can:
  • Use special tests to check the sensation in your feet
  • Help decrease cramping pain during walking
  • Evaluate and care for skin ulcers and sores that are slow to heal
  • Improve your walking ability by adapting shoes or orthotics
  • Show you how to protect your feet if they have lost sensation
  • Recommend shoe wear or assistive devices if needed

*American Diabetes Association, accessed on 11/2/09

Acknowledgment: Susan A. Scherer, PT, PhD

Physical Therapy and Walking Aids
Physical therapists, who are experts in restoring and improving motion, recommend that elderly adults who use canes and walkers as walking aids be properly assessed and fitted by a physical therapist to avoid fall-related injuries. With emergency rooms experiencing 47,000 fall-related visits annually from senior citizens due to improper use and fit of walking aids*, assessment by a physical therapist can help reduce the number of these dangerous incidents by ensuring appropriateness and proper fit of the walking device. General Tips for Using Walkers and Canes:
  • The walker or cane should be about the height of your wrists when your arms are at your sides.
  • When using a walker, your arms should be slightly bent when holding on, but you shouldn't have to bend forward at the waist to reach it.
  • Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through.

Physical therapists also advise against borrowing walking aids from friends and family. This often leads to improper fit and misuse, and can result in further injury. Your physical therapist can also evaluate your walking aid and determine if it is in proper working condition.

*Journal of the American Geriatrics Society (June 2009)

Physical Therapy and Low Back Pain

Physical therapists, who are experts in restoring and improving motion in people's lives, play an important role not only in treating persistent or recurrent low back pain, but also in prevention and risk reduction. Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility - in many cases without expensive surgery or the side effects of medications. If you have experienced low back pain, you are not alone. Approximately one quarter of Americans report experiencing low back pain within the past 3 months at any given time*. Low back pain often occurs due to overuse, strain or injury. This includes too much bending, twisting, lifting, and even too much sitting.

How Can You Prevent Low Back Pain?

  • Keep your back, stomach, and leg muscles strong and flexible
  • Keep your body in alignment, so it can be more efficient when you move
  • Don't slouch-keep good posture
  • Use good body positioning at work, home, or during leisure activities
  • When lifting, keep the load close to your body
  • Ask for help or use an assistive device to lift heavy objects
  • Maintain a regular physical fitness regimen. Staying active can help to prevent injuries

What To Do When You Have Low Back Pain

In most cases, low back pain is mild and will disappear on its own. However, for some people, back pain can return or persist, leading to a decrease in quality of life or even disability. Stay active and do as much of your normal routine as possible when you have low back pain. Bed rest for longer than a day can slow down your recovery. If your pain lasts more than a few days or gets worse, then you should schedule an appointment to see your physical therapist.

See a health care professional immediately if you experience the following symptoms:
  • Loss of bowel or bladder control
  • Numbness in the groin or inner thigh
  • Pain that does not change with rest

How a Physical Therapist Can Help

Not all low back pain is the same and your treatment should be tailored to suit your specific condition. You should expect the following from a physical therapist:

Individualized assessment: Your physical therapist will ask you a number of questions about your specific condition and will thoroughly examine you for problems with posture, flexibility, strength, joint mobility, and movement. Attention will be given to how you use your body at work, home, during sports, and at leisure.
Individualized treatment plan: Once your assessment is complete your physical therapist will develop a plan designed for your specific type of back problem. This may consist of:
  • Treatment to decrease pain and restore mobility
  • Manual therapy techniques, including spinal manipulation, to improve mobility of joints and soft tissues.
  • Specific strengthening and/or flexibility exercises
  • Education about care of your back and training for proper lifting, bending, sitting, sleeping, and doing chores both at work and in the home

*Spine November 2006

Did you know?

Physical therapist-developed exercise programs can reduce athletes’ risk of injury by 41%

Stroke: Prevention & Rehabilitation

What is a Stroke?

Like a heart attack, a stroke occurs when the blood supply to part of the brain is reduced or stopped, depriving that area of oxygen. One common cause includes blockage from a clot in blood vessels supplying the brain, or from a disease such as arteriosclerosis that has caused a narrowing of those vessels. This reduction in blood flow results in an ischemic stroke. Another common cause happens when blood supply is reduced by a leaking vessel in the brain, resulting in a hemorrhagic stroke.

