Stress Awareness and Management

Stress Awareness and Management: 3 Natural Ways To Start Feeling Better

A special guest blog post from The Kee Institute in West Bloomfield focusing on mental health, stress awareness, and management.

Back Pain Review

Stress Levels Are At Record Highs

If you’re currently feeling stressed, know that it’s normal and you are not alone. Stress and worry during the Coronavirus have increased in most adults by 30%, and there is still so much uncertainty in the world. When will things ever feel normal again? Will I have to go back into an office? When will it be safe to fly? The more unanswered questions we have, the more stressed we become. So what is stress anyway? 

What Is Stress? 

When we were hunter-gatherers, stress was our brain’s natural defense mechanism in response to danger. It would flood the body with hormones that prepare us to flee or fight whatever the threat might be. Today, while we’re less likely to run into a bear, a job interview, multiple work deadlines, or even driving in traffic can still trigger our brain with a fight or flight response. 

What Are The Symptoms of Stress? 

It can be challenging to manage stress as it doesn’t always manifest itself in the most obvious ways. Here are some of the more commonly associated behaviors and physical effects of stress: 

Common Symptoms 

● Difficulty sleeping or sleeping too much 

● Jaw clenching 

● Trouble staying on task 

● Lack of motivation 

Tension and muscle pain 

● Restlessness 

● Moodiness and irritability 

● Low energy 

● Aches, pains, and headaches 

Symptoms of Stress

Impulsive Stress Behaviors 

● Binge eating or skipping meals 

● Compulsive online shopping 

● Excessive drinking 

● Shutting yourself off from friends and family 

● A decline in self-care and personal hygiene 

You might spend every Monday feeling exhausted and moody, thinking that it’s just a “classic case of the Mondays,” without even realizing that you’re feeling stressed. A new week can be overwhelming, and Monday mornings will often greet us with a not-so-pleasant inbox. Your brain can perceive Monday as a threat because of how you’ve felt on Mondays in the past. So much so that you might start feeling anxious and restless on Sunday night. 

How You Can Manage Your Stress: 

While it’s nearly impossible to prevent altogether, there are some simple methods you can try next time you’re feeling stressed. 

Schedule Time For Yourself 

Life can be chaotic sometimes, and stress management isn’t always top of mind. We often forget to schedule a time to check in with ourselves with so much on our daily calendar. Put some relaxing “me time” on your calendar once a day. Whether that’s listening to a podcast, reading a book, taking a bath, a quick walk, or cooking yourself a nice meal, try to spend 15-30 minutes each day enjoying something that makes you happy and put the to-do lists out of mind. Make time for yourself and fit it into your schedule so, at the end of the day, you took that time to relax and breathe. 

Move Your Body 

One of the most effective ways to calm your mind is to move your body. If you’re mindlessly scrolling through your phone or struggling to get out of bed, your mind has plenty of time to run through your mental checklist of to-dos and other life triggers. When you exercise, your mind must focus on the movement, mainly so you don’t trip over your own feet. It’s difficult for your mind to wander when following a workout video, listening to a podcast on a walk, or playing a sport with friends.

Not only is exercise a great distraction, but it can increase the production of the brain’s feel-good chemical called endorphins, which can naturally improve your mood. You don’t need to go wild and take up CrossFit to feel the benefits. A simple 15-minute walk with a friend can make a world of difference. 

How to manage stress

Be Kind To Yourself 

Be kind to yourself. It might feel like it’s easier said than done but try your best to listen to your inner cheerleader and ignore your inner critic. The time you spend telling yourself that you can’t complete your tasks in time, that you won’t answer the interview questions right, that there’s no way you’ll make your flight will never positively impact the outcome. While stress is normal, you’ll have difficulty remembering a situation when worrying about something repeatedly made the outcome any different. 

It’s important to note that your feelings are valid no matter what is stressing you out. You, along with your fellow humans, have just endured one of the most challenging years in the last century. Identifying stress is the first step to effective management. While these tips are helpful, it is always beneficial to seek professional help before your stress levels get out of control.

Dry Needling Treatments

Dry Needling: Therapy for Pain and Movement Impairments

Balanced PT offers dry needling treatment to help with neuromusculoskeletal pain and movement impairment. Learn more about the dry needling process and some specific conditions that benefit from this treatment.

What is Dry Needling?

Dry needling is a safe and minimally invasive treatment used to help patients with neuromusculoskeletal pain and movement impairments(Mayo Clinic). Some benefits include decreased muscular pain, easing trigger points, and improved range of motion.

It is administered by certified and trained healthcare professionals such as physical therapists, medical doctors, and some chiropractors. Some other common names for dry needling therapy include trigger point dry needling (TDN) and Functional Dry Needling (FDN).

Difference Between Dry Needling and Acupuncture?

While dry needling stems from traditional Chinese medicine like acupuncture, dry needling is a treatment that has evolved into a modern western medicine treatment. Inserting needles into the skin is something both dry needling therapy and acupuncture share, but after that, the treatments are undoubtedly different (Denver Physical Medicine and Rehab).

Acupuncture treatments are more of traditional eastern medicine based on restoring the proper energy flow throughout the body by inserting needles along meridian lines. 

Dry needling therapy has been developing since the 1980s and focuses on relieving chronic and acute pain by inserting needles into trigger points to restore normal function.

