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Did you know that in California you do not need to be referred by a physician to see a physical therapist? This is possible due to Direct Access. What is Direct Access? Direct Access is a law that was passed in 2014 in California that allows access to physical therapists without a doctor's referral under most insurance plans. The power is now put back into the patient's hands as they can control when and where they receive care, as well as acquire it sooner. What are the Benefits? Cost-effective According to the American Physical Therapy Association (APTA), studies show that physical therapy is not only cheaper in the short term but also in the long term. You don't need to pay for costly doctor's visits or subsequent tests, x-rays, possible injections, or even surgeries. Scheduling with a physical therapist as the initial intervention can save you a ton of money, on average 18% from injections and 54% from surgeries. Working with a physical therapist from the beginning can cut out extra and unnecessary costs all while treating the root of the problem instead of the symptoms. Time-saving No need to wait weeks for a doctor's appointment before you see a PT, you can now schedule a visit with a physical therapist immediately. Getting a referral from a physician is not usually a quick process, as you might be referred to multiple specialists before you can see a PT. When dealing with pain, waiting to receive care can be agonizing, but direct access expedites the relief process. Holistic pain management In most cases, pain can be reduced and managed with physical therapy, excluding the need for pain medications, such as opioids, which are highly addictive. Here at Rehab United, we utilize the principles of Applied Functional Science which focuses on functional movements, to treat the root cause of issues instead of the superficial ones. We also personalize each treatment plan, because we know not one size fits all. Is It Safe? Skipping the doctor's office first can sound scary, but our physical therapists are highly qualified and licensed with extensive educational backgrounds. Our PTs offer an exam and treatment plan for every patient, leaving no stone unturned. They are also able to collaborate with a medical professional if another source of care is required. Limitations Under Direct Access, you can only receive physical therapy for 45 days, or 12 visits, depending on which comes first. Once your care period ends, a physician's referral is required to return to physical therapy. The same goes if you have visited a physical therapist once before under Direct Access and want to receive further care. Those under Medicare also need a referral and are therefore excluded from Direct Access. Schedule the Care You Need! If you would like to take advantage of Direct Access and are eligible, Request an Appointment today and our front desk will get in contact with your insurance company for you. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. Ariela Liberman holds the role of Marketing Associate - Lead Generation for Rehab United, with a Bachelor of Arts in Media Studies. Born and raised in San Diego, she is a Southern California native with a passion for writing, digital marketing, health, and wellness.

Rehab United has recently expanded to include Occupational Therapy at two of its facilities, and is now serving the communities of Kearny Mesa and Carlsbad! What is occupational therapy? Occupational therapy’s role is to get clients back to performing the occupations or activities that are meaningful and important to them. Whether that be basic tasks such as getting dressed or taking a warm shower, or specific activities that make up an individual’s daily routine. Our goal is to enhance participation in valued occupations while designing and implementing individualized treatment plans. “Occupations include things people need to, want to, and are expected to do” What areas does an OT specialize in? Within Rehab United, we have occupational therapists (OTs) who specialize in the population of patients with neurological conditions as well as general orthopedic and pelvic health conditions. Neurological Conditions: The neuro clinic, located in Carlsbad, treats patients with an array of neurological conditions including stroke recovery, Parkinson’s Disease, ALS, traumatic brain injury, and more. Occupational therapy applies a variety of treatment techniques including neuromuscular re-education, functional movement, strengthening/mobility, as well as modifications to daily activities. Our vision is to improve functional skills in an effort to enhance participation in meaningful daily activities. Orthopedic Conditions: In addition, occupational therapists treat other medical conditions such as shoulder tendonitis, tennis elbow, carpal tunnel, fine motor deficits, as well as other general deconditioning deficits through strength base training, adaptations, and compensatory techniques. Home and Community Safety: While navigating within the home and community may be a challenge for some, occupational therapists can evaluate and treat clients to safely participate in personal environments through individual modifications and training. What is the difference between PT and OT? Physical therapy focuses on improving a patient’s ability to move their body while investigating pain, movement impairments, and functional mobility limitations, while occupational therapy focuses on improving the patient’s ability to participate in their meaningful activities with or without impairments to maximize their independence. There may be overlap between the two disciplines, but both bring a unique perspective to patient care that ultimately works to achieve the goals of independence and improving quality of life. How do I know if OT is right for me? Coming to Rehab United for occupational therapy promotes health and wellness for clients with disabilities and non-disability needs. Our aim is to promote skill acquisition for those with neurological or orthopedic disabilities while enhancing participation in daily occupations. Questions about OT? Contact bjacobs@rehabunited.com. Rebecca (Becca) Jacobs, MS, OTD, OTR/L, is an occupational therapist and brings a new treatment approach and experience to the Rehab United team. She studied at Boston University, where she earned the trifecta of degrees in occupational therapy including her bachelor's, master's, and post-professional doctorate. Becca is one of three occupational therapists in San Diego who specialize in pelvic health occupational therapy, a discipline that is new to the field of occupational therapy.