As the third leading cause of death in the U.S.*, and the leading cause of serious long-term disability, stroke can result in temporary and/or permanent damage. Strokes may often cause physical problems that prevent persons from living their lives with normal function. These problems may include severely limited movement, balance, and coordination. Physical therapists, who are experts in restoring and improving human motion, play an important role not only in treating the effects of stroke but also in prevention and risk reduction.

Warning Signs of a Stroke

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause

If you or someone with you shows one or more of these warning signs, immediately call 9-1-1 or your local emergency medical services (EMS) so an ambulance can be sent for you. For early treatment it is important to make a note of the time symptoms began.

How a Physical Therapist Can Help

Prevention: Some risk factors, such as family history, age, gender, race (stroke death rates are higher for African Americans even at younger ages,) and previous heart attack or stroke, cannot be changed. However, there are many that can be controlled, such as high blood pressure, cigarette smoking, high blood cholesterol, diabetes, carotid artery disease, obesity, and physical inactivity. As experts in designing tailored exercise plans for individuals with a variety of medical conditions, physical therapists can help reduce risk factors and reverse their effects by creating an exercise program that addresses multiple conditions as well as prevention.

Rehabilitation: Recovering from a stroke depends on its size and location, how quickly you receive care, and, in some cases, other pre-existing health conditions. Rehabilitation begins very soon after your stroke, and physical therapists are an important part of the recovery team. After an evaluation, your physical therapist will develop an individualized plan to maximize your quality of life. The plan will address your ability to move, any pain you may have, and ways to prevent problems that can occur after a stroke. The main focus is to help you return to your highest level of activity. After rehabilitation, many stroke survivors also benefit from periodic assessments by a physical therapist to update their exercise program, help prevent further problems, and promote the healthiest possible lifestyle.

Research: Much of the current research in the field of stroke rehabilitation and recovery is being led by physical therapists. Physical therapists have discovered many innovative new treatments for stroke-related mobility issues and continue to make progress.

Preventing ACL Injuries

Research has found that Anterior Cruciate Ligament (ACL) tears occur four times more frequently in females than in males involved in the same amount of sports participation.

The difference in female and male neuromuscular control, the way muscles contract and react, is one of four primary factors contributing to why women are more susceptible to knee injuries than men. Other discrepancies are anatomical (men and women are structurally differently), hormonal (women's hormonal makeup affects the integrity of the ligament, making it more lax), and bio-mechanical (the positions our knees get in during athletic activities).

To counteract these pre-existing inclinations, physical therapists recommend that female athletes perform a series of exercises to lower their increased chances of ACL tears.

A preventative program designed by a physical therapist would aim to improve strength, flexibility, and coordination, as well as to counteract incorrect existing patterns of movement that may be damaging to the athlete's joints. These incorrect movement patterns may put them at greater risk for injuring their ACLs.

Treating Neck Pain

Studies show that treatment by a physical therapist can provide short- and long-term relief for people with neck pain. A physical therapist designed program of exercises can relieve neck pain and improve mobility without expensive surgery or side effects of pain medication. Proven treatments include manual physical therapy and exercise. Patients have reported they not only experienced pain relief, but were also less likely to seek additional medical care up to one year following treatment.

Lifting Your Child From the Floor

When picking your child up off the floor, you should use a halfkneel lift. First, stand close to your child on the floor. While keeping your back straight, place one foot slightly forward of the other foot, and bend your hips and knees to lower yourself onto one knee. Once down on the floor, grasp your child with both arms and hold him or her close to your body. Tighten your stomach muscles, push with your legs, and slowly return to the standing position. To place your child onto the floor, the same half-kneel technique should be performed.

Carrying/Holding Your Child

When holding or carrying your child, you should always hold him or her close to your body and balanced in the center of your body. Avoid holding your child in one arm and balanced on your hip. When using a child carrier, be sure to keep your back straight and your shoulders back to avoid straining your back and neck.

Picking up Toys From the Floor

As a mother, you will find yourself cleaning up after your child often. When picking toys up from the floor, keep your head and back straight, and while bending at your waist, extend one leg off the floor straight behind you.