Will Dry Needling Therapy Work For Me?

Patients that are experiencing chronic pain are typically great candidates to receive dry needling therapy. Patients can expect to see the most significant benefits when this dry needling is incorporated with exercise, manual therapy, stretching, and education. It is a low cost, low-risk treatment that can help with conditions such as (Virginia Sports Medicine Institute):

  • Acute and Chronic Tendonitis/ Tendinosis
  • Athletic Overuse Injuries
  • Carpal Tunnel Syndrome
  • Frozen Shoulder
  • Muscle Spasms
  • Whiplash from auto accidents
  • Ehlers Danlos Syndrome
  • Fibromyalgia
  • IT Band Syndrome
  • Sciatic pain
  • Tennis and Golfer’s Elbow
  • Neck and lower back pain

Whiplash from auto accident

While dry needling can be beneficial to various conditions, it is also essential to know when dry needling is not appropriate. Dry needling is not suitable and potentially harmful (Cleveland Clinic) for the following reasons:

  • A patient with a needle phobia
  • Pregnancy (first trimester)
  • Patient with an allergy to metals
  • Patients that have an infection present
  • Needling over cosmetic implants
  • Patients with a heart valve replacement (endocarditis)
  • Patients with epilepsy (or other seizure disorders)

Suppose you are looking for natural pain management treatment options, and dry needling is not an option. In that case, we always recommend scheduling an appointment with your primary care physician, orthopedic surgeon, or physical therapist. They will be able to diagnose your pain and provide you with a list of safe treatments available near you.

How Does Dry Needling Work?

Multiple clinical studies show that dry needling works by restoring muscles to a normal resting state. We know that patients suffering from chronic pain, a traumatic injury, or overused muscles often develop trigger points (also known as knots) that cause pain and discomfort. 

Looking further into why this causes you pain, research shows that the trigger points form due to prolonged or abnormal muscle contraction where your muscle is not receiving enough blood supply. The lack of blood supply (filled with oxygen and nutrients required for healing) to an injured area will cause the surrounding tissue and nerves to become more sensitive.

By stimulating the trigger point with a sterile needle, dry needling therapy can help drive more blood to an injured area, release muscular tension, and help the brain release endorphins that promote healing.

Step By Step Dry Needling Procedure

Before administering dry needling therapy to any patient, your physical therapist will perform an examination that includes your past medical history to ensure the treatment is appropriate and safe. Part of the evaluation will also consist of your therapist using palpation skills to identify trigger points causing pain and limited motion.

Phsyical Therapist finding trigger points for dry needling treatmetn

Once you and your therapist agree that dry needling will benefit your recovery, the therapist will go over each part of the treatment in more detail (Verywell Health). Specific details that help patients understand dry needling can include:

  • How long does dry needling take? Typically a single treatment can take anywhere from 15-30 minutes, which is most commonly a part of a total of 30-60 physical therapy sessions.
  • What to wear for a dry needling appointment: We recommend our patients wear the usual, comfortable physical therapy attire. Clothing that allows easy access for your therapist to administer the treatment is always a good idea. 
  • Insurance information and expected costs: Some insurances do cover dry needling, while others do not. It helps to know upfront what co-pay and out-of-pocket costs to expect.

Once an evaluation is complete, some patients can start dry needling therapy that same day( others may need to wait until the second appointment, this varies from clinician to clinician.)

Your physical therapist will always begin the dry needling procedure by sterilizing the treatment area and preparing the needles in a private setting. After preparing the treatment area, the therapist will start inserting thin, dry needles (needles that do not contain medications or fluids ) into problem-causing trigger points. 

The dry needles are inserted directly into the skin at varying depths (depending on the dry needling technique). Oftentimes, patients will feel the physical therapist gently move the needle around to stimulate a local twitch response. A local twitch is a good thing, as it signifies that a muscle is reacting to the treatment.

After 15-30 minutes, your therapist will carefully remove the dry needles. They will inspect the treatment area for bleeding and skin reactions before leaving for home.

What To Expect After a Dry Needling Treatment

After a dry needling treatment session, patients often report a decrease in pain and an increase in range of motion. In more severe cases, a patient will require more than one treatment to reach the desired results.

Muscle soreness and light bruising is a common side effect of dry needling, for which your therapist may recommend rest, heat, or ice. These symptoms typically resolve themselves over a couple of days to a week.

If you are experiencing more severe side effects (these are considered rare), such as difficulty breathing or significant bleeding, we recommend contacting emergency medical services immediately.

Schedule Dry Needling Treatment Today

Balanced Physical Therapy offers safe, effective, and certified dry needling treatments. Our patients enjoy working in one-on-one therapy settings with board-certified physical therapists. To schedule an appointment, call us at (586) 741-5806 or visit our Appointments page to schedule an evaluation.




Knee Replacement Surgery

13 Week Recovery Timeline For Knee Replacement

Find out how long it will take to recover from a knee replacement surgery. This general, 13 week timeline is an overview of common things to expect during your hospital stay, at home, and outpatient physical therapy.

How Long Does Recovering From Knee Replacement Surgery Take?