Since its founding, Rehab United has always valued community and the role we play in contributing to its health, both literally and figuratively. As an organization, we have taken a pretty public stance on supporting marginalized communities and we strive to encourage diversity both within and beyond our team. Therefore, in honor of Black History Month, we want to highlight some of the people who have contributed to the development of our industry as well as the people who play a vital role on our team each and every day. In this blog post, we interview one of our team members about his experience as a physical therapist assistant in an effort to gain insight on the influence that his African American heritage has had on this professional journey. Q: Can you introduce yourself to our readers? Tell us a little bit about you and your role as a physical therapist assistant. A: My name is Kevin Hazel, LPTA, and I am a licensed physical therapist assistant based out of RU2, otherwise known as Carmel Valley. As a physical therapist assistant I am responsible for helping to fulfill and carry out the plan of care that is established by the physical therapist and ultimately become an extension of them, which provides continuity of care for our patients and clients. Q: What made you want to go into physical therapy? A: The reason why I chose to go into physical therapy as a profession is simple: it allows me to not only live and breathe a lifestyle of service to others, but at the same time allows me to inspire a younger generation of individuals who look like me, that may aspire to enter the field one day. The recipe was simple - I really wanted something that was fulfilling but at the same time coincided with my principles and morals of the campsite rule. The campsite rule is that whenever you go camping you try to leave the campgrounds in a better place than when you first found it. The profession of physical therapy allows me to do this as well as being an integral part of the healing process for patients and clients alike. Q: Since its founding, Rehab United has always valued community and the role we play in contributing to its health, both literally and figuratively. As an organization, we’ve taken a pretty public stance on supporting marginalized communities and we strive to encourage diversity within our team. So in honor of Black History Month, we want to highlight some of the people who have contributed to our industry and people who play a vital role on our team each and every day. Can you tell us about anyone that comes to mind? A: Yes, the name Harold Rick Hawkins is the first that comes to mind. He's influential because he really spearheaded the APTA's Advisory Panel on Minority Affairs and helped develop a toolkit to foster minority representation in physical therapy. He was also a former recipient of the APTA diversity award. Another individual that comes to mind is doctor Chukwuemeka Nwigwe, who is the chair of the California Physical Therapy Associations Diversity Affairs Committee on which I also serve on. Dr. Nwigwe has been instrumental mentor to me in helping to spearhead the challenge for change amongst increasing awareness for the need to continue to foster diversity, equity, and inclusion and drive greater representation of minorities and marginalized groups in the profession of physical therapy. I think it's also important as a personal testimony for me to mention one of our own, Davon Davis, LPTA, who was my clinical instructor and is someone that I hold in very high regard as a clinician that I aspire to be like. As a student, I would see how well respected he was, how he carried himself as a professional, and just knowing his perseverance through adversity really spoke to me and my story as well as my journey as a newer clinician in the profession of physical therapy. Q: According to the Commission on Accreditation in Physical Education, African Americans make up only 3% of graduates from physical therapy programs, compared to 73.9% Caucasian, 13.7% Asian, and 6% Hispanic or Latino. Additionally, according to the US Bureau of Labor Statistics, only 5% of practicing PTs are African American, and these numbers haven’t really changed very much over the past decade. What do these numbers mean to you? Do you feel that this has any effect on our ability as an industry to treat the African American community? A: In academia, within DPT and or PTA education, we constantly discuss facilitators and barriers when it comes to access to care and being able to provide care for our patients. I believe that at times this absolutely can be a barrier to not only access to any and all communities but also in building trust and rapport with minority communities, specifically the African American community. These types of conversations aren't always the easiest to have, but I think therein lies the opportunity that we need to continue to become comfortable with being uncomfortable and having these difficult discussions and challenging not only leaders within the physical therapy profession but those decision makers at academic institutions that hold the key to opportunity for prospective future PTs and PTAs. I think that, more importantly, having the willingness to create more equitable opportunities at an earlier onset for students who have an interest in exploring the field of physical therapy is ultimately priority number one. I don't think we should spend our energy and efforts worrying about the disparity or the systemic inequalities of the past, but instead be more solution-based and all of us take a look in the mirror at ways in which we can help make the profession of physical therapy, and the inroads to the profession, more equitable for all. Q: According to Zippia data from 2021, there’s a fairly significant wage gap by race, with Black or African American providers earning the lowest average salary. Do you feel that this has changed at all? A: This is difficult to speak to as wage sometimes it isn't necessarily public knowledge across the board but ultimately of course these numbers are going to be skewed based off of probability, that if there are less African American practicing physical therapists and physical therapist assistants, of course there's going to be disparity and gap based off of overall metrics. So this is tough to say - it's almost like comparing apples to oranges. Q: In order to advance as a society, it’s important to find the courage to ask inquisitive questions and be willing to listen. How can we, as an organization founded on healthcare and physical therapy, help our industry do better on this front? A: I think we already are taking major steps in this direction by being willing to have the conversation and being open to change. As an employee of this organization, I'm proud to be aligned with this company for these very reasons: we pride ourselves in pushing the boundaries and being different than what is known to be traditional as it pertains to the practice of physical therapy. I think having real conversations and being transparent within the communities that we serve is certainly a step in the right direction. Q: What advice do you have for African American students, or any student, who are either considering going into the field of physical therapy or are currently in their DPT program? A: I would say the profession needs you, and our communities also need you! The profession needs increased representation from all the underrepresented minority groups to help mirror the diverse communities in which we serve, in order to fulfill our vision which is to provide the best care for our communities and to help optimize human movement. I would also tell students who are African American that you shouldn't sit and spin your wheels on the why, but be the change and that the way forward is through leadership. We should all think of ourselves as leaders because one thing is for sure and two things are for certain: someone is always watching you and admiring you whether you know it or not, and 9 times out of 10 that person looks just like you. Q: You are obviously someone that is really passionate about leadership, especially within your field. You recently started a scholarship fund at a local college that focuses on leadership, right? Tell us about that. A: Thank you. Yes, actually, I started the LEAD Scholarship at Mesa College, which is my personal effort to enhance equity and reward PTA students that exemplify leadership and foster diversity equity and inclusion. The LEAD Scholarship was developed to create a sustainable plan for the LEAD program. LEAD was started by myself and another classmate during the summer of 2020. The social climate was one that caused a lot of internal reflection and ignited a fire to be the change. LEAD is a program where PTA students can collaborate together on initiatives that they are passionate about such as language diversity, where Spanish speaking classes were taught and developed by students as well as guest speakers that spoke and educated other allied healthcare students regarding the importance of diversity equity and inclusion. The lead scholarship is available to Mesa College students, both first and second years, and we hope to grow the fund so that it can be available to not just PTA students but potentially DPT and other allied health care students. That's incredible! Thank you so much for sharing your insight and perspective, Kevin. We really appreciate you taking the time to have this conversation with us to help us become more aware, as a community and as an organization, about the inequities and opportunities for growth and change within our industry. More importantly, thank you for your passion and leadership both within and beyond our industry. One of our goals as an organization is to take a more forefront position in driving change within our industry and our profession, and this conversation allows us to take a step in the right direction. So again, thank you. Kevin Hazel, LPTA, is a licensed physical therapy assistant at Rehab United in Carmel Valley. He graduated from the University of Cincinnati in 2005 with a degree in Criminal Justice and spent most of his professional career in recruiting and human resources. Most recently, prior to pursuing the field of physical therapy, Kevin was a traveling physical therapy recruiter. In 2021, he graduated from Mesa College's Physical Therapy Assistant program and has been practicing ever since. Kevin is a very active member of the California Physical Therapy Association, where he is a member of the Diversity Affairs Committee.