Lifting Your Child Out of the Crib

If your child’s crib has a rail that lowers, you will want it in the lowest position when lifting your child out of the crib. As you lift, keep you feet shoulder-width apart, knees slightly bent. Arch your low back and, while keeping your head up, bend at your hips. With both arms, grasp your child and hold him or her close to your chest. Straighten your hips so you are in an upright position, and then extend your knees to return to a full stand. To return your child to the crib, use the same technique and always remember to keep your child close to your chest.

Pushing a Stroller

When pushing your child in a stroller, you will want to stay as close to the stroller as possible, allowing your back to remain straight and your shoulders back. The force to push the stroller should come from your entire body, not just your arms. Avoid pushing the stroller too far ahead of you because this will cause you to hunch your back and shoulders forward.

Activities to Help You Position, Carry, Hold and Play with Your Baby

Tummy Time Tools provides parents with ideas and activities to make sure your baby gets enough time on his tummy throughout the day, while he is awake and supervised. These activities include handling, carrying, diapering, positioning, feeding and playing with your baby. Increasing the amount of time your baby lies on his tummy:
  • Promotes muscle development in the neck and shoulders
  • Helps prevent tight neck muscles and the development of flat areas on the back of the baby’s head
  • Helps build the muscles your baby needs to roll, sit and crawl

Why Do Babies Need Tummy Time?

Babies need tummy time because they are spending more and more time on their backs. In the early 90s, the American Academy of Pediatrics’ Back to Sleep program successfully decreased the incidence of sudden infant death syndrome (SIDS) in the United States by 40 percent by encouraging parents to place their babies on their backs to sleep. Around the same time, a number of infant carriers that doubled as car seats and carriers became widely used. This combination of back sleeping at night and daytime pressure on the infant’s head can create a flattening of the skull.

When a baby develops flat areas on the back of the head and possibly the forehead, it’s called plagiocephaly. Often, this flattening is made worse by a condition called torticollis. Torticollis is a single muscle or group of muscles that are tight or weak on one side of the neck, causing a baby to tilt or turn to one side. The muscle fibers can shorten because of continued resting in one position. It is very important that an infant be placed on his back to sleep. However, it is also important to a baby’s development that he get supervised tummy time and constant repositioning throughout the day. The activities in Tummy Time Tools increase your cuddle time and contact with your baby and will enhance the time you spend together. Teach these activities to family members and other caretakers, so the activities become an important part of your baby’s day.

Tummy Time Is:

  • Always supervised—never leave your baby alone on his tummy
  • Any activity that keeps your baby from lying flat in one position against a hard, supporting surface
  • Anytime you carry, position or play with your baby while he is on his belly
  • Beneficial to babies of all ages
  • Fun, and it can be designed to be easy or challenging for your baby
  • Adaptable, and changes as your baby grows and develops strength
  • A great time to bond with your baby
  • More enjoyable when you play music or give your baby interesting toys to look at and play with

Colleen Coulter-O’Berry, P.T., M.S., P.C.S., Children’s Healthcare of Atlanta Dulcey Lima, C.O., O.T.R./L., Orthomerica Products, Inc.

A Good Bike Fit for You

Whether you are a serious bicyclist or a recreational rider, when it comes to bicycling, you and your bike should fit well together. A proper bike fit minimizes discomfort, increases efficiency, and helps prevent pain or injury. Physical therapists can evaluate the way your body is positioned on the bike to make sure that your biking style “fits” your functional goals, whether they are for comfort and endurance or for speed and performance. If adjustments and equipment changes need to be made to your bicycle, consider taking it to your local bicycle dealer. Ask if the dealer knows a physical therapist who can work with you on proper fit. Or, visit APTA’s Web site at www. and click on “Find a PT.” Contact a physical therapist who treats orthopedic or sports conditions.

Trunk Position and Shoulder Angle

For the recreational rider, trunk position should be 40-80 degrees from horizontal. Shoulder angle should be between 80-90 degrees. For the road cyclist, trunk position should be between 30-40 degrees and shoulder angle should be between 90-100 degrees.

Knee to Pedal

A physical therapist can measure the angle of your knee to the pedal. The closer the angle is to 35 degrees, the better function you will have with less stress on the knee. For the recreational cyclist, the angle should be 35-45 degrees. The road cyclist should have a 30-35 degree angle.