When patients and their orthopedic surgeons agree that knee replacement surgery is a good option, one of the first questions or concerns usually is “how long will the recovery process take?” The simple answer would be about 13 weeks to recover. This timeline is dependant on a lot of factors such as type of procedure, limiting complications, and being consistent with their doctor and physical therapy visits.

Patients typically have a good understanding of the benefits of having a knee replaced, but they also appreciate knowing what is required to reach those benefits. A knee replacement, otherwise known as knee arthroplasty, is one of the most successful surgeries performed throughout the world. If you want to be a part of the 90% of people with a well-functioning knee, 15 years post-surgery, understanding each part of the recovery process can help you with that goal. 

Balanced Physical Therapy has combined real-world experience with proven clinical research from around the internet to help you better understand each part of the recovery process, specific timelines for recovery, and why each element is essential. 

Knee Replacement Recovery Timeline

Generally, someone who undergoes a knee arthroplasty takes about 12-14 weeks to recover fully. With the help of the Wisconsin School of Orthopedics and Rehabilitation and Healthline, we have broken down the recovery process into 5 phases:

Phase 1: Hospital Stay to Discharge

Phase 2: Weeks 1-2, 

Phase 3: Weeks 3-6, 

Phase 4: Weeks 7-12

Phase 5: Weeks 13 and Beyond

Knee Replacement Recovery Phase 1: Hospital Stay and Discharge

A typical hospital stay after a knee arthroplasty ranges anywhere from 1-3 days. Some patients even leave the same day, which depends on the type of procedure that is performed.

Hospital Stay After Knee Replacement

The reason knee replacement surgeries are so successful is because of their relatively low risk of complications. A majority of your hospital stay will include surgeons and hospital staff working hard to prevent complications such as infection, blood clots, pain, hardware issues, and neurovascular injuries. 

While your healthcare team continues to monitor and prevent complications, patients can expect to start rehabilitation soon after the surgery. Within 24 hours, patients will work with a physical therapist to begin standing and walking again. Lack of confidence is very common during this time, so crutches and walkers help provide that extra support many patients require. 

Another standard device used amongst the knee replacement population is a continuous passive motion (CPM) machine. This machine helps provide your knee with a constant motion to prevent scar tissue buildup and stiffness from being immobile. You can expect your surgeon or physical therapist to help educate you about this device and how to use it at home.

Knee Replacement Recovery Phase 2: Weeks 1-3

The first week after undergoing knee arthroplasty, patients can expect to be back in the comfort of their own homes. One of the first and most important things to know during this period is your follow-up appointment with your surgeon. Typically the follow-up is scheduled about two weeks after the knee replacement and is something every patient should markdown as “must-attend.”

Phase 2 of knee replacement rehabilitation also includes patients becoming more active with therapy. Some patients start treatment at home, while others can attend an outpatient clinic. One is not necessarily better than the other; it just depends on a person’s health status.

Some goals and priorities to be aware of include:

  • Reduce pain and stiffness
  • Being able to transfer from lying to sitting to standing safely with the help of assistive devices
  • Being able to “heel strike” while ambulating
  • Increase knee range of motion
  • Ability to extend leg without lag
  • Being consistent with the home exercise program provided
  • Understanding the pain scale and the difference between “hurt and harm.”

Your physical therapist will design a rehab program to help you reach these goals without harming the new knee hardware or incision. Examples of exercises to expect for the weeks 1-3 after your surgery include:

  • Heel Slides
  • Quadriceps Sets
  • Straight Leg Raises
  • Sit To Stand Squats
  • Stationary bike with little to no resistance
  • Hamstring Curls

One of the best things about Phase 2 is that while you train your body to regain a proper gait and pain-free life, your therapist will also mix in modalities to help you progress more. Common knee replacement modalities include 

  • Electrical stimulation (E-stim) can help activate the quadriceps better
  • transcutaneous electrical stimulation (TENS) can be applied to help control pain symptoms
  • Soft tissue mobilization on elevated surfaces to help reduce edema (also known as swelling)

Note: These therapeutic modalities can and often are used throughout all phases of knee rehabilitation.

Knee Replacement Recovery Phase 3: Weeks 3-6

The third phase of recovering from a knee replacement is typically outside the home, in an outpatient physical therapy setting. A follow-up appointment around the six-week mark is also required, just like the one at the two-week mark. 

The main goals for patients that are 3-6 weeks post-surgery include:

  • Continue improving knee range of motion and quad strength
  • Progress strengthening towards bodyweight, functional ambulation
  • Normalization of gait (walking)
  • Reduce the need for assistive devices, such as walking with only one crutch a just using a cane
  • Walking short distances without using any assistive devices

During this part of the knee rehabilitation, patients are progressed with more moderate exercises such as:

  • Sit to stand squats
  • Leg Press
  • Stationary bike with resistance
  • Single leg balance
  • Gastrocnemius strengthening
  • Standing knee extension with therabands
  • Hip and core strengthening as needed
  • Neuromuscular reeducation
  • Pool therapy (must have authorization from a surgeon, never before four weeks, and must have a closed incision)

Knee Replacement Recovery Phase 4: Weeks 7-12

When recovering from knee arthroplasty, the fourth phase is when most patients see the most rapid improvement to mobility and range of motion. It is an exciting time where the hard work of attending physical 2-3 times a week and staying compliant with home exercise programs starts to pay off. 