Knee Osteoarthritis (OA) is the most common form of OA in the body. Among adults 60 years of age or older, the prevalence of symptomatic knee OA is approximately 10% in men and 13% in women in the United States. Knee OA is even more prevalent in today’s society due to the active aging population. Arthritis-related conditions are the second most common reason for medical visits related to chronic conditions, only second to hypertension. Conservative treatment, such as physical therapy, is one type of intervention that has been proven to aid the individual with knee OA in regaining his or her functional capacity and quality of life. Physical Therapists utilize various interventions to help with pain management and improve knee joint mechanics, lower extremity function, dynamic balance, and fall risk. Therapeutic exercises have been proven to be one of the most effective interventions for knee OA, aimed at improving neuromuscular control, muscle strength, knee ROM, and aerobic fitness. Commonly in patients with knee OA, pain can be a barrier in participating in therapeutic exercise, but a patient must be educated that increasing the lower extremity strength of the involved limb will decrease internal knee forces, therefore reducing pain and limiting the progression of the disease. Various forms of strengthening programs can be used to rehabilitate knee OA patients. Land-based therapeutic exercises have been proven to provide better carryover in terms of performing daily functional activities, reducing pain, and improving quality of life. At Rehab United, we develop an evidence-based, individualized plan of care focused on functional therapeutic exercises and manual therapy techniques that will optimally provide the most pain relief and restoration of function. How can Rehab United help you? From our front desk to our physical therapists, everyone is highly trained to assist you in finding the best possible care. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. Arturo Valle, PT, DPT, FAFS, CSCS, STMT-1, BFR-1, CCI, is a Physical Therapist, Clinic Director of Rehab United in Escondido, and Director of Rehab United’s Quality Assurance Program. As a graduate of USC’s Doctor of Physical Therapy Program, Dr. Valle has always emphasized the implementation of Evidence-Based Practice into all plans of care. Throughout his 12 years of experience, Dr. Valle has treated thousands of orthopedic-related and sports injuries, as well as mentored countless Physical Therapists and Students of Physical Therapy.

When it comes to our own bodies, it seems we can never know enough. The body is so weird─it does so many fascinating things! This is why I became a healthcare provider. I was so curious about my own body and how it functioned. As a pelvic health specialist, I’ve delved into the depths of bowel, bladder, and sexual functions (& dysfunctions). This tends to come with SO MANY QUESTIONS! I hear ya, I was asking all the same things. So I thought I’d answer some frequently asked questions and probably some questions you never knew you had! What is Pelvic Floor PT? Pelvic floor PT is a specialty of physical therapy focusing on the functions and dysfunctions of the pelvic floor muscle group and its surrounding structures. We help patients with pelvic floor rehab mostly, as well as injury prevention. Where Is My Pelvic Floor, and What Exactly Does It Do? You’re sitting on it! Your pelvic floor is a hammock-shaped, 3-layer muscle group at the base of the torso, linking together the ring of bones that make up the pelvis… kind of like a trampoline. This muscle group is responsible for some really important things related to bowel, bladder, and sexual functions. It controls the sphincters, supports the pelvic organs, helps with blood and lymphatic flow through the lower body, stabilizes the pelvic ring so we can maintain a solid foundation for moving around, and helps achieve and maintain erections and orgasm for healthy sexual function. How Do I Know if I Have a Pelvic Floor Problem? There are many sneaky symptoms of pelvic floor dysfunction. Pelvic pain is an obvious one (during sex, while using the bathroom, exercising, or randomly!). We also see patients for urinary or fecal incontinence, constipation, post-op for abdominal or pelvic surgeries, pelvic heaviness/pressure and prolapse, difficulty or pain with emptying the bladder or bowels, core weakness or abdominal muscle separation, and sexual dysfunction. Even hip, groin, and back pain could be a pelvic floor problem. What Does a Pelvic Floor Evaluation or Treatment Look Like? Many people are apprehensive about what treatment will include. I went in-depth about this in my last blog post. But in a nutshell… we take a whole-body approach! We assess how your pelvic floor is functioning with the rest of the body as you move and live your life. Sometimes this involves internal pelvic floor muscle work or assessment, but only within your comfort level! Usually, treatment includes a combo of hands-on therapy, education, stretching, and strengthening… all customized to YOU and what we discover during our evaluation. Can I Do Pelvic Floor PT When I’m on My Period? Yes! Very common question… internal therapy can proceed during this time. No problem on our end, however, everything we do is based on your comfort level. There’s always plenty we can do without going internal, too! Do You See Men for Pelvic Floor PT Too? Absolutely! Men have pelvic floors too. We see men for many similar symptoms as women: post-op abdominal or pelvic surgeries, incontinence, constipation, or pain! The list goes on. Can My Back Pain or Sciatica Be a Pelvic Floor Problem? It can! The pelvic floor muscles attach to the tailbone which is the last bone of the spine. So you could imagine that any abnormal tugging on that tailbone would absolutely cause some low back pain. Some of these muscles even run adjacent to the sciatic nerve. Sometimes, if these muscles get too tight or irritated, it can put more strain and irritation on the sciatic nerve too causing some symptoms down the leg. How Does My Respiratory System Have Anything to Do With My Pelvic Floor? This question usually comes up later on during treatment. We often give different breathing exercises or educate on different breathing sequences depending on our patient’s pelvic floor dysfunction… but why? Breathing actually has a huge influence on our pelvic floor! Did you know the number one comorbidity to incontinence is respiratory dysfunction?! Our diaphragm is our main breathing muscle and is an arc shape that lies underneath our lungs. It is almost a mirror image of our pelvic floor and is considered to top off the core while the pelvic floor is considered to bottom off the core. As you breathe in, the diaphragm drops which increases the pressure in the abdomen and allows a gentle drop in the pelvic floor. When you exhale, the diaphragm lifts up, making more room in the abdominal cavity, reducing the pressure, and the pelvic floor gently lifts too. They work simultaneously like a piston in a car. In therapy we use this to our advantage to achieve whatever goal we’re going for: if we need more strength with a pelvic floor muscle contraction, we pair that contraction