The Handlebars

Handlebar position will affect your hand, shoulder, neck, and back comfort as well as the handling of your bicycle. For the road cyclist, correct handlebar positioning will provide better pedaling efficiency, aerodynamics, and improved safety with cornering and braking. The width of the recreational rider’s handlebars should allow hands to be slightly wider than shoulders. For the road cyclist, hands should be approximately 2 cm wider than the shoulders for comfort and to help ensure good handling of the bicycle.

Recreational Cyclist

A Note About Pedaling

Pedaling is a skilled activity that requires aerobic conditioning. You should make it your goal to work toward pedaling at 80-90 revolutions per minute. Pedaling at this rate will lessen your chance of injury.

The Saddle

The saddle on your bike should be level. If the saddle tips downward, pressure will be placed on your hands and lower back. The saddle also should be a comfortable distance from the handlebars—too close, and extra weight will be placed on your mid-back and arms; too far away, and you may put extra strain on your lower back and neck.

Foot to Pedal

Position the ball of your foot over the pedal spindle for the best leverage, comfort, and efficiency. A stiff-soled shoe is best for comfort and performance.
Physical Therapy and Bone Health
Physical therapists are experts in improving and restoring mobility and play an important role in ensuring optimal bone health. Healthy bones can help you stay strong and active throughout your life. If good bone health is achieved during childhood and maintained, it can help to avoid bone loss and fracture later in life. For healthy bones, it is important to maintain a physically active lifestyle and eat a balanced diet with plenty of calcium, and vitamin D supplements as needed. Physical therapists can design a unique program for you to help keep your bones healthy.

Osteoporosis is a common bone disease that affects both men and women (mostly women), usually as they age. It is associated with low bone Massachusetts and thinning of the bone structure, making bones fragile and more likely to break.

Some people are more at risk for osteoporosis than others. Not all risk factors can be changed, but healthy habits and a proper exercise routine designed by your physical therapist can keep bones healthy and reduce risk. Risk factors* include:
  • Age: More common in older individuals
  • Sex: More common in women
  • Family History: Heredity
  • Race and Ethnicity: Affects all races. In the US, increased risk for Caucasian, Asian, or Latino
  • Low body weight/being small and thin
  • Diet, especially one low in calcium and vitamin D
  • History of broken bones
  • Menopause
  • Inactive lifestyle
  • Smoking
  • Alcohol abuse
  • Certain medications, diseases, and other medical conditions
Physical therapists can help prevent osteoporosis and treat its effects by designing individualized exercise programs to benefit bone health, improve posture, and enhance core stability and balance. Most of these exercises are simple and can be done at home with no special equipment.

Fight Fracture with Fitness

Inactivity is a major risk factor for osteoporosis. The right exercises and good habits can keep bones strong and prevent or reverse the effects of osteoporosis. Weight-bearing exercise, such as walking, is an important way to build and maintain healthy bones. Muscle strengthening exercises have been found to stimulate bone growth and can help prevent and treat osteoporosis. These types of exercises are best if started early in life and done regularly. However, it is important to remember that you can begin exercising at any age and still reap great benefits.

If you have osteoporosis, are at high risk for a fall or fracture, or have a medical condition, affecting your ability to exercise, do not begin an exercise program without first consulting your physician and a physical therapist.

Avoid exercises and daily activities, which round the spine, such as sit-ups, crunches, bending down to tie your shoes, exercise machines that involve forward bending of the trunk, and movements and sports that round and twist the spine.

Benefits of Good Balance

Preserving balance and stability with exercises can help reduce falls and resulting fractures. Exercises that improve posture, core stability, balance, and coordination, can also protect the spine against compression fractures. An individualized program may include a walking regimen, Tai Chi, and other exercises geared toward conditioning, balance, and coordination.