Some common goals and milestones during this phase of rehab include:

  • No extensor lag (lack of full knee extension with full quadriceps contraction)
  • Normal gait without the use of an assistive device
  • Engaging in everyday activities such as driving, housekeeping, and shopping
  • Ability to ascend and descend 1-2 flight of stairs with a reciprocal gait

Knee Replacement Recovery Goals

Your physical therapist will continue to progress your rehab and increase difficulty in the 7-12 weeks following surgery. Patients can expect exercises such as:

  • Toe and heel raises while standing
  • Single leg balances
  • Step-ups in multiple directions
  • Continued lower extremity strengthening

Even if you do not see the best results, it is crucial to stay the course. Don’t give up, ask questions, and continue to follow the guidance of your healthcare team.

Knee Replacement Recovery Phase 5: Weeks 13 and Beyond

After 13 weeks since your surgery, most patients are happy to see the finish line. Some patients may still be attending physical therapy to reach the goals you set entirely, while others are safe for discharge. Both scenarios are expected, and it varies from person to person.

Providing you have not experienced any major setbacks or complications, pain should be almost nonexistent. It is a good idea to still check in with your healthcare team. If you have pain, swelling, stiffness, or unusual movement, it is always best to call your doctor immediately.

At Balanced Physical Therapy, we understand how important fully recovering from knee surgery is to our patients. From your first evaluation, we take the time to understand everything about you and your condition. Our treatments consist of one-on-one therapy with board-certified physical therapists who are always willing to help. Call us at (586) 741-5806 or visit our Appointments page to schedule an evaluation.

Uneven Hips and Abnormal Pelvic Tilt

5 Things To Know About Uneven Hips and Abnormal Pelvic Tilts

A guide for anyone who believes their hips are out of alignment. Learn about the signs and symptoms of misaligned hips. Find out how this condition relates to your pelvis, spine and posture. See the ways physical therapy can help you get realigned and get back to functional, pain free life

What Does It Mean When Your Hips Are Out Of Alignment?

When it comes to having uneven hips, it is essential to understand that your pelvis and spine are also affected. Having uneven hips is often associated with an anterior pelvic tilt. These two can drastically change a person’s back health, posture, and overall biomechanics. A slight misalignment can cause pain and discomfort in the hip and lower back regions. Over time this small problem can have compounding effects that reach up into the shoulders and neck. To help you avoid these type of complications, we will go over:
  1. How you can determine if your hips and pelvis are properly aligned
  2. Common symptoms and causes of uneven hips and abnormal pelvic tilts
  3. Physical Therapy Treatment for uneven hips and abnormal pelvic tilts

What Is A Normal Hip Alignment?

To determine whether or not you have proper hip and pelvis alignment, a physical therapist would need to observe and measure multiple factors around the hip, pelvis, and spine. As always, it is best to seek a professional opinion from your primary care physician, physical therapist, spine specialist, or chiropractor.  If you haven’t gone to see your doctor or physical therapist and would like to self-check your hip alignment, you should look out for three things:
  1. Your pelvis should be parallel to your shoulders and the ground
  2. Your hips should stay neutral and not be tilted forward or backward
  3. Your hips should be on the same level horizontally, not one higher and one lower
Uneven Hip and Pelvis Alignment
Hip and Pelvis Alignment Comparison via Runners World
An excellent way to check all three is to stand in front of a full-body mirror to observe your posture thoroughly.  First, take notice if your shoulders are even. A shoulder that sits higher than the other may present a lower, misaligned hip on the same side. A shoulder blade that sticks out can also help you determine the hip and pelvis’s misalignment on the same side.  Next, take a look at how your spine is aligned. A curved “C” or “S” shape of your spine can help you determine if the cause of your uneven hips is scoliosis-related.  It can also help to imagine a straight line from your nose to the belly button. If the line doesn’t touch, this would also indicate a spinal misalignment, possibly related to your hips or pelvis. Suppose you do not have access to a full-body mirror or have trouble visualizing the proper hip and pelvic alignment. In that case, it can help understand some common symptoms associated with misaligned hips and pelvis.

Signs And Symptoms Of Misaligned Hips or Pelvis

People with misaligned hips or abnormal pelvic tilts often experience symptoms that progress from minor and unnoticeable to significant and life-altering.  Minor symptoms that often go unnoticed for long periods include:
  • General low backache
  • Pain in the hip and buttocks area that increases during or after walking
  • Pain in the hip and low back after standing in place for long periods
  • Unbalanced walking or gait
  • Achy feeling in the lower back or hip while laying down
If these minor symptoms go untreated for too long, they can progress into more severe complications such as:
  • Pain that goes down into the thigh towards the knee
  • Pain in and around the groin
  • Inability to stand in place or walk
  • Poor spine alignment

What Causes Uneven Hips and Abnormal Pelvic Tilts?