with an exhale. If we need more relaxation, we pair that relaxation with a big deep breath in. It’s all about pressure control! What Are Some Specific Conditions That Can Be Treated With Pelvic Floor PT? So many conditions! Here are some common ones: pelvic pain, dyspareunia (pain with sex), urinary incontinence, fecal incontinence, pelvic organ prolapse, post-op for abdominal or pelvic surgeries, constipation, hemorrhoids, urinary frequency, urinary/bowel urgency, low back pain, groin/hip pain, and flank/abdominal pain. I Was Told Leaking Urine During or After Pregnancy and After Menopause Was Just a Normal Part of Being a Woman; Is It? I get this comment often. The truth is, incontinence in women is common but not normal. And there are lots we can do to fix it! Sometimes it’s a strength issue or sometimes it’s coordination! An evaluation of your pelvic floor muscles can help us narrow down what’s going on but it is definitely not something you should have to live with! Did You Enjoy This Blog? Make sure to subscribe to our mailing list to get more blogs sent straight to your inbox! Watch Now: FORUM: Pelvic Pain and Physical Therapy Our pelvic health team recently hosted a public forum on pelvic pain and the role of physical therapy in the rehabilitation of this muscle group for both women and men. For a more in-depth look at this topic, watch the recording of the session below: Schedule the Care You Need! From our front desk to our Physical therapists, everyone is highly trained to assist you in finding the best possible care. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. Sarah Shaw, PT, DPT, is a physical therapist specializing in pelvic floor rehabilitation at Rehab United's Bonita and Kearny Mesa locations. She received her Doctorate in Physical Therapy in 2019 from San Diego State University and has since been continuing her education in pelvic pain, women's and men's pelvic health, and Applied Functional Science. While the pelvic floor is her specialty, Sarah also treats other orthopedic-related injuries, ensuring a more well-rounded and holistic approach to pelvic health.

Experiencing low back pain? Knee pain? How good is your hip mobility? We at Rehab United take a comprehensive approach to addressing your injury and dysfunction. We assess all potential sources and search for the root cause of your pain/dysfunction. The majority of the time, the location of the pain is not the true issue. Did you know that your lack of hip mobility can directly correlate to back or knee problems? Whether sitting at work or being an athlete, the amount of hip mobility you can go through is huge. When you have “pain,” let’s say your low back, usually, it is compensating for lack of mobility or strength somewhere else. If we want to reduce this pain, we need to reduce the stress at this segment by allowing the joints above or below to function properly. Here is a way you can test how much hip internal rotation you have side to side. If you feel, or see, that you have a deficit on one side, here are a couple of exercises you can do to increase this mobility and improve your body's efficiency: Find a seat where your legs are hanging above the floor, and rotate the foot out as far as you can comfortably. Does one side feel more tight or painful? If one leg feels more limited, take the opposite leg and walk it around rotating over the more limited hip. You should feel this deep in the standing leg, around the hip joint. You can floss through this about 10 times multiple times a day. You can also do this to a step as a variation, or if you don’t feel the stretch in the first video. Then sit down, and retest to see the improvements! This is something you can do daily, take a break from work, and do this quick routine to improve your back pain. Schedule the Care You Need! From our front desk to our Physical therapists, everyone is highly trained to assist you in finding the best possible care. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. Dr. Stephen Garner PT, DPT, BFR-1 is a Physical Therapist at Rehab United Carmel Valley. As a graduate of the University of St. Augustine's Doctor of Physical Therapy Program, Dr. Garner has always emphasized the implementation of treating the whole body as one, using Applied Functional Science, and developing an individualized plan for each person. Stephen specializes in sports rehabilitation and injury prevention. Throughout his four-plus years of experience, Dr. Garner has treated many high-level athletes and people of all walks of life to return to what they love pain-free.

Have you ever wondered how physical therapists decide what exercises to prescribe for your plan of care? In this video blog series, we’ll be discussing the “10 Observational Essentials,” which are considerations for any movement or task analysis, or exercise prescription. Learning these ten essential concepts and “tweaks” can improve the variability of movements and exercise to help people prevent injuries, rehabilitate, and improve performance. There’s no such thing as a bad exercise, only poorly-prescribed exercises. I think modifying and tweaking these ten components is what sets Applied Functional Science (AFS) apart and makes it different and unique. When rationalizing exercise prescription, the answer shouldn’t be, “I saw it online, it’s on the protocol, it looked cool," but instead using these 10 tweaks to create the desired chain reaction to improve function. The first of these observation essentials is action. 10 Observational Essentials 1: Action Action is the desired movement pattern related to a fundamental task or skill. The movement pattern that is being performed. Examples include squatting, lunging, walking, reaching, stepping up or down, throwing, or swinging. For exercise prescription, the action should look similar to something the person needs to do for their sport or ADLs, or something that the person is having pain or dysfunction with. The action is going to be different for each person. For example, a healthy, active young adult probably shouldn’t be performing light, open-chain band exercises, whereas a sedentary, severe pain elderly patient most likely isn’t doing box jumps. For most of these videos, we will be using a lunge as the action. Other action variations include a static lunge versus a dynamic lunge. 2. Environment The environment is the surroundings or conditions in which a person lives or operates in/on. Examples can include indoors/outdoors, grass or dirt, flat or uneven surfaces, and quiet or loud. For the lunge example, are we lunging to the floor, to a BOSU, or to an Airex pad? A good starting point is lunging to a flat firm surface and progressing from there. If a soccer player wants to return to soccer, it is important to train them on uneven surfaces, on grass or turf, and try to mimic their practice or game environment. 