Bone Health Begins With Good Posture

Physical therapists recommend good posture and safe movements to protect bones from fracture during daily activities. Using proper posture and safe body mechanics during all activities protects the spine against injury. Here are some tips:
  • Keep your back, stomach, and leg muscles strong and flexible.
  • Keep your body in alignment, so it can be more efficient when you move.
  • Do not slouch. When sitting, keep your spine and head straight. Put a small pillow behind your waist to keep your spine in a good position.
  • Use good body positioning at work, home, or during leisure activities.
  • When lifting or bending forward, bend your knees, keep your back straight, bend forward at the hip crease, and lift with your legs. Keep the load close to your body.
  • Ask for help or use an assistive device to lift heavy objects.
  • Maintain a regular physical fitness regimen. Staying active can help to prevent injuries.

Physical Therapy & Lymphedema

What is Lymphedema?

The lymphatic system is responsible for distributing and removing excess fluid in the body. Lymphedema is the abnormal buildup of bodily fluid that causes tissue swelling, mostly in the arms and legs. It is typically caused by damage to the body's lymphatic system resulting from treatment for cancer, which often includes lymph node removal and radiation therapy, both of which can lead to damage and cause a back up of fluid in the areas of the body where the treatment was done. Lymphedema can also be hereditary. Lymphedema can be a debilitating condition and may result in limited movement, joint pain, and difficulty in performing activities. Physical therapists, who are experts in restoring and improving human motion, play an important role not only in treating the effects of lymphedema but also in risk reduction.

Who is at Risk for Lymphedema?

Anyone who has had lymph nodes removed for cancer treatment and/or had radiation therapy is at risk. Or, any person who has a hereditary condition of which lymphedema is a possible side effect. If identified at the very first signs, lymphedema can be effectively treated. Otherwise, it can progress to a much more advanced swelling that may cause any number of adverse conditions (limited movement, joint pain, etc.).

Risk Factors
  • Being overweight or gaining weight during or after cancer treatment
  • Having lymph nodes removed
  • Having radiation therapy
  • Having an infection or blood clot in the limb affected by cancer treatment
  • Having a hereditary condition of which lymphedema is a known possible side effect
Warning Signs
  • Aching or heaviness in the limb that was affected by cancer treatment
  • A feeling of fullness or tightness in the limb affected by cancer treatment
  • Visible swelling that affects the limb affected by cancer treatment

How a Physical Therapist Can Help
Risk Reduction: Some risk factors, such as the necessary treatment for cancer, cannot be changed. However, there are many that can be controlled. Maintaining a healthy body weight, maintaining good skin care and hygiene, and avoiding infections from cuts, burns, or skin wounds are all steps you can take to protect your limb. Exercising sensibly and avoiding unnecessary strain to the limb can also help to reduce the risk of developing lymphedema. A physical therapist can create an exercise program and monitor its effect on your limb. This includes measurements for any early changes associated with lymphedema. If these changes are seen, the physical therapist can provide conservative, early intervention that can prevent the condition from progressing.

Rehabilitation: If you have lymphedema, a physical therapist is an important part of your medical team to provide a plan that may include decongestive therapy and ongoing education for limb care, including recommendations for compression garments and further preventive measures. The plan will also include ways to improve your mobility and function to maximize your abilities. The main focus is to help you return to your highest level of activity. After rehabilitation, people with lymphedema benefit from periodic assessments by a physical therapist to monitor their limb volume, update their exercise program, obtain new compression garments, help prevent further problems, and promote the healthiest possible lifestyle.

Research: Much of the current research in the field of lymphedema risk reduction and management is being led by physical therapists. Physical therapists have discovered many innovative new treatments for early detection and treatment of lymphedema and continue to make progress in research on methods for treatment.

Is Your Backpack Making The Grade?

Wear both straps.

Use of one strap causes one side of the body to bear the weight of the backpack. By wearing two shoulder straps, the weight of the backpack is better distributed.

Wear the backpack over the strongest mid-back muscles.

Pay close attention to the way the backpack is positioned on the back. It should rest evenly in the middle of the back. Shoulder straps should be adjusted to allow the child to put on and take off the backpack without difficulty and allow free movement of the arms. Straps should not be too loose, and the backpack should not extend below the low back.

Lighten the load.

Keep the load at 10-15% or less of the child’s bodyweight. Carry only those items that are required for the day. Organize the contents of the backpack by placing the heaviest items closest to the back. Some students have two sets of books so as not to have to carry the heavy books to and from school.


Load no more than

10-15% of body weight

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