To get back to a pain-free and active life, it is always best to understand why your hips and pelvis are misaligned. We recommend everyone see their primary care physician, spine doctor, or physical therapist as soon as symptoms begin to show. A medical professional can evaluate posture, gait, measure each leg’s length, prescribe an X-Ray or CT scan for the most accurate diagnosis.  Your health care professional can diagnose the cause of misaligned hips or abnormal pelvic tilts, which may include:
  1. A functional Leg Length Discrepancy: You can think of this as poor posture for prolonged amounts of time that result in muscular imbalance. When bad posture becomes a habit (in sitting or standing), the muscles surrounding the hip and can become tight and shorten, causing the hip to pull upwards. Also, on the other side of the body, muscles can become weaker and looser, causes the hip to sit lower.
  2. Structural Leg Length Discrepancy: You can think of this as one leg being shorter/longer than the other, outside the commonly accepted range. Most people have a slight difference in leg lengths, but significant differences (4cm or more) can cause hip and pelvic misalignment. These leg length discrepancies can be congenital (naturally from birth). Other causes include growth plate injuries (Salter-Harris fracture is common amongst children and adolescents), poor healing after bone breaks, joint conditions such as arthritis, or bone diseases such as neurofibromatosis.
  3. Scoliosis: This abnormal “S” or “C” curve in the spine is a prevalent cause of hip and pelvic misalignment. Scoliosis is more common amongst young females and can run in the family. 
Once a medical professional confirm a diagnosis, people with misaligned hips and pelvis can begin the recovery process. One of the best and most common ways to correct these issues is physical therapy.

Treating Uneven Hips and Misaligned Pelvis With Physical Therapy

Physical therapy is typically one of the best non-surgical treatment options for misaligned hips and abnormal pelvic tilts. Your physical therapist can help diagnose the cause of your pain and misalignment. They can also assist you with pain management, stretching, strengthening exercises, and biofeedback to prevent and eliminate symptoms. Some techniques and practices that are effective include:
  • Muscular release to tight hip flexors, quadriceps, hamstrings, and glutes.
  • Corrective exercises that address your specific diagnosis. Each type of pelvic tilt (Anterior, Posterior, and Lateral Pelvic Tilts) requires different treatment plans to realign.
  • Help fix bad habits related to posture when standing and sitting.
  • Assist and educate patients on the best way to sleep with as little pain as possible.
Early treatment can help speed up the recovery and prevent significant complications. If you believe your hips are misaligned, you have an abnormal pelvic tilt, or unsure about the cause of your back pain, please contact us at (586) 741-5806 today to make an appointment
Preventing Overtraining Syndrome

Prevent Overtraining Syndrome and Overuse Injuries in Youth Sports

Helping parents, coaches, and young athletes understand overtraining syndrome (OTS), the specific injuries associated with overuse, early signs of detection, and general guidelines for training.

Overtraining in Youth Sports

With over 30 million youth sports participants ages 6 to 18, it is important for parents and coaches to know about overtraining syndrome (OTS), the specific injuries associated with overuse, early signs of detection, and general guidelines for training.

Every year more children and adolescents are participating in organized and recreational sports. This is a great sign in the fight against childhood obesity as it builds lifelong physical activity habits, promotes healthy competition, and builds skills for future opportunities. Unfortunately one of the downsides with increased activity in youth sports is the increased risk of overtraining, overuse injuries, and burnout.

What is Overtraining Syndrome (OTS)?

Overtraining Syndrome (OTS) is more commonly referred to as “burnout”. OTS or “burnout” is caused by intensely working the body for long amounts of time without allowing the time for rest and recovery.

The American Academy of Pediatrics describes overtraining syndromes as a “series of psychological, physiologic, and hormonal changes that result in a decreased athletic performance. With so many options such as football, gymnastics, swimming, wrestling, and tennis at all levels; kids have naturally become more likely to suffer from injury.

What is an Overuse Injury?

Overtraining can directly cause an overuse injury. Overuse injuries often include damage to bone, muscle, and tendons. These injuries can be classified into 4 stages:

  1. Pain in the affected area after physical activity
  2. Pain during physical activity, but not restricting performance
  3. Pain during physical activity that also restricts performance
  4. Chronic, persistent pain, even at rest

Because young athletes’ bodies are still developing, they are more susceptible to overuse injuries. Their bones are still growing, therefore cannot handle as much stress as fully developed adults. Generally, the best way to prevent major overuse injuries is to understand and identify the young athlete who is at most at risk.

If your young athlete is showing signs of injury, it is always a good idea to get a professional assessment. A physical therapist can diagnose the injury and provide a treatment plan to safely return to competition.  Contact Balanced Physical Therapy to schedule a free injury screening or comprehensive evaluations here.

Common Overuse Injuries in Youth Sports

Some examples of overuse injuries and risks that may result from overtraining in youth sports include:

Little league and travel baseball players can be at risk for throwing injuries such as medial apophysitis or “little leaguer’s elbow”. Too much overhand throwing, especially with poor technique, can result in excess inflammation and irritation in the elbow. This can have long-lasting effects on the medial apophysis growth plate.

A child or adolescent gymnast can be at risk for developing spondylosis (pain in the spine due to deterioration) when doing repetitive hyperextension and rotation while participating.

Preventing Overtraining in Youth Athletes

Young swimmers are susceptible to shoulder injuries such a rotator cuff or bicep tendonitis, shoulder impingement, and neck pains.

Track and distance runners often develop shin splints and stress fractures as a result of overtraining.

These injuries are commonly caused over time, and not suddenly. This is good news, especially for parents and coaches who know the signs of overtraining and overuse.