3. Position The position is the place or location where someone or something is located. Positions include supine, prone, side-lying, quadruped, sitting, tall kneeling, half-kneeling, or standing. The positions can add variability and specificity. For ground-based sports or occupations like jiu-jitsu, or a plumber, quadruped and kneeling variations might be used. For a lunge, while half-kneeling going to a lunge, you are requiring more hip and ankle ROM, more hip than ankle strategy for balance, increase quad load of the back leg, and increased patellofemoral compression. Stance positions are another tweak that can be used. For squatting, each squat position creates a different chain reaction and creates different demands on muscles, joints, and the neuromuscular system. An example of this is by putting one leg more posterior during a squat, the posterior leg will have increased weight-bearing demand, load, and ankle DF ROM. For a horseback rider, squats may be performed in a wide stance position for sport specificity. 4. Drivers Drivers can be mechanical, physical, or emotional. Drivers create, facilitate, or transmit motion to other areas. Anatomical drivers can include the arms, feet, pelvis, or eyes. Biomechanical drivers can be gravity, ground reaction force, mass, and momentum. Non-tangible drivers include fear, pain, encouragement, or confidence. An example of arm drivers during a lunge would be reaching down toward the floor while lunging. This reach is driving more hip and trunk flexion, increased posterior chain loading, and increased glute load. You can drive motion all the way down to the feet with arm drivers. An example of that is by standing and turning your trunk to the right, you will notice your right arch might get higher. Now use both arms to swing to the right and you will notice more motion occurring at the foot. An example of an emotional driver would be fear. For a person who is afraid to do a movement such as a lunge due to previous experiences of injury, the lunge will most likely look different, have limited depth, limited knee flexion, etc. 5. Direction Direction is a point to or from which a person or object moves. An angulation coordinate. A lunge can be forward, backward, lateral or medial, or anywhere in between with increased variability being better. You might notice that you don’t always lunge perfectly straight. Think about when you are picking up a child’s toys from the floor...depending on the location of the toy, the lunge will look different. Also, think about lunging down to unload a dishwasher and then lunging in a different direction to put the glass in the cabinet. Lunging narrow versus wide changes the amount of foot eversion or inversion. For some pathologies where you might not want more foot pronation and eversion, a wider lunge might be less painful than a crossover lunge. 6. Height Height is the point to or from which a person or object moves with a vertical displacement or coordinate. Lunge to a box can be easier in rehab due to less mass and momentum whereas lunging from a higher box is more demanding on the lunging leg due to more ground reaction force from increased mass and momentum. The height of a reach can also be tweaked. Lunging with a forward shoulder height reach is less demanding to the knees and hips rather than a floor reach and requires less trunk and hip flexion ROM. This can be beneficial early on after surgery and can mimic the WB demands of being in the water. With aquatic therapy, the joints are unweighted which is less demanding. Lunging to a box creates similar effects on the knee, while still maintaining range of motion. 7. Distance Distance is the amount of space between two objects/things. Horizontal coordinate. This can be measured in cm, inches, feet, yards, or can be classified in small, medium, or end range of motion. For a squat example, the distance would be small, medium, or end range for depth. Considerations might be if someone has patellofemoral pain syndrome and subpatellar pain, you might want to start at a small or medium range of motion to decrease the amount of patellofemoral compression. For a lunge, the longer the lunge the more mobility demands there are in the stance leg and the more momentum and force to the front leg. A person might want to perform lunges in a wider stance position to increase the base of support and balance. 8. Load Load is the amount of work done by a person or machine. This is often the weight or amount of resistance. In most situations, an increase in the load makes an exercise harder. This is one of the more common ways that exercises are progressed. The easiest answer is always to add weight, but might not be the most beneficial for that patient. For a lunge, you might increase the load by adding a medicine ball. You can also modify loads to muscles or specific joints during exercises by modifying other components like drivers. To increase the glute load during a lunge, you might add an arm driver to add trunk rotation to the same side. 9. Rate Rate is the speed with which something moves. The rate can be the amount of distance covered in a length of time or the number of reps performed in time. The rate can make an exercise harder or easier. An example of an increased rate becoming easier would be a marching single-leg balance exercise─the slower you are, the longer you’re on one leg which is the hard part. For the lunge example, faster lunges with quicker transitions are good for plyometric training and decrease the time between the load and explosion. A higher rate could be more specific to running or other fast-twitch movements, whereas a slower rate might be harder to focus on eccentric control with longer lengths of time in the lengthened muscle phase. 10. Duration Duration is the time at which something lasts or continues. This can be the number of reps or the number of second holds or the length of sets. Longer durations are typically harder and are how to improve aerobic and muscular endurance. For lunge durations, it would be more difficult to hold the lunge in the loaded/lower phase to turn it more into an isometric exercise, whereas if you have a runner, you could rationalize that running is similar to repeated single-leg hops. So if you’re going for tissue loading, a high duration of lunges would be more specific. Three sets of 10 reps (3x10) of an exercise will not guarantee a person can run one mile which involves around 1,500 strides. For student physical therapists and other practitioners, I hope that this video blog series serves as a good refresher crash course on exercise prescription. For patients, we hope that this series has provided you with a lot of insight into the methodology behind your physical therapist's prescription of exercises. We hope that the context provided in this video will enable you to better understand and be more successful in your plan of care. Schedule the Care You Need! From our front desk to our physical therapists, everyone is highly trained to assist you in finding the best possible care. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. Jason Averilla, PT, DPT, FAFS, OCS, CCI, is a Doctor of Physical Therapy from SDSU's inaugural class. He is a Board-Certified Orthopedic Clinical Specialist, Fellow of Applied Functional Sciences, and teaches in the DPT programs at San Diego State University and the University of St. Augustine. He is passionate about teaching and takes multiple students per year. In his free time, he likes to spend time with his family and 1-year-old son, kayak fish, golf, and play sports.

Stretching. A topic we have all heard varying advice on. There is so much information out there, it can be overwhelming and unclear. One cause of the ambiguity is the necessity of an individualized approach. We are going to look at some proven strategies to accomplish your specific goal within your stretching routine. First Off, Why Should I Stretch? Some deliberate and focal stretching will help maintain (or increase) the flexibility of a muscle. Your muscles will respond to whatever you do to them. If you stretch them, over time they will lengthen. Conversely, If you don't stretch them, over time they will shorten. This shortened state of our muscles results in decreased range of motion, poor power output, and a predisposition to injury. Stretching and a well-rounded strength-training program are the one-two punch most athletes require to maintain their desired level of play. The two main stretching approaches we will be analyzing will be static stretching and dynamic stretching. Static stretching consists of holding a single position at the end range of the targeted muscle for a specific length of time. Dynamic stretching consists of controlled motion through a particular range, often mimicking sport-specific movements. Dynamic stretching may also include holding the muscle at the end range for a brief period but is typically described as “in and out” of the full range of motion. Secondly, HOW Should I Stretch? Static? Dynamic? Do I hold it for 30 seconds? Should I stretch before or after a workout? These are all questions we will be addressing. The short answer, it depends! Stretching should be an individualized program. A soccer player will have different flexibility requirements than a gymnast and therefore should have a different stretching routine. Analyze your sport or daily activities to see what they require in terms of flexibility to help decide where to focus your stretching routine. So, how should you stretch? If the goal is to optimize muscle function within a wide range, dynamic stretching will be the best option. In sports that include jumping, cutting, and hopping, dynamic stretching provides the best performance in regard to power and high-speed activities throughout the full range of motion.[1] So prior to competition or activity, most of your stretching should be dynamic. Our muscles are meant to work within their full range of motion. Introducing your muscles to the entire range in a more controlled environment, with your dynamic stretching routine, will prepare them for any movement you may encounter during the upcoming event. Does your sport require extreme ranges of motion like a gymnast holding the splits, a hockey goalie making a save in the butterfly position, or a wrestler eluding a pin? If the goal is increasing the overall flexibility of a muscle, static stretching has proven to be more effective than dynamic stretching.[2] It should be noted that dynamic stretching is still effective at increasing muscle flexibility. However, if you are focused on increasing or maintaining end ranges of muscle flexibility, static stretching is your best option. While experts do not agree on a standard time, 3-4 sets of between 15-30 seconds of static stretching have demonstrated improvements in flexibility. [3] WHEN Should I Stretch? Many of us grew up holding a hamstring stretch for 30 seconds before our soccer game. Unfortunately, this may not be the best approach prior to competition. While the muscle will respond to prolonged stretching over time, studies have shown static stretching prior to physical activity may actually impair performance.[4] The best advice for stretching prior to agility competition would be comprised of a general warm-up (bike, jog), stretching to increase joint range of motion (dynamic stretching), as well as sport-specific activity.[5] In short, your stretching and warm-up prior to competition should look similar to your sport! So what about the timing of stretching with athletes prioritizing flexibility, like our gymnast and hockey goalie? While these athletes undoubtedly still need to maintain flexibility, it is better to do this during a separate training session or at the end of the workout so performance is unaffected. While these tips are a starting point, a licensed PT at Rehab United can assist in creating a specific program to balance your strength and flexibility needs. Schedule an appointment today to continue working towards your goals! Schedule the Care You Need! From our front desk to our Physical therapists, everyone is highly trained to assist you in finding the best possible care. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. [1] - DOI: 10.1519/R-16944.1 [2] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737866/ [3] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273886/ [4] - DOI: 10.1007/s00421-011-1879-2 [5] - DOI: 10.1519/00126548-200212000-00006 Alex Harrington PT, DPT, CSCS is a physical therapist at Rehab United Kearny Mesa specializing in orthopedic injuries. He received his Doctorate in Physical Therapy from San Diego State University in 2019. Alex is focused on helping patients reach their goals through an individualized and functional approach to rehab. He enjoys working with a wide spectrum of athletes and patients, supporting them to reach their full potential. Alex’s treatment philosophy emphasizes the mind-body connection and the role the mental state plays on physical recovery.

There's nothing more devastating than seeing an athlete get injured, especially if it's a career-threatening injury. From Derrick Rose to Yao Ming, we've seen how injuries can affect players and nobody wants to watch from the sidelines. Being such a high-intensity and high-impact sport, proper training is essential for basketball players to boost athletic performance and reduce the risk of injury. Here are a few ways basketball players can make their training more specific to the sport while staying healthy. Exercise: Stretch hip flexor/quadriceps First, here is a great stretch to improve your hip flexor/quadriceps muscle length and hip and knee mobility: By elevating the rear foot and reaching your arms overhead, we can take our pelvis, hip, and knee through a great stretch. Keep your knee right over your ankle, and the back knee directly under the hip. Go slow and controlled. Exercise: Rear foot elevated split squat Secondly, a rear foot elevated split squat is a great exercise for a basketball player. This is a safer alternative to heavy back squats and research has demonstrated that this can greatly increase quadricep, glute, and hamstring strength. You want your front ankle right underneath the knee, that way we can fully load all the hip musculature. You can vary this with different foot angles, weights in one arm, or both. The more variability the more we need to adapt which can challenge our neurological connection. There are also ways to continually progress this and program this. Enjoying This Blog? Make sure to subscribe to our mailing list to get new blogs sent straight to your inbox! Exercise: Isometric exercise with an “active foot” or “floating heel” Thirdly, this isometric exercise with an “active foot” or “floating heel” is an excellent way to get a maximum contraction in the hip musculature and in the feet. Isometrics have great value in a basketball strength program as they allow for an easy mind-to-muscle connection and recruit more muscle fibers/motor units. With the exercises we do, we want to get maximum intent each time, meaning that everything we do is intentional and planned. I love adding the basketball for fun but also to challenge this isometric exercise even more by adding a perturbation in different directions. Exercise: Kettlebell alternating lunges/scissor jumps Lastly, this kettlebell alternating lunges/scissor jumps exercise focuses on sport-specific deceleration. This allows your body to contract, relax, contract, and relax again. It isn’t always about how much you can lift, but more about how quickly and efficiently you can lift while changing gears. Pausing at different points allows you to improve your deceleration, as well as organize and put yourself in a position to strike harder and faster. This dynamic exercise can be used as a warm-up, or during a workout as it challenges multiple planes of movement and wakes up our neurological system. A lot of basketball moves are all about the setup. Be smooth, be relaxed, and get faster! With all of these exercises, take your time and do not rush your sets. This is not endurance training, utilize your rest time. We are also not looking to “chase the burn” with any of these. Some of these will have fatigue/burn, but some may not. We are not in the “no pain, no gain” mindset. We are ultimately looking for long-term development to keep you safe and healthy. Always listen to your body, and never push past joint pain (knee, ankle, back pain). These are just a few ideas to mix into your current routine. The exercises themselves aren’t going to make or break you, it is all about how you program it. There is much more depth to this, and if you want to learn more or get on a full program, give us a call at one of our locations or come find me at our Carmel Valley office. Schedule the Care You Need! From our front desk to our Physical therapists, everyone is highly trained to assist you in finding the best possible care. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. Dr. Stephen Garner PT, DPT, BFR-1 is a Physical Therapist at Rehab United Carmel Valley. As a graduate of the University of St. Augustine's Doctor of Physical Therapy Program, Dr. Garner has always emphasized the implementation of treating the whole body as one, using Applied Functional Science, and developing an individualized plan for each person. Stephen specializes in sports rehabilitation and injury prevention. Throughout his four-plus years of experience, Dr. Garner has treated many high-level athletes and people of all walks of life to return to what they love pain-free.