Signs of Overtraining and Burnout

Parents and coaches concerned about the possibility of overtraining have multiple ways to tell when a young athlete needs more time to rest and recover. The Boston Children’s Hospital lists common signs of overtraining that include:

  • Slower times in distance sports
  • A decrease in athletic performance
  • Decreased ability to achieve training goals
  • Decreased motivation to practice
  • Young athlete getting tired easily
  • Irritability and unwillingness to work with teammates
  • Disturbance in sleep schedule
  • Weight loss or appetite changes

How To Prevent Overtraining Syndrome

General guidelines suggest that to promote fun, develop skills, and achieve individual goals; a young athlete requires good training and rest balance. Some ways to prevent overuse injuries and burnout include:

  • Encourage young athletes to take 1-2 rest days per week. This allows time to recover physically and psychologically between competition.
  • Advise young athletes that their weekly training time, repetitions, or total distance should not increase more than 10% per week.
  • Encourage athletes to take a seasonal rest from a single sport for 2-3 months a year. Taking breaks and developing other skills are essential for preventing injuries.
  • Focus on proper nutrition, hydration, and sleep.
  • Be mindful and cautious when entering multiple tournaments on consecutive weeks
  • Be consistent with yearly checkups with pediatricians and family physicians. 
  • Emphasize that the reason we participate in sports is to have fun, develop healthy lifestyle habits, and improve athletic skills.

Using these guidelines, parents, coaches, and healthcare professionals can help keep young athletes injury-free. Mixing in rest days and diversifying the activities kids participate in can help tremendously when developing skills and avoiding burnout.

Balance Training For Seniors and Older Adults

Balance Training: A Better Way To Prevent Falls

A balance training guide for seniors, older adults, and their family members. Learn what conditions affect balance and coordination, ways to identify a fall risk, and how physical therapy can improve everything from stability to sensory orientation.

Improve Balance and Coordination At Physical Therapy


Balance and coordination tend to decline as a person ages. Luckily there are things you can do to improve balance, reduce fall risks, and improve the overall quality of life. Being physically active is always a great first step when it comes to improving your overall health. It can also be necessary to seek specialized care for a custom balance training program as health declines.

Balanced Physical Therapy helps senior and older adult patients improve balance, control and coordination. Patients are less likely to fall and suffer from injuries when they have

  • Increased Overall Independence
  • Reduce Fear of Falling
  • Improved Coordination
  • Faster reaction Time
  • Stronger Bones
  • Increase Walking Speed
  • Improved Muscular Function
  • Improved Cognitive Function

Seniors and older adults often experience a decline in motor and cognitive functions. Balance is strongly affected and daily activities such as cleaning, exercising, and getting dressed can become more difficult in a short time.

Knee Stability Exercise

What conditions affect balance in seniors and older adults?


The American Family Physician attributes gait and balance disorders to seven different types of medical conditions including:

Affective Disorder and Psychiatric Conditions

    • Depression
    • Fear of Falling
    • Sleep Disorders
    • Substance Abuse

Cardiovascular Disease

    • Orthostatic Hypotension
    • Coronary Artery Disease
    • Congestive Heart Failure
    • Arrhythmias

Infectious and Metabolic Diseases

    • Diabetes Mellitus 
    • Obesity
    • Hyper and Hypothyroidism
    • HIV-associated neuropathy
    • Vitamin B12 deficiency

Musculoskeletal Disorders

    • Gout
    • Lumbar Spinal Stenosis
    • Osteoarthritis
    • Osteoporosis
    • Muscle Weakness and Atrophy
    • Podiatric Conditions
    • Cervical Spondylosis

Neurological Disorders

    • Dementia
    • Parkinson Disease
    • Stroke
    • Vestibular Disorders
    • Multiple Sclerosis 
    • Myelopathy

Sensory Abnormalities

    • Hearing Impairment
    • Peripheral Neuropathy 
    • Visual Impairment


    • Other Acute Medical Conditions
    • Recent Hospitalization
    • Recent Surgery

How To Know If Someone Is a Fall Risk


A person who is a fall risk can often show signs and symptoms before having an accident. The best way to keep track of age-related balance issues is to be consistent and active when going for yearly checkups. It is extremely important to always report falls and near falls to your physician. Your primary care physician can help monitor your overall health and identify fall risks as they present themselves.

In addition to seeing your primary care physician on a regularly, it can be useful to know and watch out for some common signs of a balance deficit among friends and family. These include

  • A person having a difficult time getting up from a chair. This can indicate a weakness in the glutes, quadriceps, hamstrings, or hips.
  • A person who has a difficult time walking. Someone who tends to reach out for support on furniture or walls.
  • Near falls or someone who would have fallen if they had not caught themselves.
  • Someone taking pain medication or sleep aids. Some medications can cause dizziness, drowsiness, and balance issues.
  • Dizziness when standing up from a sitting or laying position.
  • Foot, knee, or hip pain that leads to an abnormal or shuffling type of walk.

Why Balance Training Is Important


People that fall once, have double the chance to fall again. Studies show that one out of five falls causes seniors injuries such as broken bones or head injuries. These falls can lead to long periods of pain, lower quality of life, disability, or even death. 