Made famous by the gold medal swimmer, Michael Phelps, cupping is an ancient treatment that comes from traditional Chinese medicine used to treat all kinds of ailments from migraines to high blood pressure and even fertility. Many physical therapists and massage therapists, however, have found it as a very useful tool to address pain. In Eastern medicine, cups have been used to address energies in the body that travel along meridians, which are pathways in which the energy flows. These are not anatomical structures and there are no conclusive studies to prove their existence, however, patients undeniably have benefited from the healing effects of Eastern medicine techniques including acupuncture and cupping. We've taken the Eastern medicine philosophy of energies (known as "qi") and meridians (energy pathways in the body) and integrated them into our Western medicine practices by using the cups on anatomical structures to make physiological changes for healing. How It Works While massage uses positive pressure to reduce muscle tone and relieve trigger points, the suction from these cups uses negative pressure to gain a similar effect, reduce tension, and offer improved mobility to the tissues underneath. Alongside therapeutic activities, cupping can be used as a helpful adjunct to physical therapy when the goal is to improve mobility, reduce fascial restrictions, or reduce scar tissue. Fascia is a connective tissue that exists between layers of fat, skin, muscles, and organs in our body, holding everything in place but also allowing everything to slide and move around as needed—almost like a hairnet—containing everything but allowing movement underneath. Sometimes with injury, repetitive strain or movement, or poor posture, the fascia will adapt—and not always in a good way. Sometimes the fascia can get bunched up or caught in scar tissue or grow too tight—we call this fascial restriction or tension. The idea behind cupping is that it can create a suction on the skin that can lift the skin and tissue layers underneath, moving and releasing any restrictions in the fascia, superficial muscles, or in any scar tissue that exists. Scar tissue is also a connective tissue that can sometimes get a little out of hand. Based on the depth, type of laceration, and genetics, scars can really differ! Scar tissue is great at its job—connecting the dots. However, scar tissue is not the same as the tissue that was there before and can sometimes go a little overboard, adhering to structures deeper than the surface. Cupping can help to soften scars, lifting them away from other structures underneath, improving texture, and scar mobility. In my own practice as a pelvic floor physical therapist, I love using the cups for C-section scars or other abdominal scars to help improve pelvic floor disorders. I've also noticed decreased symptoms for my patients with endometriosis, and fibromyalgia—both chronic pain disorders that usually present with pelvic pain and back pain. Cupping can be helpful for other orthopedic conditions as well including back, neck, shoulder, or upper and lower extremity pain. Would You Benefit From Cupping? Ask your physical therapist! It isn't for everyone. Here are some precautions to consider before giving it a try: Cupping is not recommended over open wounds, active infections, inflamed tissues, fractures, severe ligament sprains, or tendon ruptures. It is also not recommended for active cancer patients, those with hemophilia or similar blood disorders, organ failure, or deep vein thrombosis. It is important to use extreme caution or avoid cupping for pediatric or geriatric patients. What to Expect Cupping for the first time? Definitely expect some temporary skin discoloration in the areas being cupped. It usually looks like circular bruises (google "Michael Phelps cupping"). Sometimes a little local soreness is felt afterward. Make sure to drink extra water the day you receive cupping to address any adverse responses. Your therapist will explain ahead of time what technique is being used, how it may help, as well as any possible adverse expectations. Schedule the Care You Need! From our front desk to our Physical therapists, everyone is highly trained to assist you in finding the best possible care. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. Sarah Shaw, PT, DPT, is a physical therapist specializing in pelvic floor rehabilitation at Rehab United's Bonita and Kearny Mesa locations. She received her Doctorate in Physical Therapy in 2019 from San Diego State University and has since been continuing her education in pelvic pain, women's and men's pelvic health, and Applied Functional Science. While the pelvic floor is her specialty, Sarah also treats other orthopedic-related injuries, ensuring a more well-rounded and holistic approach to pelvic health.