Balance training under the supervision of a physical therapist is a way to promote better overall health in a safe environment. A physical therapist can help improve balance and decrease your risk of falling by implementing a training program specific to your needs.
Patients can reverse the effects of physical inactivity and overcome the fear of falling. Patients can also benefit from additional education as well as emotional support from a healthcare professional.

Physical Therapy Program for Balance and Coordination


Patients who are unsure if they require specialized balance training should consult with their primary care physician. Your doctor can prescribe physical therapy to help improve balance and coordination. 

Once prescribed, your physical therapy program will always begin with an evaluation. A physical therapist will conduct a fall-risk assessment to better understand risk factors such as vision, mobility, transfers, daily activities, environment, and nutrition. Patients can also ask questions, discuss their goals, and express any concerns during the assessment.

Based on your current health your therapist will create a balance training program that is fit for your needs. Our therapists are experienced in modifying most therapy techniques to best suit your condition and to properly challenge you on a day-to-day basis.

Exercises For Balance Training


Physical Therapy exercises can be targeted to a specific physiological system or combine multiple systems to better simulate real-life activities. Certain parts of the balance training program will be geared towards motor function while other parts will focus more on cognitive improvements. Examples of these include

  • Increase stability limits
  • Improve anticipatory postural adjustments
  • Improve postural responses
  • Improve sensory orientation
  • Improve stability in gait

Yoga Ball Balance Exercise

Therapy sessions normally last about an hour and begin with a warm-up such as riding a bike, marching in place, or stretching. After warming up patients often train using therapy balls, uneven surfaces, body weight, and resistance training. A therapy session will conclude with stretching, massage, and a cool-down period. Not every appointment will be the same, in fact, they often differ to properly progress while keeping things interesting and fun.

At Balanced Physical Therapy, we pride ourselves on providing every patient with the expertise they deserve. Each patient is treated by a DPT for their entire session, avoiding any issues that may arise when working with assistants or techs. Your therapist will always be by your side and we encourage all our patients to ask questions and issue any concerns whenever at any point of your appointment.

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Improve Post-Op Recovery with Prehabilitation

What is Prehabilitation?

Prehabilitation, or “Pre-hab”, is a proactive measure for patients scheduled for orthopedic surgeries. A surgeon or primary care physician will often prescribe patients “prehab” to help prepare them for physical and lifestyle changes associated with surgeries.

Studies show that patients who move better, feel better, and feel stronger tend to do better. This article can be useful for patients considering or expecting orthopedic surgery. You can also find some specific tips at the end of each section about some common spine, knee, shoulder, and foot surgeries.


What are the benefits of prehabilitation?

‍Patients who attend physical therapy before surgery can improve physiological, mental, nutritional, and lifestyle health. Orthopedic surgery can be thought of as a marathon, meaning the preparation put before actually running the race will ultimately help your overall performance during and after it.

Physical Therapy Before Surgery

Tip #1: Timing, Type, Setting, and Costs

When considering a prehab program prior to surgery, important things to consider are timing, type, setting, and costs.  

The U.S Department of Health and Human Services published a study related to patient outcomes of major joint replacement surgeries (Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). The evidence showed that when your rehabilitation occurs (timing), what the training consists of (type), where your rehab occurs (setting), and out-of-pocket or insurance costs are the most important things to consider for patients, surgeons, and therapists.

Physiological benefits of prehabilitation

If your surgeon has prescribed physical therapy prior to surgery, you can improve the function, strength, and conditioning of your body many weeks ahead.  A physical therapist can evaluate you and come up with a treatment plan that includes aerobic exercise, strengthening, and stretching, and pain management.

Improve Recovery After Knee Replacement

Studies show aerobic exercises such as low-impact cycling or walking as an effective nonpharmacological option for patients undergoing total joint replacements. Patients can often expect a decrease in pain symptoms, joint tenderness, and better overall function for daily activities.

Tip #2: Getting Prehab

The best way to get started with prehab is to work individually with a physical therapist.

If you are dealing with insurance issues and the number of appointments available, we recommend talking with your doctor, surgeon, or local physical therapy clinic. They may be able to direct you to some free prehab education classes or come up with a treatment plan that can be done at home.

Mental benefits of prehabilitation

‍Mental health is one of the most important and often overlooked aspects of orthopedic surgery. It is natural for patients to feel stressed and anxious before surgery. Attending physical therapy can be extremely useful to help get you prepared mentally and feel confident.

Tip #3: Make use of downtime

It is common for patients to wait multiple weeks before entering the operating room, this time can be used to get acquainted with your physical therapy clinic, your therapist, and surgical procedure. Learning how to modify daily activities, transferring positions, and using crutches or walkers can help reduce your hospital stay and home care costs.

Nutritional support from prehabilitation

Nutrition plays an important role when recovering from orthopedic surgery. Physical Therapists can assist you with fine-tuning your diet to improve blood circulation, manage glucose uptake and insulin resistance while reducing oxidative damage to blood vessels.

Daily Nutrition For Orthopedic Surgery

Tip #4: Avoid high-fat meals

Adults expecting an orthopedic surgery of any kind diets should limit fat intake to less than 35% of their daily calory intake. A high-fat meal close to surgery can increase the risk of blood clots and inflammation at the surgical site.