Do you experience knee pain with squatting? If so, how can you modify the motion to reduce pain? Squatting is a fundamental task that is performed daily for exercise, lifting, and sit-to-stand transfers. There are common faults that people utilize when squatting that can increase the stress placed on the knees and can be easily adjusted to reduce pain and improve mobility, function, and proper muscle activation with squatting. It is important to understand how and why certain positions create or increase knee pain with squatting and how to make proper adjustments to minimize pain and abnormal forces being placed on the knees with this motion. Common Errors with Squatting & Modifications to Reduce Pain and Improve Proper Loading KNEE-DRIVEN SQUAT Common Error: When squatting, if you begin the motion by bending at the knees first, the body weight is shifted forward which will increase the load that is in front of the center of gravity and therefore increases compressive and shearing forces on the knee. Modification: When squatting, we want to maintain a balanced load of weight that is forward and behind the center of gravity. To improve posterior chain loading and reduce stress on the knees, you should start the motion by sitting the hips backward and keeping the weight in the midfoot or heels. This will also ensure improved efficiency and muscle function during squatting. KNEES DIVING-IN (KNEE VALGUS) Common Error: When the knees dive in towards each other, there is increased stress placed on the inside of the knees from the weight distribution at the feet shifting to the middle of the foot. Modification: When squatting, we want to keep the weight distribution in the middle of the foot (and slightly to the inside) and not let it shift too far to the inside or outside of the foot. This will allow for better tracking of the knees and therefore reduce pain. Inability to control or maintain proper knee alignment may be the result of hip weakness or foot instability. Weakness in the hips, specifically the Gluteus Medius, may be the cause of poor knee alignment with squatting. Weakness of this muscle will result in the knees driving towards each other, which places increased stress on the medial side (inner side) of the knee. The arch of the foot and the rearfoot may have increased motion causing it to collapse too much, which will limit stability with squatting and cause the knees to dive in towards each other. EXCESSIVE FORWARD TRUNK LEAN Common Error: This position will also create an unbalanced load when looking at how much body weight is in front of and behind the center of gravity. As more weight is shifted in front of the center of gravity, more stress will be placed on the knee joints as seen with a knee-driven squat. Also, when the trunk travels more toward a horizontal position, increased stress will be placed on the low back due to being in a more gravity-dependent position. Modification: If we keep the trunk more upright, we can maintain a more balanced squat over our center of gravity, which will reduce excessive stress on the knees. The inability to maintain proper trunk alignment can be the result of weakness through the posterior chain (back extensors and glutes). More Tips! If you experience knee pain with squatting, try modifying your mechanics by adjusting your positioning to the corrections seen in the photos above or follow the instructions listed below: Begin the motion by sitting the hips backward first, and then bending the knees to get deeper into the squat. The foot should remain flat on the ground and the weight should be in the heels or midfoot (arch), and should not shift towards the forefoot or toes. This is easily replicated by utilizing a chair as a target. Take 1-2 steps forward from the chair, begin by sitting your hips backward, and then lower your hips to the chair. If your trunk begins to fall forward too much, you can reach your hands out in front of you or overhead to keep the chest upright and therefore reduce stress on the knees. If your knees are diving in towards each other, work on keeping them in line with the toes and focus on keeping them pulled apart If you continue to experience knee pain with squatting or want to improve depth or mobility, give us a call and speak with a physical therapist, or come into one of our eight Rehab United locations throughout San Diego for a thorough evaluation of mobility, strength, and stability. Schedule the Care You Need! From our front desk to our Physical therapists, everyone is highly trained to assist you in finding the best possible care. At Rehab United, we excel in combining our services to give you the best experience and get you back to doing what you love. Chelsea Sanscartier PT, DPT, is a physical therapist working at the La Mesa Rehab United Clinic. She graduated with her Doctorate of Physical Therapy from San Diego State University in 2018 and has been focusing on challenging her knowledge of Applied Functional Science to work with an outpatient orthopedic population for pain management.

Yes, you read that headline right: Bowel and Bladder Habits. You might be thinking, why is this topic so important and how is this related to my pelvic health? Well, did you know that how we are peeing or pooping tells a lot about how our body is doing especially our pelvic floor? On average, a person should be peeing 5 to 7 times per day that are 2-4 hours apart, and at night time you shouldn’t be getting up to pee unless you are pregnant or over the age of 65 years old, which should then be 1 to 2 times per night. Our liquid intake is important as well. A person should be consuming about half their body weight in ounces or simply 6-8 cups of water per day. Bladder Habits Two-thirds of our fluid intake should be coming from water. If we consistently consume less fluid or consume bladder irritants, such as coffee, carbonated drinks, and acidic drinks to name a few, the urine in our bladder becomes too concentrated and can cause the muscles in the bladder to spasm, making you feel like you need to go to the bathroom. Over time, frequent trips to the bathroom cause a new habit pattern in which using the bathroom less than 2 hours apart becomes second nature. On the flip side of that, not using the bathroom every 2-4 hours and holding urine can also become a problem. Being aware of our daily habits can help improve the health of our bladder. Bowel Habits Poop. It is a topic no one likes to talk about but yet it is something someone should experience every day. Yes, you heard me right, a person on average should be having a bowel movement 1 to 2 times per day. When we have a bowel movement, the consistency of the stool is just as important. Was the stool hard, soft, or watery? The Bristol Stool Chart provides a good image of the different consistencies. For a healthy gut on average, we should have a type 4. Did you have to push or strain to have the bowel movement? When the stool is hard and requires us to push or strain, this puts a lot of pressure on our pelvic floor, and over time if this becomes chronic in nature, it can start to cause pain to the pelvic floor. Being consistent with our fluid intake and what we eat is vital to keeping our bowel habits consistent and normal. Is How I Poop or Pee Important? Yes! When we pee and poop, our pelvic floor should be relaxed. A way to help with pelvic floor relaxation while we sit on the toilet is to actually change how we are sitting on the toilet. It isn’t something major, but when we make a slight change we can see a big difference. The rule of thumb is when sitting on the toilet, our knees should be higher than our hips, so putting a box, a stool, or a stack of books underneath our feet will help achieve proper positioning. Squatty Potty, a popular consumer item, does just that. What Do Poop and Pee Have to Do with PT? Pelvic health physical therapy can help when there is dysfunction happening in the pelvic floor. Dysfunction of the pelvic floor can be present with a variety of symptoms, but some of the most basic ones are actions that people are experiencing on a daily basis such as peeing and pooping. When Should I See a Pelvic Health PT? If you find yourself outside the normal values mentioned above, such as frequent urination, pain, and/or straining with a bowel movement, painful urination, etc. these are good indicators that something bigger is going on. Pelvic physical therapy will provide a holistic approach to diving deeper into the "why" of the symptoms. This approach will help you achieve a life without interruptions or dysfunctions in the bathroom. The first step towards improving your bowel, bladder, and pelvic health can be as easy as a conversation. Beth Ann Soelberg, PT, DPT, is a physical therapist specializing in pelvic floor rehabilitation at Rehab United's Kearny Mesa facility. She received her Doctorate in Physical Therapy in 2016 from Idaho State University. Since graduating, she has continued to pursue her passion in pelvic health through courses focusing on pelvic pain, women's and men's pelvic health, and Applied Functional Science. Beth Ann’s treatment philosophy focuses on pursuing a holistic and patient-centered approach.