Lifestyle support from prehabilitation

Physical therapy can help patients adjust to various lifestyle changes associated with surgery recovery. Helping you prevent fall-related injuries, work from home tasks, and things like sleeping or showering.

Tip #5: Home Preparation For Knee and Hip Surgery

Move things you use frequently above waist level, prepare food ahead of time, and make sure your bed, armchair, car, and toilet seat are at safe levels before you leaving the hospital.

Question about Prehabilitation?

Balanced Physical Therapy is dedicated to providing everyone an equal opportunity for a full recovery. Contact us with any questions you have about insurance, treatments, and the rehabilitation process.

Sciatica Symptom

Sciatica: Symptoms, Causes, and Treatments To Know

A simple guide to a common problem. We cover the sciatic nerve anatomy, elated pain, and physical therapy treatments proven to relieve sciatica.

Sciatica is a term used to describe pain along the sciatic nerve. The Sciatic nerve is made up of five nerve roots; two at the lumbar spine (lower back) and three at the sacrum (lowermost part of the spine). These nerve groups combine to make up the left and right sciatic nerve.

What does Sciatica feel like?

‍Pain is normally one of the first symptoms a person suffering from sciatica experiences. This pain can either be constant or intermittent down one leg( although both legs can experience this pain). The most common symptom of sciatica is a sharp, burning feeling. Other sciatica symptoms include:
  • Electric shock-like, shooting pain
  • Numbness and tingling feeling at the back of the leg
  • Throbbing or pulsating pain
  • Dull aching feeling
  • Discomfort that comes or goes
  • Weakness at the lower back, leg, or foot

What causes Sciatica?

‍Some of the most common reasons for the onset of sciatica include:
  • Herniated or Slipped Disk that puts pressure onto the nerve roots. The Cleveland Clinic ( estimates that about 1% to 5% of people will experience a slipped disk at some point in their lives. When too much pressure is applied to the vertebrae of the spine, it can “push” out a disk causing it to bulge( herniate). A herniated disk along the lower portion of the spine can put pressure on the sciatic nerve.
  • Degeneration ( of the tissues along the lumbar spine, facet joints, and the actual vertebral bone can all cause pressure to the sciatic nerve through compression and inflammation.
  • Spinal Stenosis is the actual narrowing of the spinal canal (the passageway where your sciatic nerve runs through). Spinal Stenosis is most common for people over the age of 60, resulting in pinching of the sciatic nerve.
  • Spondylolisthesis occurs when one vertebra slips out of line with the vertebrae above it. A good example of this is when the L5 vertebra slips forward over the S1 vertebra, causing sciatic nerve compression. Spondylolisthesis is most common with young adults and can result in pain along the right and left sciatic nerves.
  • Osteoarthritis and the bone spurs (jagged edges of bone) that develop with age can also compress the sciatic nerve.

What are the treatment options for sciatica?

‍Most often, patients experiencing acute or chronic sciatica will receive nonsurgical treatments by their primary care physician or spine doctor. Nonsurgical treatments for sciatica often include rest, physical therapy, medications, or therapeutic injections. Physical Therapy can be one of the most beneficial treatments for sciatic pain. Combining pain management techniques with flexibility and strengthening exercises can be a long term solution for patients to:
  • Restore pain-free functional movements
  • Relieve lower back, buttock, thigh, and leg pain
  • Reduce muscle spasms
  • Improve lower body mobility
  • Promote a better soft tissue healing environment for the lower back
  • Prevent future flare-ups
  • Restore function of the lumbar spine and sacroiliac joint

What should I expect when going to physical therapy for Sciatica?

‍If you have received a referral for physical therapy to treat your sciatica, the first step would be to undergo an initial evaluation with a licensed Doctor of Physical Therapy. This first appointment serves to provide your therapist with a baseline knowledge of your current condition. Your physical therapist will use this time to learn about your specific sciatic symptoms, past medical history, lab tests (MRI or X-rays), lifestyle habits, and short/long-term goals. Your therapist will also test specific functional movements such as range of motion, flexibility, posture, and reflexes. From there your therapist will craft a therapeutic program designed to reach your goals based on the results found from the initial evaluation. A typical sciatica treatment program will consist of passive and active techniques. Depending on the severity of symptoms, your physical therapist will progress these techniques as required. Passive techniques for sciatic nerve pain serve to help patients with promoting blood flow, reduce muscle spasms, and decrease pain. The passive portion of a sciatica treatment program can consist of modalities such as:
  • Hot/Cold packs
  • Traction
  • Manual Therapy
  • Transcutaneous Electric Nerve Stimulation (TENS unit)
  • Neuromuscular Electric Muscle Stimulation.
Active techniques for sciatica serve to improve leg mobility and range of motion, strengthen core muscles, stretch tight muscles such as the hamstrings, and encourage the flow of nutrients and fluids throughout the body. Active physical therapy techniques may include:
  • McKenzie Method
  • Abdominal and Back Exercises
  • Abdominal and Back Stabilization
  • Hip Mobilization
  • Functional stretching of the hamstrings, quadriceps, and deep lower back muscles
It is best to seek treatment for sciatica as early as possible. Pain symptoms often progress and flare-ups become more common as you age. To make an appointment with one of our physical therapists call (586) 741-5806 and one of our friendly staff will assist you with the process.